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and is helpful for determining how a patient is progressing. Each level is briefly described below.

Level 1—No Response. The individual appears to be in a deep sleep or coma, does not respond to any stimulus, including voices, sounds, light or touch.

Level 2—Generalized Response. The individual remains primarily asleep, but may respond to certain stimuli such as pain. Movements do not seem to have any purpose. Eyes may open but do not focus on anything in particular.

Level 3—Localized Response. The individual remains alert for several minutes at a time and responds more consistently to general stimuli such as turning the head to noise, looking at people, or squeezing a hand when asked.

Level 4—Confused and Agitated. The individual is confused and agitated about where he or she is and what is happening around him or her. The slightest provocation can lead to aggression, restlessness, or verbal abuse. Conversations may be confused or coherent.

Level 5—Confused, Inappropriate, Non-agitated. The individual is confused and may not make sense in conversations. Agitation is no longer an issue, although the individual may experience some frustration as memory begins to return.

Level 6—Confused, Appropriate. The individual’s speech makes sense and he or she can perform simple tasks such as getting dressed, eating, and brushing teeth. Knowing when to start and stop an activity may be difficult, as well as learning new things.

Level 7—Automatic, Appropriate. The individual is able to perform all self- care activities and is coherent. He or she may have trouble remembering recent events. Judgment and problem-solving abilities may be impaired, although the ability to learn new information is improved.

Level 8—Purposeful, Appropriate. The individual is independent and can process new information. Judgment and problem-solving abilities are restored. Some problems with short-term memory and judgment in unusual situations


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