Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
• Outcome scales
• Cognitive deficits
• Visual deficits
• Physical and Functional
deficits
• Behavioral issues
SECTION TITLE OR HEADER 5
Cognitive Deficits
• Attention
• Memory
• Problem solving
• Executive Function
Visual Deficits
• Nystagmus
• Visual field cut
– Hemianopsia
• Diplopia
• Perceptual
– Neglect
– Objection Recognition
– Depth perception
Physical Deficits
• Weakness
• Spasticity
• Swallowing
Behavioral Deficits
• Restlessness
• Confusion
• Decreased insight
• Verbal Aggression
• Physical Aggression
Glasgow Coma Scale
– verbal response
– motor response
• Moderate = 9-12
• Severe = 3-8
• www.glasgowcomascale.org
Disability Rating Scale
www.tbims.org/combi/crs/index.html
JFK Coma Recovery Scale – Revised
– Auditory Function
– Visual Function
– Motor Function
– Oromotor/Verbal Function
– Communication
– Arousal
• Commonly used tool used to describe a patients level of cognitive function across
the continuum of recovery after TBI
• Level I - No Response
– Patient appears to be in a deep sleep and is completely
unresponsive to any stimuli
• Level IV – confused/agitated
– Alert and in heightened state of activity
– Behavior is bizarre and non-purposeful related to environment
• Attempts to remove restraints/tubes or crawl out of bed
• Motor activities without purpose
• Gross attention is very brief, selective attention is non-existent
• Absent short-term and long-term memory
• May exhibit aggressive or flight behavior
• Mood may swing from euphoric to hostile
• Verbalizations are incoherent & inappropriate
Agitation
• Coma
• Vegetative
• Minimally conscious
Coma
• Eye opening
• Sleep/wake cycle
• No purposeful movement
Minimally Conscious State
• Intelligible verbalization
• Object manipulation
• Automatic motor response
• May affect the RAS and increase arousal and attention to the level
necessary to perceive incoming stimuli
• Patients who are less aroused may require more intense and general
stimulation at first, and as they become more responsive stimulation can
be downgraded and become more specific
• Eliminate distractions
• Vestibular
• Auditory
• Tactile
• Olfactory
• Gustatory
• Visual
Position or Movement Stimulation
• Monitor patient’s BP
• Transfers
– Supine<>sit
– Rolling in bed
• Big ball
• Bolster
• Rocker board
Proprioceptive & Kinesthetic Activities
• ROM activities
• Positional changes
• Tilt table
• Side lying
Auditory Stimulation
• Verbal Communication
– Calling the person’s name
• Listening to the TV
• Ring a bell
• Whistle
Tactile Stimulation
• Sternal Rub
• Various textures
– Personal clothing
– Blankets
– Stuffed animals
– Lotion
• Variety of temperatures
– Warm and cold cloths
• Pleasant odors
– After shave, cologne, perfume, favored extracts, coffee grinds,
shampoo, favorite foods
• Noxious odors
– Use garlic or mustard
• Tracking Objects
– Colored light or pen
– Self in a mirror
QUESTIONS??
References
• Main Line Health, Bryn Mawr Rehab Hospital. Brain Injury Family Guide. Retrieved 11/6/08 from
http://www.mainlinehealth.org/doc/Page.asp?PageID=DOC000235
• Copp EP, Harris R, Keenan J. Peripheral nerve block and motor point block with phenol in the management of spasticity. Proc R Soc
Med. 1970 Sep;63(9):937-8.
• Sawyer E, Mauro LS, Ohlinger MJ. Amantadine Enhancement of Arousal and Cognition After Traumatic Brain Injury. The Annals of
Pharmacotherapy. February 2008: Volume 2. 247 – 252.
• Giacino J, Ashwal S, Childs N, et al. The Minimally Conscious State – definition and diagnostic criteria. Neurology. 2002. 58:349-
353.
• Giacino, JT. Whyte, J. Bagiella, E. Kalmar,K. Childs, N. Khademi, A. Eifert, B. Long, D. Katz, DI. Cho, S Yablon, SA. Luther, M.
Hammond, FM. Nordenbo, A. Novak, P. Mercer, W. Maurer-Karattup, P. Na, R. Sherer, M. Placebo-Controlled Trial of
Amantadine for Severe Traumatic Brain Injury. n engl j med 366;9 nejm.org march 1, 2012
• Lombardi F. Taricco M. De Tanti A. Telaro E. Liberati A Sensory stimulation of brain-injured individuals in coma or vegetative
state: results of a Cochrane systematic review. Clinical Rehabilitation. 16(5):464-72, 2008 Aug
• Effectiveness of Amantadine Hydrochloride for Treatment of Severe Traumatic Brain Injury. Retrieved 11/4/09 from http://Clinical
Trials.gov/ct2/show/record/NCT00970944
• www.tbims.org/combi/crs/CRS%20form.pdf
• www.tbims.org/combi/crs/index.html
References
• Multi-society Task Force: Medical aspects of the persistent vegetative state. Part 1. New England Journal of Medicine. 1994. 330:
1499-1508
• McCullough K. Crea D. Current Concepts in the Management of Patients with Traumatic Brain Injury. Topics in Physical Therapy:
Neurology. American Physical Therapy Association 2002. Alexandria, VA. www.apta.org.
• Gerber CS. Understanding and Managing Coma Stimulation: Are We Doing Everything We Can? A Review. Critical Care Nursing
Quarterly. 28(2):94 – 108. April-June 2005.
• Sosnowski C. Ustik M. Early Intervention: Coma Stimulation in the intensive care unit. Journal of Neuroscience Nursing. 26(6):
336-41. December 1994.
• Kessler KR, Benecke R. Botulinum toxin: from poison to remedy. Neurotoxicology. 1997;18(3):761-70.
• Arnon SS et al. Botulinum Toxin as a Biological Weapon Medical and Public Health Management. JAMA. 2001;285:1059-1070.
• Kalmar, Giacino JT. The JFK Coma Recovery Scale-Revised. Neuropsychological Rehabilitation. 2005. 15: 454-460.
• Davis AE. Cognitive impairments following traumatic brain injury. Etiologies and interventions. [Review] [50 refs] Critical Care
Nursing Clinics of North America. 12(4):447-56, 2000 Dec
• Brain Injury Patient Care and Education Manual, by Pinecrest Rehabilitation Hospital: Neuro section of the Trauma Manual. Coma
Stimulation in TBI: Rationale, goals, Principles, and techniques of coma stimulation. 1998. Oct. 26-28.
• Megha M., Harpreet, S., & Nayeem, Z. Effect of frequency of multimodal coma stimulation on the consciousness levels of traumatic
brain injury comatose patients. Brain Injury. 2013 27(5): 570-577.
References
• Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: SLACK
• Lundy-Ekman, L. (2013) Neuroscience: Fundamentals for rehabiliatation. St. Louis, MO: Elsevier Saunders.