Mental Function and Balance

Ascending Reticular activating system

communicates and functions to arouse and awaken the brain, controls sleep-wake cycle ~ lesions in brain stem are associated with sleep and coma

descending reticular activating system

medial reticulospinal tract enhances spinal cord antigravity reflexes and extensor tone of lower extremity ~ lateral reticulospinal tract reduces antigravity control

consciousness

alert and awake, aware's of one's environment

lethargy

altered consciousness, level of arousal is diminished, drowsy, falls asleep but can be awakened and respond

Obtunded State

difficult to arouse from sleeping, but does wake up, confused, non-productive responses

stupor

altered mental status and responsiveness to one's environment

coma

unconscious, cannot be aroused

What is the FAST cognition test?

A functional scale designed to evaluate patients at the more moderate-severe stages of dementia.

When is the FAST cognition test used?

When the MMSE can no longer reflect changes in a meaningful clinical way.

CAM-ICU

Confusion Assessment Method for ICU ~ tool used to screen delirium

Mini-Cog

is another screening tool that can be administered in 5 minutes or less and requires minimal training. 3 item recall, clock drawing test (CDT)

Brief cognitive rating scale

an objective tool that consists of five axes that assess concentration, recent memory, past memory, orientation, functioning and self-care

what are the feedback systems for balance

proactive-feedforward mechanisms

adaptive-feedback mechanisms

coordination

ability to execute smooth, accurate, controlled movement

somatosensory

our sense of touch, temperature, and pain

what is the cutoff level for TUG alone

13.5 seconds

what is the cutoff for the TUG cognitive and TUG manual

14.5 seconds and 15 seconds

what is the appropriate score in the Tinetti POMA that indicates high fall risks

less than or equal to score of 18

what is the appropriate score in the BERG balance scale that indicates high fall risks

less than 20

what is the appropriate score in the BERG balance scale that indicates medium fall risk and low fall risk

medium: 21-40; low: 41-56

how much change between two BERG assessments is required to reveal a genuine change in function

8 point difference

what is the appropriate score in the DGI that indicates risk for falls

less than 21

what is the common score for moderate stage parkinson disease in the DGI assessment

9-11 out of 24 points

what is the recommended population of people for the DGI

recommended for post stroke patients and high level patients walking in unpredictable environments

who is the recommended population for BERG balance scale

best used amongst older people with impairment in balance function

what is the purpose of the TUG assessment

to identify/screen elderly individuals who are prone to falls ~ hazard/risk assessment tool