Slpa 985 - Tbi (Exam 1 - Part 2)

Front 1

What are some terminologies for people with persistent impaired consciousness?

Back 1

-coma
-vegetative state
-persistent vegetative state
-permanent vegetative state
-minimally conscious state

Front 2

What is the outcome rating for a person who has been unconscious for less than 5 minutes?

Back 2

very mild

Front 3

What is the outcome rating for a person who has been unconscious for 5 to 60 minutes?

Back 3

mild

Front 4

What is the outcome rating for a person who has been unconscious for 1 to 24 hours?

Back 4

moderate

Front 5

What is the outcome rating for a person who has been unconscious for 1 to 7 days?

Back 5

severe

Front 6

What is the outcome rating for a person who has been unconscious for 1 to 4 weeks?

Back 6

very severe

Front 7

What is the outcome rating for a person who has been unconscious for more than 4 weeks?

Back 7

profound

Front 8

Describe a patient who is in a coma.

Back 8

-eyes closed all the time
-respond to painful stimuli? (via subcortical reflexes)
-no signs of awareness
-only generalized responses (respiratory, postural, facial grimaces)
-no sleep/wake cycles

Front 9

Describe a patient in a vegetative state.

Back 9

-after coma ends
-sleep/wake cycles
-spont. eye opening (doll's eyes phenomenon)
-return of reflexes (startle, postural, chewing, sucking)
-spont. responses to external stimuli
-may vocalize (not verbalize)
-don't become use to stimuli
-no communication

Front 10

Define persistent vegetative state.

Back 10

vegetative state has persisted for more than 1 month with no functional change
*controversial term

Front 11

Define permanent vegetative state.

Back 11

vegetative state has persisted for more than 1 year with no functional change
**very controversial term

Front 12

What are individuals in a minimally conscious state called?

Back 12

minimally responsive or slow to recover

Front 13

True or false: Individuals in a minimally conscious state have inconsistent control of voluntary movements or behaviors.

Back 13

True

Front 14

What factors must a person in a minimally conscious state demonstrate at least one of (8)?

Back 14

-single limb withdrawal to stimulus (localized)
-intermittent localization
-visual tracking
-inconsistent object grasping
-inconsistent command following
-communicate via verbal yes/no or gestures
-verbalization
-contingent movement or emotional responses to environment

Front 15

What does emergence from minimally responsive state require?

Back 15

reliable and consistent evidence of functional communication or functional object use

Front 16

True or false: Misdiagnosis of PVS is common.

Back 16

True
-occurs in 10-43%
-negatively impacts chance of getting rehab
-prompts premature talk of stopping life-sustaining care

Front 17

What is the criterion for evidence of functional communication?

Back 17

accurate yes/no response to 6 of 6 situational orientation questions on 2 consecutive evals

Front 18

What is the criterion for evidence of functional object use?

Back 18

appropriate use of 2 different objects on 2 consecutive evals

Front 19

Is there presence of arousal for a coma?

Back 19

no

Front 20

Is there presence of arousal for vegetative state?

Back 20

yes but not consistent

Front 21

Is there presence of arousal for minimal consciousness?

Back 21

yes

Front 22

Is there presence of awareness for a coma?

Back 22

no

Front 23

Is there presence of awareness for vegetative state?

Back 23

no

Front 24

Is there presence of awareness for minimal consciousness?

Back 24

partial

Front 25

What type of motor is present for a coma?

Back 25

reflexive

Front 26

What type of motor response is present for vegetative state?

Back 26

-reflexive
-inconsistent withdrawal and non-purposeful movement

Front 27

What type of motor is present for minimal consciousness?

Back 27

-localized
-reaches
-automatic movements

Front 28

What auditory is present for coma?

Back 28

none

Front 29

What auditory is present for vegetative state?

Back 29

-startle
-brief orientation

Front 30

What auditory is present for minimal consciousness?

Back 30

-follows commands inconsistently
-localized

Front 31

What visual is present for coma?

Back 31

none

Front 32

What visual is present for vegetative state?

Back 32

-startle
-brief fixation

Front 33

What visual is present for minimal consciousness?

Back 33

sustained fixation and tracking

Front 34

What emotion is present for coma?

Back 34

none

Front 35

What emotion is present for vegetative state?

Back 35

none or reflexive

Front 36

What emotion is present for minimal consciousness?

Back 36

present or inconsistent

Front 37

What communication is present for coma?

Back 37

none

Front 38

What communication is present for vegetative state?

Back 38

none

Front 39

What communication is present for minimal consciousness?

Back 39

present or inconsistent

Front 40

Compare/contrast arousal for akinetic mutism and locked-in syndrome.

Back 40

AK: present
LIS: present

Front 41

Compare/contrast awareness for akinetic mutism and locked-in syndrome.

Back 41

AK: partial
LIS: full

Front 42

Compare/contrast motor for akinetic mutism and locked-in syndrome.

Back 42

AK: purposive but delayed
LIS: quadriplegic

Front 43

Compare/contrast auditory for akinetic mutism and locked-in syndrome.

Back 43

AK: localized; delayed command following
LIS: intact

Front 44

Compare/contrast visual for akinetic mutism and locked-in syndrome.

Back 44

AK: fixation and tracking; discrimination
LIS: intact

Front 45

Compare/contrast emotion for akinetic mutism and locked-in syndrome.

Back 45

AK: severely blunted or flat
LIS: preserved

Front 46

Compare/contrast communication for akinetic mutism and locked-in syndrome.

Back 46

AK: present/inconsistent; delayed
LIS: aphonic/anarthric; based on eye movement/switch control/safe laser

Front 47

What is akinetic mutism sometimes conceptualized as?

Back 47

a subtype of minimal consciousness

Front 48

True or false: Locked-in Syndrome is a disorder of consciousness or awareness.

Back 48

False (complete denervation of entire body but are cognitively with it)

Front 49

What does the DOCS score predict?

Back 49

whether a person is or is not likely to recover consciousness by one year post-injury

Front 50

What is DOCS?

Back 50

Disorders of Consciousness Scale
-government funded (free access to anyone)

Front 51

What does the DOCS track?

Back 51

-can track very subtle changes in neurobehavioral functioning over time

Front 52

How is the DOCS administered?

Back 52

1: eliminate environmental confounds leading to unintentional stimulation
2: following positioning guidelines (limit pain, spasticity, or discomfort responses)
3: perform baseline observational profile (document)
4: quietly observe survivor 2-5mins while completing a checklists (present one type of stimuli at a time)

Front 53

What are the scores given for the DOCS?

Back 53

0 = no response
1 = general response
2 = localized response
(use best response; can have multiple trials)

Front 54

How long should an examiner wait between presentation of stimuli?

Back 54

up to 30 secs (avoid delayed responses)

Front 55

What modalities does the DOCS assess (7)?

Back 55

-social knowledge
-taste and swallowing (swab; massage)
-olfactory (2 odors)
-proprioceptive and vestibular (passive joint movement)
-auditory (startle, localized, comprehension)
-visual (blinking response to all fields, focus to all fields, tracking objects and familiar faces, focusing on familiar faces in all fields)
-tactile (light, firm, temperature)