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Assessing Traumatic Brain Injury - The Glasgow and Rancho Los Amigos Scales

Feb 25, 2008
Traumatic brain injury (TBI) can result in a number of differing effects in victims, including loss of consciousness and even coma. Published in 1974 by neurosurgeons Bryan J. Jennett and Graham Teasdale of the University of Glasgow, the Glasgow Coma Scale is a tool doctors use to assess a patient's consciousness. When doctors wish to assess a brain injury patient's recovery, they turn to the Rancho Los Amigos Scale, which was developed by head injury treatment specialists at a California hospital in order to assess a patient's progression during the traumatic brain injury rehabilitation process.

The Glasgow Coma Scale

The Glasgow Coma Scale allows doctors to place a numerical value on the amount of consciousness they perceive in a brain-injured patient. It is essentially a mathematical formulation in which motor response, verbal response and eye opening are added together to create a numeric value that stands for the degree to which the TBI patient is in a coma state (in which "coma" is defined as unable to obey commands, speak coherently or open the eyes).

The Glasgow scale is as follows:

Eye Response (E):

* Eyes open spontaneously (4);

* Eyes open to speech [not to be confused with a sleeping person awakening, which rates a 4 on the scale] (3);

* Eyes open to pain [pain is administered by applying pressure to the fingernail of the victim, with other measures implemented if there is no response] (2);

* Eyes do not open (1).

Verbal Response (V):

* Oriented - patient is able to respond to queries about date, time, place, and his name and age (5);

* Confused - patient is somewhat disoriented, though he or she can respond coherently when questioned (4);

* Inappropriate words - patient cannot engage in conversation and forms sentences of random words or utters individual words at random (3);

* Incomprensible sounds - patient makes moaning sounds or other verbalizations, but does not form words (2);

* No verbal response (1).

Motor Response (M):

* Obeys commands - patient can complete simple tasks when asked (6);

* Localizes to pain - patient can try to prevent or change pain administered by a doctor (5);

* Withdraws from pain - patient flexes, flinches or pulls the body away when pain is administered (4);

* Flexion to pain (3);

* Extension to pain (2);

* No motor response (1).

After assessing numbers for each area, the practitioner adds them together for a final score. A score of eight or under indicates that the patient is in a coma; at least 50 percent of patients at an eight score or lower more than six hours after TBI will die. A score of 9 to 11 indicates a moderate coma or injury, while a score of 12 or higher means a moderate injury.

The Rancho Los Amigos Scale

The Rancho Los Amigos Scale was developed to help practitioners, families and therapists to understand a brain injury victim's progression through the rehabilitation process. Though it stipulates "levels" of recovery, it is possible for patients to exhibit characteristics of different levels simultaneously, and plateaus are common in recovery. The scale is not intended to predict outcomes of traumatic brain injury.

The Rancho Los Amigos Scale is as follows:

* Level I - No Response - Patient cannot respond to external stimuli including sound, touch, or speech;

* Level II - Generalized Response - Patient can respond to stimuli only inconsistently and may open the eyes without appearing to see or focus;

* Level III - Localized Response - Patient may respond to simple commands; patient responds inconsistently to external stimuli;

* Level IV - Confused, Agitated - Patient is in a state of agitation and exhibits excitable behaviors that may range to the abusive or aggressive;

* Level V - Confused, Inappropriate, Non-Agitated - Patient is unable to process new information and may display verbally inappropriate behavior; patient can follow commands and appears alert;

* Level VI - Confused Appropriate - Patient has some self-awareness and can be taught simple tasks; patient's attention and memory span are improving;

* Level VII - Automatic Appropriate - Patient no longer seems confused, but carries out tasks in a "robotic" fashion; patient appears normal but has poor judgment and needs guidance;

* Level VIII - Purposeful Appropriate - Patient is oriented as to time and place and exhibits alertness and functionality.

If You've Been Affected By Traumatic Brain Injury

If you or a loved one has been in a coma or has experienced the effects of TBI, consider contacting an experienced brain injury attorney. Your traumatic brain injury lawyer may be able to obtain compensation for your injury including paying for medical bills, surgeries and therapies, covering the costs of lost wages and future medical care.
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