Coma
Glasgow Coma Scale
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The Glasgow Coma Scale (GCS) (Teasdale & Jennett, 1974) is a medical rating system that was developed as an attempt to structure and quantify observations of unconsciousness. The GCS is commonly used to assess level of consciousness of patients in the early and/or minimal response phases after suspected brain injury. (The neurosurgical definition of coma is: no eye opening, no recognizable speech, no following motor commands.)
The Glasgow Coma Scale can be used in a variety of settings, including the accident scene, outpatient medical settings, and hospital emergency rooms. Grading a patient’s level of consciousness helps plan an immediate course of action to be taken in the hospital. The GCS is often rechecked at various intervals, to follow the patient’s neurological progress. The GCS has been used widely for both clinical and research purposes.
The GCS is scored on a scale of 3 to 15 points. The GCS score is equal to the total of the three categories of response: eye opening, motor (movement), and verbal response. The maximum score is 15 and the minimum score is 3. Scores from 13 to 15 represent mild injury, scores from 9 to 12 indicate a moderate brain injury, while scores of 8 or less represent severe brain injury (Jane & Rimel, 1982). The items of the scale and the score levels are shown below:
Eye opening is graded on a 4-point scale:
Score
1 None
2 To pain
3 To speech
4 Spontaneous
Motor responses (movements) are graded on a 6-point scale:
1 None
2 Extension
3 Abnormal flexion
4 Withdrawal
5 Localizes pain
6 Obeys commands
Verbal responses (talking) are graded on a 5-point scale:
1 None
2 Incomprehensible sounds
3 Inappropriate words
4 Confused conversation
5 Oriented
Once the person with brain injury becomes more responsive, another scale, the Levels of Cognitive Functioning Scale (known informally as the Rancho Scale) is used to describe the stages of cognitive improvement.
Websites
Brain Injury Association of America
Dr. Kiefel holds both a Masters and Doctoral degree in psychology with a specialty in clinical neuropsychology. Her specialty training in clinical child psychology was completed at Mount Sinai Medical Center in New York City and postdoctoral training completed at Childrens Hospital in Columbus, Ohio. Dr. Kiefel, a licensed a Psychologist in Georgia has been on staff at Children's Healthcare of Atlanta since 1996.
References
Brain Injury Association, 1776 Massachusetts Avenue, N.W., Suite 100,
Washington, D.C., 20036, 202-296-6443; 1-800-444-6443.
HDI Publishers. Houston, Tx. 713-682-8700, has a catalog of books about traumatic brain injury
Deboskey, D., Hecht, J., & Calub,C. (1991). Educating Families of the Head Injured: A Guide to Medical, Cognitive, and Social Issues. Aspen Publishers, Inc.
Lash, Marilyn & Haltiwanger, Jane (1994). When Young Children Are Injured: Families as Caregivers in Hospitals and at Home. 49 pages. $9.00. Lash & Associates Publishing/Training Inc. (www.lapublishing.com)
Childhood Injury Series, Exceptional Parent, Dept. ML. P.O. Box 8045, NJ, 08723 (1-800-535-1910). Also available from HDI Publishers, 800-321-7037. For families with infants, toddlers, or preschoolers who were seriously injured.
Raines, S & Waaland, P. For Kids Only: A guide to Brain Injury (booklet for siblings). Available from Medical College of Virginia, Box 434, Richmond, VA 23298-0434
Cera, R. Vulanich, N., & Brady, W. (1995). Patients with Brain Injury: A
Family Guide To Assisting In Speech, Language, and Cognitive Rehabilitation. Pro-Ed, Austin, Tx.
Stoler, D. & Hill, B. (1998). Coping with Mild Traumatic Brain Injury. Avery Publishing Group, Inc. Garden City, NY
Crimmins, C. (2000). Where Is the Mango Princess? First Vintage Books.
Teasdale, G., & Jennett, B. (1974). Assessment of Coma and Impaired Consciousness: A practical scale. Lancet, 2, 81-84.
Jane, J.A. & Rimel, R.W. (1982). Progress in head injury. Clinical Neurosurgery, 29, 516-124.