Cognition

Question 1

List the level of consciousness.

Answer 1

1. Alertness
2. Lethargy
3. Obtundation
4. Stupor
5. Coma
6. Unresponsive vigilance state
7. Minimally conscious state

Question 2

Describe a patient who would be considered alert.

Answer 2

• opens eyes and looks at therapist

- responds fully and appropriately to stimuli

Question 3

Describe a patient who is considered at a lethargy conscious level.

Answer 3

• pt appears drowsy; FALLS asleep EASILY
• opens eyes and looks at examiner
• responds to questions

Question 4

Describe a patient who is demonstrating obtundation?

Answer 4

• opens eyes and looks at therapist
• responds to questions, but responds SLOWLY and is confused
• decreased alertness and interest in environment

Question 5

Describe a patient in a stupor.

Answer 5

• can only be aroused from sleep with PAINFUL stimuli
• verbal responses are slow or absent
• Pr returns to unresponsive state with stimuli is removed
• demonstrates minimal awareness of self and environment

Question 6

Describe a patient in a coma

Answer 6

• state of consciousness from which pt CANNOT be aroused
• eyes remained close
• no response to external stimuli or environment

Question 7

Describe a patient in Unresponsive vigilance state.

Answer 7

• a state characterized by the return of sleep/wake cycles, normalization of vegetative vitals
• lack of cognitive responsiveness (can be aroused but is unaware)

Question 8

What is considered a persistent vegetative state?

Answer 8

a state lasting > 1 year for TBI and >3 mons for anoxic brain injury

Question 9

Describe a patient in a minimally conscious state.

Answer 9

State characterized by severely altered consciousness with nominal but definite evidence of self or environment awareness

Question 10

A score ranging from 1-8 is considered what on the glascoma scale (GCS)

Answer 10

Severe brain injury

Question 11

A score ranking from 9-12 is considered what kind of brain injury on the Glasgow Coma Scale (GCS)?

Answer 11

Moderate brain injury

Question 12

A score ranking from 13-15 is indicative of what kind of brain injury on the Glasgow Coma Scale (GCS)?

Answer 12

Minor brain injury (scores 13-15)

Question 13

When going through the Glasgow Coma Scale a therapist is assessing response to what three elements?

Answer 13

1. Eye opening
2. Motor response
3. Verbal response e

Question 14

A therapist is wanting to test immediate recall (memory), how can she/he do this?

Answer 14

Name three items previous presented after a brief interval (i.e. 5 minutes)

Question 15

A therapist is wanting to assess short-term memory of patient. How can he/she do this?

Answer 15

Recall recent events (i.e. What did you have for breakfast)

Question 16

A therapist is wanting to assess remote (long-term) memory. How can he/she do this?

Answer 16

Recall of past events (i.e. where were you born? Where did you grow up)

Question 17

A therapist asks a patient to recall seven numbers in the order they were presented. What is the therapist trying to assess?

Answer 17

Length of attention span and therapist is using a digit span retention test

Question 18

A therapist wants to assess the patients ability to attend to task without redirection (sustained attention). How can he/she do this?

Answer 18

Determine time spent on task and frequency of redirection

Question 19

Describe divided attention.

Answer 19

Ability to shift attention from one task to another

Question 20

When assessing attention what else should a therapist assess?

Answer 20

Divided attention

Ability of dual task control

perseveration (mental inertia)

Question 21

Describe perseveration.

Answer 21

Getting stuck on a task

Question 22

Describe focused attention.

Answer 22

Ability to stay on task in presence of detractors

Question 23

How would a therapist assess focused attention

Answer 23

Assess impact of environmental vs internal detractors

Question 24

True or false: therapist should assess the ability of a patient to follow one- or two step, multilevel commands

Answer 24

True

Question 25

List Emotional Responses/Behaviors that should be assessed.

Answer 25

1. Safety, judgment: impulsivity and lack of inhibition
2. Affect/mood: irritability, agitation, depression and withdrawal
3. Frustration tolerance
4. Self-centeredness
5. Insight into disabilty
6. Ability to follow rules of social conduct
7. Ability to tolerate criticism

Question 26

List Higher-level cognitive abilities that can be assessed.

Answer 26

1. Judgement, problem-solving
2. Abstract reasoning
3. Fund of general knowledge: current events, ability to learn new information, generalize learning to new situations
4. Calculation: Serial 7 test (count backwards from 7)
5. Sequencing: ability to order components of cognitive or function task; assess if cueing is necessary, frequency of cues

Question 27

The MMSE screening includes what items?

Answer 27

Orientation

Registration

Attention and calculation

Recall and language

Question 28

A max score on the MMSE is ?

Answer 28

30

Question 29

A score on the MMSE 21-24 indicates what?

Answer 29

Mild cognitive impairment

Question 30

A score on the MMSE of 16-20 indicates ?

Answer 30

Moderate impairment

Question 31

A score of <15 on MMSE indicates?

Answer 31

Severe cognitive impairment

Question 32

Describe the 8 levels of the Rancho los amigos

Answer 32

No response (I)

Decrease response (II-III)

confused levels (IV, V, and VI)

Appropriate (automatic, purposeful) levels (VII and VIII)