TBI Arousal, Cog, and DOC Flashcards
Cognition based Outcome Measures
- GOAT
- O-Log
- Moss Attention Scale
- Agitated Behavior Scale
- Rancho Los Amigos levels of cognition recovery: revised
how many levels are there to the Rancho?
10
first 3 are disorders of consiousness (DOC)
describe RLAS Level 1
No response: Total Assistance
complete absence of observable change in behavior when presented w/any type of stimuli
describe RLAS Level 2
Generalized Response: Total Assistance
demos generalized reflex response to noxious stimuli
- responds to repeated auditory stimuli with increased/decreased generalized activity
- responds to external stimuli w/physiologic changes generalized gross body movement and/or not purposeful vocalization
- responses may be sig delayed
describe RLAS Level 3
Localized Response: Total Assistance
- demos withdraw or vocalization to painful stimuli
- turns toward or away from auditory stimuli
- blinks when strong light crosses visual field
- follows moving obj passed within visual fields
- responds inconsistently to simple commands
match the RLAS level to DOC
- Coma → Level 1
- Vegetative State → Level 2
- Minimally Conscious State → Level 3
what is consciousness?
process of knowing including wakefullness + awareness
discrimination between, and selection of, relevant info, acquisition of info, understanding and retention, and the expression and application of knowledge in the appropriate situation
describe the DOC level coma
Level 1 → no response: total assistance
- complete failure of arousal system
- no spontaneous eye opening
- unable to be awakened by application of vigorous sensory stimulation
- all behavioral responses consist entirely of reflex activity
- loss of both reticular and cortex function
how long do comas last?
rarely longer than 2-4 weeks
describe vegetative state
Level 2 → generalized response: total assistance
- complete absence of behavioral evidence for self or environmental awareness
- can still spontaneously be aroused via stimulus
- eyes open (spontaneously)
- +Sleep/wake cycles on EEG
what is a persistent vegetative state?
VS for at least 1 year
describe minimally conscious state
RLAS Level 3
a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated
list the diagnostic criteria for MCS
one or more of the following:
- simple command-following
- gestural or verbal yes/no response (regardless of accuracy)
- intelligible verbalization
- movements or affective behaviors that occur due to relevant stimuli and are not reflexive
give some examples of contingent motor and affective responses
- crying, smiling, or laughing produced by the linguistic or visual content of emotional but not neural stimuli
- vocalizations or gestures that occur in direct response to verbal prompts
- reaching for objs with clear relationship between obj location and direction of reach
- touching/holding obj in a manner that accommodates size and shape of the obj
- visual pursuit or sustained fixation in response to a moving or salient stimuli
why do we care about distinguishing between VS and MCS?
Prognosis difference is HUGE
much more favorable for MCS