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TšLščō|±10$**  "%* +! 1& ,E9      #'(-.)/Aƒ š0ƒ†AæĄÅA’ń’@ń÷š8ó€ó €Ššśgžż4adad4Ł’æ0tpÜ’æŁ’昒’’@’’’pūppū@ ’ <ż4!d!d²  PŁ’æpÜ’æŁ<ż4BdBd²  PŁ’æpÜ’æŁśgžż4PdPd4Ł’æ0tpÜ’æŁ’æż’’ ’’’pū@ pūpŗuģŹš;2NĶÉŹš;<ż4dddd²  PŁ’æŗuģŹš;ˆØŠ0ŗ___PPT10‹ ĄĄŠhŗ___PPT2001‹Dˆ<‰4X€ą?Ł Ś %OŁ Ś =š7óŸØ!The Disability Rating Scale (DRS)”&"!0BŸØ<Jerry Wright Laura Jamison Santa Clara Valley Medical Center”==ó ŸØWhat is the DRS?ŸØŗ8-Item outcome measure. Scoring reversed from many scales. The scale is intended to measure accurately general changes over the course of recovery. Widely used in brain injury research. ”"ŗZZ»ó+#ŸØHistory of the DRSŸ  The DRS was developed in the late 1970 s as an alternative to the Glasgow Outcome Scale (GOS), which was thought to be insensitive. It was developed and tested with older juveniles and adults with moderate and severe brain injuries in an inpatient rehab setting.ó2(ŸØHistory of the DRSŸØ°First citation: Rappaport M, Hall KM, Hopkins HK, Belleza T, Cope DN. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil 1982;73:911-16. ”0°ŠŖ,3^ó3)ŸØHistory of the DRS & the NDBŸ NAn original National Database variable (1988) for Form I and II. In 1994 a 0.5 rating option was added for the last 5 items. In 2001 the DRS was placed on a  Less Dynamic schedule and only Level of Functioning & Employability were collected annually. In 2010 the 0.5 rating option was omitted.”((ó4*ŸØAdvantages of the DRSŸØ¦Brevity (3 minute average from DC survey) Reliability and validity tested Useful in a wide variety of settings (coma to community) Can be administered over the phoneó5+ŸØDisadvantages of the DRSŸ ^ Difficult to rate Expertise required 4/5 (DC Survey) Content difficulty 4/5 (DC Survey) Not sensitive to mild injuries Not meant to measure change over short periods of time”6FVFVó ŸØ8-Items of the DRSŸØŗEye Opening Best Communication Ability Best Motor Response Cognitive ability for Feeding Cognitive ability for Toileting Cognitive ability for Grooming Level of Functioning Employability”»»óŸ 8DRS  What are we assessing?”(ŸØEye Opening - Arousability Communication - Awareness Motor Response - Responsivity Feeding Toileting - Cognitive Ability for Self Care Activities Grooming Level of Functioning - Dependence on Others Employability - Psychosocial Adaptability ” ZóŸØ Eye OpeningŸ š0  Spontaneous 1  To speech and/or sensory stimulation 2  To pain 3  Noneó% ŸØBest Communication AbilityŸ ’0  Oriented 1  Confused 2  Inappropriate 3  Incomprehensible 4  NoneóŸØBest Motor ResponseŸ ¤0  Obeying 1  Localizing 2  Withdrawing 3  Flexing 4  Extending 5  Noneó&!ŸØCognitive Ability for Self CareŸØ4Feeding, Toileting, & Grooming When and How Rate each of the three functions separately. For each function answer the question: Does the patient show awareness of when and how to perform each specified activity? Ignore motor disabilities that interfere with carrying out a function (Level of Functioning). ”ŚZZ ZTZ0Z%Z^ZZ T#    %^ó ŸØFeeding (How and When)ŸØCognitive ability for feeding: How to use suitable utensils How to bring food to mouth How to chew and swallow safely How to drink from a cup or glass How to open cans, cut meat, put straw in glass, scoop food, pour liquids, etc. When is it appropriate to eat?”8ēęó<,ŸØFeedingŸØDo you need someone to structure or set up, to give prompts or reminders as to how or when to eat? Slow down, chew your food, come to eat, etc.ó ŸØFeeding RatingŸØ60.0 Complete 1.0 Partial 2.0 Minimal 3.0 None”77ó ŸØFeedingŸØGExample of Partial: Subject who is able to eat with some supervision (due to eating too fast if not prompted) and asks for food at appropriate times. Score 1 Example of Minimal: Subject seems vaguely aware - once or twice a week asks for food. Can eat a modified diet if supervised because of choking due to gulping. Score 2”\P‹PP•P‹•ó0'ŸØToileting (How and When)ŸØŃBladder and bowel behavior Other associated toileting activities Do you need someone to structure or set up, or to give cues, prompts or reminders as to how or when use the bathroom or perform toileting tasks?ó ŸØToileting RatingŸØ60.0 Complete 1.0 Partial 2.0 Minimal 3.0 None”77ó ŸØ ToiletingŸØŒExample for Partial: Subject is continent of bowel, and during the day indicates need to void, but by end of day does not consistently show awareness of need (due to fatigue, confusion). Score 1 Example for Minimal: Subject indicates awareness for both bowel and bladder need during the day, but is incontinent at night. Subject rarely shows that he can help with toileting activities. Score 2”\P°PP³P°³ó$ŸØGrooming (How and When)ŸØ4Wash Brush teeth Comb or brush hair Bath Dress ShaveóŸØGroomingŸØDo you need someone to structure or set up, or to give cues, prompts or reminders as to how or when to perform grooming tasks? óŸØGrooming RatingŸØ70.0 Complete 1.0 Partial 2.0 Minimal 3.0 None ”*7P7óŸØGroomingŸ šExample of Partial: Subject s caregiver sets out all the equipment for personal hygiene, (toothbrush, comb, shaver). She also sets out his clothes, then he can dress himself and complete the rest of his grooming tasks independently. Score 1 Example of Minimal: Subject does not initiate any personal hygiene task, and will wear the same clothing for several days. He requires close supervision for some hygiene items due to safety considerations. Score 2 ”\ZßZZĒZßĒóŸØLevel of FunctioningŸØ<Remember to consider both physical and cognitive disability.”==ó"ŸØLevel of FunctioningŸØCould you live alone with no assistance? Do you need special equipment? (Cane, walker, memory book,etc). Do you need someone coming in at times to give limited help? (shopping, bill-paying, meal preparation) Do you need someone around all of the time (safety)? Do you need assistance with all of your major activities? Are you able to assist at all in your care? Do you need 24-hour nursing care? ”ó>-ŸØLevel of FunctioningŸØø0.0 Completely Independent 1.0 Independent in special environment 2.0 Mildly Dependent 3.0 Moderately Dependent 4.0 Markedly Dependent 5.0 Totally Dependent” ¹ZøóA/ŸØLevel of FunctioningŸØ%Example of Mildly Dependent: Subject is mostly independent living at home. Only needs helper for light housecleaning and meal preparation. Score 2 Example of Markedly Dependent: Subject needs assistance with all ADL activities and cannot be left unsupervised because of safety issues. Score 4”\PvPPtPvtóŸØ EmployabilityŸ :Rate capability for activity not actual performance. Distinguish between  Not restricted and  Selected Jobs based on deficits caused by the brain injury. Is the job any different now then it was before the injury? Is it the same? Did they need to cut back on hours/responsibilities? ”&óŸØ EmployabilityŸØŹPlan, initiate, understand and carry out work related tasks, as in office/paper work, or manual/factory work, household management, or school assignments. Handle social situations at work, school or in the community. Get around independently (use transportation system) Deal with number concepts, like telling time, doing simple addition Buy things at the store, handle cash transactions Handle your own schedule, get to places on time and keep appointments ”ĖZĖó'"ŸØ EmployabilityŸ LAre you able to: 1 - Understand, remember and follow instructions. 2  Plan and carry out tasks at least at the level of an office clerk or in simple routine, repetitive industrial situations or can do school assignments. 3  Remain oriented, relevant and appropriate in work and other psychosocial situations. 4  Get to and from work or shopping centers using private or public transportation effectively. 5  Deal with number concepts 6  M ake purchases and handle simple money exchange problems. 7  Keep track of time schedules and appointments.”6ó?.ŸØ EmployabilityŸØp0.0 Not Restricted 1.0 Selected jobs, competitive 2.0 Sheltered workshop, non-competitive 3.0 Not Employable ”*pZZpóB1ŸØ EmployabilityŸØExample of selected jobs-competitive: Subject continues to work as a accountant, but because of fatigue issues only works 4-hour days. Score 1 Example of sheltered workshop-noncompetitive: Subject cannot complete even simple school assignments without any assistance. Score 2”\&PiP.PXP&i.XóŸØTips:ŸØüIf in doubt, give the subject the benefit of the doubt. Remember that feeding, toileting and grooming items are rated on cognitive ability to know how and when, not physical ability. Level of functioning includes both physical and cognitive disability.”żżóŸŖ ŸŖ /šó*ó6ó7ó8ó9ó:ó;ó=ó@óD źų ļ `š ’’’ff3’’’ff™™™™’’’`š J’’’MMM’’’Ģ3ff™’™’’’`š @@’’’ff™’’’’Ģ’3Ģ™Ģ3`š f™’’’MMMĢģ’3™f3f’3Ģ’’’’`š ’’’ff™Ģ’f’™3’Ģ33™`š ’’’ĄĄĄĢ3ff™™™MMM`š ’’’33™f3™’™™’Ģ’___£>’ż?" dP@’’ļ’’’’’’,£’’ż?nKdŲ@’’ļ’’’’’’`AŌ `7Š@č§dš`hU€ £n’ż?" d’d@’’ļ’’’’’’   @@``€€P£T    @ ` €`£>p£>€£> |štš ,š š( š š,šą š, “ š6€ “W‡ƒæĄ’ "ńæš*P`śšĆ Ö¤ šTŸØ Click to edit Master title style¢!Ŗ !š$ š, ƒ š0€`µWƒæĄ’ "ń暀P`pšĆ Ö¤ šžŸØRClick to edit Master text styles Second level Third level Fourth level Fifth level¢!    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Ŗ SšÖ šŲ “ š6€gn‡ƒæĄ’ š_PšĆ  ŲT šXŸ *” śŖšŲ šŲ “ š6€pin‡ƒæĄ’ š_ ßšĆ ŲT šZŸ *” ŲŖšH šŲ ƒ š0ƒ“Ž½h”ŽŸ‹æ’ ?š ’’’€€€»ąć33™™™™Ģˆ8Š0ŗ___PPT10‹ė.-#Ć@5\É€ š`šąš š( š šąšŠ šą ƒ š0€ąįšƒæĄ’ šP šĆ  ŲT šXŸ *” łŖšŅ šą ƒ š0€ĄćšƒæĄ’ š ß šĆ ŲT šZŸ *” ųŖšÖ šą “ š6€@嚇ƒæĄ’ š_PšĆ  ŲT šXŸ *” śŖšŲ šą “ š6€Ąęš‡ƒæĄ’ š_ ßšĆ ŲT šZŸ *” ŲŖšH šą ƒ š0ƒ“Ž½h”ŽŸ‹æ’ ?š ’’’€€€»ąć33™™™™Ģˆ8Š0ŗ___PPT10‹ė.-#ĆĄ‡pī‰ļ€  š˜0šš0š( š ššx š c š$€ĄaXæ’0š°`0@šĆ × š žšx š c š$€ąhXæ’0š0 ` Ģ šĆ × š žšH š ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’€€€»ąć33™™™™Ģˆ‘Š‰ŗ___PPT10‹iė.žĆ`IiŠ+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒpšHš$š( š šHšr šH S š€ąēšæ’,š*P`śšĆ  × š žšr šH S š€@čšæ’,š@P`pšĆ × š žšH šH ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.#Ć@Wf+Dń='ń Ē ’’’’=ń @Bń +ī$ļ € ”šŒ€šdš$š( š šdšr šd S š€ąźšæ’,š*P`śšĆ  × š žšr šd S š€€źšæ’,š€P`pšĆ × š žšH šd ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ8Š0ŗ___PPT10‹ė.§+Ćąė„Üī0ļ €  š˜š€š0š( šé š€šx š€ c š$€ źšæ’,ˆš*P`śšĆ  × š žšx š€ c š$€`ģšæ’,ˆš€P`pšĆ × š žšH š€ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š 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€ ˆš€ šĢšš( š šĢšl šĢ C š€0k›æ’,š*P`śšĆ  × š žšl šĢ C š€Šj›æ’,šŠP`pšĆ × š žšH šĢ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.%"Ć čę+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€@štšš( š štšl št C š€0óæ’,š*P`śšĆ  × š žšl št C š€Šņæ’,špP`pšĆ × š žšH št ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.ŖĆ€¤€+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒ`šŠš$š( š šŠšr šŠ S š€öæ’,š*P`śšĆ  × š žšr šŠ S š€0öæ’,šP`pšĆ × š žšH šŠ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.!#Ć æ×+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒpšš$š( š ššr š S š€P÷æ’,š*P`śšĆ  × š žšr š S š€šöæ’,š€P`pšĆ × š žšH š ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.{!Ć WĪī+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€€šØšš( š šØšl šØ C š€°÷æ’,š*P`śšĆ  × š žšl šØ C š€ųæ’,š€P`pšĆ × š žšH šØ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.{!Ć WĪī+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€šTšš( š šTšl šT C š€pųæ’,š*P`śšĆ  × š žšl šT C š€Šųæ’,špP`pšĆ × š žšH šT ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.%Ćą›Ŗk+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒ°š8š$š( š š8šr š8 S š€°śæ’,š*P`śšĆ  × š žšr š8 S š€Pśæ’,š€P`pšĆ × š žšH š8 ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.Ć`óĢ+Dń='ń Ē ’’’’=ń @Bń +īļ € ˆš€Ąšxšš( š šxšl šx C š€Šūæ’,š*P`śšĆ  × š žšl šx C š€pūæ’,š P`pšĆ × š žšH šx ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ8Š0ŗ___PPT10‹ė.+-Ć ~¢ˆī}ļ € ”šŒŠšPš$š( š šPšr šP S š€°ąæ’,š*P`śšĆ  × š žšr šP S š€įæ’,š@P`pšĆ × š žšH šP ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.%ĆĄ+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒšš4š$š( š š4šr š4 S š€šāæ’,š*P`śšĆ  × š žšr š4 S š€āæ’,š€P`pšĆ × š žšH š4 ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.§ĆČO³+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒšøš$š( š šøšr šø S š€°ćæ’,š*P`śšĆ  × š žšr šø S š€Pćæ’,š€P`pšĆ × š žšH šø ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė."Ćąīō!+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€špšš( š špšl šp C š€0āæ’,š*P`śšĆ  × š žšl šp C š€äæ’,š€P`pšĆ × š žšH šp ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.ŖĆ „É+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒ šXš$š( š šXšr šX S š€Šäæ’,š*P`śšĆ  × š žšr šX S š€0åæ’,šP`pšĆ × š žšH šX ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.%Ć•bå+Dń='ń Ē ’’’’=ń @Bń +ī‰ļ €  š˜@šš0š( š ššx š c š$€ēæ’,š*P`śšĆ  × š žšx š c š$€°ęæ’,š€P`pšĆ × š žšH š ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’€€€»ąć33™™™™Ģˆ‘Š‰ŗ___PPT10‹iė.„Ć@"j~+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€Pš`šš( š š`šl š` C š€0čæ’,š*P`śšĆ  × š žšl š` C š€Šēæ’,šP`pšĆ × š žšH š` ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.&Ć°ē+Dń='ń Ē ’’’’=ń @Bń +īvļ €ł$ šˆ`š¤š š( š š¤šš š¤ C š€čæ’,š*P`śš”$ń Ņ€Ć  ׈PŠHŗ___PPT2001‹$‡ĻP š žšš š¤ C š€ščæ’,š@P`pš”$ńŅ€Ć ׈PŠHŗ___PPT2001‹$‡ĻP š žšH š¤ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆv‰*ŗ TIMINGŗ|1.|0.4Š<ŗ___PPT10‹ź.ė."Ć@«žžīļ € 6š.pš°šĘš( šˆ `­ š°š¦ š° £ š<€Šź…‡æƒæĄ’š< ØÖ  š:Ÿ” Ŗ šl š° C š€0ėæ’,š*P`śšĆ  × š žšl š° C š€ėæ’,špP`pšĆ × š žšH š° ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.&Ć°ē+Dń='ń Ē ’’’’=ń @Bń +ī•ļ € ¬š¤šĄš<š( š šĄš~ šĄ s š*€ Ī”æ’,ˆš*P`śšĆ  × š žš~ šĄ s š*€@Ī”æ’,ˆš@P`pšĆ × š žšH šĄ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’€€€»ąć33™™™™Ģˆ‘Š‰ŗ___PPT10‹iė.„Ć@"j~+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€ šdšš( š šdšl šd C š€`Ļ”æ’,š*P`śšĆ  × š žšl šd C š€ąĶ”æ’,š€P`pšĆ × š žšH šd ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.¢Ć –+Dń='ń Ē ’’’’=ń @Bń +ī}ļ € ”šŒ°šhš$š( š šhšr šh S š€Ļ”æ’,š*P`śšĆ  × š žšr šh S š€ĄĻ”æ’,š€P`pšĆ × š žšH šh ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.¢Ć ØzÓ+Dń='ń Ē ’’’’=ń @Bń +īqļ € ˆš€ĄšŌšš( š šŌšl šŌ C š€ąŠ”æ’,š*P`śšĆ  × š žšl šŌ C š€€Š”æ’,š€P`pšĆ × š žšH šŌ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.(#Ć@nÅé+Dń='ń Ē ’’’’=ń @Bń +īqļ €  ˆš€Ššøšš( š šøšl šø C š€ Ń”æ’,š*P`śšĆ  × š žšl šø C š€@Ń”æ’,š@P`pšĆ × š žšH šø ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’ff3’’’ff™™™™’’’ˆ‘Š‰ŗ___PPT10‹iė.¢Ć –+Dń='ń Ē ’’’’=ń @Bń +ī•ļ € ¬š¤ššČš<š( š| šČš~ šČ s š*€€Ó”æ’,ˆš*P`śšĆ  × š žš~ šČ s š*€ Ó”æ’,ˆš0P`pšĆ × š žšH šČ ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’€€€»ąć33™™™™Ģˆ‘Š‰ŗ___PPT10‹iė.„Ć@"j~+Dń='ń Ē ’’’’=ń @Bń +ī‰ļ €  š˜šš0š( š ššx š c š$€ Ō”æ’,š*P`śšĆ  × š žšx š c š$€@Ō”æ’,š€P`pšĆ × š žšH š ƒ š0ƒ“ŽŸ‹”Ž½hæ’ ?š ’’’€€€»ąć33™™™™Ģˆ‘Š‰ŗ___PPT10‹iė.”Ć@š