1. Death
Severe injury or death without recovery of consciousness
2. Persistent vegetative state
Severe damage with prolonged state of unresponsiveness and a lack of higher mental functions
3. Severe disability
Severe injury with permanent help with daily living
4. Moderate disability
No need for assistance in everyday life; employment is possible but may require special equipment
5. Low disability
Light damage with minor neurological and psychological deficits
The Rancho Los Amigos Scale of Cognitive Functioning, developed in a rehabilitation centre of the same name in California, is a graded scale, assessing TBI patients with closed injury, on a score of 1–10, based on cognition and behaviour. This can be used in combination with the OBR assessment tools and also assists the family members to understand the stages of recovery in TBI.
In general terms, following trauma, most patients admitted to an acute rehabilitation facility will be dependent for all or some of their needs. The goal of physical rehabilitation is to maximise independence for each patient in terms of activities of daily living (ADLs). Most acute rehabilitation facilities will accept patients with tracheostomy tubes, PEG tubes, and IV lines. Ventilated patients are accepted by some units; however the ability of the patient to follow an intensive therapy program may be curtailed if dependent on a ventilator.
Recent technological developments for use in the rehabilitation of patients, such as the Lokomat® (Hocoma GmBH, Zurich, Switzerland) (Fig. 80.1) and Exoskeleton (Fig. 80.2), are becoming more widespread and available in rehabilitation facilities and are used in spinal cord injuries and traumatic brain injuries.
