GOS Syllabus

Definition of Terms

1	DEAD
2	VEGETATIVE STATE Unable to interact with environment; unresponsive Patients who show no evidence of meaningful responsiveness. Patients who obey even simple commands, or who utter any words, are assigned to the better category of severe disability. Vegetative patients breathe spontaneously, have periods of spontaneous eye-opening when they may follow moving objects with their eyes, show reflex responses in their limbs (to postural or painful stimuli), and they may swallow food placed in their mouths. This non-sentient state must be distinguished from other conditions of wakeful, reduced responsiveness--such as the locked-in syndrome, akinetic mutism and total global aphasia.
3	SEVERE DISABILITY Able to follow commands/ unable to live independently This indicates that a patient is conscious but needs the assistance of another person for some activities of daily living every day. This may range from continuous total dependency (for feeding and washing) to the need for assistance with only one activity--such as dressing, getting out of bed or moving about the house, or going outside to a shop. Often dependency is due to a combination of physical and mental disability--because when physical disability is severe after head injury there is almost always considerable mental deficit. The patient cannot be left overnight because they would be unable to plan their meals or to deal with callers, or any domestic crisis which might arise. The severely disabled are described by the phrase "conscious but dependent."
4	MODERATE DISABILITY Able to live independently; unable to return to work or school These patients may be summarized as "independent but disabled," but it is perhaps the least easily described category of survivor. such a patient is able to look after himself at home, to get out and about to the shops and to travel by public transport. However, some previous activities, either at work or in social life, are now no longer possible by reason of either physical or mental deficit. Some patients in this category are able to return to certain kinds of work, even to their own job, if this happens not to involve a high level of performance in the area of their major deficit.
5	GOOD RECOVERY Able to return to work or school This indicates the capacity to resume normal occupational and social activities, although there may be minor physical or mental deficits. However, for various reasons, the patient may not have resumed all his previous activities, and in particular may not be working.

ref: Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol, Neurosurg, Psychiat 1981;44:285-293.