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Flashcards in Exam 2 Deck (141)
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1

Coma

- complete paralysis of cerebral function; a state of unresponsiveness
- eyes are closed; no response to painful stimuli;
- reflexes may be present depending on the site of the lesion
- 2-4 weeks, nearly all patients begin to awaken

2

Consciousness

- alert wakefulness
- clearly appreciates environment
- responds quickly and appropriately to visual, auditory, other sensory stimuli
- gradual recovery of orientation and recent memory

3

Minimally Conscious State

definite evidence of environmental awareness

characterized by inconsistent behavior but reproducible and localized rather than generalized

4

PT for patients in a minimally conscious state includes:

- disorders of consciousness program
- structured stimulation and recording of responses to document emergence

5

Persistent Vegetative State

- wakeful, reduced responsiveness
- no evident cerebral function
- eye tracking, minimal motor
- no speaking or response to verbal stimuli
- non-purposeful movement

6

JFK Coma Recovery Scale

a research tool used for studying recovery of patient's in a coma; 23 items that comprise six subscales addressing:
1. auditory
2. visual
3. motor
4. oral motor
5. communication
6. arousal functions

7

What are the two most commonly used clinical rating scales for patients s/p TBI?

1. Rancho Los Amigos Hospital Level of Cognitive Functioning Scale (LOCF)
2. Glasgow Coma Scale

8

Rancho Los Amigos LOCF

- consists of 10 levels
- describes pt. during recovery
- not always clearly in one level

9

Rancho Los Amigos LOCF: Levels 1-3

total assistance

10

Rancho Los Amigos LOCF: Levels 4-5

maximal assistance

11

Rancho Los Amigos LOCF: Levels 6

moderate assistance

12

Rancho Los Amigos LOCF: Levels 7-10

progressively less assistance

13

Glasgow Coma Scale

- quantify degree of coma at time of injury, and every 2-3 days
- three categories (EMV score): Eye opening, best Motor response, and Verbal response
- 3-15 point range; 3 = coma

14

Functional Assessment Measure

an adjunct to the FIM to specifically address major functional area less emphasized in the FIM including:
- cognitive
- behavioral
- communication
- community functioning

15

Mortality after TBI

over 1600 subjects surviving 1 year after injury, with increased risk of death from:
- aspiration pneumonia
- seizures
- pneumonia
- suicide
- digestive conditions

16

Postural changes following TBI:

- decorticate posture - UE flexed, LE extended
- decerebrate posture - UE and LE extended

both indicate low brain function and absence of selective movement

17

Sensory changes following TBI:

- light touch
- deep pressure
- pain
- temperature
- proprioception
- kinesthesia
- cranial nerve involvement

18

Motor changes following TBI:

- monoparesis
- hemiparesis
- tetraparesis
- coordination, timing, sequencing deficits

*Highly variable between patients

19

Perceptual changes following TBI:

- unilateral visuospatial neglect
- hemispatial neglect, hemiagnosia, and contralateral neglect

20

Input vs. Output Neglect

input neglect or "inattention" includes ignoring contralesional sights, sounds, smells, or tactile stimuli; output neglect includes motor and pre-motor deficits. A person with motor neglect does not use a contralesional limb despite the neuromuscular ability to do so.

21

The presence of neglect w/in the first ten days following TBI is a strong predictor of ____ __________ ________ after 1 year than several other variables

poor functional recovery

22

Perception

integration of sensory info into meaningful psychological info, including prior information; more complex than sensation

23

Cognitive impairments following TBI:

- memory deficits
- attention deficits

24

Memory deficits

post-traumatic amnesia - time between the injury and the time patient remembers ongoing events (short-term); declarative (habit) vs. declarative (facts)

25

Retrograde vs. Anterograde amnesia

retrograde amnesia is the inability to recall memories of prior events, while anterograde amnesia is the inability to make new memories

26

Attention deficits

- decreased attention span
- impulsiveness/lack of safety awareness
- distractibility

27

Emotional/behavioral changes

most enduring and socially disabling of any sequelae
- disinhibition
- lability
- aggression
- low frustration tolerance
- inpatient

28

Secondary body function/structure impairments

- soft tissue contractures
- altered muscle tone/spasticity
- pressure sores
- DVT
- heterotopic ossification

29

Factors in predicting outcomes following TBI

- severity of injury
- duration of coma
- duration of post-traumatic amnesia (≥12 wks = poor; ≤4 wks = good prognosis)
- low Glasgow Coma Scale

30

Predicting outcomes

motor disturbances generally have GOOD prognosis, but cranial nerve injury - hearing, smell, vestibular sense are rarely fully recovered