Disability Rating Scale (DRS)
Assesses the level of cognitive ability in patients with traumatic brain injury, for disability and rehabilitation purposes.
In the text below the calculator there is more information on the score interpretation and on the original study.
The disability rating scale evaluates the status of cognitive function in patients who have suffered a traumatic brain injury.
The scale, also known as the Rappaport scale, aims to reflect the effect of injury on patient’s ability to perform daily activities.
DRS can also be used for monitoring recovery progress.
The answers to each of the 8 items in the scale are awarded a number of points which is then summed to obtain the final score which ranges from 0 to 29, where 0 indicates no cognitive dysfunction and 29 indicates extreme vegetative state.
The scores and their interpretations are presented in the following table.
| DRS | Level |
| 0 | None |
| 1 | Mild |
| 2 - 3 | Partial |
| 4 - 6 | Moderate |
| 7 - 11 | Moderately severe |
| 12 - 16 | Severe |
| 17 - 21 | Extremely severe |
| 22 - 24 | Vegetative state |
| 25 - 29 | Extreme vegetative state |
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The scale explained
This Disability Rating Scale (DRS) evaluates the level of disability and rehabilitation in terms of cognitive ability in patients with traumatic brain injury.
The 8-item questionnaire is also known as the Rappaport scale, after its creator. It is also a great monitoring tool for tracking rehabilitation progress.
The DRS consists of 8 items which are divided into 4 categories:
1. Arousal and awareness;
2. Cognitive ability to handle self-care functions;
3. Physical dependence upon others;
4. Psychosocial adaptability for work, housework, or school.
The following table introduces the items in the scale and the number of points awarded to each answer:
| DRS item | Answer choices (points) |
| 1a. Eye opening | Spontaneous (0) To speech (1) To pain (2) None (3) |
| 1b. Communication | Oriented (0) Confused (1) Inappropriate (2) Incomprehensible (3) None (4) |
| 1c. Motor response | Obeying (0) Localizing (1) Withdrawing (2) Flexing (3) Extending (4) None (5) |
| 2a. Feeding | Complete (0) Partial (1) Minimal (2) None (3) |
| 2b. Toileting | Complete (0) Partial (1) Minimal (2) None (30) |
| 2c. Grooming | Complete (0) Partial (1) Minimal (2) None (3) |
| 3. Dependance/ Level of functioning | Completely independent (0) Independent in special environment (1) Mildly dependent (2) Moderately dependent (3) Markedly dependent (4) Totally dependent (5) |
| 4. Psychosocial Adaptability/ Employability | Not restricted (0) Selected jobs (1) Sheltered workshop (non-competitive) (2) Not employable (3) |
The model was intended as a solution to the pitfalls of the Glasgow Outcome Scale.
Its initial use was only in the rehabilitation assessment for patients with TBI in an inpatient rehabilitation setting.
Currently, the scale is used to evaluate impairment and disability in the early stages of traumatic brain injury.
The scale is also renowned for its sensitivity in tracking behavioral disability.
Subsequent studies have shown a correlation between the scores obtained in DRS and hospitalization and rehabilitation of patients with acute brain dysfunctions.
One of the limitations of the scale consists in its high reported variability and the fact that its application might require training in some cases.
The scale might also be difficult to use when assessing mild to severe functional impairment.
Interpreting the DRS score
The score provided once the evaluation is performed offers information on the level of dysfunction the patient is under at the time of rating.
It is important to note that the below levels are only a clinical guideline and patient personal factors should also be taken in consideration.
The DRS results vary between 0 and 29, where the later means extreme vegetative state.
The interpretation for each score can be found in the table below:
| DRS | Level |
| 0 | None |
| 1 | Mild |
| 2 - 3 | Partial |
| 4 - 6 | Moderate |
| 7 - 11 | Moderately severe |
| 12 - 16 | Severe |
| 17 - 21 | Extremely severe |
| 22 - 24 | Vegetative state |
| 25 - 29 | Extreme vegetative state |
About the study
The DRS was created by Rappaport in 1982 as a tool that could overcome the poor precision of the Glasgow Outcome Scale.
Compared to the latter, the DRS is able to track progress of patient in time, not only straight after injury.
The application of the scale lasts below 30 minutes and in some cases, it can even be patient reported. The scale is usually applied in an inpatient rehabilitation setting.
During the initial study, the scale was completed by several independent raters for more than 88 serious head injury patients. It was found that inter-rater correlations were highly significant.
The admission DRS result was found to be significantly related to clinical outcome at 1 year after injury and significantly related to electrophysiological measures of brain dysfunction.
Original source
Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil. 1982; 63(3):118-23.
Other references
1. Eliason MR, Topp BW. Predictive validity of Rappaport's Disability Rating Scale in subjects with acute brain dysfunction. Phys Ther. 1984; 64(9):1357-60.
2. Ashley MJ, Persel CS, Clark MC, Krych DK. Long-term follow-up of post-acute traumatic brain injury rehabilitation: a statistical analysis to test for stability and predictability of outcome. Brain Inj. 1997; 11(9):677-90.
Specialty: Disability
System: Nervous
Objective: Evaluation
Type: Scale
No. Of Items: 8
Year Of Study: 1982
Abbreviation: DRS
Article By: Denise Nedea
Published On: April 18, 2017 · 10:31 AM
Last Checked: April 18, 2017
Next Review: April 18, 2023