MTBI diagnosis should be considered when one or more of the following conditions occur following a brain injury:
- Confusion or disorientation,
- Amnesia near the time of the injury,
- Loss of consciousness up to 30 minutes,
- Neurological or neuropsychological problems, and/or
- Score of 13 or higher on the Glasgow Coma Scale (GCS) (please refer to scale below)
- Diagnosing MTBIs can be challenging because symptoms often are common to other medical problems, and onset of symptoms may occur days, weeks, or months after the initial injury.
Assessment(s) of Coma & Scale(s)
Glasgow Coma Scale (GCS) is the standard measurement of coma in the acute phase. This scale measures the depth of coma, based on (1) motor response, (2) eye opening, and (3) vocal response.
Ratings range from 3 -15.
- Total rating of 3 -5 indicates very severe brain injury
- Total rating of 6 – 8 indicates severe brain injury (still in coma)
- Total rating of 9 – 15 indicates brain injury out of coma
- Total rating of 9 – 12 indicates moderate TBI
- Total rating of 13 – 15 indicates mild TBI
Rancho Los Amigos Scale (RLAS) – is used as the patient improves or stabilizes.
There are 8 levels in this scale:
- Level I – No response to any stimuli – indicates coma
- Level II – Generalized response, i.e. patient reacts inconsistently and non- purposefully to stimuli in a non-specific manner, such as eye blinking, changes in breathing rate, gross body movement, and vocalization – indicates coma
- Level III – Localized response, i.e. patient reacts specifically but inconsistently to stimuli, such as turning head toward a sound or focusing on an object presented and following simple commands in an inconsistent, delayed manner – not considered coma, but stimulation techniques appropriate through Levels III.
- Level IV – Confused-Agitated, i.e. patient is in a heightened state of activity with severely decreased ability to process information. The patient is detached from the present and responds primarily to his/her own internal confusion. Behavior is often bizarre.
- Level V – Confused, Inappropriate, Non-Agitated, i.e. patient appears alert and is able to respond to simple commands fairly consistently, but responds to more complex commands in a non-purposeful, random manner and is agitated by external stimuli
- Level VI – Confused-Appropriate, i.e. the patient shows goal-directed behavior, but is dependent on external input for direction. He/she follows simple directions and shows carryover for tasks that have been relearned, such as self-care activities. Responses may be incorrect due to memory problems, but they are appropriate to the situation.
- Level VII – Automatic-Appropriate, i.e. the patient appears appropriate and oriented, but goes through daily routines automatically, and has shallow recall of what he/she has been doing. The patient shows increased, but superficial awareness of self and other people, demonstrates decreased judgment and problem-solving abilities, lacks realistic planning for the future, and requires at least minimal supervision for learning and safety purposes. Judgment and other higher level cognitive abilities remain compromised.
- Level VIII – Purposeful and Appropriate, i.e. the patient is alert and oriented able to recall and integrate past and recent events, is aware of and responsive to the environment, and needs no supervision once learning has occurred. He/she may continue to show decreased reasoning, tolerance for stress, judgment in emergencies or unusual circumstances, and decreased social, emotional, and intellectual capacities
Disability Rating Scale (DRS) gauges the level of disability from “none” to “Extremely Vegetative State” based on eye opening, communication ability, and motor response (arousability, awareness and responsivity); feeding, toileting, and grooming (cognitive ability for self-care activities); level of functioning (dependence on others); and employability (psychosocial adaptability).
- 2-3 – Partial
- 4-6 – Moderate
- 7-11 – Moderately Severe
- 12-16 – Severe
- 17-21 – Extremely Severe
- 22-24 – Vegetative State
- 25-29 – Extreme Vegetative State
Source: Toral Family Foundation
The information provided by this website does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.