Appendix: Coma Scales

There are several scales used to describe the level of response in patients with brain injury.

In acute care the Glasgow Coma Scale is often used. The Glasgow Coma Scale rates eye opening, motor movement (movement of the arms and legs), and verbal response.

Glasgow Coma Scale

Eye Opening

4 = Spontaneously
3 = To voice
2 = To pain
1 = No response

Best Motor Response

6 = Follows commands
5 = Localizes to pain
4 = Withdrawal to pain
3 = Decorticate
2 = Decerebrate
1 = No Response

Best Verbal Response

5 = Oriented and converses
4 = Disoriented and converses
3 = Inappropriate words
2 = Incomprehensible sounds
1 = No response

Rehabilitation centers may use a scale called the Rancho Levels. The Rancho scale measures levels of cognitive or mental functioning.

Rancho Levels of Cognitive Functioning

  1. No response to stimulation
  2. Generalized response to stimulation
  3. Localized response to stimulation
  4. Confused, agitated behavior
  5. Confused, inappropriate, nonagitated behavior
  6. Confused, appropriate behavior
  7. Automatic, appropriate behavior
  8. Purposeful, appropriate behavior