GCS SCORING & DEEP TENDON, SUPERFICIAL REFLEXES

1. GLASSGOW COMA SCALE
&
REFLEXES
Sudeshna Banerjee
M.Sc (N) 2nd year
HFCON

2. Definition:
A neurological scale that aims to give a reliable,
objective way of recording the conscious state of a
person for initial as well as subsequent assessment.

4. SPONTANEOUS eye opening : Useful as a reflection of the
intensity of impairment of activating functions.
• It indicates arousal mechanisms brain stems are active
Eye opening in response TO SPEECH
• It is sought by speaking or shouting at the patient.
• Any sufficiently loud sound can be used, not necessarily a
command to open the eyes.

5. Eye opening response TO PAIN
• It is assessed if the person is not opening their eyes to
sound.
• The stimulus should be pressure on the bed of a finger
nail.
An ABSENCE of eye opening
• It implies substantial impairment of brain stem arousal
mechanisms.
• Substantial effort should be made earlier to ensure that
this is not due to an inadequate stimulation.

6. VERBAL RESPONSE
Orientation
• It is the highest level of response and implies awareness of
self and environment.
• The person should be able to provide answers to at least
three questions,
1. who they are
2. where they are
3. the date – at least in terms of the year the month and
day of the week.

7. Confused Conversation
• It is recorded if the patient engages in conversation but is
unable to provide any of the foregoing three points of
information.
• The key factor is that the person can produce appropriate
phrases or sentences.

8. Inappropriate Speech
• It is assigned if the person produces only one or two words,
in an exclamatory way, often swearing.
• It is commonly produced by stimulation and does not result
in sustained conversation exchange.
Incomprehensible Sounds
• It is consist of moaning and groaning but without any
recognizable words.
• It is commonly produced by stimulation and does not result
in sustained conversation exchange.

9. No Verbal Response
• No verbal response upon pain stimulus.
• Substantial effort should be made earlier to ensure
that this is not due to an inadequate stimulation.

10. MOTOR RESPONSES
Obeying Commands :
• The assessment of motor responsiveness becomes
important in a person not conversing to at least a
confused level Obeying Commands
• It is the best response possible.
• Confirmation of the specificity of the response by
squeezing and releasing the fingers or holding up
the arms or other movement elicited by verbal
command.

11. Moves to localized pain:
• It is done with the application of pressure on the
supraorbital notch.
• Localizing should be recorded only if the person’s hand
reaches above the clavicle in an attempt to remove the
stimulus.
• If in doubt, stimulation can be applied to more than one
site to ensure that the hand attempts to remove it.

12. Withdrawal Response
• It is recorded if the elbow bends away from pain
stimulus but the movement is not sufficient to
achieve localization
An Abnormal Flexion Response (Decorticate)
• It is recorded if the elbow bends in decorticate
posturing and the movement is not sufficient to
achieve localization

13. An Extension Response (Decerebrate)
• It is recorded if the elbow only straightens and the
movement should not sufficient to achieve localization.
Absence of Motor Response.
• It is recorded if no limb movement upon pain stimulus.

14. REFLEXES
A reflex is a motor response to a sensory input. Reflexes have
three components.
There is a sensory component, which may consist of only one
sensory input or multiple inputs.
There is an integrative CNS component that processes the
sensory component and “decides” whether it is strong enough
to warrant a motor response.
Finally the motor component executes the response.

15. The 3 components together constitute a “reflex arc”.
Reflexes are mediated by lower areas of the brain or by the
spinal cord, so that they happen without conscious thought.
Reflexes may be:-
 Inborn (Intrinsic) or Learned (Acquired)
 Involve only Peripheral Nerves & Spinal Cord
 Involve Higher Brain Centers as Well

16. Deep tendon reflexes
 Biceps reflex

17.  Triceps reflex

18.  Brachioradialis Reflex

19.  Patellar reflex

20.  Achilles reflex

21. Superficial reflexes
 Abdominal reflex

22.  Cremasteric reflex

23.  Babinski’s reflex

24.  Corneal reflex
 Gag reflex