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A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced.
Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury.
A persistent vegetative state (PVS) or post-coma unresponsiveness (PCU) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative state (VS), the patient is classified as in a persistent vegetative state. This diagnosis is classified as a permanent vegetative state some months after a non-traumatic brain injury or one year after a traumatic injury. Today, doctors and neuroscientists prefer to call the state of consciousness a syndrome, primarily because of ethical questions about whether a patient can be called "vegetative" or not.
Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage, while neurotoxicity typically refers to selective, chemically induced neuron damage.
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.
Closed-head injury is a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people. Overall, closed-head injuries and other forms of mild traumatic brain injury account for about 75% of the estimated 1.7 million brain injuries that occur annually in the United States. Brain injuries such as closed-head injuries may result in lifelong physical, cognitive, or psychological impairment and, thus, are of utmost concern with regards to public health.
A minimally conscious state (MCS) is a disorder of consciousness distinct from persistent vegetative state and locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The natural history and longer term outcome of MCS have not yet been thoroughly studied. The prevalence of MCS was estimated to be 112,000 to 280,000 adult and pediatric cases.
Acquired brain injury (ABI) is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent or temporary changes in functioning. These impairments result from either traumatic brain injury or nontraumatic injury derived from either an internal or external source. ABI does not include damage to the brain resulting from neurodegenerative disorders.
Rancho Los Amigos National Rehabilitation Center is a rehabilitation hospital located in Downey, California, United States. Its name in Spanish means 'Friends' Ranch'.
Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it.
A coma scale is a system to assess the severity of coma. There are several such systems:
Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.
The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, to months, or even more than six months.
The California Verbal Learning Test (CVLT) is one of the most widely used neuropsychological tests in North America. As an instrument, it represents a relatively new approach to clinical psychology and the cognitive science of memory. It measures episodic verbal learning and memory, and demonstrates sensitivity to a range of clinical conditions. The test does this by attempting to link memory deficits with impaired performance on specific tasks. It assesses encoding, recall and recognition in a single modality of item presentation (auditory-verbal). The CVLT is considered to be a more sensitive measure of episodic memory than other verbal learning tests. It was designed to not only measure how much a subject learned, but also reveal strategies employed and the types of errors made. The CVLT indexes free and cued recall, serial position effects, semantic clustering, intrusions, interference and recognition. Delis et al. (1994) released the California Verbal Learning Test for Children (CVLT-C). The California Verbal Learning Test-II (CVLT-II) is an updated version of the original CVLT, which has been standardized and provides normative data.
An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousness or alertness may be classed as lethargy; someone in this state can be aroused with little difficulty. People who are obtunded have a more depressed level of consciousness and cannot be fully aroused. Those who are not able to be aroused from a sleep-like state are said to be stuporous. Coma is the inability to make any purposeful response. Scales such as the Glasgow coma scale have been designed to measure the level of consciousness.
Disorders of consciousness are medical conditions that inhibit consciousness. Some define disorders of consciousness as any change from complete self-awareness to inhibited or absent self-awareness and arousal. This category generally includes minimally conscious state and persistent vegetative state, but sometimes also includes the less severe locked-in syndrome and more severe but rare chronic coma. Differential diagnosis of these disorders is an active area of biomedical research. Finally, brain death results in an irreversible disruption of consciousness. While other conditions may cause a moderate deterioration or transient interruption of consciousness, they are not included in this category.
The Wechsler Test of Adult Reading (WTAR) is a neuropsychological assessment tool used to provide a measure of premorbid intelligence, the degree of Intellectual function prior to the onset of illness or disease.
The Disability Rating Scale (DRS) was developed as a way to track a traumatic brain injury (TBI) patient from ‘Coma to Community’. The scale was used to rate the effects of injury and decide how long recovery might take. The rating gives insight into the cognitive impairment of the individual who suffered from the TBI.
The Westmead Post-traumatic Amnesia Scale (WPTAS) is a brief bedside standardised test that measures length of post-traumatic amnesia (PTA) in people with traumatic brain injury. It consists of twelve questions that assess orientation to person, place and time, and ability to consistently retain new information from one day to another. It is administered once a day, each and every day, until the patient achieves a perfect score across three consecutive days, after which the individual is deemed to have emerged from post-traumatic amnesia. PTA may be deemed to be over on the first day of a recall of 12 for those who have been in PTA for greater than four weeks. The WPTAS is the most common post-traumatic amnesia scale used in Australia and New Zealand.
References
- ↑ Rancho Los Amigos National Rehabilitation Center. (1 March 2011). The Rancho Levels of Cognitive Functioning. Retrieved May 15, 2011, from https://web.archive.org/web/20110514024558/http://rancho.org/Research_RanchoLevels.aspx
- 1 2 3 4 Fulk, G. D. (2007). Traumatic Brain Injury. In S. B. O’Sullivan & T. J. Schmitz (Eds.), Physical Rehabilitation (5th ed., pp. 895-935). Philadelphia, PA: F. A. Davis Company.
- ↑ Gouvier, W. D., Blanton, P. D., LaPorte, K. K., & Nepomuceno, C. (1987). Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury. Archives of Physical Medicine and Rehabilitation, 68(2), 94-97.