NEUROLOGICAL ASSESSMENT
-SHUCHI JOSHI
ARIP
03-07-2017
09:00-10:00
CONSCIOUSNESS AND AROUSAL
• determine the degree to which an individual is able to
respond.
• Ascending reticular activating system: includes
• core neurons in the brainstem, the
• locus ceruleus, and raphe nuclei
• Function- to arouse and awaken the brain and control
sleep– wake cycles.
• High levels of activity are associated with extreme
excitement (high arousal), whereas lesions in the
brainstem are associated with sleep and coma.
• Descending reticular activating system (DRAS) :
• pontine and medullary reticulospinal tracts.
• Pontine (medial) reticulospinal tract enhances spinal
cord antigravity reflexes and extensor tone of lower
limbs.
• Medullary (lateral) reticulospinal tract has the
opposite effect, reducing antigravity control.
5 LEVELS OF CONSCIOUSNESS
• Consciousness- a state of arousal accompanied by
awareness of one’s environment.
• A conscious patient is awake, alert, and oriented to his
or her surroundings.
• Lethargy - altered consciousness in which a person’s
level of arousal is diminished.
• The lethargic patient appears drowsy but when
questioned can open the eyes and respond briefly.
• The patient easily falls asleep if not continually
stimulated and does not fully appreciate the
environment.
• The therapist should speak in a loud voice while calling
the patient’s name. Questions should be simple and
directed toward the individual (e.g., How are you
feeling?).
• Obtunded state - diminished arousal and awareness.
• The obtunded patient is difficult to arouse from
sleeping and once aroused, appears confused.
• Attempts to interact with the patient are generally
nonproductive.
• The therapist should shake the patient gently as if
awakening someone from sleep and again use simple
questions.
• Stupor - a state of altered mental status and
responsiveness to one’s environment.
• The patient can be aroused only with vigorous
or unpleasant stimuli (e.g. sharp pressure or
pinch, or rolling a pencil across the nail bed).
• No significant voluntary verbal or motor
responses.
• Mass movement responses may be observed
in response to painful stimuli or loud noises.
• The unconscious patient is said to be in a coma
and cannot be aroused.
• The eyes remain closed and there are no sleep–
wake cycles.
• The patient does not respond to repeated painful
stimuli and may be ventilator dependent.
• Reflex reactions may or may not be seen,
depending on the location of the lesion(s) within
the CNS.
• Clinically the patient can progress from one level
of consciousness to another.
• Minimally conscious (vegetative) state-
• return of irregular sleep–wake cycles and normalization of
the so-called vegetative functions
• respiration, digestion, and blood pressure control.
• The patient may be aroused, but remains unaware of his or
her environment. There is no purposeful attention or
cognitive responsiveness.
• Persistent vegetative state –
• individuals who remain in a vegetative state 1 year or
longer after TBI and 3 months or more for anoxic brain
injury. This state is caused by severe brain injury.
