Figure 1.

Illustration on how to evaluate the pain response, an integral component of the NWT of unconscious patients unable to obey commands. Apply a steady pressure at the medial aspect of the periorbital rim, at the supraorbital notch (A), or preferably at the angle of the jaw (B). After the pain response has been noted, a peripheral pain stimulus is provided by compressing the fingertips with a pencil (C) and, e.g., a localization, withdrawal, flexion, or extension response can be recorded (52). Based on the response of the patient, the motor component of the Glasgow Coma Scale can then be evaluated. The pupillary response to light and the presence of anisocoria as well as any focal neurological deficits are also noted.