STANDARDIZED ASSESSMENT INSTRUMENTS FOR MINIMALLY-RESPONSIVE, BRAIN-INJURED PATIENTS

Among the most significant advances in the care and rehabilitation of severely brain injured, minimally-responsive patients (MRP) has been t he development of standardized assessment scales. Currently available instruments include the Coma/Near Coma Scale (CNC), Coma Recovery Scal e (CRS), Sensory Stimulation Assessment Measure (SSAM), and the Wester n Neuro Sensory Stimulation Profile (WNSSP). Each scale is reviewed in terms of content, psychometric properties, and clinical attributes. D ata is then presented comparing converted, percentile admission scores for the CRS, WNSSP, and CNC in a group of ten MRP at Rancho Levels II -IV, with a mean age of 31 years and mean time from injury of 37.5 day s. Admission CNC and CRS scores tended to group in the middle range, w hile WNSSP scores tended to group in the lower quartile. This suggests the potential concern for 'floor effect' with the WNSSP. At admission , none of the three scales was able to effectively distinguish between dichotomized outcome variables: disposition (home vs. nursing home), advancement to active rehabilitation, or discharge Functional Independ ence Measure score (> 80 vs. < 80). The data indicate the CRS demonstr ates moderately strong relationships with both the CNC and WNSSP. Full delineation of how these scales relate to one another awaits both cro ss-sectional and longitudinal analyses in larger samples and should in clude the SSAM.