Contact Dr. Linda Isaac, PhD
Director, Rehabilitation Research Center
Santa Clara Valley Medical Center
Assistant Professor (Affiliated)
Stanford University, School of Medicine
Department of Orthopedic Surgery
Citation Isaac, . (2000). The
Glasgow Outcome Scale. The Center for Outcome Measurement
in Brain Injury. http://www.tbims.org/
combi/gos ( accessed
This citation is for the COMBI web material. Dr. Isaac is
not the scale author for the GOS.
Unable to interact with environment; unresponsive
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
Able to follow commands/ unable to live independently
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."
Able to live independently; unable to return to work or school
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.
Able to return to work or school
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.
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.