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S6- Neuro 2 > Week 2- TBI: Arousal And Cognitive Considerations > Flashcards

Week 2- TBI: Arousal And Cognitive Considerations Flashcards

1
Q

PART 1: INTRODUCTION

A

PART 1: INTRODUCTION

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2
Q

What are the 5 levels of Arousal?

A
  • Full Consciousness
  • Lethargy
  • Obtundation
  • Stupor
  • Coma
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3
Q

What are the major domains of Cognition? (6)

A
  • Attention
  • Memory
  • Intelligence
  • Executive Function
  • Social Cognition
  • Judgement
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4
Q

What are the main (5) Cognition-based outcome measures?

A
  • GOAT
  • O-Log
  • Moss Attention Scale
  • Agitated Behavior Scale
  • Rancho Los Amigos Levels of Cognitive Recovery (RLAS-R)
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5
Q

Describe the 10 levels of the RLAS-R.

What is a good way to remember the first 8 levels?

A

I.) No Response: Total Assistance
II.) Generalized Response: Total Assistance
III.) Localized Response: Total Assistance
IV.) Confused/Agitated: Maximal Assistance
V.) Confused, Inappropriate Non-Agitated: Maximal Assistance
VI.) Confused, Appropriate: Moderate Assistance
VII.) Automatic, Appropriate: Minimal Assistance for Daily Skills
VIII.) Purposeful, Appropriate: Stand-by Assistance
IX.) Purposeful, Appropriate: Stand-by Assistance on Request
X.) Purposeful, Appropriate, Modified Independent

No General Located a Confused Co-in in a CAP (app)

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6
Q

When do we progress a patient from a RLAS-R level I to level II?

A

-Whenever we start to see a generalized response to noxious stimuli. May have NOT PURPOSEFUL vocalization.

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7
Q

What is the typical generalized response seen when providing noxious stimuli to a RLAS-R level II?

A

-Posturing

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8
Q

When do we progress a patient from a RLAS-R level II to level III?

A
  • When the patient demonstrates a localized response to noxious stimuli. Patient will withdrawal or vocalize to painful stimuli.
  • Patient will also start to respond to non-noxious stimuli.
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9
Q

PART 2: DISORDERS OF CONSCIOUSNESS

A

PART 2: DISORDERS OF CONSCIOUSNESS

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10
Q

Consciousness = _______ + ________

A
  • Wakefulness (ability to open eyes and have basic reflexes)

- Awareness (complex thought processing)

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11
Q

When patients are in RLAS-R level I-III, we will also describe them as having Disorders of _________.

A

-Consciousness (I=Coma, II=Vegetative State, III=Minimally Conscious)

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12
Q

Level 1 (Coma) - No Response: Total Assistance

  • Complete failure of _______ system.
  • No ___________ eye opening.
  • Unable to be awakened by application of vigorous ________ stimulation.
  • All behavioral responses consist entirely of _______ activity.
  • Loss of function both _______ and _________ system.
  • Rarely lasts longer than __-__ weeks.
A
  • 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 function both both CORTEX and RETICULAR system.
  • Rarely lasts longer than 2-4 weeks.
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13
Q

Level 2 (Vegetative State) - Generalized Response: Total Assistance

  • Complete absence of behavioral evidence for self or environmental ____________.
  • Preserved capacity for spontaneous or stimulus-induced arousal. (_____ _______ (spontaneously))
    • _____/_____ cycles on EEG
A
  • Complete absence of behavioral evidence for self or environmental AWARENESS.
  • Preserved capacity for spontaneous or stimulus-induced arousal (EYES OPEN (spontaneously)).
    • SLEEP/WAKE cycles on EEG.
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14
Q

Level 3 (Minimally Conscious State) - Localized Response: Total Assistance

-“MCS is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental ___________is demonstrated”.

A

-“MCS is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental AWARENESS is demonstrated”.

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15
Q

The reemergence of eye opening is signaling that the _________ system has regained control of wakefulness.

A

-Reticular System

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16
Q

How long until Vegetative State is considered persistent?

A

-1 year

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17
Q

1 of what (4) behaviors must be present to distinguish MCS from VS?

A
  1. ) Simple command following.
  2. ) Gestural or verbal yes/no responses (regardless of accuracy).
  3. ) Intelligible verbalization.
  4. ) Movements of affective behaviors that occur in contingent relation to relevant environmental stimuli and are not attributed to reflexive activity.
18
Q

VS vs MCS, does it matter? Why?

A

-Yes, the prognosis of MCS is significantly more favorable relative to VS.

19
Q

What are the criteria for emergence from MCS?

A

1.) Functional interactive communication.
OR
2.) Functional use of TWO different objects.

20
Q

PART 3: DOC OUTCOME MEASURES AND POC

A

PART 3: DOC OUTCOME MEASURES AND POC

21
Q

What is the biggest standardized outcome measure for DOC population?

A

-John F. Kennedy Coma Recovery Scale (CRS-R)

22
Q

How often is the CRS-R performed? Why?

A

-Multiple times a day to catch reproducible, purposeful responses.

23
Q

The JFK CRS-R includes 23 items and is split into what 6 subscales?

A
  • Auditory
  • Visual
  • Motor
  • Oromotor
  • Communication
  • Arousal

You SEE and HEAR a COMA

24
Q

What is the second most widely used outcome measure for Disorders of Consciousness?

A

-Disorders of Consciousness Scale (DOCS)

25
Q
  • The DOCS is a bedside test measuring ____________ functioning during recovery.
  • It evaluates a patient as they are brought through a series of test stimuli by modalities (No response, Generalized response, Localized response).
A

-neurobehavioral

26
Q

What are (6) things important for rehabilitation of DOC?

A
  • Positioning
  • Tone Management
  • Sensory Stimulation
  • Equipment Prescription
  • Family Training
  • Family Education
27
Q

While still in the VS/MCS stages, cognition goals are largely based off of what?

A

-CRS-R

28
Q

PART 4: RLAS 4-10

A

PART 4: RLAS 4-10

29
Q

RLAS-R IV - Confused/Agitated: Maximal Assistance:
-Absent _____-_____ memory
-May cry out or scream out of proportion to stimulus even after its removal.
-May exhibit _________ or ______ behavior.
-Mood may swing from euphoric to _______ with no apparent relationship to environmental events.
Unable to cooperate with treatment efforts.
-Alert and in __________ state of activity.

A
  • short-term
  • aggressive or flight
  • hostile
  • heightened
30
Q

RLAS-R V - Confused, Inappropriate Non-Agitated: Maximal Assistance:

  • Alert, not ________ though may have infrequent outbursts.
  • _________; severely impaired recent memory.
  • Lack of self monitoring or _____ _______ behavior.
  • Unable to learn _____ tasks.
A
  • not agitated
  • disoriented
  • goal directed behavior
  • NEW
31
Q

RLAS-R VI - Confused, Appropriate: Moderate Assistance:

  • Emerging awareness of appropriate response to self, family, and basic needs.
  • _________ _______ to person, time, and place.
  • Able to attend to highly familiar tasks in ____-________ environment for short duration and w/ assist.
  • Consistently follows _______ directions.
  • For the first time, we will see slight improvement in _______, _______ _________, and _________ capabilities.
A
  • Inconsistently oriented
  • non-distracting
  • simple
  • memory, problem solving, and learning capabilities
32
Q

RLAS-R VII - Automatic, Appropriate: Minimal Assistance:

  • _________ ________ to person and place with highly familiar environments. ModA for orientation to time.
  • Able to attend highly familiar tasks in a ____-_________ environment for at least 30 minutes with MinA to complete tasks.
  • _____ supervision for new learning. Demonstrates _____ ______ of new learning.
  • Superficial _________ of their condition.
  • Unrealistic planning for the future, unable to think about consequences, and overestimates abilities.
A
  • Consistently oriented
  • non-distracting
  • MinA, carry over
  • superficial awareness (but unaware of impairments and disabilities and limits)
33
Q

RLAS-R VIII - Purposeful, Appropriate: Stand-By Assistance:

  • __________ _________ to person, place, and time.
  • Independently attends to familiar tasks for 1 hour in distracting environment.
  • Able to recall and integrate past and recent events.
  • Uses _________ memory devices to recall daily schedule, “to do” lists and record critical info for later use with SbA.
  • Requires _____ assistance once new tasks are learned.
  • Overestimates or _____________ abilities.
A
  • Consistently oriented
  • assistive memory
  • no assistance
  • underestimates
34
Q

RLAS-R IX - Purposeful, Appropriate: Stand-By Assistance on Request:

  • Independently shifts back and forth between tasks and completes them accurately for at least __ consecutive hours.
  • Uses _______ memory devices to recall daily schedule, “to do” lists independently.
  • Initiates and carries out steps to complete familiar personal, household, work, and leisure tasks ___________. (Completes unfamiliar tasks with assistance when requested).
  • Accurately estimates abilities but requires ______ to adjust to task demands.
  • Able to self monitor appropriateness of social interaction with ______.
A
  • 2 consecutive hours
  • assistive memory
  • independently
  • SbA
  • SbA
35
Q

RLAS-R X - Purposeful, Appropriate: Modified Independent:

  • Able to handle _______ tasks simultaneously in all environments but may require periodic breaks.
  • Able to independently procure, create, and maintain own _________ memory devices.
  • Independent in carrying out familiar and unfamiliar tasks but may require more _____ and/or compensatory strategies to complete them.
  • Lose the need for _______, needs extra time.
  • Social interaction behavior is consistently appropriate.
A
  • multiple tasks
  • assistive memory
  • time
  • cues
36
Q

PART 5: ADDITIONAL OUTCOME MEASURES

A

PART 5: ADDITIONAL OUTCOME MEASURES

37
Q

What are 5 Outcome Measures used?

A
  • GOAT
  • O-Log
  • MARS
  • ABS
  • RLAS-R
38
Q

Galveston Orientation and Amnesia Test (GOAT):

  • Normal = ______
  • Borderline = _______
  • Impaired = _______
A
  • Normal = 76-100
  • Borderline = 66-75
  • Impaired = <66
39
Q

The Orientation Log (O-Log):

  • What 3 things does it look at?
  • > ___ on GOAT and >____ on O-Log → no longer in PTA
  • Is O-Log or GOAT better prediction of rehabilitation outcomes with post-traumatic amnesia (PTA)?
A
  • Place, Time, Situation
  • > 75 GOAT, >25 O-Log
  • O-Log
40
Q

Moss Attention Rating Scale (MARS):

  • Measures ___________ responses that affect attention.
  • Involves the rating of what 3 major factors?
  • Higher scores = _______ attention
A
  • behavioral responses
  • Irritability, Initiation, Sustained attention
  • better attention
41
Q

Agitated Behavioral Scale (ABS):

  • WNL = _______
  • Mild agitation = ________
  • Moderate agitation = _______
  • Severe agitation = ________
A
  • WNL = 21 or below
  • Mild agitation = 22-28
  • Moderate agitation = 29-35
  • Severe agitation = 35 or above

S6- Neuro 2 (18 decks)

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