Review

Cognition for Test 2

Levels of Consciousness
• You have received a referral for a
patient in the ICU (intensive care
unit). The patient does not
respond when you introduce
yourself. After repeating the
patient’s name, the patient still
does not respond. After
performing a sternal rub, the
patient winces and mumbles but
is unable to interact with you.
• What LOC is this describing?
Levels of Consciousness
• You have received a referral for a
patient in the ICU (intensive care
unit). The patient does not respond
when you introduce yourself. After
repeating the patient’s name several
times, the patient opens his eyes
briefly. You help the nurse reposition
the patient in the bed. The patient
winces and opens his eyes briefly but
does not follow directions.
• What LOC is this describing?
Levels of Consciousness
• You have received a referral for a patient in
the ICU (intensive care unit). The patient
does not respond when you introduce
yourself. After repeating the patient’s name
several times, the patient opens his eyes and
makes eye contact. You explain that you are a
physical therapist and what you are planning
to do. The patient is able to follow simple
commands after the question is repeated 2-3
times and with occasional verbal stimulation
for the patient to keep his eyes open.
• What LOC is this describing?
Levels of Consciousness
• You have received a referral for a
patient in the ICU (intensive care
unit). You walk into the hospital room
and observe the patient in this
posture.
• What is the most likely LOC of this
patient?
Documentation
• Arousal: Examples 
• Lethargic-Patient required verbal stimulation of calling name 3 times
before opening eyes. Pt was able to keep eyes open and interact with
therapist for periods of 3 minutes.  
• Stupor-Patient did not respond to verbal stimulation but did respond
to sternal rub. Pt’s eyes opened briefly but did not remain open. 
• Obtunded-Patient responded only to repeated verbal stimulation of
name and to open eyes.  
Attention
• You have a patient that is unable to focus on your instructions when
• They hear a beep on their IV machine
• Another patient in the gym counts while exercising

• This patient is having difficulty with?

Attention
• You have a patient that loses their balance
• when walking if they are asked a question
• While standing at the kitchen countertop and figuring out how to double a
recipe

• What type of attention is the patient having difficulty with?

Attention
• A patient is able to perform 2 step commands without repeated
instructions at the beginning of a therapy session but after 15 minutes
the patient needs several cues to redirect.
• What type of attention is the patient having difficulty with?
Cognition
• What is the difference between A and O and testing with the MOCA?
Documentation
• MOCA 22/30 This score indicates mild cognitive impairment. Patient
had the most difficulty with memory and attention.  
• Memory: Patient has difficulty recalling exercises performed at end of
the session.  
• A and O x 3
The 3 Ds
• A patient has a sudden onset of confusion and inattention.

• A patient has a gradual onset of loss of memory.

• A patient has difficulty with memory following the diagnosis of a

progressive disease.
• Depression screen
Communication

• Aphasia
• Fluent/Wernicke/Receptive-Loss of auditory comprehension with fluent speech and
word substitutions; impaired reading and writing receptive aphasia

• Non-fluent/Broca/Expressive-Intact comprehension of oral and written language with

difficulty producing speech, articulating, naming, and writing; limited vocabulary
expressive aphasia
Documentation
• The patient requires face to face communication to interact with
patient.  
• The patient has difficulty with verbal answers. Patient responded with
nodding yes or shaking head for no 
• The patient has difficulty with verbal answers. Patient responded with
pointing to yes or no on a card 
• The patient required visual and tactile cues with verbal commands.