Understanding Traumatic Brain Injury, Part 1

Shortly after the car accident, the hospital informed me of an ongoing weekly class they held in the evening to help family members understand Traumatic Brain Injury (TBI). It was informative, helpful and overwhelming. I attended the classes every week only because it was information I needed, but it was definitely not wanted information. To be honest, I hated the class. It was frightening and discouraging. I wanted Mark’s recovery to be like the ones portrayed in the movies, where a person in a coma just one day wakes. I didn’t realize there was a measurement to the depth of a coma and there would be a process for waking up. After all, we do it every morning with little thought. It was difficult to throw out the mentality that you’re either comatose or not and realize there are levels or stages.

At first I was introduced to the Glasgow Coma Scale (GCS), which is used to measure the depth of a coma. “The GCS rates three aspects of functioning: eye opening, motor response and verbal response. Individuals in deep coma score very low on all these aspects of functioning, while those less severely injured or recovering from coma score higher. A GCS score of 3 indicates the deepest level of coma, describing a person who is totally unresponsive. A score of 9 or more indicates that the person is no longer in coma, but is not fully alert. The highest score (15) refers to a person who is fully conscious.” http://www.msktc.org/tbi/factsheets/Understanding-TBI/What-Happens-During-Injury-And-In-Early-Stages-Of-Recovery

I. Eye Opening
1 = No eye opening
2 = Eyes open to pain
3 = Eyes open to speech
4 = Spontaneous eye opening
II. Verbal Response
1 = No sounds
2 = Incomprehensible sounds
3 = Inappropriate words and jumbled phrases consisting of words
4 = Confused, yet coherent, speech
5 = Alert and oriented
III. Motor Response
1 = No response
2 = Extensor response, abnormal body posture that involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backwards. The muscles are tightened and held rigidly. This type of posturing usually means there has been severe damage to the brain.
3 = Abnormal flexion, posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest.
4 = Withdraws from unpleasant or painful stimuli
5 = Localizes to unpleasant or painful stimuli
6 = Obeys commands fully

The final score is determined by adding the values of I+II+III. This number helps medical practitioners categorize the four possible levels for survival, a lower number indicating a more severe injury and a poorer prognosis.

Mark’s highest score for the first seven weeks was 4: Eye Opening 2 + Verbal Response 1+ Motor Response 1 = 4.

Mild TBI Symptoms – score 13-15

Moderate Disability score 9-12:

  • Loss of consciousness greater than 30 minutes
  • Physical or cognitive impairments which may or may not resolve
  • Benefit from rehabilitation

Severe Disability score 3-8:

  • Coma: unconscious state. No meaningful response, no voluntary activities

 Vegetative State score less than 3:

  • Sleep wake cycles
  • Arousal, but no interaction with environment
  • No localized response to pain

 Persistent Vegetative State:

  • Vegetative state lasting longer than one month

 Brain Death:

  • No brain function
  • Specific criteria needed for making this diagnosis

Resource: http://www.traumaticbraininjury.com/symptoms-of-tbi/glasgow-coma-scale/

When he moved to Western Rehab, they used a Rancho Los Amigos Scale or Level of Cognitive Functioning Scale (LCFS) which I’ll save for part 2.

Did you find this information helpful? What has been your experience or understanding of TBI?

2 thoughts on “Understanding Traumatic Brain Injury, Part 1

  1. You were so young, and struggling to understand such intense medical information. I look at Mark, and think about how he makes me laugh, and cannot even imagine the uncertainty of your life at that time! Thank you for sharing these details; it’s new information for me.

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