6
Which level of consciousness:
- Irregular sleep wake cycles
- Normalization of "vegetative" functions - respiration, digestion, and blood pressure control
- May be aroused, minimal evidence of self or environmental awareness
- Cognitively mediated behaviors occur inconsistently
- Instead of withdrawing or posturing to stimuli, patients will localize to stimuli and may inconsistently reach for objects
- Patients may localize to sound locations and demonstrate sustained visual fixation and visual pursuit
Minimally conscious state
No meaningful motor or cognitive function and a complete absence of awareness of self or the environment for a period greater than 1 year after TBI and greater than 3 months after anoxic brain injury
Permanent/persistent vegetative state **
What are the 4 types of attention?
1. Focused/selective
2. Sustained
3. Divided
4. Alternating **
Type of attention:
Ability to move flexibility between tasks and respond appropriately to demands of each task
EX: obstacle course, circuit training
Alternating
What range of scores can a person obtain on the Glasgow Coma Scale ?
3-15
Which level of consciousness:
- Unresponsive wakefulness
- Normalization of "vegetative" functions
- can be weaned off the ventilator if on it prior
- sleep wake cycle present
- No awareness of surroundings - meaningful cognitive and communication function absent
- Reflexive in response to external stimuli - movement will not be reproducible
- Permanent/persistent vegetative state
Vegetative state
Which level of consciousness:
- Unconscious
- Unarousable
- eyes closed
- no sleep/wake cycle
- No response to painful stimuli
- may be ventilator dependent
- may not demonstrate reflex reactions
Coma
Type of attention:
Ability to attend to as task despite environmental, visual or auditory stimuli
Ex: Driving, taking exams, busy clinic
Attention deficit:
Easily distracted by any activity in the environment; responds to background noise; difficulty attending to therapists directions while in a crowded therapy clinic
Selective
What score on GCS is severe TBI?
Less than 8
Type of attention:
Ability to attend to relevant information during activity
EX: walking down the hallway and being aware of water on the floor
Sustained
- Acute confusional state, reversible
- Deprivation of oxygen to the brain, metabolic imbalance, or adverse drug reactions can all include confusion
- clouding of consciousness, dulling of cognitive processes, imapired alertness
- inattentive, incoherent, and disorganized with fluctuating levels of consciousness
- Hallucinations and agitation are also common
Delirium
Type of attention:
Ability to respond simultaneously to two or more tasks/stimuli when all stimuli are relevant
EX: Walking and using AD
Divided
- Requires attention
- cognitive flexibility
- Goal setting
- information processing
- prefrontal cortex
Executive functions
What score on GCS is mild TBI?
13-15
Attention deficit:
Difficulty with details; stops a task midway; stops doing exercises after 6 reps when asked to do 15
Sustained
Attention deficit:
Unable to return to original task if interrupted; during cooking activity, therapist stops patient to correct use of mobility device; patient requires cue to resume cooking task
Alternating
Attention deficit:
Unable to do two things at one time; complete dressing and answer questions about weekend plans
Divided
What are the 3 response score categories in the Glasgow coma scale?
1. Motor response
2. Verbal response
3. Eye opening
What score on GCS is moderate TBI?
9-12
LOC: 0-30 mins
AOC: brief > 24 hours
PTA: 0-1 day
GCS: 13-15
Neuroimaging: normal
Mild TBI
LOC: > 24 hours
AOC: > 24 hours
PTA: > 7 days
GCS: < 9
Neuroimaging: normal or abnormal
Severe TBI
LOC: > 30 mins and < 24 hours
AOC: > 24 hours
PTA: > 1 and < 7 days
GCS: 9-12
Neuroimaging: normal or abnormal
Moderate TBI
T/F: Ranchos Los Amigos scale tells us the physical impairment of a patient with TBI?
FALSE.. cognitive impairment.. does not assess physical
- Low initial GCS
- Older age
- Lower education level
- Previous TBI
- Midline shift
- Duration of PTA - GOAT or O log
Prognosis -- poor recovery