Arousability Awareness and Responsivity
Eye Opening
0 – Spontaneous
When the patient’s eyes open up with the sleep/wake rhythms indicating active arousal mechanisms. This does not assume that the patient is aware.
1 – To Speech and/or Sensory Stimulation
When the eyes move in response to any verbal stimulation‚ whether the patient is spoken to or shouted at. This is not necessarily a command to open the eyes. Eyes can also open in response to a mild touch or pressure.
2 – To Pain
When the eyes open as a result of the patient feeling pain.
3 – None
When the eyes will not open for anything – even painful stimulus.
Communication Ability
0 – Oriented
This is when the patient is aware their surroundings. In this state‚ the patient can tell you basic facts about his/her location and other details of his/her life.
1 – Confused
This is when the patient’s attention can be held and he/she can answer questions. When answering questions‚ the answers may be delayed and/or indicate a level of disorientation or confusion.
2 – Inappropriate
The patient is able to talk with intelligible articulation but nothing meaningful is said. Patient’s speech is typically random or exclamatory. having sustainable conversations with the patient is not possible.
3 – Incomprehensible
Patient is able to make sounds such as groaning or moaning but is not able to make recognizable words. Conversations with the patient are impossible.
4 – None
The patient displays no signs of communication or sounds whatsoever.
Motor Response
0 – Obeying
The patient obeys commands such as “move your fingers”. This also includes other commands such as “blink your eyes” or “move your lips”. Grasping‚ reflexes‚ and other complicated movements should not be used.
1 – Localizing
When the patient moves his/her limb (even a little bit) to move away from painful stimulus occurring on more than one point on that limb. There must be a deliberate motor act to move away from‚ or remove‚ the source of stimulation. This is very similar to withdrawing.
2 – Withdrawing
When the patient moves away from a stimulus and exhibits more than a reflex response.
3 – Flexing
When the patient flexes at the elbow and attempts to withdraw in a result of feeling a painful stimulus.
4 – Extending
When the patient extends his/her limb after feeling a painful stimulus.
5 – None
When the patient exhibits no response to stimulus whatsoever.
Cognitive Ability for Self Care Activities
Feeding
0 – Complete
When the patient continuously shows awareness about how to feed and the patient can convey the information that be/she knows when feeding should occur.
1 – Partial
When the patient can sometimes show awareness that he/she knows how to feed and/or convey information that he/she knows when feeding should occur.
2 – Minimal
When the patient rarely shows awareness about how to feed and/or rarely shows that he/she knows when this is to occur. The patient can communicate desire to feed with certain signs‚ sounds‚ or activities.
3 – None
Shows no awareness of how to feed or when to feed. The patient cannot convey any information by signs‚ sounds‚ or activity.
Toileting
0 – Complete
When the patient continuously shows awareness that he/she knows how to use the toilet and convey information that he/she knows when this should occur.
1 – Partial
When the patient can sometimes show awareness that he/she knows how to use the toilet and/or can convey information that he/she knows when the act should occur.
2 – Minimal
When the patient rarely shows awareness that he/she knows how to use the toilet and/or rarely show that he/she knows when this is to occur.
3 – None
Shows no awareness of how to use the toilet or when he/she should go. The patient cannot convey any information by signs‚ sounds‚ or activity.
Grooming
0 – Complete
When the patient continuously shows awareness that he/she knows how and when to groom.
1 – Partial
When the patient can sometimes show awareness that he/she knows how to groom and/or convey information that he/she knows when grooming should occur.
2 – Minimal
When the patient rarely shows awareness about how to groom and/or rarely shows that he/she knows when this is to occur based on certain signs‚ sounds‚ or activities
3 – None
Shows no awareness of how to groom or when to groom. The patient cannot convey any information by signs‚ sounds‚ or activity.
Dependence on Others
Level of Functioning
0 – Completely Independent
The patient is able to live as he/she wishes without any restrictions regarding physical‚ mental‚ emotional‚ or social situations.
1 – Independent in Special Environment
The patient is capable of living as he/she wishes‚ as long as certain requirements are met (such as mechanical aids).
2 – Mildly Dependent
The patient is able to care for most of her/his own needs but s/he needs a little help due to physical‚ mental‚ emotional‚ or social problems.
3 – Moderately Dependent
The patient can partially take care of himself/herself. In some cases‚ the patient may need another person there at times.
4 – Markedly Dependent
The patient needs help with all major activities and the help of another person at all times.
5 – Totally Dependent
The patient is not able to care for anything by himself/herself and requires 24-hour nursing care.
Psychosocial Adaptability
Employability
0 – Not Restricted
The patient can compete with others in a large variety of jobs that incorporate existing skills. The patient can also initiate‚ plan‚ execute‚ and assume responsibilities associated with homemaking. In addition he/she can also carry out and complete most age relevant school assignments.
1 – selective Jobs‚ Competitive
The patient can compete with others in a limited variety of jobs that incorporate existing skills because of some type of limitations. He/she can also initiate‚ plan‚ execute‚ and assume responsibilities of some homemaking tasks. It is also possible for her/him to carry out and complete some‚ but not all age relevant school assignments.
2 – Sheltered Workshop‚ Non-Competitive
The patient cannot compete with others in any variety of jobs that incorporate existing skills because of moderate or severe limitation. He/she cannot‚ without major assistance‚ initiate‚ plan‚ execute‚ and assume responsibilities associated with homemaking. In addition‚ the patient cannot carry out and complete age relevant school assignments without assistance.
3 – Not Employable
The patient is completely unemployable because of extreme limitations. He/she is completely unable to initiate‚ plan‚ execute‚ and assume responsibilities associated with homemaking. In addition‚ the patient cannot carry out and complete any age relevant school assignments.
TBI: Traumatic brain injury
Score 0 – Normal
Score 1 – Mild
Score 2 to 3.5 – Partial
Score 4 to 6 – Moderate
Score 7 to 11 – Moderately Severe
Score 12 to 16 – Severe
Score 17 to 21 – Extremely Severe
Score 22 to 24 – Vegetative State
Score 25 to 29 – Extreme Vegetative State (or‚ if the person has a score of 29‚ possible death)
This instrument can be found at: http://www.tbims.org/combi/drs/DRS%20Form.pdf & https://en.wikipedia.org/wiki/Disability_Rating_Scale
Rappaport‚ et al. (1982) Disability Rating Scale for Severe Head Trauma Patients: Coma to Community. Archives of Physical Medicine and Rehabilitation‚ 63:118-123.
Eliason & Topp (1984) Predictive Validity of Rappaport’s Disability Rating Scale in Subjects with Acute Brain Dysfunction. Journal of the American Physical Therapy Association‚64:1357-1360
Gouvier‚ W.‚ Blanton‚ P.‚ et al. (1987). “Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury.” Archives of physical medicine and rehabilitation 68(2): 94.
Rappaport‚ M.‚ Herrero-Backe‚ C.‚ et al. (1989). “Head injury outcome up to ten years later.” Arch Phys Med Rehabil 70(13): 885-892.
Nichol‚ et al. (2011) Measuring Functional and Quality of Life Outcomes Following Major Head Injury: Common Scales and Checklists. Injury‚ Int J. 42:281-287
Shulka‚ Devi‚ & Agrawal (2011) Outcome Measures for Traumatic Brain Injury. Clinical Neurology and Neurosurgery‚ 113:435-441
Malec‚ J. F.‚ Hammond‚ F. M.‚ et al. (2012). “Structured interview to improve the reliability and psychometric integrity of the Disability Rating Scale.” Arch Phys Med Rehabil 93(9): 1603-1608.