I. No Response: Patient appears to be in a deep sleep and is unresponsive to stimuli.
II. Generalized Response: Patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Reflexes are limited and often the same, regardless of stimuli presented.
III. Localized Response: Patient responses are specific but inconsistent, and are directly related to the type of stimulus presented, such as turning head toward a sound or focusing on a presented object. He may follow simple commands in an inconsistent and delayed manner.
IV. Confused-Agitated: Pt in heightened state of activity and severely confused, disoriented, and unaware of present events. Behavior frequently bizarre and inappropriate to immediate environment. Unable to perform self-care. If not physically disabled, may perform automatic motor activities such as sitting, reaching and walking as part of agitated state, but not necessarily as a purposeful act.
V. Confused-Inappropriate, Non-Agitated: Pt appears alert and responds to simple commands. More complex commands, however, produce responses that are non-purposeful and random. Pt may show some agitated behavior in response to external stimuli rather than internal confusion. Pt is highly distractible and generally has difficulty in learning new information. Can manage self-care activities with assistance. Memory is impaired and verbalization is often inappropriate.
VI. Confused-Appropriate: Pt shows goal-directed behavior, but relies on cueing for direction. Can relearn old skills such as activities of daily living, but memory problems interfere with new learning. Has beginning awareness of self and others.
VII. Automatic-Appropriate: Pt goes through daily routine automatically, but is robot-like with appropriate behavior and minimal confusion. Has shallow recall of activities, and superficial awareness of, but lack of insight to, condition. Requires at least minimal supervision because judgment, problem solving, and planning skills are impaired.
VIII. Purposeful-Appropriate: Pt alert and oriented, and is able to recall and integrate past and recent events. Can learn new activities and continue in home and living skills, though deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.