When an individual endures a traumatic brain injury (TBI) and falls into a state of unconsciousness known as a coma, it can be difficult to assess that individuals consciousness as well as their recovery. Doctors and medical professionals use two tools known as the Glasgow Coma Scale and Rancho Los Amigos Scale to evaluate and test a patient's awareness and endurance while they are in the coma and when they are recovering from it.



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);

. The eyes show movement and open upon the sound of speech (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 - this is when a patient is capable of answering a question, but they are not entirely oriented to the situation (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 - the ability to accomplish easy tasks by a victim occurs (6);

. Localizes to pain - this is when a victim attempts to change or stop pain that is being conducted by a medical professional (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. After figuring out the scores of a coma patient, one can asses the severity of the traumatic brain injury by knowing that a score of 9-11 is associated with a moderate injury/coma while a score of 12+ is the sign of 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 1 - No Response - a victim shows no sign of response to touch or sound;

. 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.