Medical professionals often use medical lingo and special scales to describe severity of brain injury. The Glasgow and Rancho scales are defined below.
Glasgow Coma Scale The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery at the University of Glasgow. The pair went on to author the textbook Management of Head Injuries (FA Davis 1981, ISBN 0-8036-5019-1), a celebrated work in the field.
Glasgow Coma Scale
|
6 |
5 |
4 |
3 |
2 |
1 |
| Eyes |
N/A |
N/A |
Opens eyes spontaneously |
Opens eyes in response to voice |
Opens eyes in response to painful stimuli |
Does not open eyes |
| Verbal |
N/A |
Oriented, converses normally |
Confused, disoriented |
Utters inappropriate words |
Incomprehensible sounds |
Makes no sounds |
| Motor |
Obeys Commands |
Localizes painful stimuli |
Withdraws from painful stimuli |
Decorticate posturing upon painful stimuli |
Decerebrate posturing upon painful stimuli |
Makes no movements |
The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), and the highest is 15 (fully awake person).
RANCHO Coma Scale This scale is commonly used by both medical and rehabilitation providers to measure and track emergence and recovery from coma after brain injury. It is a 10-point scale, although many medical professionals only use the first 7 Levels. All levels are defined below:
- Level I No Response: Appears to be in a deep sleep and does not outwardly respond to pain or stimulation of the senses
- Level II Generalized Response: Will sometimes respond to stimulation by becoming more or less physically active. The person's reaction may be the same to pain, noise, a visual stimulus or any other stimulation encountered. He or she will continue to "sleep" much of the time.
- Level III Localized Response: Is awake a greater amount of the time and reacts more to what is happening around him or her. For example, the person may begin to turn toward sounds such as a door closing or to look at objects. Also, the person may begin to recognize familiar faces.
- Level IV Confused, Agitated: Behavior may appear bizarre and out of character at this stage. The individual may act aggressively and attempt to remove restraints, tubes, or crawl out of bed. Talking may be incoherent and not related to anything around them. The person has a hard time remembering current events and may only recall what happened prior to the accident.
- Level V Confused, Inappropriate, Not Agitated: More alert and beginning to follow simple directions. Situations or activities that are unfamiliar or difficult may trigger restless behavior or outbursts, but this happens less frequently. Concentration improved, but redirection is still needed. Poor memory from moment to moment.
- Level VI Confused, Appropriate: Now follows simple directions consistently. Beginning to show awareness of the injury and may become frustrated or annoyed when they can't do things they could before the injury. Confused and disoriented at times. Attends to activities for up to 30 minutes.
- Level VII Automatic, Appropriate: Appears appropriate and normal on the surface. Goes through daily routine automatically, but may have little recollection of what has been happening day to day or week to week. Improving awareness. Lack of insight and judgment for safety.
- Level VIII Purposeful-Appropriate, Standby Assistance: Oriented to person, place, time and space. Able to complete familiar activities in a distracting environment for short periods of time. Uses memory device with help. May still require supervision for some familiar executive tasks. Depression, irritability, and frustration common.
- Level IX Purposeful-Appropriate, Standby Assistance at Request: Able to shift attention back and forth between activities without help. Uses memory device independently. Assistance with problem solving. Occasional help for socially acceptable behavior. Depression, irritability and low tolerance for frustration.
- Level IX Purposeful-Appropriate, Standby Assistance at Request: Able to shift attention back and forth between activities without help. Uses memory device independently. Assistance with problem solving. Occasional help for socially acceptable behavior. Depression, irritability and low tolerance for frustration.
- Level X Modified Independence: Completes activities from before injury independently with extra time and compensatory techniques. Requires periodic breaks for fatigue. Anticipates and independently solves problems. May still have periods of depression and frustration especially when tire, under stress, or sick.
Madonna Rehabilitation Hospital partners with the Veterans Administration to provide assessment and services to military personnel. Contact Nancy Hall, case manager, for more information.
