1 – Normal 2 – Mild Dysfunction 3 – Moderate Dysfunction 4 – Severe Dysfunction 5 – Very Severe Dysfunction Score

SCORE:

6

Mental Status Normal sleep/wake;appropriate responsivity Sleepy but arousable to noise/ touch/movement and/or periods of social nonresponsivity Lethargic and/or irritable Minimal arousal to stimulus(stupor) Unresponsive and/or Coma and/or Vegetative

Sensory Intact hearing and vision and responsive to touch Suspected hearing or Suspected vision loss Not reactive to auditory stimuli or Not reactive to visional stimuli Not reactive to auditory stimuli and Not reactive to visional stimuli Abnormal response to pain or touch

Communication Appropriate noncrying vocalizations, interactive facial expressiveness, or gestures Diminished Vocalization Diminished Facial Expression and/or social responsiveness Absence of attention getting behavior No demonstration of discomfort Absence of communication

Motor Function Coordinated body movements and Normal muscle control and Awareness of action and why it’s being done 1 limb functionally impaired 2 or more limbs functionally impaired Poor head control Diffuse Spasticity, Paralysis, Decerebrate/Decorticate Posturing

Feeding All food taken by mouth with age appropriate help NPO or need for age inappropriate help with feeding Oral and tube feedings Parenteral Nutrition with oral or tube feedings All parenteral nutrition

Respiratory Room air and no artificial support or aids Oxygen and/or Suctioning Tracheostomy CPAP for all or part of the day and/or Mechanical ventilator support for part of the day Mechanical ventilatory support for all of the day and night