GCS Motor

train54

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Can someone point me to where I can get detailed/in depth description of what the different levels of CGS Motor scores look like? I get confused with localizes pain vs withdrawl as well as the other scores...

Thanks!
 
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train54

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Still confused

First off, it's GCS.
Oops... I know that, I guess I,m just dyslexic. I can't seem to edit my original post now, doh!

"Best motor response (M)

There are 6 grades starting with the most severe:

1. No motor response
2. Extension to pain (abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response)
3. Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
4. Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
5. Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
6. Obeys commands. (The patient does simple things as asked.)"

I understand 6, but don't get the difference between 4 and 5.

I guess I need to memorize the definitions of decorticate and decerebrate. Any suggestions on how to easily remember the difference between these two?

Thanks!
 

Handsome Robb

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DeCORticate = towards the core.

Localizes pain = Makes an reasonable attempt to stop whatever is causing the pain. For example, swatting away a hand doing a sternal rub.

Withdraws from pain = Not as direct as the above. Pulls away from pain but doesn't make a direct action to stop the source.

Does that make sense? That's my overly simplified, running on 4 hours of sleep along with working a 13 hour shift from hell, explanation of it.
 

Aprz

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I always remembered it as the difference between an appropriate response to pain vs. inappropriate response to pain. Some articles I've read got into so much details that in order for the patient to get a 5, they'd have to be able to cross over midline and/or their clavicle. It's like a fly landing on your shoulder, you use the contralateral (opposite side) arm to smack it off. Same thing when you do the trapezius pinch.... Those articles usually advise against sternal rub because of how long it takes and difficulty between distinguishing between the two special postures (decorticated and decerebtrated postures). Another one that I read was on paramedicine.com, and the author where it's command (6), IN (5), OUT (4), IN (special posture - decorticated) (3), OUT (special posture - decerebrated posture) (2), no response (1). There's another article on theemtspot.com also, but I don't recall the details of it.
 
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train54

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DeCORticate = towards the core.

Localizes pain = Makes an reasonable attempt to stop whatever is causing the pain. For example, swatting away a hand doing a sternal rub.

Withdraws from pain = Not as direct as the above. Pulls away from pain but doesn't make a direct action to stop the source.

Does that make sense? That's my overly simplified, running on 4 hours of sleep along with working a 13 hour shift from hell, explanation of it.
That helps a lot! Thanks!

I always remembered it as the difference between an appropriate response to pain vs. inappropriate response to pain. Some articles I've read got into so much details that in order for the patient to get a 5, they'd have to be able to cross over midline and/or their clavicle. It's like a fly landing on your shoulder, you use the contralateral (opposite side) arm to smack it off. Same thing when you do the trapezius pinch.... Those articles usually advise against sternal rub because of how long it takes and difficulty between distinguishing between the two special postures (decorticated and decerebtrated postures). Another one that I read was on paramedicine.com, and the author where it's command (6), IN (5), OUT (4), IN (special posture - decorticated) (3), OUT (special posture - decerebrated posture) (2), no response (1). There's another article on theemtspot.com also, but I don't recall the details of it.
Interesting. Thanks for the help!

I will check out those sites for more detail.
 

Aprz

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By the way, to clarify what I said, to distinguish between decorticated and appropriate response (cause their arm will go towards the sternal as you rub if it's an appropriate response to pain/try to smack it off), and between decerebrated and inappropriate response (their arm is going away from the pain). I didn't mean between the difference between decorticated and decerebrated.
 

ffemt8978

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Edited thread title to remove confusion.
 

MSDeltaFlt

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The question has already been answered. Good stuff. One caveat, though. For "obeys simple commands", let's keep in mind that following simple commands is more than merely squeezing your hand. New born babies squeeze fingers when put in their hands. Squeezing hands to a pattern or give you a thumbs up or give them a simple (ethical) gesture to mimicking: hold up a peace sign or the like.
 

Aidey

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To expand on what MS said that is the grasping reflex. It, the sucking reflex and a several others are the primitive reflexes. They are normal in babies but abnormal in adults. In adults they are normally suppressed so if they show up it can be a sign of neurological deficits. Similar to how Babinski's sign works.
 

Akulahawk

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With the grasping reflex, yes it is a primitive reflex. What I'd be looking for is a purposeful squeeze and relaxation of grip upon command. With the grasp reflex, as soon as you put something in the palm of the hand, the fingers close around and grasp immediately. If I saw that... I would consider that a "bad sign" as that grasp reflex is supposed to "disappear" within a few months of life.

One way that I test for following simple commands is to instruct my patient to reach for my fingers and squeeze them. I make it so that all the patient has to do is move just a little... but that little bit must be purposeful. There are other things you can do to test for this, but it boils down to purposeful movement upon command, not some other physical stimulus.
 

Mountain Res-Q

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Was reviewing paperwork this morning for a call yesterday. One of my people gave the patient a GCS of 16 on the paperwork. Still trying to figure that out...
 

MSDeltaFlt

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Was reviewing paperwork this morning for a call yesterday. One of my people gave the patient a GCS of 16 on the paperwork. Still trying to figure that out...
I've seen someone chart a GCS of 1. :glare:
 

ffemt8978

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