Tuesday, February 5, 2008

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

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

. Incomprehensible 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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