The Glasgow Coma Scale Test is a test that is used to get an impression about the comateus patient. It is a test that uses the movements of the Eye, the body Movements and the Verbal movements to give awareness points.

It is also called EMV-test. Movements of the eye give maximum 4 points, the movements of arm and leg maximum 6 points and the voice maximum 5 points.

It is the question how objective this test is to measure the awareness of a patient in coma. Maybe we would better first determine what a "patient in coma" is?

When a patient in coma is someone that can not move visibly, it is not possible to get any visible reaction to measure the awareness of the patient.

The Coma Science Group has proved scientifically that patients that are in coma and can not move visibly, have brainactivity that fit to the asked movement. This is the cause that it now is known that the patient in coma has mental activity and that looks like that patient in coma is more aware than had been thought.

A patient that had a CVA two weeks before, could not open her eyes since. She was on the Intensive Care Unit and was observed by machines.

The doctors asked the son to get permission to take off these machines so the woman would die. The son did not give this permission so short after the accident. He had been patient in coma the year before and it had taken longer for him to come out of the coma again.

He asked for help to move his mother. She was tied to the sides of the bed with her wrists so there was only little movement possible. A nurse entered with an electrical light and shined with it in the eye that she opened with power. She answered on the question why the wrists of the woman were fastened to the bed, that it was to prevent that the woman would pull the tubes.

There was a document of the woman that she had made to make clear that she did not want to be kept alive with machines, but being in coma and on the machines, taking her off them was seen as death help.

By turning the hands and bowing the elbows (as far as the fixation permited), activity of the woman was felt during these movements and, after both arms were moved, the son saw that the eyes of his mother opened spontaneously a little.

	GLASGOW COMA SCALE TEST   min. 3 points - max. 15 points
Number points	Eye	Movement	Verbal - Sound
6	-	Simple order is carried out	-
5	-	Other hand goes to pain stimulus (over center body	Aware of one self, knows what, who, where
4	Eyes open spontaneously	Averting movement at pain stimulus, evtl. retraction	Confused - signs of desorientation and confusion
3	Eyes open when asked for	Bendingaction: typical spasmodic bending (legs mostly stretched)	Unadapted -understandable words - no sentences
2	Eyes open at pain stimulus	Stretching arms (exorotation hands)	Unintelligible sounds (graoning, moaning)
1	Eyes keep closed	No reaction on pain stimulus	Absence, no verbal reaction

These simple movements caused a change of the E-score of 1 to 4 (no movement changes into spontaneous opening eyes)? 1 is the score that is given when the eyes stay closed. 2 if the eyes open when a pain stimulus is given and 3 if the eyes open when spoken to and 4 when the eyes open spontaneously.

It is not likely that these simple movements with the arms would cause an enormous change of awareness. It is more likely that the test is not suitable to measure the awareness.

In the Glasgow Coma Scale Test painful stimuli are used and, if they do not give a visible or hearable reaction, it is thought that the patient has no awareness. How come, that this is the case? Isn't it true that there are hardly any people that, if they feel pain, show this?

"A man should not cry" and a woman neither. In the streets it is no longer allowed to hiss, but you can get a penalty for it and beating back or protesting if someone hurts you, can cost your life.

A lot of people that are not patient in coma, have placed their pain border higher so they will not react with a movement, eyemovement or sound on a pain stimulus.

Because the patient in coma CANNOT move visibly, he CAN NOT react with a movement or sound on pain stimuli. If we imagine being in shock (the state the patient in coma is in), we know we are hyper sensitive.

A lot of people live with a partly shock. They can nor bear intense light, loud sounds, a big crowd, small places like elevators a.s.o. The patient in coma is, because he can not move visibly, in life danger and this life danger must be taken away by making it possible for the patient to move.

"Move" can the patient not without help. This help must FEEL what movements that are made with the patient are easy to make and give a nice feeling. That are the movements that are moving stimulating for the patient.

By preventing that the patient is hurt, the patient will stay in his body and if the body awareness is stimulated, without hurting the patient, he will rejoice the handling that is done with him and this will stimulate his healing.