Moderate to Severe TBI
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Recovery and Outcome from Acquired Brain Injury
RECOVERY
Recovery after ABI can be broken down into four stages, each representing a step in the recovery process for the brain-injured child. Understanding where a child is in the recovery process helps in planning appropriate treatment and care. As recovery progresses, the child will move from one stage to the next.
Stage I: Acute Medical, Pre-Neurorehabilitation Phase
- No or minimal level of response to the environment
- Child may be comatose or semi-comatose
- Acute or subacute medical problems
- May be in ICU
- Preparation for formal neurorehabilitation begins
- This stage is analogous to Rancho Level I.
Stage II: Early Stages of Recovery
- Child may begin to show generalized or localized responses to environment
- Inconsistent arousal, attention and behavior
- Formal neurorehabilitation efforts begin now, including formulating an initial treatment plan with the child's parents and school (when applicable).
- This stage is analogous to Rancho Levels II and III.
Stage III: Middle Stages of Recovery
- Confusion predominates the clinical picture.
- Child may be agitated, inappropriate or just confused
- Disorientation, difficulty learning new information and "language of confusion" are present.
- Child remains structure-dependent
- Neurorehabilitation efforts intensify.
- Medical status is likely stable
- Formal discharge planning begins.
- This middle stage is analogous to Rancho Levels IV, V and VI.
Stage IV: Late Stages of Recovery
- Child begins to display more automatic and purposeful behaviors
- Orientation is consistent, and the ability to learn new information is more reliable.
- As awareness increases, the child may begin to show a psychological or behavioral response to their situation.
- Impulsivity and impaired problem-solving and judgement may be observed in non-structured situations.
- Educational team reconvenes with neurorehabilitation team
- Home visits and discharge planning commence.
- This stage is analogous with Rancho Levels VII and VIII.