DRS Testing

DRS Testing Vignette

Admission

The patient is a 26-year-old male status post a gunshot wound to the right eye, penetrating behind the globe. Secondary to the rupture of the globe, the right eye was enucleated. The patient was unconscious at the scene of the accident and the Glasgow coma score on admission to the ER was 3. Urgent intubation, craniotomy and evacuation of the subdural hematoma were performed.

On admission to the rehabilitation unit, the patient had a trach in place, but was capable of limited vocalization. He is able to open his eyes spontaneously. He is able to tolerate soft to liquid foods independently and is able to make staff aware when he is hungry. He is able to move all four limbs in full ranges of motion. His coordination is impaired on the upper and lower extremities. The patient is able to hold his head normally but his ability to control his trunk and balance during sitting and standing is significantly impaired. He is required to wear a helmet at all times, secondary to severely impaired vision and decreased attention and awareness and increased agitation. He is able to perform transfers from bed to wheelchair and vice versa but needs to have an attendant present at all times to prevent falls. He is continent in bladder and bowel but occasionally requires cuing. He has demonstrated the ability to put on and take off his hospital gown, socks, and to comb his hair with significant cuing and some physical assistance; however, bathing was not testable due to decreased endurance and increased agitation. When questioned, he can name the city in which he resides and his own name, but he is not oriented to time and the details of his injury. He can follow simple, one-step commands but demonstrates delayed auditory processing and cannot express simple ideas.

Please rate Admission DRS

1. Eye Opening:

2. Communication Ability:

3. Motor Response:

4. Feeding:

5. Toileting:

6. Grooming:

7. Level of Functioning:

8. Employability:

Discharge

The patient was discharged to home in the care of his significant other, who will be the primary caregiver. He has a right eye enucleation and is left eye blind secondary to optic atrophy. The patient has normal tone in the upper and lower extremities. He is able to ambulate but requires assistance in terms of safety. He is required to wear a helmet. Neurologically, he is alert and oriented x3 with a GOAT score of greater than 75 x3. His cranial nerves are intact except for #2. Otherwise, sensation is intact throughout. His coordination is intact, however, affected by his lack of vision.

The patient is independent in bed mobility, requires an assistant to be present for transfers secondary to blindness, and needs additional assistance for walking. He is able to dress his upper body with supervision, but sometimes requires cuing for dressing of his lower body. When using a seated-level shower, he requires supervision. He is fully continent in bowel and bladder. He has been tolerating oral feeding and does not require supervision or cuing.

He has demonstrated adequate safety and judgment. He requires further work on being able to remember and respond to multi-step commands on an independent level. He is being referred to outpatient speech therapy for aphasia, memory, orientation, and cognition. He is also being referred to a Center for the Blind and Visually Impaired for additional reintegration back into the community before he will be ready for vocational rehabilitation.

Please rate Discharge DRS

1. Eye Opening:

2. Communication Ability:

3. Motor Response:

4. Feeding:

5. Toileting:

6. Grooming:

7. Level of Functioning:

8. Employability:

Follow-Up

At follow-up, the patient states that his memory has improved; this was confirmed by his sister only recently in the last few days. The sister states that his memory has improved with regards to his short-term memory retention and long-term as well. His GOAT score was equal to 83, which was an improvement from his prior examination.

He is currently not wearing his helmet, as he states that it does not fit well. It was strongly recommended that he wear his helmet at all times; he will be referred to Occupational Therapy if he cannot make the appropriate helmet adjustments himself. He is currently independent in regards to his mobility with walking; he is also able to independently go up and down stairs as well. He is independent in all his activities of daily living, which include bathroom activities, toileting, hygiene and grooming, self-feeding and dressing. He is currently "hanging out" at home and shows no motivation to engage in productive activity although he has demonstrated the skills to perform simple housekeeping tasks. He is using a cane for any sort of ambulation to assist in negotiating his environment. For community mobility, he requires contact guard assistance, as he is unable to negotiate complex and unfamiliar environments.

Please rate Follow-up DRS

1. Eye Opening:

2. Communication Ability:

3. Motor Response:

4. Feeding:

5. Toileting:

6. Grooming:

7. Level of Functioning:

8. Employability:

You will typically receive the results from your test within 1 week.