Coma

Coma

A state of profound unconsciousness with

• Not awake and not aware

• No spontaneous eye opening

• No purposeful movement

• No speech

• No sleep-wake cycle on EEG

• < 8 on GCS

Unresponsive Wakefulness

• Awake but unaware

• Does not follow commands

• Do not visually track

• Eyes open spontaneously

• Autonomic functions working: respiration, digestion, sleep-wake cycle

• Brainstem functioning is preserved with reflexes present

Minimally Conscious State (MCS)

• Somewhat aware

• Making eye contact

• Yes/no responses (verbally or gestures)

• Verbalizes intelligibly

• Purposeful behavior

MCS Plus

• Follow simple commands

• Produce intelligible verbalizations

• Communicate yes/no responses

MCS Minus

Purposeful responses but not language-based behaviors

Loss of Consciousness (LOC)

A determinant of TBI severity categorized as mild, moderate, or severe based on duration.

Glasgow Coma Scale (GCS)

A scale used to assess consciousness level after brain injury, scoring from 3 to 15.

On the GCS, what number is the critical score

8

GCS score of 9-11 indicates

Moderate severity

GCS score > 12 indicates

Minor injury

GCS score < 8 indicates

Coma

Decerebrate Posturing

Extension of arms and legs indicating brainstem damage.

Decorticate Posturing

Flexion of arms and wrists with extension of legs indicating damage to cerebral hemispheres.

Which is more serious: Decerebrate or Decorticate rigidity?

Decerebrate rigidity

GCS Score Calculation

A method to assess brain injury severity based on eye, motor, and verbal responses.

What is a limitation of the GCS?

• Limited use for intubated patients and young children

• Does not account for certain cognitive aspects

Post-Traumatic Amnesia (PTA)

Inability to form new memories after a TBI.

Retrograde Amnesia

Loss of memories formed before the injury.

Galveston Orientation & Amnesia Test (GOAT)

• A test assessing orientation and memory in TBI patients.

• Score of 76 or above on 3 consecutive occasions indicate post-traumatic amnesia

Rancho Level I

No response to stimuli, requiring interventions to prevent complications.

Rancho Level II

Generalized responses to stimuli, needing sensory stimulation interventions.

Rancho Level III

Localized responses to stimuli, requiring structured sensory stimulation and tasks.

Role of Occupational Therapist

Support recovery through prevention of complications, sensory stimulation, and family education.

Which is an appropriate goal for a patient in a coma?

Patient will respond to tactile stimulation with increased muscle tone within 2 weeks

Which is an appropriate goal for a patient in a unresponsive wakefulness state?

Patient will open eyes in response to auditory stimuli in 50% of trials

Which is an appropriate goals for a patient in a minimally conscious state?

Patient will follow one-step commands in 2 out of 5 trials