Cognitive Lecture 2 Sequelae TBI Flashcards
(53 cards)
Coma
Altered state of consciousness; a deep state of unconsciousness where a person does not consciously respond to external stimuli; can be brief or last for weeks at a time; occurs secondary to underlying neurological condition or TBI
Coma Characteristics
No eye opening, no communication, no following directions, no purposeful movement
Vegetative State:
Patient has lost cognitive ability & awareness of surroundings; will maintain normal sleep-wake cycles; spontaneous movement may occur & include crying, laughing, grimacing; may open eyes to external stimuli
Persistent Vegetative State
once it has persisted past 1 month
Characteristics of Vegetative State
unconsciousness, no communication, no following directions, no purposeful movement
Minimally Conscious State (MCS)
pts. that exhibit a slow recovery of consciousness; continue to have poor self-awareness as well as awareness of world around them; very inconsistent; may intermittently follow directions, communicate y/n via gestures/ vocalizations, use some recognizable words+phrases, reach for objects or try to hold onto objects, focus on items or people for longer periods of time
TBI Severity Ratings
Pts. may be classified as having a mild, moderate, or severe TBI based on level of consciousness
3 Main rating scales: Glasgow Coma Scale, Post-Traumatic Amnesia, Ranchos Los Amigos Scale of Cognitive Functioning
Glasgow Coma Scale
Teasdale & Jennette, 1974,76
Estimation of the depth of coma as a measure of severity w/in the 1st 24hours of the trauma
Pt. assigned a score of 3-15; points are assigned per BEST eye opening (1-4), BEST motor response (1-6), BEST verbal response (1-5); greater the score, more conscious the person
Cell phone, pen GCS
3
Versions of GCS
Adult version
Modified pediatric version
GCS Coma Severity Ratings:
13-15 Mild TBI
9-12 Moderate TBI
Less than 8 Severe TBI
Decorticate Flexion (Posturing)
Results from damage to 1 or both CSTs; Arms adducted & flexed, wrists & fingers flexed on chest; legs stiffly extended & internally rotated, plantar flexion of feet (toes pointed); “mummy pose”
Decerebrate Flexion (Posturing)
Results from damage to upper brainstem; arms are adducted & extended, wrists pronated & fingers flexed; legs stiffly extended, plantar flexion of feet (toes pointed)
PTA
Duration focus; may be used as an alternative to GCS; references period of time where pt. has regained consciousness but is still in a disoriented & confused state & until time pt.’s memory for ongoing events become reliable & accurate
PTA levels
Mild TBI: Period of coma+PTA less than 1 hr.
Moderate TBI: Pd. of coma+PTA is 1-24 hrs.
Severe TBI: Pd. of coma+PTA is 1-7 days
Profound TBI: Pd. of coma+PTA is 7+ days
Some MDs don’t use profound
Response progression
Pts. may progress thru several types of responses during recovery from a state of altered consciousness; deepest stage-> reflexive behaviors->generalized responses ->localized responses->physiological responses
Deepest Stage
pt. is totally unresponsive to any stimuli including painful or aversive types
Reflexive Behaviors Stage
pts. exhibit production of unconscious, subcortical reflexive behaviors; may return to primitive behaviors
Generalized Response Stage
stimulation triggers movement of a body part not associated w/ actual stimulus; noise in the room may trigger chewing response
Localized Response Stage
noise occurs in the room and pt. turns toward stimulus; fixating on where stimulus came from
Physiological Response Stage
Stimulus triggers change in BP, RR, O2, Temp, Pupils
Ranchos Scale (RLAS)
way to describe cognitive functioning from early stages of injury to later stages of recovery; pt. assigned level based on presentation using #s 1-10 (Can change; be able to back up findings)
Levels 1-3: severe deficits/vegetative state
Levels 4-6: moderate deficits
Levels 8-10: milder deficits
Ranchos Scales Levels I-III
Pt. presents as comatose or emerging from coma; may be persistent vegetative state or minimally conscious state
Ranchos Scales Levels IV-VI
Pts. present as beginning process or regaining orientation & memory skills necessary for full consciousness; getting better
