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What Are the 10 Traumatic Brain Injury Recovery Stages?

Traumatic brain injury recovery can be a long and difficult process. To offer an idea of what this process might look like, this article will cover all the major TBI recovery stages patients may experience.

We’ll also give you some tips on how to maximize your chances of getting through to the last stage.

Early Stages of Traumatic Brain Injury Recovery

According to the Rancho Los Amigos scale, there are ten stages in traumatic brain injury recovery that patients may typically progress through. These stages are based on the level of cognitive function that the person has attained.

It is important to note, however, that these stages offer only a general outline. Not every person will experience each stage in identical ways, and each patient will recover at a different pace.

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

Stage 1. Coma (No Response, Total Assistance)

coma is one of the first traumatic brain injury recovery stages

After a severe brain injury, your loved one may remain in a coma for some time. This is not always a negative sign. In fact, comas are considered the first stage in traumatic brain injury recovery, as they allow the brain to begin its healing process uninterrupted.

A coma is the deepest state of unconsciousness. When in a coma, a patient is observably 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 may progress to the next stage of recovery.

Stage 2. Vegetative State (Generalized Response, Total Assistance)

Many people often confuse comas and vegetative states with each other, but they are actually separate states of consciousness.

The primary difference between comas and vegetative states are the neurological responses the patient displays. In a coma, there are no responses at all. In a vegetative state, the person has regained some of their reflexes.

People in a vegetative state may sometimes seem awake. Their eyes might open and close, and they can even react to pain and loud noises. However, they are not yet truly conscious. Rather these reactions, which are often delayed, are caused by autonomic responses of the brain that are still intact or have begun to heal themselves.

If a person begins to react and communicate in a purposeful way, they have entered the next stage of recovery: the minimally conscious state.

Stage 3. Minimally Conscious State (Localized Response, Total Assistance)

doctors giving oxygen to man in minimally conscious state

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

At this stage, a doctor might prescribe medicines to help stimulate the brain to help the patient fully regain consciousness.

Once the patient consistently responds to instructions and can communicate verbally and/or nonverbally, they have reached the fourth stage of traumatic brain injury recovery.

Stage 4. Post-Traumatic Amnesia (Confused/Agitated, Maximal Assistance)

Post-traumatic amnesia refers to the stage after emerging from a coma when the brain is in a severe state of amnesia.

It involves both retrograde amnesia (the inability to remember past events) and anterograde amnesia (the inability 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.

During this stage, the person may appear erratic and even display aggressive or inappropriate behavior. That is because, immediately after emerging from a coma, the person loses their inhibition. This is especially the case after frontal lobe damage.

Post-traumatic amnesia is considered resolved once a person can consistently remember day-to-day events. After that, the doctors will 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

therapist helping traumatic brain injury patients relearn how to walk as part of the later stages of recovery

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

However, there are still six more recovery stages a person may pass through as they continue to heal from traumatic brain injury.

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

  • Stage 5 – Confused/Inappropriate: 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: Once a person reaches this stage of recovery, they can follow a strict schedule and complete daily routines on their own, but they still have problems initiating activities and planning ahead. They can not live independently.
  • Stage 8 – Purposeful/Appropriate: By stage 8, the patient’s self-awareness and memory will have 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 even live on their own with minimal help from others.
  • Stages 9 and 10 – Purposeful/Modified Independent: In these last stages, the person is functionally independent and has essentially made a full recovery. They can handle multiple tasks at once, initiate new tasks and plan ahead, and adjust to unexpected circumstances. Their cognition is still a little slower than most people. but they have learned how to compensate.

Unfortunately, not every traumatic brain injury survivor will progress through all of these recovery stages. Some severe TBI patients might stall at levels 7 or 8, or at any other level depending on their injury. However, there are methods to help encourage a fuller recovery from brain injury.

How to Progress Through the TBI Recovery Stages

The key to progressing through the ten brain injury recovery stages lies in activating neuroplasticity. This term refers to the brain’s ability to repair neural connections and reassign functions to other, undamaged portions of the brain. It is neuroplasticity that allows people to regain functions even after a devastating injury.

You can activate neuroplasticity through intensive, therapeutic activities and exercises. That explains why doctors encourage so much therapy in the early stages of recovery. Frequently, patients will participate in physical, occupational, and speech therapy to address multiple areas of recovery.

Want 25 pages of TBI recovery exercises in PDF form? Click here to download our free TBI Rehab Exercise ebook now (link opens a pop up for uninterrupted reading)

Even after you return home, it is critical to continue with regular therapy. If you struggle to remember your exercises, have your therapist write you a home exercise sheet to help you know and remember exactly how to do them. There are also home therapy devices, such as FitMi, which can walk you through common exercises in a more stimulating and engaging manner.

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

According to most experts, the bulk of brain injury recovery occurs within the first two years. After two years:

  • 90% of moderate to severe TBI patients lived in a private residence.
  • 50% of severe brain injury survivors could drive again, with some adaptations
  • 70% of severe TBI patients were functionally independent

However, if you do not achieve these milestones within two years, there is still hope. In fact, recent research shows that recovery may in fact continue past those first two years.

For example, a study that followed TBI patients for a decade found that even at the 10-year mark some patients were still improving their function.

Since recovery may continue, it’s crucial for survivors to persevere with therapy and other treatments.

Understanding 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 may look like.

We just have one final word of advice: If you feel stuck on a particular stage for a long time, do not give up. It’s common to experience plateaus during recovery, where it seems like you just aren’t making progress anymore.

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

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

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