Glasgow Coma Scale
Card Set Information
Glasgow Coma Scale
review of the Glasgow Coma Scale
What does the Glasgow Coma Scale measure?
level of initial injury in relation to the neurological severity caused to the brain
What are the levels of the GCS?
What are the categories that determine GCS?
best motor response
best verbal response
best eye opening response
What are the scores for best motor response?
4-w/draws from stimulus
What are the scores for best verbal response?
4-conversant, but confused
3-states recognizable words or phrases
2-makes unintelligible sounds
What are the scores for best eye opening response?
4-eyes open spontaneously
3-eyes open to voice
2-eyes open to painful stimulus
What GCS levels result in mild brain injury?
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
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
Which GCS are considered moderate brain injury?
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
Which GCS levels are considered severe brain injury?
8 or less
Severe brain injury:
occurs when prolonged unconscious state or coma lasts days, weeks, or months
further categorized into subgroups w/ separate features
What are the subgroups of severe brain injury?
persistent vegetative state (PVS)
minimally responsive state
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
arousal is present, but the ability to interact w/ the environment is not
What is eye opening like in vegetative state?
can be spontaneous or in response to stimuli
What is response to pain in vegetative state?
general responses to pain exist, such as increased HR, increased respiration, posturing, or sweating
What functions return in vegetative state?
What test diagnoses vegetative state?
there is no test, the diagnosis is made only by repetitive neurobehavioral assessments
Persistent vegetative state (PVS)
vegetative state that has lasted for more than a month
criteria same as vegetative state
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
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
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
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
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
length of time b/w injury and initiation of rehab
duration of coma
At how many days of coma does it predict poor functional outcome?
more than 20 days
Models of Care:
acute medical rehab
community integrated rehab
adapted lifestyle sustaining services