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Home› Physical Therapy› Free Self-Checks› Disability Rating Scale (DRS)

Disability Rating Scale (DRS)

8 clinician-rated items for brain injury, from coma to community. Total 0 to 29.

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Reviewed by Dr. Richard Holsman, PT, DPT, NCS · Last reviewed November 14, 2026 · For clinicians

The Disability Rating Scale (DRS) was developed by Rappaport and colleagues in 1982 to track people with moderate and severe traumatic brain injury “from coma to community.” Its 8 items cover arousal and awareness, cognitive ability for self-care, dependence on others, and “employability.” The total runs from 0 (no disability) to 29 (extreme vegetative state).

⚠️ For clinicians. Not a self-check.

  • The DRS is rated by a clinician from observation, an interview with the patient or family, or the medical record.
  • Ratings should not be made while the person is under the influence of anesthesia or other mind-altering drugs, or soon after a seizure.
  • Feeding, toileting and grooming are rated on cognitive ability only (knowing how and when), not physical ability.

Instructions

Choose one rating for each of the 8 items. Open “Rating definitions” under an item to see the full wording. If in doubt, COMBI advises giving the patient the benefit of the doubt. Use whole-number ratings only (COMBI no longer recommends 0.5 ratings).

A. Eye opening
Rating definitions
0 – Spontaneous
Eyes open with sleep/wake rhythms indicating active and arousal mechanisms; does not assume awareness.
1 – To speech and/or sensory stimulation
A response to any verbal approach, whether spoken or shouted, not necessarily the command to open the eyes. Also, response to touch, mild pressure.
2 – To pain
Tested by a painful stimulus.
3 – None
No eye opening even to painful stimulation.
B. Best communication ability
Rating definitions
0 – Oriented
Implies awareness of self and the environment. Patient able to tell you a) who he is; b) where he is; c) why he is there; d) year; e) season; f) month; g) day; h) time of day.
1 – Confused
Attention can be held and patient responds to questions but responses are delayed and/or indicate varying degrees of disorientation and confusion.
2 – Inappropriate
Intelligible articulation but speech is used only in an exclamatory or random way (such as shouting and swearing); no sustained communication exchange is possible.
3 – Incomprehensible
Moaning, groaning or sounds without recognizable words; no consistent communication signs.
4 – None
No sounds or communication signs from patient.
C. Best motor response
Rating definitions
0 – Obeying
Obeying command to move finger on best side. If no response or not suitable try another command such as “move lips,” “blink eyes,” etc. Do not include grasp or other reflex responses.
1 – Localizing
A painful stimulus at more than one site causes a limb to move (even slightly) in an attempt to remove it. It is a deliberate motor act to move away from or remove the source of noxious stimulation. If there is doubt as to whether withdrawal or localization has occurred after 3 or 4 painful stimulations, rate as localization.
2 – Withdrawing
Any generalized movement away from a noxious stimulus that is more than a simple reflex response.
3 – Flexing
Painful stimulation results in either flexion at the elbow, rapid withdrawal with abduction of the shoulder or a slow withdrawal with adduction of the shoulder. If there is confusion between flexing and withdrawing, then use pin prick on hands, then face.
4 – Extending
Painful stimulation results in extension of the limb.
5 – None
No response can be elicited. Usually associated with hypotonia. Exclude spinal transection as an explanation of lack of response; be satisfied that an adequate stimulus has been applied.
D. Cognitive ability for feeding (cognitive ability only)

Does the patient show awareness of how and when to perform this activity? Ignore motor disabilities that interfere with carrying out this function (this is rated under Level of Functioning).

Rating definitions
0 – Complete
Continuously shows awareness that he knows how to feed and can convey unambiguous information that he knows when this activity should occur.
1 – Partial
Intermittently shows awareness that he knows how to feed and/or can intermittently convey reasonably clearly information that he knows when the activity should occur.
2 – Minimal
Shows questionable or infrequent awareness that he knows in a primitive way how to feed and/or shows infrequently by certain signs, sounds, or activities that he is vaguely aware when the activity should occur.
3 – None
Shows virtually no awareness at any time that he knows how to feed and cannot convey information by signs, sounds, or activity that he knows when the activity should occur.
E. Cognitive ability for toileting (cognitive ability only)

Does the patient show awareness of how and when to perform this activity? Ignore motor disabilities that interfere with carrying out this function (this is rated under Level of Functioning). Rate best response for toileting based on bowel and bladder behavior.

Rating definitions
0 – Complete
Continuously shows awareness that he knows how to toilet and can convey unambiguous information that he knows when this activity should occur.
1 – Partial
Intermittently shows awareness that he knows how to toilet and/or can intermittently convey reasonably clearly information that he knows when the activity should occur.
2 – Minimal
Shows questionable or infrequent awareness that he knows in a primitive way how to toilet and/or shows infrequently by certain signs, sounds, or activities that he is vaguely aware when the activity should occur.
3 – None
Shows virtually no awareness at any time that he knows how to toilet and cannot convey information by signs, sounds, or activity that he knows when the activity should occur.
F. Cognitive ability for grooming (cognitive ability only)

Does the patient show awareness of how and when to perform this activity? Ignore motor disabilities that interfere with carrying out this function (this is rated under Level of Functioning). Grooming refers to bathing, washing, brushing of teeth, shaving, combing or brushing of hair and dressing.

Rating definitions
0 – Complete
Continuously shows awareness that he knows how to groom self and can convey unambiguous information that he knows when this activity should occur.
1 – Partial
Intermittently shows awareness that he knows how to groom self and/or can intermittently convey reasonably clearly information that he knows when the activity should occur.
2 – Minimal
Shows questionable or infrequent awareness that he knows in a primitive way how to groom self and/or shows infrequently by certain signs, sounds, or activities that he is vaguely aware when the activity should occur.
3 – None
Shows virtually no awareness at any time that he knows how to groom self and cannot convey information by signs, sounds, or activity that he knows when the activity should occur.
G. Level of functioning (physical, mental, emotional or social function)
Rating definitions
0 – Completely independent
Able to live as he wishes, requiring no restriction due to physical, mental, emotional or social problems.
1 – Independent in special environment
Capable of functioning independently when needed requirements are met (mechanical aids).
2 – Mildly dependent
Able to care for most of own needs but requires limited assistance due to physical, cognitive and/or emotional problems (e.g. needs non-resident helper).
3 – Moderately dependent
Able to care for self partially but needs another person at all times.
4 – Markedly dependent
Needs help with all major activities and the assistance of another person at all times.
5 – Totally dependent
Not able to assist in own care and requires 24-hour nursing care.
H. “Employability” (as a full time worker, homemaker, or student)

The psychosocial adaptability or “employability” item takes into account overall cognitive and physical ability to be an employee, homemaker or student.

Rating definitions
0 – Not restricted
Can compete in the open market for a relatively wide range of jobs commensurate with existing skills; or can initiate, plan, execute and assume responsibilities associated with homemaking; or can understand and carry out most age relevant school assignments.
1 – Selected jobs, competitive
Can compete in a limited job market for a relatively narrow range of jobs because of limitations of the type described above and/or because of some physical limitations; or can initiate, plan, execute and assume many but not all responsibilities associated with homemaking; or can understand and carry out many but not all school assignments.
2 – Sheltered workshop, non-competitive
Cannot compete successfully in job market because of limitations described above and/or because of moderate or severe physical limitations; or cannot without major assistance initiate, plan, execute and assume responsibilities for homemaking; or cannot understand and carry out even relatively simple school assignments without assistance.
3 – Not employable
Completely unemployable because of extreme psychosocial limitations of the type described above; or completely unable to initiate, plan, execute and assume any responsibilities associated with homemaking; or cannot understand or carry out any school assignments.

Running total: 0 / 29 (0 of 8 items rated)

This is a clinical rating, not a diagnosis or prognosis. DRS totals describe the level of disability at the time of rating and should be read with the full clinical picture.

For patients and families

After a brain injury, the care team uses scales like this to describe progress over time. Your therapist can explain what the ratings mean for your family member. If you or a family member would like help from a physical therapist, request an appointment with Holsman Physical Therapy or call 1-855-465-7626.

How it is scored

  • Add the 8 ratings. Eye opening is 0–3, communication 0–4, motor response 0–5, feeding, toileting and grooming 0–3 each, level of functioning 0–5 and employability 0–3.
  • The total runs from 0 (no disability) to 29 (extreme vegetative state). Higher scores mean more disability. In the original scale, 30 represented death.
  • The first three items are a slight modification of the Glasgow Coma Scale, scored so that higher numbers mean worse function.

Disability categories

DRS totalLevel of disability
0None
1Mild
2–3Partial
4–6Moderate
7–11Moderately severe
12–16Severe
17–21Extremely severe
22–24Vegetative state
25–29Extreme vegetative state

COMBI notes that these categories “were not based on any statistical analysis of scaling” and were provided to help with clinical description; research should use the summed score. The labels are the scale’s original wording.

Measurement properties

  • Inter-rater reliability: Pearson correlations of 0.97–0.98 among three raters in 88 inpatients with TBI (Rappaport et al., 1982), and Spearman rho of 0.98 in a separate study (Gouvier et al., 1987), as summarized by COMBI.
  • Test-retest reliability: Spearman rho 0.95 (Gouvier et al., 1987, as summarized by COMBI).
  • Limits: the DRS is relatively insensitive at the mild end of the scale, and COMBI does not recommend it for rating people with mild brain injury.

Related tools for later stages of recovery: High-Level Mobility Assessment Tool (HiMAT) · Modified Ashworth Scale.

Sources. 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):118-123. Wright J. The Disability Rating Scale. The Center for Outcome Measurement in Brain Injury (COMBI), 2000 (syllabus, rating form, FAQ and properties pages). Shirley Ryan AbilityLab, Rehabilitation Measures Database: Disability Rating Scale. It is one of the measures reviewed in the Academy of Neurologic Physical Therapy (ANPT) TBI EDGE outcome measure recommendations; see neuropt.org for the task force’s recommendations.

Permissions. Per the Center for Outcome Measurement in Brain Injury (COMBI), “There is no charge for using the DRS. It can be copied freely.” Item wording follows the COMBI DRS syllabus and rating form.

Clinically reviewed by Dr. Richard Holsman, PT, DPT, NCS. Last reviewed: November 14, 2026. Holsman Physical Therapy is not affiliated with these authors, organizations or journals, and they do not endorse this website.

Common Questions

What is the Disability Rating Scale?

The Disability Rating Scale (DRS) is an 8-item clinician rating developed by Rappaport and colleagues in 1982 for people with moderate and severe traumatic brain injury. It covers eye opening, communication, motor response, cognitive ability for feeding, toileting and grooming, level of functioning, and employability.

How is the DRS scored?

The 8 item ratings are added for a total from 0 to 29. A score of 0 means no disability and 29 means extreme vegetative state; higher scores mean more disability.

What do the DRS categories mean?

COMBI lists categories from None (0) through Mild (1), Partial (2-3), Moderate (4-6), Moderately severe (7-11), Severe (12-16), Extremely severe (17-21), Vegetative state (22-24) and Extreme vegetative state (25-29). They were not derived statistically and are meant only to help describe the level of disability.

Can the DRS be used for mild brain injury?

COMBI does not recommend it for mild brain injury because the scale is relatively insensitive at the mild end.

Is my information saved?

No. Everything runs in your web browser. Nothing is sent to us or stored.

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