Lesson 2 Glascow Coma Scale & Components of Neurological Assessment

Glasgow Coma Scale development

Created in 1974 at University of Glasgow; standardized tool to evaluate and communicate neurological status

GCS total score range

3 (worst) to 15 (best); scores added from eye, verbal, and motor responses

GCS score ≤8 significance

Often indicates coma; may require intubation for airway protection

Decorticate posturing (abnormal flexion)

GCS motor score 3; arms flexed toward core, wrists/fingers bent, legs extended

Decerebrate posturing (abnormal extension)

GCS motor score 2; arms/legs extended, head arched back; indicates brainstem damage

Motor response: localizes to pain

GCS motor score 5; purposefully moves toward painful stimulus to remove it

AVPU scale

Quick LOC check: Alert, responds to Verbal stimuli, responds to Pain, Unresponsive

Early signs of neurological deterioration

Confusion before decreased LOC; recognize subtle changes to prevent further decline

Mental status assessment components

Orientation, memory (short and long-term), attention, language, mood

Short-term vs long-term memory testing

Short-term: recall 3 objects after 5 minutes; Long-term: personal history, past events

Motor function assessment components

Strength, tone, coordination, involuntary movements, gait, balance

Muscle tone abnormalities

Flaccid (decreased tone), spastic (increased tone), rigid (resistance throughout movement)

Coordination testing

Finger-to-nose, heel-to-shin, rapid alternating movements; tests cerebellar function

Involuntary movements assessment

Observe for tremors, fasciculations, tics, chorea, athetosis

Gait assessment

Observe walking pattern, balance, coordination, symmetry; tests multiple neurological systems

Sensory function testing

Light touch, pain (sharp/dull), temperature, vibration using appropriate tools

Bilateral sensory comparison

Always compare sensory findings on both sides of body for symmetry; asymmetry indicates focal deficit

GCS trending importance

Serial GCS scores track improvement or deterioration over time; guides treatment decisions

GCS communication benefit

Standardized scoring allows consistent communication between healthcare providers about patient status