II. Grading
- Score 1: Difficult or unable to arouse
- Score 2: Asleep but responds normally to verbal or physical contact
- Score 3: Drowsy, appears sedated
- Score 4: Quiet and awake (normal level of activity)
- Score 5: Signs of over activity (physical or verbal); calms down with instructions
- Score 6: Extremely or continuously active; does not require restraint
- Score 7: Violent Behavior requiring restraint