Score DRS : Disability rating scale

 DRS Terms and Definitions

Eye Opening

Best Communication Ability

If patient cannot use voice because of tracheostomy or is aphasic or dysarthric or has vocal cord paralysis or voice dysfunction then estimate patient’s best response and enter note under comments.

Best Motor Response

Cognitive Ability for Feeding, Toileting and Grooming

Rate each of the three functions separately. For each function answer the question, does the patient show awareness of how and when to perform each specified activity. Ignore motor disabilities that interfere with carrying out a function, this is rated under Level of Functioning described below. Rate best response for toileting based on bowel and bladder behavior. Grooming refers to bathing, washing, brushing of teeth, shaving, combing or brushing of hair and dressing.

Level of Functioning

"Employability"

The psychosocial adaptability or "employability" item takes into account overall cognitive and physical ability to be an employee, homemaker or student. This determination should take into account considerations such as the following :

– 1. Able to understand, remember and follow instructions ;
– 2. Can plan and carry out tasks at least at the level of an office clerk or in simple routine, repetitive industrial situations or can do school assignments ;
– 3. Ability to remain oriented, relevant and appropriate in work and other psychosocial situations ;
– 4. Ability to get to and from work or shopping centers using private or public transportation effectively ;
– 5. Ability to deal with number concepts ;
– 6. Ability to make purchases and handle simple money exchange problems ;
– 7. Ability to keep track of time schedules and appointments.

Testing Tips

If in doubt, give the patient the benefit of the doubt.
Remember that feeding, toileting and grooming items are rated on cognitive ability to know how and when, not physical ability.
Always use two independent raters when possible, and compare ratings after completed. If there is a one point discrepancy that cannot be resolved, mean the two ratings (a .5 score). If there is a discrepancy of 1.5 or more points, obtain additional information on the case and re-rate.
If a patient clinically falls between two ratings, rate in .5 increment (e.g. between 2 and 3 = 2.5)

 Interpreting Score

The maximum score a patient can obtain on the DRS is 29, which represents an extreme vegetative state. A person without disability would score zero. For the DRS to be reliable, it must be employed when the individual is free from the influence of anesthesia, other mind-altering drugs, recent seizure, or recovery from surgical anesthesia.

The DRS can be self-administered or scored through interview with the client or family member. The ease of scoring and the brevity of the scale are compelling reasons for its popularity. Scoring time can range from 30 seconds (if one is very familiar with the scale and the client) to 15 minutes, assuming the rater must interview the client/family and seek additional information from available staff.

An additional advantage is the ease and brevity with which information can be obtained by phone interview. Although not optimum, DRS ratings can even be obtained by medical record review retrospectively in certain cases. Another advantage of the DRS is that expertise in the field is not needed to complete it accurately.

A limitation of the DRS is its relative insensitivity at the low end of the scale (mild TBI) and its inability to reflect more subtle but sometimes significant changes in an individual within a specific, limited window of recovery.

 The Disability Rating Scale

– 1. Eye opening : ______________

• 0 Spontaneous
• 1 To Speech
• 2 To Pain
• 3 None

– 2. Communication Ability : ______________

• 0 Oriented
• 1 Confused
• 2 Inappropriate
• 3 Incomprehensible
• 4 None

– 3. Motor Response : ______________

• 0 Obeying
• 1 Localizing
• 2 Withdrawing
• 3 Flexing
• 4 Extending
• 5 None

– 4. Feeding (knows how and when) : __________________

• 0.0 Complete
• 0.5
• 1.0 Partial
• 1.5
• 2.0 Minimal
• 2.5
• 3.0 None

– 5. Toileting (knows how and when) : __________________

• 0.0 Complete
• 0.5
• 1.0 Partial
• 1.5
• 2.0 Minimal
• 2.5
• 3.0 None

– 6. Grooming (knows how and when) : __________________

• 0.0 Complete
• 0.5
• 1.0 Partial
• 1.5
• 2.0 Minimal
• 2.5
• 3.0 None

– 7. Level of Functioning (physical & cognitive disability) : ______________

• 0.0 Completely independent
• 0.5
• 1.0 Independent in special environment
• 1.5
• 2.0 Mildly dependent - Limited assistance (Non-resident helper)
• 2.5
• 3.0 Moderately dependent - Moderate assistance (Person in home)
• 3.5
• 4.0 Markedly dependent (Assistance with all major activities, at all times)
• 4.5
• 5.0 Totally dependent (24 hour Nursing Care)

Disability Categories

 Références

– Rappaport et al., (1982). Disability rating scale for severe head trauma patients : coma to community. Archives of Physical Medicine and Rehabilitation, 63 : 118-123