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70 Cards in this Set
- Front
- Back
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Eyes do not open spontaneously or to external stimulation
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Level 1 - Coma
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Does not follow commands
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Level 1 - Coma
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No intentional movements
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Level 1 - Coma
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Does not sustain pursuit of eyes, even when held open
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Level 1 - Coma
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No awareness of self or environment
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Level 2 - VS
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Shows no evidence of sustained, reproducible, purposeful or voluntary motor responses to auditory, visual, tactile or noxious stimuli
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Level 2 - VS
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No language comprehension
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Level 2 - VS
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Variable CN and spinal nerve reflexes
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Level 2 - VS
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*Pt. has intermittent sleep/wake cycles*
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Level 2 - VS
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*pt consistently follows simple commands*
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Level 3 - minimally conscious
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pt can verbally or physically respond to yes or no questions
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Level 3 - minimally conscious
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Can demonstrate purposeful behavior NOT due to reflexes
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Level 3 - minimally conscious
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Responds to own INTERNAL confusion
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Level 4: Confused-agitated
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Behavior is non-purposeful and maybe bizarre
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Level 4: Confused-agitated
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Aggressive behavior
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Level 4: Confused-agitated
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Attention is brief and selective
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Level 4: Confused-agitated
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Can do automatic movements but they are often non-purposeful
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Level 4: Confused-agitated
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Are patients in a level 4 able to learn?
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No
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Appears alert but is agitated towards EXTERNAL stimuli
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Level 5: Confused-inappropriate
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Highly distractible
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Level 5: Confused-inappropriate
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Is a level 5 patient able to learn?
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No
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*Impulsive, lacks judgement*
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Level 5: Confused-inappropriate
Level 6: Confused-appropriate Is becoming a problem because the patient is becoming more mobile |
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Often lacks social and/or sexual inhibition
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Level 5: Confused-inappropriate
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May start to confabulate
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Level 5: Confuse-inappropriate
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**Pt can consistently respond to simple, one-step commands**
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Level 5: Confused-inappropriate
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Pts often perseverate
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Level 5: Confused-inappropriate
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Dysarthria
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Level 5: Confused-inappropriate
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Perceptual issues are common (often stems from CN damage)
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Level 5: Confused-inappropriate
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Define level 6
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Confused-appropriate; can complete tasks but not external direction
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Demonstrates goal directed activities but needs some direction (manual or cueing or both); can follow simple directions
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Level 6: Confused-appropriate
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**Begins to show carry-over for learning**
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Level 6: Confused-appropriate
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*Pt begins to have insight into his or her condition -> depression*
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Level 6: Confused-appropriate
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Attention is impaired for complex/difficult tasks
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Level 6: Confused-appropriate
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Cannot anticipate or predict events (find out at what level a pt can do this)
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Level 6: Confused-appropriate
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Poor abstract reasoning
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Level 6: Confused-appropriate
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Responses are often appropriate but incorrect. Pt presents with a lot of inconsistency especially regarding orientation to time and place
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Level 6: Confused-appropriate
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*Supervised for old/familiar learning but requires max A for new learning due to memory deficits*
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Level 6: Confused-appropriate
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Post traumatic amnesia is coming to an end
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Level 6: Confused-appropriate
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At this level, speech is usually possible
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Level 6: Confused-appropriate
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May have some ability to plan a motor activity but still lacks an automatic motor program
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Level 6: Confused-appropriate
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Regarding functional activities:
• Now usually supervised for ADL in a controlled or familiar environment; sometimes verbal or manual cueing • Dependent in complex or non-structured environments |
Level 6: Confused-appropriate
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4 major problems in the confused levels?
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1) Decreased initiative (see COMBI- Apathy evaluation)
2) Resistance to change 3) Impaired memory/learning 4) Decreased motor planning ability |
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Goals for treatment of confused levels?
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• Decrease assistance (in all areas)
• Increase the accuracy of performance for tasks (not done in level 4 but is done in 5+6) • Improve functional tasks • Increase memory/attention span • Develop appropriate social interactions |
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When can pt begin to use memory book?
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Confused levels 5+6
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Purpose of memory book?
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Cues used to substitute for cognitive deficits
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At what level(s) can group therapy be introduced?
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Levels 5+6
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What is the underlying principal (according to ch.24) for treating patients in the confused levels and below?
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Consistency
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5 steps to behavior modification?
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1) Identify the behavior that needs changing
2) Determine frequency and duration of behavior 3) Functional analysis: Precedants and consequences of behavior 4) Determine intervention plan a) replacing action with an incompatible behavior b) positive reinforcement 5) wean patient off of needing the reinforcement |
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Define level 7
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Automatic-appropriate. Pt is doing what they are supposed to be doing it but are doing so in a "robot" like fashion.
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*pt is consistently oriented to person and place in a familiar environment BUT still struggles with time*
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Level 7: Automatic-appropriate
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pt is able to attend to distract environment for ~30min
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Level 7: Automatic-appropriate
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Needs only minimal assist with memory aids
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Level 7: Automatic-appropriate
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**Minimal supervision for new learning**
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Level 7: Automatic-appropriate
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Initiates and carries out familiar tasks but does so in a robot like fashion
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Level 7: Automatic-appropriate
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Still unaware of specific impairments -> safety issues
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Level 7: Automatic-appropriate
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Minimal supervision of safety for in home and community tasks
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Level 7: Automatic-appropriate
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Unable to think of consequences for decisions or actions; lacks realistic planning of future
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Level 7: Automatic-appropriate
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One goal that definitely needs to be implemented for a level 7
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Integrate patient into community (could start at level 6)
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Define level 8
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Purposeful-appropriate
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**Consistently oriented to person, place and time**
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Level 8: Purposeful-appropriate
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can attend for one hour or more at a time
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Level 8: Purposeful-appropriate
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**Memory is completely intact**
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Level 8: Purposeful-appropriate
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Requires NO assistance for newly learned tasks
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Level 8: Purposeful-appropriate
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Completely self-aware
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Level 8: Purposeful-appropriate
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Thinks about consequences with min A
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Level 8: Purposeful-appropriate
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May still have difficulty with abstract reasoning
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Level 8: Purposeful-appropriate
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**Independent in home and community skills**
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Level 8: Purposeful-appropriate
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Goals for level 7 + 8
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1) Develop cognitive skills like judgement, problem solving and abstract reasoning
2) Develop skills for home and community |
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At what level can you begin confronting a patient with inconsistencies?
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Level 7
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1) Major issue that creates ataxia?
2) how to treat? |
1) Lack of ability to co-contract
2) approximation |
