Ch 5: Disorders Of Consciousness

Question 1

How many individuals in the US are classified in a vegetative state annually?

Answer 1

4,200

Question 2

What is the prevalence of people who present with a DOC in the US?

Answer 2

315,000

Of those, 35,000 are in a vegetative state and 280,000 are minimally conscious

Question 3

What are the three continuum stages of DOC?

Answer 3

1. Coma
2. Vegetative state
3. Minimally conscious state

**Lowest to highest functioning

Question 4

Arousal

Answer 4

Primitive, involuntary responsiveness to the world, as demo’d by reflex (generalized) responses to both internal and external stimuli.

The reticular activation system (RAS), a collection of primitive structures and nerve pathways within the brain, is responsible for maintaining arousal

Question 5

Awareness

Answer 5

Refers to an individuals ability to receive and process sensory info and use that info to relate in an intentional way to the outside world

Required for voluntary responses to stimuli and is regulated by the higher cortical areas in the cerebrum

Question 6

Minimally conscious state

Answer 6

Demonstrate intermittent or inconsistence behavior reactions that demonstrate conscious awareness

Question 7

Coma

Answer 7

No behavioral evidence of arousal and demonstrates no voluntary response to internal or External stimuli; reflexes may be observed.

Eye opening absent 
No sleep/wake cycle 
Resolves within 2-4 weeks (either pass away or progress) 
Impaired spontaneous breathing 
Impaired brainstem reflexes
No vocalizations > 1hr

Question 8

Vegetative state

Answer 8

Complete absence of behavioral evidence for awareness of self and environment, with preserved capacity for spontaneous or stimulus induced arousal

Responses to stimuli are generalized, nonpurposeful and nonspecific

+sleep/wake cycle
No visual pursuits
Persists for months to years w/o measurable improvement

Question 9

Emergence from DOC

Answer 9

Given at least one of the criteria:

1. Functional communication as demonstrated by verbal or gestural yes/no response
2. Functional use of 2 or more objects (ie: cup, hairbrush)

Question 10

What are complications of DOC?

Answer 10

Central apnea
Autonomic dysfunction syndrome
Metabolic distress
Dystonia

Question 11

Common medical challenges associated w/ DOC

Answer 11

Skin breakdown
Respiratory
Bowel/bladder dysfunction
Autonomic dysfunction syndrome

Question 12

Autonomic dysfunction syndrome

Answer 12

Imbalance in the autonomic nervous system, located in the medulla- regulates automatic bodily functions (respiration, HR)

Symptoms: dystonia, agitation, tachycardia (rapid heart rate), diaphoresis (sweating), hyperthermia (elevated temperature), HTN (elevated blood pressure), tachypnea (rapid breathing)

Tx: Environmental control and Pharmacological intervention

Question 13

Pharmacological neuromodulation

Answer 13

The use of medication to affect arousal and awareness.

Stimulate the CNS

Antidepressants, dopaminergic agents, and drugs for ADHD

Question 14

What neurobehavioral assessment tools were determined to have acceptable standardization?

Answer 14

Systematic review of neurobehavioral assessments available to practitioners who eval individuals with DOC.

Coma/near coma scale (CNC)
Coma recovery scale- revised (CRS-R)
The disorders of consciousness scale (DOCS)
Sensory modality assessment and rehab technique (SMART)
Sensory stimulation assessment measure (SSAM)
Wessex head injury matrix (WHIM)
Western neuro sensory stimulation profile (WNSSP)

Question 15

Goal setting for person w/ DOC

Answer 15

Goals are based on responses to stimuli, tolerance for stimuli/activity, risk mgmt, and caregiver development

Question 16

Common goals for structured sensory stimulation and regulation programs

Answer 16

1. Increase the level of arousal and awareness through stimulating the reticular activating system
2. Prevent sensory deprivation associated with prolonged immobility and dependence
3. Facilitate increased response frequency and consistency through structured sensory input
4. Facilitate the ability to follow commands and to communicate meaningfully

Question 17

What is central apnea?

Answer 17

lack of signals from the brain to the muscles that control breathing

Question 18

What is metabolic distress?

Answer 18

abnormal hormone response producing a marked increase in energy demands

Question 19

What is dystonia?

Answer 19

involuntary muscle contraction causes slow repetitive movements or abnormal postures

Question 20

What is the gold standard for assessment of persons with DOC?

Answer 20

bedside neurobehavioral evaluation

Question 21

What are the components of a quality physical management program?

Answer 21

range of motion, orthotic use, upright positioning, bed positioning (turning schedule)