Assessment Overview

Purpose: Assess disorders of consciousness to help diagnose, evaluate, and predict treatment outcomes.

Summary: There are 6 subscales within this measure that assess auditory, visual, motor, oromotor, communication, and arousal functions. Scoring is based on a patient’s ability to complete the 23 behaviors within the measure and ranges from reflexive activity to cognitively-mediated behaviors, with a maximum score of 23.

Equipment: An assortment of items is needed to complete the test and a full list can be found in the manual.

ICF Category: Body structure and function

Notes: Before administering this test, there are some considerations that clinicians should be aware of. It is unclear how frequently the Coma Recovery Scale - Revised (CRS-R) should be repeated though some suggest as many as five applications are needed to determine the optimal level of function of a patient. In addition, this test is only designed to be used with patients within the Rancho Levels of I-IV.

It is recommended that the CRS-R no longer needs to be completed after a patient is able to move on command, respond to yes-no questions, and focus attention on three consecutive examinations over a two week period. When completing the exam, if a clinician has doubt about a patient meeting a criteria, the item should not be scored. The general rule of certainty required for scoring is when the examiner believes 9 out of 10 observers would agree on the response. For pediatric populations under the age of 5, a separate version has been created to help assess children who may not have full language and motor development.

Assessment Handout

Assessment Psychometrics

There is not yet evidence to suggest the use of the CRS-R with patients after a brain injury who are completely independent, mildly dependent, moderately dependent, or severely dependent. The CRS-R is recommended for use in acute care and highly recommended for use in inpatient rehabilitation, skilled nursing facilities, outpatient rehabilitation, and home health. This measure should be taught to students and is appropriate for use in research. Below are the psychometrics for this measure:

• Concurrent Validity: Good correlation with Disability Rating Scale (DRS), Good correlation with Glasgow Coma Scale (GCS)

• Construct Validity: Hierarchy of behaviors examined in each subscale empirically supported

• Criterion Validity:

  • Perturbation Complexity Index detects patients in a minimally conscious state (MCS)

  • Adequate correlation with GCS (r=0.597)

  • Excellent correlation with FOUR Score (r=0.900)

  • Structural MRI findings correlated with total score

• Cutoff Score: Score of 8 detects consciousness

• Floor/Ceiling Effects: Negligible floor and ceiling effects

• Interrater Reliability: Excellent (ρ=0.76) for total score; Fair to Excellent for subscales

• Intrarater Reliability: Very high (97.4%)

• Mean Data: Admission: 8.5 +/-5.1

• Responsiveness: Change in score was associated with change in diagnosis

• Test-retest: Excellent for total scores (ρ=0.94)