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| Coma
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Best motor response, verbal performance, and eye opening are the three
behavior responses evaluated on a clinical scale developed by Teasdale
and Jennett. This scale is used for measuring the depth and duration
of coma, or impaired consciousness due to trauma, infection, or vascular
disorders. The scale can be administered by doctors or nurses and
facilitates consultation between general and specialized brain injury units.
Due to concerns regarding degree and duration of coma, it is important
to use this scale to assess and record changes in the patient.
Impaired consciousness is an indication of brain dysfunction caused by either focal or diffuse damage. At the time of injury, it is next to impossible to determine the extent to which the brain was damaged. Many injuries are of mixed origin and, therefore, the assessment needs to be general and applicable to both types of damage. The authors state that there are abundant, yet inconsistent terms to describe the stages of impaired consciousness that healthier professionals may use. Clinicians and doctors have typically not used formal assessments and have used these abundant terms to describe a patient's state. This practice leads to confusion and misunderstandings between involved parties when information is exchanged. Healthier professionals have not been able to agree on what terms or levels to use. Some professionals use multiple observed behaviors to assign the patient to a level of consciousness, and others look at a single behavior. For reasons discussed above, Teasdale and Jennet support the use of the Glasgow Coma Scale. To assess the stages of coma and impaired consciousness, the authors developed this evaluation tool to examine three observable behaviors that can be rated on a continuum of impairment. They chose three behaviors because sometimes a single behavior cannot be observed due to effects of the injury. The three behaviors are motor response, verbal response, and eye opening. Motor response is assessed in a hierarchy with obeying commands at the highest level, followed by response to painful stimulus, localizing response, flexor response, extensor posturing, and no response. The best verbal response is assessed next. The hierarchy continuum is as follows: orientation to person, place, time, and situation is the best level, followed by confused conversation, inappropriate speech, and incomprehensible speech. The last area assessed is eye opening. The highest level is spontaneous eye opening in a normal sleep/wake cycle. Eye opening in response to speech and eye opening in response to pain are second and third, respectively. Teasdale and Jennett, along with other healthier professionals, used this scale with success. Disagreements about level of consciousness were rare between doctors and nurses examining the same patients with this scale. When asked only to determine if a patient was conscious or unconscious, this same group of professionals showed a 20% discrepancy rate. The authors feel that this assessment tool aids doctors in making decisions about prognosis for recovery because of the multiple observations about severity and duration of coma and impaired consciousness.
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