TBI Treatment 1-5

• Consciousness is a state of awareness of self and environmental that requires alertness and arousal.
• Arousal is the level of consciousness.
• Awareness is the content of consicousness.
• The disorders of consciouness are coma, unresponsive wakefulness, and minimally conscious state.
• With coma, the eyes will never open (arousal), there is no communication, and there is no awareness.
• Coma is very similar to LOCF 1.
• When evaluating a patient that is LOCF 1, assess PROM and GCS. Note any responses, spasticity, or vital responses to movement (HR, O2, BP).
• Treatment of LOCF 1 includes positioning with an emphasis on arousal, monitoring emerging changes, and family education.
• In unresponsive wakefulness, the patient will have their eyes open at time but be sluggish (arousal), but will not have any communication or awareness.
• When evaluating a LOCF 2, assess PROM, GCS, and response to position changes. Note any responses, spasticity, and any vital responses to movement (HR, BP, O2).
• Treatment for LOCF 2 consists of out-of-bed activities, sitting balance, PROM, and transfer training for the family.
• In a minimally conscious state, patients will frequently open their eyes and may track movement. Communication is minimal, and awareness is purposeful but inconsistent.
• When evaluating a LOCF 3, assess communication, command following, ROM, and mobility. Note vitals, pain, response time, and any motivating factors.
• LOCF three patients are the first to be able to object manipulate.
• When educating families, include the following: stimulation should be kept to a minimum outside of therapy and to ensure the patient has ample time to respond to all stimuli.
• Paroxysmal sympathetic hyperactivity, or storming, is an increase in the activity of the sympathetic nervous system and adrenal glands.
• Storming is the result of a dissociation or loss of balance between the sympathetic and parasympathetic nervous systems.
• Common signs of storming include diaphoresis, episodic agitation, hyperthermia, tachycardia, tachypnea, and posturing.
• The best intervention for storming is to find the cause, change the environment, and allow the patient to rest.
• When evaluating a LOCF 4, assess communication, command following, mobility, and orientation. Note vitals, pain, response time, and agitating factors.
• Treatment of a LOCF 4 consists of orientation and mobility.
• Be prepared to constantly redirect LOCF 4 patients who are agitated.
• Patients who are confused and agitated need consistency. This includes people, time of therapy, and location of therapy. The best thing for them is a set routine.
• Agitation may present with increased physical symptoms and decreased cognitive abilities.
• When evaluating a LOCF 5, assess communication, command following, mobility, and orientation. Note vitals, pain, response time, and prior learned tasks.
• Treatment for LOCF 5 includes orientation and mobility.
• People with TBI are three times more likely to have sleep disorders.