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DISABILITY RATING SCALE - tbims.org

TBI NATIONAL DATABASE COLLECTION FORM Patient Name: Date of RATING : _____ Name of Person Completing Form: _____ DISABILITY RATING SCALE : DISABILITY RATING SCALE ratings to be completed within 72 hours after Rehab. Admission. And within 72 hours before Rehab. Discharge. A. EYE OPENING: (0) Spontaneous 0-SPONTANEOUS: eyes open with sleep/wake rhythms indicating active arousal mechanisms, does not assume awareness.

1-LOCALIZING: a painful stimulus at more than one site causes limb to move (even slightly) in an attempt to remove it. It is a deliberate motor act to move away from or remove the source of noxious stimulation. If there is doubt as to whether withdrawal or localization has occurred after 3 or 4 painful stimulations, rate as localization.

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MAST Form I for COMBI - a - tbims.org

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The Orientation Log (O-Log) Key - tbims.org

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30 25 20 15 10 5 0 Date Time City Month Date Year Clock Time Kind of Place Name of Hospital Day of Week Etiology/ Event Pathology Deficits Patient Name: The Orientation Log (O-Log) Key: 3=spontaneous/free recall

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Mayo-Portland Adaptability Inventory-4

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JFK COMA RECOVERY SCALE - REVISED - tbims.org

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CRS R COMA RECOVERY SCALE REVISED ©2004

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procedure for a total of 4 trials, 2 on each side. If needed, reorient the head to midline between trials. Head and/or eyes orient toward the location of the stimulus on both trials in at least one direction (ie, twice to the right or twice to the left) within 10 seconds of stimulus presentation. This item is scored when there is clear

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