Coma Recovery Scale Revised - For Accelerated Standardized Testing

(CRSR-FAST)

(Bodien, Y. G. & Giacino, J. T., 2023)

Administration and Scoring Manual

The CRS-R For Accelerated Standardized Testing (CRSR-FAST) was developed as an abbreviated version of the full-length CRS-R and specifically designed for the ICU/acute care setting.

The CRSR-FAST assesses only those CRS-R behaviors that differentiate conscious (MCS or emerged from MCS [eMCS]) from unconscious (coma or VS/UWS) patients.

Target Population

The CRSR-FAST was normed for patient with acute traumatic brain injury who were at least 18 years old and not consistently following-commands.

Descriptions

The assessment is composed of 5 items and 3 supplemental items which are scored as either “present” or “not present”

Testing Items

  1. Reproducible movement to command (+)

  2. Fixation/Visual pursuit (-)

  3. Automatic motor response (-)

  4. Localization to noxious stimulation (-)

  5. Intelligible expression (+)

Supplementary Testing Items

  1. Functional Object use *

  2. Functional: Accurate communication *

  3. Non-Functional: Intentional communication (+)

(+) MCS+; (-) MCS-; * eMCS

Testing Items

  • For Main Testing items

    • Hand Mirror

  • For Supplementary Testing Items

    • 2 common objects (i.e., cup, comb, toothbrush)

Scoring

Scoring is rated as either “conscious” or “not conscious”

Arousal Facilitation Protocol

  • Goal: prolong the length of time the patient maintains arousal

  • Protocol administered anytime: the eyes close and/or there is no response to verbal or tactile stimuli.

References

Bodien, Y. G., Vora, I., Barra, A., Chiang, K., Chatelle, C., Goostrey, K., Martens, G., Malone, C., Mello, J., Parlman, K., Ranford, J., Sterling, A., Waters, A. B., Hirschberg, R., Katz, D. I., Mazwi, N., Ni, P., Velmahos, G., Waak, K., … Giacino, J. T. (2023). Feasibility and validity of the Coma Recovery Scale‐Revised for accelerated standardized testing: A practical assessment tool for detecting consciousness in the intensive care unit. Annals of Neurology, 94(5), 919–924. https://doi.org/10.1002/ana.26740