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ActrrE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 4-11. The Glasgow Coma Scale

Response

Score

Eye opening (E)

Spontaneous: eyes open without stimulation

4

To speech: eyes open to voice

3

To pain: eyes open to noxious stimulus

2

Nil: eyes do nor open despite variery of stimuli

Motor response (M)

Obeys: follows commands

6

Localizes: purposeful anemprs to move limb to sdmuJus

5

Withdraws: flexor withdrawal without localizing

4

Abnormal flexion: decorticate posturing to stimulus

3

Extensor response: decerebrate posturing [Q stimulus

2

Nil: no motor movement

Verbal response (V)

Oriented: normal conversation

5

Confused conversation: vocalizes in sentences, incorrect

4

context

Inappropriate words: vocalizes with comprehensible

3

words

Incomprehensible words: vocalizes with sounds

2

Nil: no vocalization

Source: Data from B jennen, G Teasdale (cds). Management of Head Injuries. Phibdel·

phia: FA Davis, 198 I .

score (i.e., E + M + V). Scores range from 3 to 15. A score of 8 or less

signifies coma.10

Clinical Tip

Calculation of the GCS usually occurs at regular intervals.

The GCS should be used to confirm the type and amount

of cueing needed to communicate with a patient, determine what time of day a patient is most capable of participating in physical therapy, and delineate physical therapy goals.

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285

Cognition

Cognitive testing includes the assessment of attention, orientation,

memory, abstract thought, and the ability to perform calculations or

conStruct figures. General intelligence and vocabulary are estimated

with questions regarding history, geography, or current events. Table

4- 1 2 lists typical methods of testing the components of cognition.

Table 4-12. Tests of Cognitive Function

Cognitive

Function

Definition

Task

Attention

Ability to artend to a

Repetition of a series of

specific stimulus or task

numbers or lerrers

Spelling words forward and

backward

Orientation

Ability to orient to

Identify name, age, current

person, place, and time

date and season, birth

date, present location,

rown, etc.

Memory

Immediate recall

Recount three words after a

few seconds

Short-term memory

Recount words (after a few

minutes) or recent events

Long-term memory

Recount past events

Calculation

Ability to perform verbal

Add, subtract, multiply, or

or written mathematical

divide whole numbers

problems

Construction

Ability to construct a

Draw a figure after a verbal

two- or three-dimencommand or reproduce a

sional figure or shape

figure from a picture

Abstraction

Ability to reason in an

Inrerpret proverbs

abstract rather than a

Discuss how two objects are

literal or concrete

similar or different

fashion

Judgment

Ability to reason

Demonstrate common sense

(according to age and

and safery

lifestyle)

Source: Dam from LS Bickley, RA Hoekelman (cds). 8ate's Guide fO Physical Examination and History Taking {7th cd}. Philadelphia: Lippincott, 1999.

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ACtITE CARE HANDBOOK fOR PHYSICAL THERAPISTS

Emotional State

Emotional State assessment entails observation and direct questioning to ascertain a patient's mood, affect, perception, and thought process, as well as to evaluate for behavioral changes. Evaluation of

emotion is not meant to be a full psychiatric examination; however,

it provides insight as to how a patient may complete the cognitive

portions of the mental status examination. I I

Clinical Tip

It is important to note that a patient's culture may affect

particular emotional responses.

Speech and Language Ability

The physician should perform a speech and language assessment

as soon as possible according to the patient'S level of consciousness. The main goals of this assessment are to evaluate the patient'S ability to articulate and produce voice and the presence,

extent, and severity of aphasia." These goals are achieved by testing comprehension and repetition of spoken speech, naming, quality and quantity of conversational speech, and reading and writing abilities. 12

A speech-language pathologist is often consulted to perform a

longer, more in-depth examination of cognition, speech, and swallow using standardized tests and skilled evaluation of articulation, phonation, hearing, and orofacial muscle strength testing.

Clinical Tip

• The physical therapist should be aware of and use, as

appropriate, the speech-language pathologist's suggestions

for types of commands, activity modification, and positioning as related to risk of aspiration.

• The physical therapist is often the first clinician to

notice the presence or extent of speech or language dysfunction during activity, especially during higher-level tasks or those activities that cause fatigue. The physical

therapist should report these findings to other members of

the health care team.

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287

Vital Sig1ts

The brain is the homeostatic center of the body; therefore, vital

signs are an indirect measure of neurologic status and the body's