Levels of Coma

Glasgow Coma Scale

The Glasgow Coma Scale is a standardized system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome.

The Glasgow Coma Scale involves three determinants:

• eye opening,
• verbal responses
• and motor response (movement).

These determinants are evaluated separately according to a numerical value that indicates the level of consciousness and the degree of dysfunction. Scores run from a high of 15 to a low of 3. Persons are considered to have experienced a "mild" brain injury when their score is 13 to 15. A score of 9 to 12 is considered to indicate a "moderate" brain injury and a score of 8 or less reflects a "severe" brain injury.

[It should be noted, however, that the terms "mild", "moderate" and "severe" are used as relative terms to describe the severity of the brain injury and are not meant to trivialize the seriousness of any brain injury.]

Rancho Los Amigos Scale

The Rancho Los Amigos Scale is most helpful in assessing the patient in the first weeks or months following an injury, because it does not require cooperation from the patient. These Rancho Levels are based on observations of the patient's response to external stimuli. They provide a descriptive guideline of the various stages a brain injury patient will experience as he/she progresses through recovery.

Just as every brain injury is unique; so is the rate of recovery. One cannot predict the speed with which a brain injury patient will progress from level to level, or at which level the patient will reach a plateau, which is a temporary or permanent leveling off in the recovery process.

It is important to understand the Rancho Levels and their characteristics. An understanding of the eight levels provides insight into the progression through recovery and rehabilitation.