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| I-No Response | patient appears to be in a deep sleep and is unresponsive to stimuli
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| II-Generalized Response | pt reacts inconsistently and nonpurposefully to stimuli. responses are limited and often the same regardless of stimulus presented. responses may be physiological changes, gross body mvmts, an or vocalization
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| III-Localized Response | pt reacts specifically but inconsistently to stimuli. responses are directly related to the type of stimulus. follows simple commands in an inconsistent, delayed manner
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| IV-Confused Agitated | pt is in a heightened state of activity. Bizarre behavior that is nonpurposeful to environment. Doesn't discriminate people or objects, incoherent or inappropriate verbalization, no short or long term recall, gross attention is brief
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| V-Confused Inappropriate | pt is able to respond to simple commands consistently, but randomly if too complicated. demonstrates gross attention to the environment but is highly distractible. impaired memory. inappropriate. unable to learn new tasks.
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| VI-Confused Appropriate | goal directed behavior but is dependent on external input or direction. follows simple directions w/ carryover. responses may be incorrect due to memory problems, but appropriate to situation. Better past memory than present.
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| VII-Automatic Appropriate | appears appropriate and oriented w/in the hospital and home settings. daily routine. needs notebook. min-no confusion. able to initiate social or recreational activities, impaired judgement
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| VIII-Purposeful Appropriate | able to recall and integrate past and recent events and is aware of and responsive to environment. carryover for new learning and needs no supervision once activities are learned. abstract reasoning, tolerance for stress all decreased.
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| Level I, II, and III | sit pt on side of the bed w/ assist, tilt in space wc, positioning, contraindication=increased ICP, PROM, sensory stimulation, tilt table for wt bearing and alertness
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| Level IV | incorporate creativity and flexibility to tx, improve endurance,avoid new learning due to lack of memory. use pt, rewards, and redirection. Have daily routine. performs functional tasks, pt reflects the demeanor of the caregiver.limited attn span.
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| Level V and VI | confused, but able to follow simple commands, gait examinations, still presents w/ behavioral and cognitive deficits, mental and physical fatigue, improved mobility, but lack of insight
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| Level VII and VIII | wean pt from external structure provided by hospital setting. goal is to integrate cognitive, physical, and emotional skills. Judgement, problem solving, planning, are emphasized.
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| level 1 tx | PROM; bed positioning; environmental stim; family education for support and what to expect and instruction on rom and pos.;instruct other staff in pos. and rom; techniques to decrease abnormal posture and primitive reflexes; be alert; talk normal
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| level 2 tx | all level 1 + supported sitting; tt as appropriate; sensory stim; techniques to decrease abnormal posturing and primitive reflexes
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| level 3 tx | environmental stim (talk), tactile; bed positioning; prom; active ex; sitting balance supported to unsupported; stimulate normal postural and balance; functional tasks; tt as appropriate; stretch of position to prevent tight hip flexors, heel cords, hs
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| level 4 tx | rom; ther ex to promote funcional skills and strength; ambulation;transfers; family instruction; therapist should stay calm; stay consistent
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| level 5 tx | rom; pre; coordination activities; ther ex functional activities; reciprocal activities; transfers; wc mobility; gait; family ed; maximize reps and consistency; work on memory by having pt repeat
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| level 6 tx | increase attn span; increase recall of personal info prior to accident
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| level 7 tx | incorporate functional activities in less controlled environment to assess pts safety and judgement; selective strengthening of weak mms; advanced wc training; do not simplify vocab; use notebook; encourage recall; give emotional support
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| level 8 tx | same as 7
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