In the popular imagination, a coma is a coma, and all comatose people are in a deep state of unconscious. The reality is much more complicated. Though comas are unpredictable, doctors use a number of measures to assess the health of people in comas and to make predictions about whether and when a comatose person might awaken.
The Glasgow Coma Scale is one measure for objectively evaluating consciousness. The scale ranges from three (a deep coma) to 15 (no coma and full consciousness). Like all medical measurements, the scale is somewhat subjective, since a doctor's assessments will depend on when he or she evaluates the patient. Your loved one's “score” may change over time. And while the degree of unconsciousness on the scale does not predict whether or when your loved one will awaken, it does provide important insights about the extent of his or her injuries.
People with scores less than eight may be comatose, and almost always have severe brain injuries. Scores between 8-12 indicate moderate brain injury, while scores about 13 generally suggest less serious injuries. Your doctor may use the Glasgow Coma Scale in conjunction with other consciousness and brain injury measurements.
The visual section of the scale ranges from 1-4 as follows:
- Does not open eyes.
- Will open eyes only in response to pain.
- Opens eyes in response to others' voices.
- Spontaneously opens eyes.
Verbal signals provide significantly information about a person's consciousness and cognitive state, though the scale may be heavily modified for people with a history of verbal communication issues. This section of the scale is scaled from 1-5 as follows:
- Makes no verbal sounds.
- Utters non-word sounds such as groans or babbling.
- Utters words, but words are inappropriate to context.
- Talks, but seems disoriented and confused.
- Conversant and alert.
The motor section of the scale has the most variability, and like other sections, may not work with people who have spinal cord injuries or mobility issues. This section is scaled from 1-6 as follows:
- Does not move.
- Extends the extremities in response to pain.
- Rigidity or abnormal flexion in response to pain.
- Withdrawing or flexing in response to pain.
- Moves appropriately in response to pain, by moving the foot in response to pressure on the foot.
- Obeys motor commands.
To gain more insight about your loved one's score on the Scale, ask the doctor how he or she responded to each section of the test, and how frequently your loved one will be tested.
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