DRS Frequently Asked Questions

1. What makes the DRS different from most other scales?
2. Can the DRS be done over the phone?
3. Can the DRS be done retrospectively through medical chart review?
4. How do I get to cognitive ability over the phone?
5. How do you know whether to ask the patient or the caregiver for the information?
6. Can a person have a "0" score for toileting and be incontinent?
7. How do you rate "employability" for a person who is retired or in the hospital?
8. Why a .5 rating?
9. When in doubt, do I rate higher or lower?
10. How sensitive is the DRS to Mild Brain Injury?
11. Isn't the DRS total score broken into clinical categories?
12. Does it cost anything to use the scale, and can I copy it freely?

1. What makes the DRS different from most other scales?
The DRS can be used for both inpatient and follow up evaluations and is one of the few scales that can track a person from "coma to community." This scale takes both cognitive and physical function into consideration for scoring, as well as impairment, disability, and handicap, and may present a more global picture of the patient. It is brief and rater training is not difficult.

2. Can the DRS be done over the phone?
Yes. Reliability and validity have been well demonstrated.

3. Can the DRS be done retrospectively through medical chart review?
Yes, as long as sufficient information is available to rate each item accurately. Remember, Feeding, Grooming, and Toileting items address cognitive not physical ability.

4. How do I get to cognitive ability over the phone?
Find out what the physical limitations are first. If there are none, than anything less than the ability for full functioning can be assumed to be due to cognitive deficits. Questions such as " Does subject need help to complete personal hygiene? Does subject need someone else to help set up equipment (toothbrush and toothpaste, comb, shaver)? Does subject need prompting to complete task or reminders, ie, changing clothes? Does subject indicate (i.e., squirming in his chair) that he needs to void?" will help scoring for cognitive ability.

5. How do you know whether to ask the patient or the caregiver for the information?
Speaking to the patient is preferred, however, if the patient is unable or not available the rater may speak to someone close to the patient.

6. Can a person have a "0" score for toileting and be incontinent?
Yes. The items "feeding, grooming, and toileting" are rated for cognitive ability (knowing how and when) only.

7. How do you rate "employability" for a person who is retired or in the hospital?
"Employability" is not employment. The item refers to the overall cognitive and physical ability to be an employee, homemaker or student. For example, client "A" returns to her home. She employs three staff members to garden, cook and clean, and is involved in doing several volunteer projects (rate "0"). Client "B" returns to her home. She has three employees because she cannot garden, clean or cook safely and consistently, but can complete selected activities with structure or supervision (rate 2-2.5).

8. Why a .5 rating?
In 1994, the Traumatic Brain Injury Model Systems (TBIMS) National Database adopted a 0.5 rating option for the last 5 items of the DRS. Although raters found the half point discrimination useful, no validation study was ever completed on the use of the 0.5 rating option. In 2010, the TBIMS National Database members voted to omit the 0.5 rating option. Use of the 0.5 rating option after April 1, 2010 is not recommended.

9. When in doubt, do I rate higher or lower?
If in doubt, give the patient the benefit of the doubt.

10. How sensitive is the DRS to Mild Brain Injury?
A one point change on the low end of the 30 point scale (mild to normal) is substantially more clinically significant than a one point change at the high end. The DRS is not recommended for rating persons who have sustained a mild brain injury due to its relative insensitivity at that end of the scale.

11. Isn't the DRS total score broken into clinical categories?
The categories seen below and on older DRS forms, were assigned for ranges of summed scores to help describe the level of dysfunction.

0	None
1	Mild
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
30	Death

These categories were not based on any statistical analysis of scaling. They were provided to be helpful for clinical purposes. Any use of the DRS for research purposes should utilize the actual summed scores.

12. Does it cost anything to use the scale, and can I copy it freely?
There is no charge for using the DRS. It can be copied freely.