Glasgow Coma Scale

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  1. What does the Glasgow Coma Scale measure?
    level of initial injury in relation to the neurological severity caused to the brain
  2. What are the levels of the GCS?
    • Mild
    • Moderate
    • Severe
  3. What are the categories that determine GCS?
    • best motor response
    • best verbal response
    • best eye opening response
  4. What are the scores for best motor response?
    • 6-Obeys commands
    • 5-Localizes stimulus
    • 4-w/draws from stimulus
    • 3-flexes arm
    • 2-extends arm
    • 1-no response
  5. What are the scores for best verbal response?
    • 5-oriented
    • 4-conversant, but confused
    • 3-states recognizable words or phrases
    • 2-makes unintelligible sounds
    • 1-no response
  6. What are the scores for best eye opening response?
    • 4-eyes open spontaneously
    • 3-eyes open to voice
    • 2-eyes open to painful stimulus
    • 1-remain closed
  7. What GCS levels result in mild brain injury?
  8. Mild Brain Injury:
    • loss of consciousness if very brief, usually a few seconds or minutes or does not occur at all
    • dazed and confused
    • testing or scans of the brain may appear normal
    • diagnosed only when there is a change in the mental status at the time of injury -- person is dazed, confused, or loses consciousness
  9. Mild brain injury symptoms:
    • headache, fatigue, sleep disturbance
    • irritability, sensitivity to noise/light, balance problems
    • decreased concentration and attention span
    • decreased speed of thinking and memory
    • nausea, depression, and anxiety
    • emotional mood swings
    • can be debilitating, confusing to family as they are thinking, brain injury is mild
  10. Which GCS are considered moderate brain injury?
  11. Moderate brain injury:
    • loss of consciousness lasts from a few minutes to a few hours
    • confusion lasts from days to weeks
    • 60% make good recovery
    • 25% left w/ moderate degree of disability
    • physical, cognitive, and/or behavioral impairments last for months or are permanent
  12. Which GCS levels are considered severe brain injury?
    8 or less
  13. Severe brain injury:
    • occurs when prolonged unconscious state or coma lasts days, weeks, or months
    • further categorized into subgroups w/ separate features
  14. What are the subgroups of severe brain injury?
    • coma
    • vegetative state
    • persistent vegetative state (PVS)
    • minimally responsive state
    • akinetic mutism
    • locked-in syndrome
    • brain death
  15. Coma
    • state of unconsciousness from which the individual can't be awakened, in which the individual responds minimally or not at all to stimuli, and initiates no voluntary activites
    • persons appear to be asleep, but can't be awakened
    • there is no meaningful response to stimulation
  16. Vegetative state:
    arousal is present, but the ability to interact w/ the environment is not
  17. What is eye opening like in vegetative state?
    can be spontaneous or in response to stimuli
  18. What is response to pain in vegetative state?
    general responses to pain exist, such as increased HR, increased respiration, posturing, or sweating
  19. What functions return in vegetative state?
    • sleep-wake cycles
    • respiratory functions
    • digestive functions
  20. What test diagnoses vegetative state?
    there is no test, the diagnosis is made only by repetitive neurobehavioral assessments
  21. Persistent vegetative state (PVS)
    • vegetative state that has lasted for more than a month
    • criteria same as vegetative state
  22. Minimally responsive state:
    • no longer in a coma or vegetative state
    • demonstrates primitive reflexes; inconsistent ability to follow simple commands; awareness of environmental stimulation
    • brief head turn to noise/voices; notices lights, TV on/off
  23. Akinetic mutism
    • neurobehavioral condition that results when the dopaminergic pathways in the brain are damaged resulting in
    • -minimal amount of body movement
    • -little or no spontaneous speech
    • -speech which can be elicited
    • -eye opening and visual tracking
    • -infrequent and incomplete ability to follow commands
  24. How is akinetic mutism different from minimal responsive state?
    b/c the lack of movement and speech w/ akinetic mutism is not b/c of neuromuscular disturbance
  25. Brain death
    • brain shows no sign of functioning
    • physician performs specific formula brain death exam
    • families must be asked for organ donation at this stage; high grief while making this decision
  26. Prognosis determinants:
    • pre-injury characteristics (past med history, psychological conditions, social status, economic status)
    • age (plasticity is improved in younger clients)
    • severity of brain injury (site of lesion, mechanism of injury, secondary damage)
    • severity of other injuries
    • medical complications
    • length of time b/w injury and initiation of rehab
    • duration of coma
  27. At how many days of coma does it predict poor functional outcome?
    more than 20 days
  28. Models of Care:
    • acute medical rehab
    • community integrated rehab
    • adapted lifestyle sustaining services
Card Set
Glasgow Coma Scale
review of the Glasgow Coma Scale
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