The disability rating and Coma/Near-Coma scales in evaluating severe head injury

Abstract

The Disability Rating (DR) and Coma/Near-Coma (C/NC) scales for evaluating severe head injury are described. Scales are related to patient status, course and outcome and also underlying electroneurophysiological dysfunction. They lend themselves to high inter-rater reliability with brief training and can be completed in minutes, conserving staff time and energy.

The Relationship Between Coma Near Coma, Disability Ratings, and Event-Related Potentials in Patients with Disorders of Consciousness: A Semantic Association Task

“…Specifically, the DRS has the goal to furnish a quantitative measure of the disability outcomes for patients with severe head injury, documenting evolution from initial coma to various stages of impaired levels of consciousness (Rappaport 2005;Rappaport et al 1982;Teasdale and Jennett 1974). However, it allows the monitoring of patient progress and it is predictive about the long-term outcomes.…”

“…The CNC scale was used to evaluate levels of responsiveness of patients with severe brain injury and it analyzes the patient's response to stimulation with different sensory modalities (Rappaport 2005;Scozzafava et al 2010). Compared to the DRS it has a higher sensitivity in detecting small changes that define the degree of patient's responsiveness.…”

“…Clinical tests rely on a patient demonstrating awareness by means of overt behaviors, as does the Coma Near Coma (CNC), the Glasgow Coma Scale (GCS) and the Disability Rating Scale (DRS) (Rappaport 2005;Rappaport et al 1982;Teasdale and Jennett 1974). Also recently CRS-R (Coma Recovery Scale-Revised) (Giacino et al 2004) was developed to assess differences between levels of consciousness (Coma, Vs and MCS), whereas a critical point remains the low reliability levels for patients with significant cognitive syndromes (such as aphasia or neglect).…”

Does an Early Onset and Continuous Chain of Rehabilitation Improve the Long-Term Functional Outcome of Patients with Severe Traumatic Brain Injury?

“…The GOSE was administrated in a structured face-to-face interview conducted by the first author. The secondary outcome measures included the Disability Rating Scale (DRS) (Rappaport, 2005), the patient's employment status and the living situation 12 months post-injury. The DRS scale measured the levels of arousal, awareness, and responsiveness (including eye opening, communication ability, and motor response); cognitive ability for self-care activities (such as feeding, using the toilet, and grooming); dependency on others (level of functionality); and psychosocial adaptability (employability).…”

A Comment on “Effect of Tactile Stimulation on Lingual Motor Function in Pediatric Lingual Dysphagia” (Dysphagia 20:311–324, 2005)

“…Case study 1, patient 2 was in a Level 2 moderate coma [13]. Specifically, she consistently responded to tactile oral stimulation and inconsistently responded to stimulation presented to two or three sensory modalities; she was not responsive to simple vocal commands as eye, finger, hand, extremity movements; she did not respond to visual stimuli or pain; she inconsistently responded to olfactory stimuli and diaper changing by grimacing and/or crying.…”