RAPPAPORT COMA/NEAR-COMA SCALE. (For patents with «Disability Rating (DR) score 221, .e., Vegetative Ste) (Compl form twice «day for 3 days then weekly for 3 weeks; every two Weeks threafier if DR score 221. IfDR <21 follow monthly with DR scores)! DATE oF uumymuuness. DATE OF ADMISSION EAD nuURY__ ANOKA __ pare 7 Sime COMMAND RESPONSIVITY eye ptt apn cm ee, Reed command? VISUAL wi pen i ase (i) os ly ‘Shin nino aan 3 Mutt iw open ey: i re ¢ ‘ehcp oto an wm ch Pera feo (ocak sims un eae 3) Nowe “el pte “Lk aes mee 3 Fenn cig ‘Soi cing 3X) coup uate Pein ‘Qty move hd rend wii COLFACTORY git wacbonomy 35 ‘Ameo spe 1 er Wana (ido ote Rede 2 uly we) Seine pen ‘ees onde poe ined ima Serie gain ‘ito pening acm sch de Souler vemet o Peay ane Neceang rome a wh ch men nc aly Waar oe Bako ‘hae, qi win? we 20 sein peeae Se) Twn a Seep eo Rabon er cpu ch ie Wire ober rags Rend 2 609K Seto sen Ee ttn pie mn 1 VOCALIZATION® ming owe eae bt pene) ‘Se Ser Ce Spaces wort intact Novetavcs (ous, pas) ‘COMMENTS: de impor ngs inp cotton meh con pum, YAR, er ume) Tul CNC Ser dd ore) Nar of em eed ‘Average CNC Sore + 8 ‘Rappaport etal. Disability Rating Scale fr Severe Head Trauma Patients: Coma to Community. Arch Phys Mod Rebub, 6:118-123, 1982 (Revised Form 1987) {See beck for TRAINING NOTE and COMA/NEAR-COMA LEVELS, {Hoste we brain sem auditory evoked response (BAER) testa 80 db aH. to etabish ability to hea ina lest one et. "Whether or oot patient appears receptive to spech, speak encouragingly and supporively for about 30 sc, to help establish avarenes tht anotber person is preseat and advise patent oH willbe asking hinvher to make a simple response, Thea request the patel tory Lo mae the same response with bit priming before 2nd, 3rd and subsequent tis. ‘“Conault with munng staff on arousabily; do ot judge solely on performance during testing. I patient is sleeping, repeat the assessmet Ine. Revised 890,COMA/NEAR-COMA CATEGORIES Lewh | Range © 0.00-0.89 1 0.90 - 2.00 2 -201-2.89 3 290-349 4350-400 Sensory stimulation tests are ‘Level of Aunreness/Responsivity NO COMA; consistently and really responsive to atleast 3 sensory stimulation tests ® plus consistent responsivity 10 simple commands. NEAR COMA; consistently responsive to stimulation presented to 2 sensory modalities and/or inconsistently or partly responsive o simple commands MODERATE COMA; inconsistently responsive to stimulation presented 10 2 of 3 sensory modalities but not responsive to simple commands. May ‘vocalie (in absence of tracheostomy) with moans, groans & grunts but no recognizable words MARKED COMA; inconsisttly responsive to stimulation presented to one sensory modality and aot responsive to simple commands. No vocalization, EXTREME COMA; no responsivity to any sensory stimulation tests; no response to simple commands. No vocalization. ms 1, 2, 3, 4, 5, 6,7, 8, 9, 10 ‘TRAINING NOTE TO NEW RATERS: ‘While one person does the testing, 2, 3 or more observers rate each item independently (without discussion). ARerwards discuss ratings. IF raing is changed, leave inital ‘ating but place changed rating in parenthesis next to it. Repeat this process on 5 to 10 patients or until rater train themselves to place patients least inthe same ‘category range. Thereafter single ratings ean be used but, for purposes of reliability, a minimum of two independent ratings per patient is encouraged. Ratings should be done a about the same time each day if possible. Under "Comments record special information tht may bave had an extraordinary effect on the ratings on 8 given day ~ such as Patient was severely ill with pneumonia; palit was vomuting; patent had known increase in intracranial pressure (viz., hydrocephalus) patient fell out of bed; a. ADDITIONAL COMMENTS: Pease eal copies of completed forms for purposes of evaluation and improvement to: Dr, Maurice Rappaport 1120 McKendrie Street San Jose, Ca. 95126 408-248-2459 an1090