GLASSGOW COMA &
RANCHO LOS AMIGOS
HEMACHANDRAN G
BOT 2ND YEAR
RA1821002010077
GLASSGOW COMA
COMA-INTRODUCTION
Coma is a state of extreme unresponsiveness, in which an individual exhibits
no voluntary movement or behavior.
Furthermore, in a deep coma, even painful stimuli(actions which, when
performed on a healthy individual, result in reactions) are unable to affect any
response, and normal reflexes may be lost.
GLASSGOW COMA
Glassgow coma scale is a way of objective recording monitoring the state of
head injured patients.
HISTORY:
Neurological assessment tool.
Published in 1974 by Jennett & Teasdale.
SCALE SCORING
Eye response
Verbal response
Motor response
EYE RESPONSE
Response Score
Spontaneously 4
To commands 3
To pain 2
No response 1
VERBAL RESPONSE
Response Score
Oriented to time,place and person 5
Confused 4
Inappropriate words 3
Incomprensible sounds 2
No response 1
MOTOR RESPONSE
Response Score
Obeying command 6
Moves to localised pain 5
Flexion withdrawal from pain 4
Abnormal flexion(decorticate) 3
Abnormal extension(decerebrate) 2
No response 1
TOTAL SCORE
Response Score
Best response 15
Comatose client 8 or less
Totally unresponsive 3
GLASSGOW COMA SCALE SCORE
Mild 13-15
Moderate 9-12
Severe 3-8
INTERPRETATION
3-Brain DEAD
8-SEVERE-Passive ROM, sensory stimulation activities.
9 to 12-MODERATE-Assistive ROM,Hands on ADL,Verbal and visual
cues/prompts over simple cog tasks.
13 to 15-MILD-Active Activities, Higher cognitive tasks, ADL demonstration,
cues periodically.
GLASSGOW COMA SCALE
VERBAL MOTOR
EYE OPENING RESPONSE RESPONSE
1. Spontaneous > 4 1. Orientated > 5 1. Obey commands > 6
2. To sound > 3 2. Confused > 4 2. Localised > 5
3. To pressure >2 3. Words > 3 3. Normal flexion > 4
4. None > 1 4. Sounds > 2 4. Abnormal flexion > 3
5. None > 1 5. Extension > 2
6. None > 1
RANCHO LOS AMIGOS
RANCHO LOS AMIGOS(RLS)
Rancho los amigos(RLA) is clinical tool used to rate how people with brain injury
are recovering.
The scale has 10 levels of recovery
As patient “wake up” After a head injury, they go through different levels of
recovery on the Rancho scale.
Each level describes a general pattern of recovery, with focus on cognition &
behavior.
RANCHO LOS AMIGOS SCALE
Level 1-No response to pain,touch,sound or sight.
Level 2-Generalised reflex response to pain.
Level 3-Localized response. Blinks to strong light, turns toward/away from
sound, responds to physical discomfort, inconsistent response to commands.
Level 4-Confused/agitated. Alert, performs motor activities but behaviour is non-
purposeful extremely short attention span.
Level 5-Confused/non-agitated.Gross attention to environment,highly
distractible, inappropriate verbalization.
Level 6-Confused,appropriated. Inconsistent orientation to time and place,
consistently follows simple direction.
Level 7-Automatic,appropriate. Skills noticeably deteriorated.
Level 8-Purposeful,appropriate.
Level 9-Purposeful,appropriate-assistance on request.
Level 10-Purposeful,appropriate-Modified Independence.
THANK YOU
