Coma Recovery Scale (Revised)
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Objective
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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
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Traumatic Brain Injury (TBI)
Stroke (CVA)
Brain Tumour
Method of Use[edit | edit source]
The CRS consists of 23 items, grouped into 6 subscales:
- Auditory
- Visual
- Motor
- Oromotor
- Communication
- Arousal
The lowest score on each subscale represents reflexive activity; the highest respresents behaviours mediated by cognitive input.
The total score ranges between 0 (worst) and 23 (best).
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, eg. toothbrush, 'phone
- Hand-held mirror
- Baseball sized ball
- Pencil
- Tongue depressor
Available in several languages[edit | edit source]
As well as the original English version, there are French, German, Italian, Spanish, Dutch and Norwegian translations available.
Reference
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Giacino,Kalmar and Whyte [1] 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[edit | edit source]
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:
(Giacino et al, 2004[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/Intrarater Reliability[edit | edit source]
Disorders of Consciousness Presentation (variety of neurological conditions, including TBI (Traumatic Brain Injury):
Schnakers et al, 2008[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.
Responsiveness[edit | edit source]
Miscellaneous
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The Center for Outcome Measurement in Brain Injury {COMBI) has a useful page on the CRS-R:
Giacino, J & 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 ).
Links[edit | edit source]
A pdf of the CRS-R Administration and Scoring Guidelines:
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 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
- ↑ 2.0 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.
