Learn about TBI - For Individuals and Families
Tests to Evaluate TBI
Individuals with traumatic brain injury require frequent assessments and diagnostic tests. These may include:
- Neurological Exam: A series of questions and simple commands to see if the person with a brain injury can open their eyes, move, speak and understand what is going on around them. For example: What is your name? Where are you? What day is it? Wiggle your toes. Hold up two fingers. A standard way to describe responses may be used. Most hospitals use the Glasgow Coma Scale or Rancho Levels of Cognitive Functioning. You can read about these scales and what the scores mean below.
- X-ray: A picture that looks at bones to see if they are broken (fractured). It can also be used to take a picture of the chest to look at the lungs. This test may be done at the bedside or in the X-ray department and takes between five and 30 minutes to complete.
- CT Scan (CAT Scan): An X-ray that takes pictures of the brain or other parts of the body. The scan is painless but the individual must lie very still. The test takes 15 to 30 minutes to complete.
- MRI (Magnetic Resonance Imaging) Scan: A large magnet and radio waves are used, instead of X-rays, to take pictures of the body's tissues. It is painless but noisy. The machine is shaped like a long tube. The individual must lie still on a flat table in the middle of the machine. The test takes about 60 minutes to complete.
- Angiogram: A test to look at the blood vessels in the brain. Using a catheter, or small flexible tube, dye is put into an artery (usually in the groin) that supplies blood to the brain. This test can tell if the blood vessels have been damaged or are spasming. The test takes one to three hours.
- ICP Monitor: A small tube placed into or just on top of the brain through a small hole in the skull. This will measure the pressure inside the brain (intracranial pressure).
- EEG (Electroencephalograph): A test to measure electrical activity in the brain. Special patches called electrodes are applied to the head to measure the activity. The test is painless and can be done at the bedside or in the EEG department. The length of the test varies.
- Neuropsychological battery: Neuropsychologists test thinking, memory, judgment, emotions, behavior and personality. This information can be used to help guide treatment. It will also help determine the amount of supervision that patients need when they leave the hospital.
Coma Scales
There are several scales used to describe the level of response in individuals with brain injury.
Glasgow Coma Scale
In acute care, the Glasgow Coma Scale is often used. The Glasgow Coma Scale rates eye opening, motor movement (movement of the arms and legs) and verbal response. Each response has a score. Total scores range from a low of 3 to a high of 15. The lower the score, the more complicated or severe is the brain injury.
Eye Opening
4 = Spontaneous
3 = To voice
2 = To pain
1 = No response
Best Motor Response
6 = Follows commands
5 = Localizes to pain
4 = Withdrawal to pain
3 = Abnormal extremity flexion
2 = Abnormal extremity extension
1 = No Response
Best Verbal Response
5 = Oriented and converses
4 = Disoriented and converses
3 = Inappropriate words
2 = Incomprehensible sounds
1 = No response
The Glasgow Coma Score is figured by adding one score from each category. Eye + Motor + Verbal = Total Score
| Brain Injury | Score |
|---|---|
| Mild | 13-15 |
| Moderate | 9-12 |
| Severe | 8 or less |
Rancho Los Amigos Scale
Rehabilitation centers and hospitals may use the Rancho Los Amigos Scale. The Rancho scale measures levels of cognitive or mental functioning.
There are eight levels of cognitive functioning in the Rancho scale:
- No response to stimulation
- Generalized response to stimulation
- Localized response to stimulation
- Confused, agitated behavior
- Confused, inappropriate, non-agitated behavior
- Confused, appropriate behavior
- Automatic, appropriate behavior
- Purposeful, appropriate behavior