Coma Scales
Glasgow Coma Scale
The Glasgow Coma Scale ("GCS") is often used to describe the initial level of injury and coma for a patient. The Rancho Los Amigos Scale is used to communicate information on the level/stage of recovery as the patient begins to emerge from coma.
"Mild", "moderate" and "severe" are terms used to describe the level of initial injury caused to the brain. This is usually done by emergency personnel using the Glasgow Coma Scale. There may be no relationship between the initial Glasgow Coma Scale score and the outcome of the victim.
"Coma" is defined as a prolonged period of unconsciousness. The deeper the coma, the more severe the injury is. An individual who cannot respond to any aspects of the environment, even a painful stimulus, is considered to be in the deepest coma. An individual who can open eyes to command, or attempt to speak is at the upper limit of the comatose scale.
GCS scares range from 3 [the most severe] to 15 [the least severe]. The length of time it takes to emerge from a coma will vary from minutes to months. The length of time in coma is an important indicator of severity.
The Glasgow Coma Scale measures patient responses to three determinants:
- Eye Opening - on a scale of 1 to 4
- Verbal Response - on a scale of 1 to 5
- Motor Response - on a scale of 1 to 6
Class of brain injury is determined by the initial GCS score [discussed in greater detail below
- "mild" brain injury - score 13 to 15
- "moderate" brain injury - score 9 to 12
- "severe' brain injury - score 8 or less
| EXAMINER'S TEST | PATIENT'S RESPONSE | SCORE |
| Eye Opening (E) | Opens eyes on own | 4 |
| Opens eyes when asked in loud voice | 3 | |
| Opens eyes when pinched | 2 | |
| Does not open eyes | 1 | |
| Best Motor Response (M) | Follows simple commands | 6 |
| Pulls examiner's hand away when pinched | 5 | |
| Pulls a part of body away when examiner pinches him/her | 4 | |
| Flexes body inappropriately to pain (decorticate posturing) | 3 | |
| Body becomes rigid in an extended position when examiner pinches victim (decerebrate posturing) | 2 | |
| Has no motor response to pinch | 1 | |
| Verbal Response (Talking) (V) | Carries on a conversation correctly and tells examiner where he/she is, and the month and year | 5 |
| Seems confused or disoriented | 4 | |
| Talks so examiner can understand victim but makes no sense |
3 |
|
| Makes sounds that the examiner can't understand | 2 | |
| Makes no noise | 1 | |
|
COMA SCORE (E+M+V) = 3 TO 15 |
||
The Rancho Los Amigos Cognitive Scale
The Rancho Los Amigos Cognitive Scale was developed at the Rancho Los Amigos Rehabilitation Center. It is an evaluation tool used in rehabilitation. The eight levels of the scale described the patterns or stages of recovery typically seen after a brain injury.
The Rancho Scale assists the rehabilitation team to understand and focus on the patient's abilities and design an appropriate treatment program. Each patient will be affected differently by brain injury. The Scale gives insight as to the behaviours that the survivor may demonstrate and those which may emerge as they move through the levels of recovery.
The Rancho Los Amigos Cognitive Scale was developed at the Rancho Los Amigos Rehabilitation Center. It is an evaluation tool used in rehabilitation. The eight levels of the scale described the patterns or stages of recovery typically seen after a brain injury.
The Rancho Scale assists the rehabilitation team to understand and focus on the patient's abilities and design an appropriate treatment program. Each patient will be affected differently by brain injury. The Scale gives insight as to the behaviours that the survivor may demonstrate and those which may emerge as they move through the levels of recovery.
| LEVEL I | No
Response: The patient is in deep coma and completely unresponsive. |
| LEVEL II |
Generalized Response: The patient reacts inconsistently and
nonpurposefully to stimuli in a non-specific manner. |
| LEVEL III | Localized
Response: The patient reacts specifically but inconsistently to stimuli,
orienting, withdrawing, or even following simple commands. |
| LEVEL IV |
Confused-Agitated: The patient is in a heightened state of activity with
severely decreased ability to process information. |
| LEVEL V | Confused,
Inappropriate, Non-agitated: The patient appears alert and is able to
respond to simple commands fairly consistently; however, with increased
complexity of commands or lack of any external structure, responses are
nonpurposeful, random, or at best, fragmented toward any desired goal. |
| LEVEL VI |
Confused-Appropriate: The patient shows goal-directed behaviour but is
dependent on external input our direction. |
| LEVEL VII |
Automatic-Appropriate: The patient appears appropriate and orientated
within hospital and home settings, goes through daily routine
automatically, but frequently robot-like with minimal to absent
confusion, and has shallow recall of what he/she has been doing. |
| LEVEL V111 |
Purposeful and Appropriate: The patient is alert and orientated, is able
to recall and integrate past and recent events, and is aware and
responsive to his environment. |
[Acquired Brain Injury] [Definitions] [Concussion] [Coma Scales] [Stats] [Costs]
Resources for Acquired Brain Injury pages are from the following websites:
Ontario Brain Injury Association www.obia.ca
Canadian Brain Injury Association:www.biac-aclc.ca
Brain Trust Canada: www.braintrustcanada.com
Brain Injury Association of Nipissing:http://dawn.thot.net/brain/