Rappport et al developed a disability rating scale for patients who have had severe head injury with coma. This can help evaluate a patient's level of disability and monitor rehabilitation into the community. The authors are from the University of California in San Francisco and the Santa Clara Valley Medical Center in San Jose.
Parameters:
(1) arousability, awareness and responsivity (based on a modified Glasgow Coma Score using eye opening, verbalization and motor response)
(2) cognitive ability for self-care activities in: feeding, toileting, grooming
(3) dependence on others and level of functioning
(4) psychosocial adaptability and employability
where:
• The Glasgow Coma Score elements are scored as 1 or higher. The modified score used here is reversed (better functioning scored lower) and has 0 as lowest value. The usual GCS ranges from 3 to 15. The modified score would range from 12 to 0.
|
Parameter |
Finding |
Points |
|---|---|---|
|
eye opening |
spontaneous |
0 |
|
|
to speech |
1 |
|
|
to pain |
2 |
|
|
none |
3 |
|
best verbal response |
oriented |
0 |
|
|
confused |
1 |
|
|
inappropriate |
2 |
|
|
incomprehensive |
3 |
|
|
none |
4 |
|
best motor response |
obeying |
0 |
|
|
localizing |
1 |
|
|
withdrawing |
2 |
|
|
flexing |
3 |
|
|
extending |
4 |
|
|
none |
5 |
|
ability to feed self |
complete |
0 |
|
|
partial |
1 |
|
|
minimal |
2 |
|
|
none |
3 |
|
ability to toilet by self |
complete |
0 |
|
|
partial |
1 |
|
|
minimal |
2 |
|
|
none |
3 |
|
ability to groom self |
complete |
0 |
|
|
partial |
1 |
|
|
minimal |
2 |
|
|
none |
3 |
|
level of functioning |
complete independence |
0 |
|
|
independent in special environment |
1 |
|
|
mildly dependent (needs limited assistance) |
2 |
|
|
moderately dependent |
3 |
|
|
markedly dependent (needs assistance with all major activities at all times) |
4 |
|
|
totally dependent (needs 24 hour nursing care) |
5 |
|
employability |
not restricted |
0 |
|
|
selected jobs (competitive) |
1 |
|
|
sheltered workshop (non-competitive) |
2 |
|
|
not employable |
3 |
total score =
= SUM(points for all 8 measures)
Interpretation:
• minimum score: 0
• maximum score: 30 (to indicate death, 29 maximum by tallying values)
• The higher the score the greater the level of disability.
|
Total Score |
Level of Disability |
|---|---|
|
0 |
none |
|
1 |
mild |
|
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 |
|
30 |
dead |
Purpose: To evaluate a patient for disability after severe head injury using the Rappaport Disability Rating Scale (DRS).
Specialty: Sports Medicine & Rehabilitation, Neurology
Objective: severity, prognosis, stage, disability and performance
ICD-10: R40.2,
