Stages of Recovery

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

The length of time it takes for a child/young person to improve after a brain injury will differ depending upon each case. How long this recovery will take is probably the hardest question for the rehabilitation team to answer, especially in the early stages. Recovery is usually most rapid in the early weeks and months. An unconscious child/young person will rarely wake up all at once, as often suggested in movies. Rather, children/young people usually recover gradually.

The Ranchos Los Amigos Scale is a scale used to describe recovery after a brain injury. When children/young people recover from a brain injury, they may go through some or all of the stages. It is important to remember that the child/young person may show signs from more than one level at a time, or stop at a level in their recovery.

Stage 1 (No response)

• They appear to be in a deep sleep and don't respond to sounds or stimulation. This is referred to "coma".
• Whilst in coma, the brain is not functioning at the normal level. There is a limited ability to take in information or respond to light, sound or touch.

Stage 2 (Generalised Response)

• As the injured brain recovers, the child/young person will begin to react to loud noises or painful sensations by making noise or moving their arms or legs.
• This response may not happen frequently and they may still appear to be asleep for much of the time.

Stage 3 (Localised Response)

• The person may respond by moving away from uncomfortable procedures such as injections.
• They may turn towards sounds or try to watch people around them.
• The child/young person may respond to simple instructions such as "close your eyes".

Stage 4 (Confused - Agitated)

• Their behaviour is variable during this stage. They may be inactive or restless, loud or agitated. Though this can be distressing, it is important to remember that the child/young person cannot control this behaviour.
• The child/young person may be confused and try to wander. They may need close supervision during this time as they may not fully know where they are going.
• Their attention span is short and they may forget things that have happened to them.
• Although they are more aware of what is going on, they can't make sense of it all.

Stage 5 (Confused - Inappropriate)

• Children/young people are usually calmer at this stage and can do simple things for themselves.
• They may become agitated if they are over stimulated or asked to do something they are not able to do.
• They will start to talk more clearly but what they say might seem inappropriate.

Stage 6 (Confused - Appropriate)

• The child/young person may still be confused but start to behave more appropriately.
• They will start to show that they remember simple day-to-day things such as the names of staff.
• They may be able to work at tasks in therapy sessions for longer periods.

Stage 7 (Automatic - Appropriate)

• The child/young person is able to do normal activities with only a little help.
• They may be able to learn things but it may be slower and harder than before.
• The child/young person tires easily.

Stage 8 (Purposeful - Appropriate)

• They are able to recall past information and recent events.
• They may better understand what has happened to them and be upset.
• The child/young person may have changes in their thinking, concentration, memory and social skills compared to before the accident.

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/