GLASSGOW COMA SCALE & REFLEXES

GCS SCORING & DEEP TENDON, SUPERFICIAL REFLEXES

1. GLASSGOW COMA SCALE & REFLEXES Sudeshna Banerjee M.Sc (N) 2 nd year HFCON

2. Definition: A neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment.

3. SPONTANEOUS eye opening : Useful as a reflection of the intensity of impairment of activating functions. It indicates arousal mechanisms brain stems are active Eye opening in response TO SPEECH It is sought by speaking or shouting at the patient. Any sufficiently loud sound can be used, not necessarily a command to open the eyes.

4. Eye opening response TO PAIN It is assessed if the person is not opening their eyes to sound. The stimulus should be pressure on the bed of a finger nail. An ABSENCE of eye opening It implies substantial impairment of brain stem arousal mechanisms . Substantial effort should be made earlier to ensure that this is not due to an inadequate stimulation.

5. VERBAL RESPONSE Orientation It is the highest level of response and implies awareness of self and environment. The person should be able to provide answers to at least three questions, 1. who they are 2. where they are 3. the date – at least in terms of the year the month and day of the week.

6. Confused Conversation It is recorded if the patient engages in conversation but is unable to provide any of the foregoing three points of information . The key factor is that the person can produce appropriate phrases or sentences.

7. Inappropriate Speech It is assigned if the person produces only one or two words , in an exclamatory way, often swearing . It is commonly produced by stimulation and does not result in sustained conversation exchange . Incomprehensible Sounds It is consist of moaning and groaning but without any recognizable words. It is commonly produced by stimulation and does not result in sustained conversation exchange.

8. No Verbal Response No verbal response upon pain stimulus . Substantial effort should be made earlier to ensure that this is not due to an inadequate stimulation.

9. MOTOR RESPONSES Obeying Commands : The assessment of motor responsiveness becomes important in a person not conversing to at least a confused level Obeying Commands It is the best response possible. Confirmation of the specificity of the response by squeezing and releasing the fingers or holding up the arms or other movement elicited by verbal command .

10. Moves to localized pain: It is done with the application of pressure on the supraorbital notch. Localizing should be recorded only if the person’s hand reaches above the clavicle in an attempt to remove the stimulus . If in doubt, stimulation can be applied to more than one site to ensure that the hand attempts to remove it.

11. Withdrawal Response It is recorded if the elbow bends away from pain stimulus but the movement is not sufficient to achieve localization   An Abnormal Flexion Response (Decorticate) It is recorded if the elbow bends in decorticate posturing and the movement is not sufficient to achieve localization

12. An Extension Response ( Decerebrate ) It is recorded if the elbow only straightens and the movement should not sufficient to achieve localization . Absence of Motor Response. It is recorded if no limb movement upon pain stimulus.

13. REFLEXES A reflex is a motor response to a sensory input. Reflexes have three components . There is a sensory component, which may consist of only one sensory input or multiple inputs. There is an integrative CNS component that processes the sensory component and “decides” whether it is strong enough to warrant a motor response. Finally the motor component executes the response.

14. The 3 components together constitute a “reflex arc”. Reflexes are mediated by lower areas of the brain or by the spinal cord, so that they happen without conscious thought. Reflexes may be:- Inborn (Intrinsic) or Learned (Acquired) Involve only Peripheral Nerves & Spinal Cord Involve Higher Brain Centers as Well

15. Deep tendon reflexes Biceps reflex

16. Triceps reflex

17. Brachioradialis Reflex

18. Patellar reflex

19. Achilles reflex

20. Superficial reflexes Abdominal reflex

21. Cremasteric reflex

22. Babinski’s reflex

23. Corneal reflex Gag reflex