Coma Recovery Scale (Revised): Difference between revisions

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'''Original Editor '''- Your name will be added here if you created the original content for this page.
'''Original Editor '''- Wendy Walker


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== Objective<br>  ==
== Objective ==
[[File:Man in coma.jpeg|thumb|Man is a coma]]
The Coma Recovery Scale (CRS-R) , also known as the JFK Coma Recovery Scale - revised, is used to assess patients with a [[Disorders of Consciousness|disorder of consciousness]], commonly [[coma]].<ref name="CRS-R 1">Giacino, J. T., K. Kalmar and J. Whyte (2004). "The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility." Arch Phys Med Rehabil Dec 2004: 2020-9</ref> It may be used to differentiate between vegetative state (VS) and minimally conscious state (MCS).<ref name="CRS-R 2">Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessmentfckLRSchnakers C, Vanhaudenhuyse A, Giacino J, et al. "Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment". BMC Neurol. 2009; 9:35.</ref>  It can also be used to monitor emergence from minimally conscious state (EMCS or MCS+).<ref name="CRS-R 2" />


The Coma Recovery Scale [CRS-R] , also known as the JFK Coma Recovery Scale - Revised, is used to assess patients with a disorder of consciousness, commonly coma<ref name="CRS-R 1">Giacino, J. T., K. Kalmar and J. Whyte (2004). "The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility." Arch Phys Med Rehabil Dec 2004: 2020-9</ref>.
== Intended Population  ==
 
* [[Traumatic Brain Injury]] (TBI)
It may be used to differentiate between vegetative state (VS) and minimally conscious state (MCS)<ref name="CRS-R 2">Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessmentfckLRSchnakers C, Vanhaudenhuyse A, Giacino J, et al. "Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment". BMC Neurol. 2009; 9:35.</ref>. It can also be used to monitor emergence from minimally conscious state (EMCS or MCS+)<ref name="CRS-R 2" />.
* [http://www.physio-pedia.com/Stroke Stroke] (CVA)
 
* Brain Tumour  
== Intended Population<br> ==
 
Traumatic Brain Injury (TBI)  
 
Stroke (CVA)  
 
Brain Tumour  


== Method of Use  ==
== Method of Use  ==
 
The CRS-R consists of 23 items, grouped into 6 sub-scales:  
The CRS consists of 23 items, grouped into 6 subscales:  
 
#Auditory  
#Auditory  
#Visual  
#Visual  
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#Arousal
#Arousal


The lowest score on each subscale represents reflexive activity; the highest respresents behaviours mediated by cognitive input.  
The lowest score on each sub-scale represents reflexive activity; the highest represents behaviors mediated by cognitive input. The total score ranges between 0 (worst) and 23 (best). This measure takes a minimum of 25 minutes to complete.  
 
The total score ranges between 0 (worst) and 23 (best).  


=== Equipment Required  ===
=== Equipment Required  ===
 
*Instruction Sheet
*Instruction sheet
*Scoring Sheet
*Scoring sheet
*2 Common Functional Objects (often a cup and a hairbrush or comb)  
*2 common functional objects (often a cup and a hairbrush or comb)  
*An object which produces a loud noise  
*An object which produces a loud noise  
*Brightly coloured object
*Brightly Coloured Object
*ADL items, eg. toothbrush, 'phone  
*ADL Items, e.g. toothbrush, phone  
*Hand-held mirror
*Hand-held Mirror
*Baseball sized ball
*Baseball Sized Ball
*Pencil  
*Pencil  
*Tongue depressor
*Tongue Depressor
 
=== Languages  ===
=== Available in several languages ===
Available in several languages. As well as the original English version, there are French, German, Italian, Spanish, Dutch and Norwegian translations available.


As well as the original English version, there are French, German, Italian, Spanish, Dutch and Norwegian translations available.
== Evidence ==


== Reference<br>  ==
Giacino,Kalmar and Whyte&nbsp;<ref name="CRS-R 1" />&nbsp;studied 80 patients with severe acquired brain injury. These individuals were admitted to an inpatient Coma Intervention Programme with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS). They compared the CRS-R to the Disability Rating Scale (DRS), and found that the total scores showed "significant correlation" between the 2 scales, which indicates acceptable concurrent validity. In addition, the CRS-R was able to distinguish 10 patients in an MCS who were scored as in VS by the DRS.
 
Giacino,Kalmar and Whyte&nbsp;<ref name="CRS-R 1" />&nbsp;studied 80 patients with severe acquired brain injury. These individuals were aditted to an inpatient Coma Intervention Programme with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS). They compared the CRS-R to the Disability Rating Scale (DRS), and found that the total scores showed "significant correlation" between the 2 scales, which indicates acceptable concurrent validity.  
 
In addition, the CRS-R was able to distinguish 10 patients in an MCS who were scored as in VS by the DRS.  
 
== Evidence  ==


=== Reliability  ===
=== Reliability  ===


==== Test-retest Reliability  ====
==== Test-retest Reliability  ====
 
Disorder of Consciousness Presentation - TBI (Traumatic Brain Injury), CVA (Stroke), hypoxi-ischaemic Brain injury and Tumour<ref name="CRS-R 1" />: 
Disorder of Consciousness Presentation - TBI (Traumatic Brain Injury), CVA (Stroke), hypoxi-ischaemic Brain injury and Tumour:
 
(Giacino et al, 2004<ref name="CRS-R 1" />)


n=20; mean age = 36.7 years (ranging from 17 to 57 years); mean time post injury = 57.15 days (range 22 to 169 days).  
n=20; mean age = 36.7 years (ranging from 17 to 57 years); mean time post injury = 57.15 days (range 22 to 169 days).  
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*Excellent test-retest reliability (Spearman rho = .94)
*Excellent test-retest reliability (Spearman rho = .94)


==== Inter/Intrarater Reliability  ====
==== Inter/Intra-rater Reliability  ====
 
Disorders of Consciousness Presentation (variety of neurological conditions, including TBI (Traumatic Brain Injury)<ref name="CRS-R 2" />:
Disorders of Consciousness Presentation (variety of neurological conditions, including TBI (Traumatic Brain Injury):
 
Schnakers et al, 2008<ref name="CRS-R 2" />  


n=77; age range 19-86 years; 43 patients 1-27 days post injury, 34 27 days to 24 years post injury.  
n=77; age range 19-86 years; 43 patients 1-27 days post injury, 34 27 days to 24 years post injury.  


*Excellent reliability for total score (k=.80_
*Excellent reliability for total score (k=.80)
*Excellent reliability for subscales:
*Excellent reliability for subscales:


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=== Validity  ===
=== Validity  ===
This scale shows excellent concurrent validity as it correlates significantly with total scores on the orginal CRS and the DRS<ref name="CRS-R 1" />:  
This scale shows excellent concurrent validity as it correlates significantly with total scores on the orginal CRS and the DRS<ref name="CRS-R 1" />:  


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=== Sensitivity and Specificity  ===
=== Sensitivity and Specificity  ===
Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness.<br>Bodien et al, 2016<ref>Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness.fckLRBodien YG, Carlowicz CA, Chatelle C, Giacino JT. Arch Phys Med Rehabil. 2016 Mar;97(3):490-492</ref>:


Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness.<br>Bodien et al, 2016:
*CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS  
 
*CRS-R total score of 10 or higher gave a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (i.e, were diagnosed with vegetative state or coma)
*CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS
*CRS-R total score of 10 or higher gave a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (ie, were diagnosed with vegetative state or coma)
 
<br>
 
=== Miscellaneous<br>  ===
 
The Center for Outcome Measurement in Brain Injury {COMBI) has a useful page on the CRS-R:


Giacino, J &amp; Kalmar, K. (2006). Coma Recovery Scale-Revised. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/crs ( accessed March 13, 2016 ).  
== Miscellaneous  ==
The Center for Outcome Measurement in Brain Injury (COMBI) has a useful page on the CRS-R http://www.tbims.org/combi/crs <ref>Giacino, J &amp; Kalmar, K. Coma Recovery Scale-Revised. The Center for Outcome Measurement in Brain Injury 2006 ( accessed March 13, 2016 ).</ref>


== Recommendations  ==
== Recommendations  ==
The American Congress of Rehabilitation Medicine, Brain Injury - Interdisciplinary Special Interest Group set up a Disorders of Consciousness Task Force to conduct a systematic review of assessment scales for DOC (Disorders of Consciousness) and establish recommendations for use in clinical settings<ref>Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.fckLRAmerican Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force1, Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, Zafonte R, Biester RC, Kaelin D, Kean J, Zasler N. Arch Phys Med Rehabil. 2010 Dec;91(12):1795-813</ref>.  
The American Congress of Rehabilitation Medicine, Brain Injury - Interdisciplinary Special Interest Group set up a Disorders of Consciousness Task Force to conduct a systematic review of assessment scales for DOC (Disorders of Consciousness) and establish recommendations for use in clinical settings<ref>Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.fckLRAmerican Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force1, Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, Zafonte R, Biester RC, Kaelin D, Kean J, Zasler N. Arch Phys Med Rehabil. 2010 Dec;91(12):1795-813</ref>.  


The conclusion was that the CRS-R was the most appropriate scale to assess DOC, scoring better than all the other scales examined, (which included SMART, WNSSP, SSAM, WHIM, DOCS).  
The conclusion was that the '''CRS-R was the most appropriate scale to assess DOC''', scoring better than all the other scales examined, (which included SMART, WNSSP, SSAM, WHIM, DOCS).  


== Links  ==
== Links  ==
 
[https://www.sralab.org/rehabilitation-measures/coma-recovery-scale-revised CRS-R Administration and Scoring Guidelines (Updated)]
A pdf of the [http://www.tbims.org/combi/crs/CRS%20Syllabus.pdf CRS-R Administration and Scoring Guidelines]: &nbsp;
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1RGmO3jHeXUt8o1DUrEwPKY35GlHP4g8QYsrZ3Ufq6mfWD4AhW|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==
References will automatically be added here, see [[Adding References|adding references tutorial]].
<references /> &nbsp;  
<references /> &nbsp;  


[[Category:Outcome_Measures]] [[Category:Neurology]]
[[Category:Outcome_Measures]]  
[[Category:Neurology]]
[[Category:Neurological - Outcome Measures]]
[[Category: Acquired Brain Injuries]]
[[Category:TBI Content Project]]
[[Category:Course Pages]]
[[Category:Plus Content]]
[[Category:Assessment]]
[[Category:Head]]
[[Category:Head - Assessment and Examination]]

Latest revision as of 09:59, 18 August 2022

Original Editor - Wendy Walker

Top Contributors - Wendy Walker, Kim Jackson, Naomi O'Reilly, Simisola Ajeyalemi, WikiSysop, Lucinda hampton and Olajumoke Ogunleye  

Objective[edit | edit source]

Man is a coma

The Coma Recovery Scale (CRS-R) , also known as the JFK Coma Recovery Scale - revised, is used to assess patients with a disorder of consciousness, commonly coma.[1] It may be used to differentiate between vegetative state (VS) and minimally conscious state (MCS).[2] It can also be used to monitor emergence from minimally conscious state (EMCS or MCS+).[2]

Intended Population[edit | edit source]

Method of Use[edit | edit source]

The CRS-R consists of 23 items, grouped into 6 sub-scales:

  1. Auditory
  2. Visual
  3. Motor
  4. Oromotor
  5. Communication
  6. Arousal

The lowest score on each sub-scale represents reflexive activity; the highest represents behaviors mediated by cognitive input. The total score ranges between 0 (worst) and 23 (best). This measure takes a minimum of 25 minutes to complete.

Equipment Required[edit | edit source]

  • Instruction Sheet
  • Scoring Sheet
  • 2 Common Functional Objects (often a cup and a hairbrush or comb)
  • An object which produces a loud noise
  • Brightly Coloured Object
  • ADL Items, e.g. toothbrush, phone
  • Hand-held Mirror
  • Baseball Sized Ball
  • Pencil
  • Tongue Depressor

Languages[edit | edit source]

Available in several languages. As well as the original English version, there are French, German, Italian, Spanish, Dutch and Norwegian translations available.

Evidence[edit | edit source]

Giacino,Kalmar and Whyte [1] studied 80 patients with severe acquired brain injury. These individuals were admitted to an inpatient Coma Intervention Programme with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS). They compared the CRS-R to the Disability Rating Scale (DRS), and found that the total scores showed "significant correlation" between the 2 scales, which indicates acceptable concurrent validity. In addition, the CRS-R was able to distinguish 10 patients in an MCS who were scored as in VS by the DRS.

Reliability[edit | edit source]

Test-retest Reliability[edit | edit source]

Disorder of Consciousness Presentation - TBI (Traumatic Brain Injury), CVA (Stroke), hypoxi-ischaemic Brain injury and Tumour[1]:

n=20; mean age = 36.7 years (ranging from 17 to 57 years); mean time post injury = 57.15 days (range 22 to 169 days).

  • Excellent test-retest reliability (Spearman rho = .94)

Inter/Intra-rater Reliability[edit | edit source]

Disorders of Consciousness Presentation (variety of neurological conditions, including TBI (Traumatic Brain Injury)[2]:

n=77; age range 19-86 years; 43 patients 1-27 days post injury, 34 27 days to 24 years post injury.

  • Excellent reliability for total score (k=.80)
  • Excellent reliability for subscales:

Auditory k=.82; Visual k=.85; Motor k=.93; Oromotor k=.92; Communication k=.98; Arousal k=.74.

Validity[edit | edit source]

This scale shows excellent concurrent validity as it correlates significantly with total scores on the orginal CRS and the DRS[1]:

  • Concurrent validity with CRS: Spearman rho = .97

In addition, in the original study by Giacino, Kalmar & Whyte[1], which had 80 inpatients with severe ABI, the CRS-R was able to distinguish 10 patients in an MCS who were misclassified as being in a VS by the DRS.

Sensitivity and Specificity[edit | edit source]

Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness.
Bodien et al, 2016[3]:

  • CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS
  • CRS-R total score of 10 or higher gave a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (i.e, were diagnosed with vegetative state or coma)

Miscellaneous[edit | edit source]

The Center for Outcome Measurement in Brain Injury (COMBI) has a useful page on the CRS-R http://www.tbims.org/combi/crs [4]

Recommendations[edit | edit source]

The American Congress of Rehabilitation Medicine, Brain Injury - Interdisciplinary Special Interest Group set up a Disorders of Consciousness Task Force to conduct a systematic review of assessment scales for DOC (Disorders of Consciousness) and establish recommendations for use in clinical settings[5].

The conclusion was that the CRS-R was the most appropriate scale to assess DOC, scoring better than all the other scales examined, (which included SMART, WNSSP, SSAM, WHIM, DOCS).

Links[edit | edit source]

CRS-R Administration and Scoring Guidelines (Updated)

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Giacino, J. T., K. Kalmar and J. Whyte (2004). "The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility." Arch Phys Med Rehabil Dec 2004: 2020-9
  2. ↑ 2.0 2.1 2.2 Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessmentfckLRSchnakers C, Vanhaudenhuyse A, Giacino J, et al. "Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment". BMC Neurol. 2009; 9:35.
  3. ↑ Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness.fckLRBodien YG, Carlowicz CA, Chatelle C, Giacino JT. Arch Phys Med Rehabil. 2016 Mar;97(3):490-492
  4. ↑ Giacino, J & Kalmar, K. Coma Recovery Scale-Revised. The Center for Outcome Measurement in Brain Injury 2006 ( accessed March 13, 2016 ).
  5. ↑ Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.fckLRAmerican Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force1, Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, Zafonte R, Biester RC, Kaelin D, Kean J, Zasler N. Arch Phys Med Rehabil. 2010 Dec;91(12):1795-813

 

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