It is important to keep in mind that the coma patient may exhibit reflex activities which mimic conscious activities. Patients in coma may exhibit several different types of spontaneous ocular movements. Despite the patient does not cooperate, the neglectful practice of dismissing the examination of eye movements is unacceptable. Locked-in syndrome is a rare neurological disorder in which there is complete paralysis of all voluntary muscles except for the ones that control the movements of the eyes. The Rancho Level of Cognitive Functioning Scale (LCFS) is a scale used to assess cognitive functioning in people with brain injury. The person does not respond to vigorous efforts to elicit a response of any kind—sound, movement, or eye-opening—and shows no variation in behavior, simply a sleeplike state with eyes closed. A fully conscious patient has a Glasgow Coma Score of 15. 0 if normal eye movement noted 0 if patient able to track your movements Coma - hold eyes open and turn head side-to-side. Confused - Make eye contact and move to other side of bed 3 Visual 0 if blinks to visual threat 3 if no blink in any field 3 if blind due to any cause Coma In addition, the available diagnostic approaches are largely derived from outpatients with neurodegenerative or … 11 The first three levels are similar to the stages of coma, VS, and MCS. Such remarks as “eye movements cannot be examined” are too frequent in medical reports. many patients who suffer trauma to the brain (often after a road accident) or a lack of oxygen (for example, after a cardiac arrest or drowning), but if the damage is severe, the victim will slip into a coma. Coma patients may be restrained to keep them from removing tubes or dislodging IVs. Abnormal movements are frequently encountered in patients with brain injury hospitalized in intensive care units (ICUs), yet characterization of these movements and their underlying pathophysiology is difficult due to the comatose or uncooperative state of the patient. The defining characteristics of a coma are: No eye movement or opening; Lack of speech or other forms of communication; No purposeful movement; Most comas only last for a couple of weeks. A coma is the deepest state of unconsciousness. During a coma, a person cannot communicate, so diagnosis is through the outward signs. The person in the coma may exhibit movement, make sounds, and experience agitation. Spontaneous vertical eye movements in coma. In such cases, instead of the voluntary – guided and commanded – eye movements, the reflex ones should be checked. Diagnosis is clinical. A minimally conscious state, unlike a vegetative state, is characterized by some evidence of awareness of self and/or the environment, and patients tend to improve. When in a coma, a patient is unresponsive to their environment and cannot wake up, even when stimulated. Three forms of spontaneous vertical movements have been distinguished based on the relative velocities of their downward and upward phases. Patients may have complex reflexes, including eye movements, yawning, and involuntary movements to noxious stimuli, but show no awareness of self or environment. When the reflex is present, the eyes of the patient remain stationary while the head is moved, thus moving in relation to the head. Extra-ocular muscles may be evaluated by inducing eye movements via reflexes. A person in a deep coma has a Glasgow Coma Score of 3 (there is no lower score). 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