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Patient appears to be in a deep sleep 1. No Response
Completely unresponsive to any stimuli 1. No Response
Reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner 2. Generalized Response
Responses are limited & often the same regardless of stimulus presented 2. Generalized Response
Responses may be physiological changes, gross body movements, and/or vocalization 2. Generalized Response
Reacts specifically but inconsistently to stimuli 3. Localized Response
Responses are directly related to the type of stimulus presented 3. Localized Response
May follow simple commands such as closing eyes or squeezing hand in an inconsistent, delayed manner 3. Localized Response
Heightened state of activity 4. Confused- Agitated
Behavior is bizarre and nonpurposeful relative to immediate environment 4. Confused- Agitated
Does not discriminated among persons or objects 4. Confused- Agitated
Unable to cooperate directly with treatment efforts 4. Confused- Agitated
Verbalizations frequently are incoherent and/or inappropriate to the environment 4. Confused- Agitated
Confabulation may be present 4. Confused- Agitated
Gross attention to environment is very brief 4. Confused- Agitated
Selective attention is often nonexistent 4. Confused- Agitated
Lacks short and long term recall 4. Confused- Agitated
Able to respond to simple commands fairly consistently 5. Confused- Inappropriate
Increased complexity of commands or lack of any external structure, responses are nonpurposeful, random, or fragmented 5. Confused- Inappropriate
Demonstrates gross attention to the environment but is highly distractible and lacks ability to focus attention on a specific task. 5. Confused- Inappropriate
With structure may be able to converse on a social automatic level for short periods of time 5. Confused- Inappropriate
Verbalization is often inappropriate and confabulatory 5. Confused- Inappropriate
Memory is severely impaired 5. Confused- Inappropriate
Often shows inappropriate use of objects 5. Confused- Inappropriate
May perform previously learned tasks with structure but is unable to learn new information 5. Confused- Inappropriate
Shows goal-directed behavior but is dependent on external input or direction 6. Confused- Appropriate
Follows simple directions consistently and shows carryover for relearned tasks such as self-care 6. Confused- Appropriate
Responses may be incorrect due to memory problems, but they are appropriate to the situation 6. Confused- Appropriate
Past memories show more depth and detail than recent memory 6. Confused- Appropriate
Appears appropriate and oriented within the hospital and home settings 7. Automatic- Appropriate
Goes through daily routine automatically, but frequently robotlike 7. Automatic- Appropriate
Shows minimal to no confusion and has shallow recall of activities 7. Automatic- Appropriate
Shows carryover for new learning but at a decreased rate 7. Automatic- Appropriate
With structure is able to initiate social or recreational activities 7. Automatic- Appropriate
Judgement remains impaired 7. Automatic- Appropriate
Able to recall and integrate past and recent events and is aware of and responsive to environment 8. Purposeful- Appropriate
Shows carryover for new learning and needs no supervision once activities are learned 8. Purposeful- Appropriate
May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgement in emergencies or unusual circumstances 8. Purposeful- Appropriate
Created by: PT2014



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