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What Are the 10 Traumatic Brain Injury Recovery Stages?

These are the factors that affect recovery from coma after brain injury

Traumatic brain injury recovery is a long and difficult process with many stages.

To help you get an idea of what this process might look like, today we’re covering all the major traumatic brain injury recovery stages.

We’ll also give you some tips on how to make sure you can progress all the way through to the last stage and regain your independence.

Let’s dive in.

Early Stages of Traumatic Brain Injury Recovery

Before we get started, we want to remind you that the stages of recovery we’ll look at today are only general categories. Not every person will experience them, and everyone will recover at a different pace.

With that said, here are the four stages of recovery that a person may experience during the first few weeks after their traumatic brain injury.

Stage 1. Coma

coma is one of the first traumatic brain injury recovery stages

The initial stage after a severe brain injury is a coma.

A coma is the deepest state of unconsciousness. When someone is in a coma, they are unresponsive to their environment and cannot wake up, even when stimulated.

The defining characteristics of a coma are:

  • No eye movement or opening
  • Lack of speech or other forms of communication
  • No purposeful movement

Most comas only last for a couple of weeks. After that, patients will usually progress to the next stage of recovery.

Stage 2. Vegetative State

Many people often confuse comas and vegetative states with each other, but they are very different.

The main difference between comas and vegetative states are the responses the patient displays. In a coma, there are no responses at all. In a vegetative state, there are some.

People in a vegetative state may sometimes seem awake. Their eyes open and close, and they might even react to pain and loud noises, but they are not actually conscious.

Rather, these reactions are caused by autonomic responses of the brain that are still intact or have begun to heal themselves.

If a person reacts and communicates in a purposeful way, they have entered the next stage of recovery: the minimally conscious state.

Stage 3. Minimally Conscious State

minimally conscious state is one step away from fully waking up from a coma after brain injury

When in the minimally conscious state, a person may drift in and out of consciousness, but unlike the vegetative state, they now have a reduced sense of awareness of the world around them.

At this stage, a doctor might prescribe medicines to help stimulate the brain to help the person fully wake up.

Once the patient consistently responds to instructions and can communicate, they have reached the final stage of initial recovery from brain injury.

Stage 4. Post-Traumatic Amnesia

post-traumatic amnesia is one of the traumatic brain injury recovery stages

Post-traumatic amnesia refers to the stage after emerging from a coma when the brain can’t form any new short-term memories.

It involves both retrograde amnesia (memory of past events) and anterograde amnesia (the ability to form new memories).

In other words, the person has no memory of where they are or how they got there, and they have no memory of day-to-day events.

Even though they can’t remember anything at this stage, this doesn’t mean they can’t benefit from therapy.

In fact, people in this state can often relearn basic skills like walking without even remembering they learned them! (this is called procedural or implicit memory.)

Post-traumatic amnesia is considered resolved once a person can consistently remember day-to-day events.

After that, the doctors usually send the person to a rehab facility or back home, which is when the real work of recovery begins.

Later Stages of Traumatic Brain Injury

The initial four stages of recovery usually only take a few months to pass through.

According to one very popular brain injury recovery scale, there are six more stages a person will pass through as they continue to recover from TBI.

Below is a brief summary of the last six stages of brain injury recovery.

Stage 5 – Confused/inappropriate.

confusion is a normal part of this brain injury recovery stage

In this stage, a person has trouble focusing and is still confused by their surroundings.

Their responses to questions and commands are inaccurate and don’t make much sense.

Stage 6 – Confused/appropriate.

At this stage, the person can follow commands and carry on a short conversation, though they still have memory problems and cannot focus very well.

Stage 7 – Automatic/appropriate.

at this stage the person still has cognitive issues but is able to cope better

Once a person reaches this stage of recovery, they can follow a strict schedule on their own, but they still have problems initiating activities and planning ahead. They can not live independently.

Their judgments and reactions are still significantly impaired, though. They are not aware of their deficits and do not react well to a sudden change of plans.

Stage 8 – Purposeful/appropriate.

Here a patient’s self-awareness and memory has greatly improved.

They still have impairments with social interaction and reaction times, and are troubled by unexpected situations, but are developing ways to cope. They can live on their own with minimal help.

Stages 9 and 10 – Purposeful/modified independent.

the final stage of brain injury recovery is when you regain your independence

In these last stages, the person is functionally independent.

They can handle multiple tasks at once, initiate new tasks and plan ahead, and adjust to unexpected circumstances. Their thinking is still a little slower than most people. but they have learned how to compensate.

Again, not every person will progress through all of these stages. Some people will halt at a certain level, and some will not perfectly fit into one particular level or another.

But while the Rancho Cognitive Function Scale is not a blueprint that describes every brain injury recovery, it is still helpful for assessing how far you are on your journey. It also gives you a general idea of the major milestones that you must achieve to fully recover.

How to Progress Through the TBI Recovery Stages

progress tips for tbi recovery

Now that you know the different stages you’ll pass through on your recover from brain injury, you probably have a question to ask:

How do I progress to stage 10 and reach normal function again?

This is a great question!

The best way to progress through the traumatic brain injury recovery stages is through massed practice of therapeutic movements and cognitive rehab exercises.

High repetition activates neuroplasticity, which is a mechanism your brain uses to rewire itself and form new neural pathways.

This means the more you practice and activity, the more you will reinforce those neural pathways, and the easier that activity will become!

How Long Will It Take to Reach the Last Recovery Stage?

While every brain injury is different, how long your recovery lasts will mainly depend on how severe your injury is.

In general, the more severe your TBI is, the longer it will take to recover.

With that said, here are a few more facts to keep in mind:

  • Most TBI patients who persevere with therapy will regain significant function after 2 years.
  • With consistent therapy, most TBI patients will regain the ability to walk within 6 months.
  • The more rigorous your therapy program, the faster your recovery will be.

Traumatic Brain Injury Recovery Stages

successful progress through traumatic brain injury recovery stages

Hopefully, this guide to traumatic brain injury recovery stages has helped you get an idea of what your recovery journey will look like.

We just have one final word of advice:

If you feel like you have been stuck on a particular stage for a long time, do not give up!

It’s normal to hit plateaus during recovery, where it seems like you just aren’t making progress anymore.

But the key thing to remember is that plateaus are only temporary. If you persevere with your therapy, eventually you will begin to make progress again and reach those higher stages.

And with that, we wish you the best of luck on your traumatic brain injury recovery journey.

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