Disability grade

Clinical symptoms

Extreme

10 points

Severe

9 points

Moderate

8 or 7 points

Mild

5 points

Slight

0 points

1. Voluntary movement

1) Absent 2) Acrocontracture 3) Pain reflex but slight trembling and rough breathing

1) Almost absent but parts of the extremities move minutely

2) Part of the extremity flexed and part paralyzed 3) Pain reflex or no pain reflex with clearly frowning face

1) Occasional all/partial extremity movement with no intention 2) Extremity could be paretic 3) Brushing away reaction for pain (7 points when good)

1) Occasional movement to meet an object 2) Capable of raising the arms upward or moving them in the intended direction, that is, face or head, imitating a posture of the investigator

1) Capable of movement with intention

2) Capable of unassisted posture change (partial change inclusive) 3) Moving wheelchair unassisted, even if awkwardly

2. Voluntary Ingestion

Totally incapable of masticating and swallowing; on tube nutrition (gastric/nasal feeding)

1) Almost on tube nutrition 2) Saliva swallowing or mastication is found 3) Capable of attempting slight perusal ingestion, that is, fruit juice, custard pudding, and so forth

1) Capable of masticating; even if not, almost capable of assisted auroral ingestion by swallowing, though sometimes choking 2) Insufficient peroral ingestion requires tube nutrition, (7 points if relatively accomplished)

1) Capable of unassisted ingestion by swallowing; mastication could be awkward

2) Capable of ingesting all the rice gruel served or chopped food with assistance

3) Attempting to reach mouth with a passed spoon or put the food into mouth awkwardly

Ingesting unassisted using spoon awkwardly

3. Incontinence

No observed somatic movement when evacuating/ urinating

Slight somatic movement when evacuating/urinating

After incontinence, a displeased look or some signal is observed, that is, frequent somatic movement. (7 points if relatively clear.)

1) Forced regular evacuating and urinating lead to the prevention of fecal and urinary incontinence 2) Communicating the fact in a certain way after incontinence

Except during the night, preevacuation and preurination communication is possible

4. Following with eyes and visual recognition

1) Eyes not opened 2) Eyes opened, no blink reflex

1) Eyes opened, blink reflex

2) No following ocular movement and no focusing eyes on an object

1) Looking straight toward the direction of the call

2) Following a moving object or staring at a TV, although understanding is impossible (7 points for rapid direct gaze)

1) Discriminating close relatives followed by a facial expression

1) Capable of reading easy words

2) Capable of understanding simple numbers

3) When watching TV, response and laughter are apparent

5. Meaningful speech

1) No vocalization 2) No lip movement under tracheostomy

1) Groaning without meaningful utterances 2) Lip movement observed under tracheostomy

1) A short utterance though not understandable (7 points if relatively clear)

2) Occasional inarticulate vocal response to calls (7 points if relatively clear)

3) Under tracheostomy, response to calls is through lip movement (7 points if relatively clear)

1) Occasional vocalizing of a meaningful word

2) Vocal response to calls

3) Imitating talking by the tester under tracheostomy

1) Capable of vocalizing a simple word response

2) Lip movement corresponds to what is asked

6. Follows simple directions and communicative

No reaction to being called (commands)

Some reaction to being called. Body movement, eye movement.

Can respond to calls, but communication not possible. (7 Points for clear response)

Responds to simple calls, communication at times

Responds well to calls, communication almost always possible

7. Facial expression changes

No response to ambient sound stimulations and TV sounds, among other things

Change of expression, such as smiling, crying, and anger, is not due to ambient stimulations

Change of expression is occasionally found in response to ambient stimulations (7 points for relatively clear change)

Change of expression, such as smiling, crying, and anger, closely matches an expected response to the ambient stimulation

Change of expression, such as crying and smiling, exactly matches an expected response to the ambient stimulation