Measurement Characteristics and Clinical Utility of the Coma Recovery Scale-Revised Among Individuals With Acquired Brain Injury

      The Coma Recovery Scale-Revised1 (CRS-R; 23 items) requires common items and straightforward instructions from the CRS-R manual ( to administer the 25-minute test. The CRS-R is a clinical measure for adults with disorders of consciousness (DOC) from acquired brain injury. It was first developed as the JFK Coma Recovery Scale in 1991,2 but feedback from users of the scale and Rasch analysis led to revision.1 Standardized sensory stimuli including visual, motor, auditory, oromotor, and communication domains are tested, with responses consistent with coma, vegetative state, minimally conscious state, or emergence from the minimally conscious state. The standard approach of the CRS-R reduces the likelihood of DOC misdiagnosis.1,3,4
      CRS-R items demonstrate excellent content validity.5 Total scores demonstrate excellent internal consistency and interrater and test-retest reliability.1,3 Validity of the CRS-R is good, with expected relationships shown with the Glasgow Coma Scale6 and the Disability Rating Scale.1,3 Experience in working with patients with DOC increases reliable interpretation of results,3 but the use of the CRS-R by a range of health professionals is appropriate. Of the measures recommended by the American Congress of Rehabilitation DOC Task Force, the CRS-R was the only one recommended with minor reservations,5 and is the only measure that attends to all aspects of the Aspen Workgroup Criteria.7
      A full review of the CRS-R and reviews of nearly 200 other instruments can be found at
      Please address correspondence to [email protected] .
      • 1.
        Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 2004;85:2020-9.
      • 2.
        Giacino JT, Kezmarsky MA, DeLuca J, Cicerone KD. Monitoring rate of recovery to predict outcome in minimally responsive patients. Arch Phys Med Rehabil 1991;72:897-901.
      • 3.
        Lovstad M, Frøslie KF, Giacino JT, Skandsen T, Anke A, Schanke AK. Reliability and diagnostic characteristics of the JFK Coma Recovery Scale-Revised: exploring the influence of rater's level of experience. J Head Trauma Rehabil 2010;25:349-56.
      • 4.
        Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 2009;9:35.
      • 5.
        Seel RT, for the American Congress of Rehabilitation Medicine, Brain Injury–Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil 2010;91:1795-813.
      • 6.
        Schnakers C, Majerus S, Giacino J, et al. A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 2008;22:786-92.
      • 7.
        Giacino J, Whyte J. The vegetative and minimally conscious states: current knowledge and remaining questions. J Head Trauma Rehabil 2005;20:30-50.
      This instrument summary is designed to facilitate the selection of outcome measures by trained clinicians. The information contained in this summary represents a sample of the peer-reviewed research available at the time of this summary's publication. The information contained in this summary does not constitute an endorsement of this instrument for clinical practice. The views expressed are those of the summary authors and do not represent those of authors' employers, instrument owner(s), the Archives of Physical Medicine and Rehabilitation, the Rehabilitation Measures Database, the United States Department of Education, or the Retirement Research Foundation. The information contained in this summary has not been reviewed externally.
      The Rehabilitation Measures Database and Instrument Summary Tear-sheets are funded by the National Institute on Disability and Rehabilitation Research, United States Department of Education through the Rehabilitation Research and Training Center on Improving Measurement of Medical Rehabilitation Outcomes (grant no. H133B09OO24) and the Retirement Research Foundation (grant no. 2011-027).