The stimulus should not be applied to the face, because painful stimulus in the facial area may cause the eyes to close tightly as a protective reaction. It is the type and quality of the patient’s reaction to the painful stimulus that constitute the scoring criteria. If the patient does not give a motor response to a verbal command, then the examiner should attempt to elicit a motor response to a painful stimulus. This action may cause a grasp reflex, not a response to a command. Commands given to the patient should be simple, such as, “Move your arm.” The patient should not be asked to squeeze the examiner’s hand, nor should the examiner place something in the patient’s hand and then ask the patient to grasp it. When scoring motor responses, it is the ease with which the motor responses are elicited that constitutes the criterion for the best response. Otherwise, the patient is graded on a 5-point scale depending on the motor response to a painful stimulus (see Table 2.5). The second test involves motor response the patient is given a grade of 6 if there is a response to a verbal command. If unsure, the examiner may use different sound-making objects (e.g., bell, horn) to elicit an appropriate response. A patient who opens his or her eyes in response to the examiner’s voice is probably responding to the stimulus of sound, not necessarily to the command to open the eyes. This finding does not necessarily mean that the patient is aware of the surroundings or of what is happening, but it does imply that the patient is in a state of arousal. Spontaneous opening of the eyes indicates functioning of the ascending reticular activating system. Each of these responses is given a numeric value: spontaneous eye opening- 4 response to speech- 3 response to pain- 2 and no response- 1. Eye opening may occur spontaneously, in response to speech or pain, or there may be no response at all. Its primary use in evaluating individuals for concussion is to rule out more severe brain injury and to help determine which individuals need immediate emergent medical attention. Concussions are usually rated between 13 and 15.

An initial score of greater than 11 is associated with 90% chance of recovery.

An initial score of less than 5 is associated with an 80% chance of being in a lasting vegetative state or death. The responses are scored between 1 and 5 with a combined total score of 3 to 15, with 15 being normal. The Glasgow Coma Scale (see Table 2.5) is a scoring scale of eye opening and motor and verbal responses that can be administered to individuals to objectively measure the level of consciousness and severity of the head injury. Magee PhD, BPT, CM, in Orthopedic Physical Assessment, 2021 Glasgow Coma Scale

Pediatric glasgow coma scale