This Disability Rating Scale (DRS) calculator evaluates disability and rehabilitation in terms of cognitive ability in patients with traumatic brain injury. Discover an explained version of each of the eight items and the score interpretation below the form.
How does this Disability Rating Scale DRS calculator work?
This is a health tool developed to assess functionality in patients who have suffered a traumatic brain injury TBI. It is a scale that reflects the effects of the injury on patient’s abilities and can provide useful information in regard to how much the recovery is going to take.
This Disability Rating Scale calculator evaluates the patient’s cognitive abilities and can be used over time in order to keep track of the progress. The DRS is often called the Rappaport scale to discriminate it from the Dementia Rating Scale with the same acronym.
It is a simple 8 item questionnaire and can be either self administered or by sustained by a professional through interview. Each of the items has from 4 to 6 answers that are awarded a fixed number of points each. The calculator computes the sum of these points and offers a result which is then interpreted on the disability scale.
Disability rating scale
The DRS model was introduced in 1982 by Rappaport as a solution to the pitfalls of the Glasgow Outcome Scale. Initially it was used as rehabilitation assessment for patients with TBI in an inpatient rehabilitation setting but soon after it was also implemented to evaluate impairment and disability in early stages.
Studies such as that of Eliason and Topp have shown a correlation between the scores obtained in DRS and hospitalization and rehabilitation of patients with acute brain dysfunctions, thus verifying the predictability component of the model.
One of the main factors for which the model is so popular is because it allows the clinician to keep an accurate track of patient progress “from coma to community” and because the scale is considered to be very sensitive in tracking behavioral disability.
Criticism of the model is mainly focused on the reported high variability and on the fact that its implementation requires previous trainer for the assessor. There are also discussions about the difficulty in assessing mild to severe functional impairment.
Arousability, Awareness and Responsivity
■ Spontaneous – eyes are open and indicate active and arousal mechanisms.
■ To speech or sensory stimulation – response to any verbal approach and also to touch with mild pressure.
■ To pain by a stimulus, for example pressure across index fingernail or pinching nose tip.
■ None – no eye open to either stimulation.
■ Oriented – awareness of self and environment upon asking simple questions.
■ Confused – patient responds to questions but with delay or a degree of confusion and disorientation.
■ Inappropriate – intelligible articulation but not a sustained communication effort.
■ Incomprehensible – no recognizable words or communication signs.
■ None – no communication signs and no sounds.
■ Obeying – listening and respecting the command.
■ Localizing – withdrawal and localization after painful stimulus.
■ Withdrawing – response to a noxious stimulus in the shape of generalized movement not just reflex.
■ Flexing – rapid withdrawal with abduction of the shoulder or slow withdrawal with adduction at painful stimulation.
■ Extending – extension response to painful stimulation.
■ None – hypotonia present, no response.
Cognitive Ability: Feeding, Toileting, Grooming
■ Complete – awareness of the act in question and explanation around it.
■ Partial – intermittent awareness of the act and explanation around it.
■ Minimal – questionable or infrequent awareness about the act and vaguely aware of the appropriate use.
■ None – no awareness of the act and no conveying of information around it.
Dependance/ Level of functioning
■ Completely independent – no physical, mental, emotional or social restrictions.
■ Independent in special environment – mechanical aids required to function independently.
■ Mildly dependent – able to tend to most needs but with limited assistance.
■ Moderately dependent – in need of assistance at all times but with partial independence in some activities.
■ Markedly dependent – in need of permanent assistance and help with all major activities.
■ Totally dependent – 24 hour nursing care required.
Psychosocial Adaptability/ Employability
■ Not restricted – no restrictions in competing in the open market with existing skills and in regard to homemaking or age appropriate skills.
■ Selected jobs – limited competiveness in the job market because of physical, mental or emotional limitations.
■ Sheltered workshop – non-competitive in the job market because of moderate to severe limitations.
■ Not employable – completely unemployable due to extreme limitations.
Interpreting the rating score
This score is suggestive of the level of dysfunction at the time of the rating and as discussed above can be used to monitor progress.
Remember that the score interpretation is merely a clinical guideline and there are personal factors to take in consideration according to each case. The rating is between 0, meaning no disability and 29, the highest obtainable, indicating extreme vegetative state.
|2 - 3||Partial|
|4 - 6||Moderate|
|7 - 11||Moderately severe|
|12 - 16||Severe|
|17 - 21||Extremely severe|
|22 - 24||Vegetative state|
|25 - 29||Extreme vegetative state|
1) Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN. (1982) Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil; 63(3):118-23.
2) Ashley MJ, Persel CS, Clark MC, Krych DK. (1997) Long-term follow-up of post-acute traumatic brain injury rehabilitation: a statistical analysis to test for stability and predictability of outcome. Brain Inj; 11(9):677-90.
3) Eliason MR, Topp BW. (1984) Predictive validity of Rappaport's Disability Rating Scale in subjects with acute brain dysfunction. Phys Ther; 64(9):1357-60.
4) Boake C, High WM Jr. (1996) Functional outcome from traumatic brain injury: unidimensional or multidimensional? Am J Phys Med Rehabil; 75(2):105-13.08 Aug, 2015