Once an individual with brain injury is in a rehabilitative setting, the treatment team will use a variety of tests and assessments to determine the individual’s progress. These results of these assessments may be discussed with the person’s family and loved ones and may be reported to insurance companies to demonstrate the patient’s improvement over time.
Functional Independence Measure™ (FIM)
The Functional Independence Measure™ (FIM) is the most widely accepted assessment used by clinicians in hospital-based, acute rehabilitation. The FIM is an 18-item ordinal scale, made up of twelve physical items and six cognitive items. It is designed to assess an individual’s progress during inpatient rehabilitation. The FIM is also useful in assessing the amount of assistance the individual may require after he or she is discharged from rehabilitation.
Functional Assessment Measure (FAM)
The Functional Assessment Measure (FAM) was developed as an addition to the FIM to assesses an individual’s cognitive, behavioral, communicative, and community functioning abilities. The FAM adds twelve items to the 18 items measured by the FIM.
The treatment team will likely combine the two, referring to them as FIM+FAM. Professionals administering the FIM and the FAM are required to undergo education and obtain a certification.
Disability Rating Scale (DRS)
The Disability Rating Scale (DRS) is an eight item assessment used by the treatment team to measure an individual’s impairment, disability, and handicap. The DRS is designed to track an individual who has had a brain injury from the point they sustain their injury to their return to the community.
Rancho Los Amigos Level of Cognitive Functioning Scale (RLAS)
Brain injury professionals use the Rancho Los Amigos Level of Cognitive Functioning Scale (RLAS) to measure and track an individual’s progress following brain injury. A Rancho Level is determined based on observation. This scale is normally used once a person is closer to medical stability.
It is important to note that most rehabilitation programs will expect a patient to be at a minimum of a Rancho Level III or IV before the person can begin rehabilitation.
Rancho Los Amigos Level of Cognitive Functioning Scale: Scores range from I to VIII.
| I | No Response | The individual appears to be in a deep sleep and is unresponsive to any stimuli. |
| II | Generalized Response | The individual reacts inconsistently and non-purposefully to stimuli. Responses are limited in nature and are often the same, regardless of stimuli presented. Responses may include gross motor movements, vocalization, and physiologic changes. Response time is likely delayed. Deep pain evokes the earliest response. |
| III | Localized Response | The individual responds specifically but inconsistently to a direct stimulus. Responses are directly related to the type of stimulus presented. For example, an individual’s head will turn toward a sound, or his or her eyes will focus on an object when presented. The individual may follow simple commands and may respond better to some people (for example, family and friends) than to others. |
| IV | Confused-Agitated | The individual is in a heightened state of activity, with a severely decreased ability to process information. Behavior is not related to the immediate environment. Hostility and attempts to climb out of bed or remove restraints are common. The individual requires maximum assistance to perform self-care. He or she may sit, reach, and walk, but will not necessarily perform these activities upon request. |
| V | Confused-Inappropriate | The individual appears alert and responds to simple commands consistently. Agitation that is out of proportion with, but directly related to stimuli may be evident. Lack of external structure results in random or non-purposeful responses. Inappropriate verbalizations and high distractibility are common. Memory is severely impaired, but the individual may feed him or herself with supervision, and requires only assistance for self-care activities. |
| VI | Confused-Appropriate | The individual shows goal-directed behavior but is dependent on external input for direction. Response to discomfort is appropriate. Responses are incorrect because of memory problems, but are appropriate to the situation. The individual follows simple commands consistently, and carry-over for re-learned activities is evident. Orientation is inconsistent, but awareness of self, family, and basic needs is increased. |
| VII | Automatic-Appropriate | The individual appears to act appropriately in the hospital and at home and goes through daily routines automatically, but robot-like and has poor recall of activities performed. The individual has absent-to-minimal confusion and lacks insight. The individual frequently demonstrates poor judgment and problem-solving ability and expresses unrealistic future plans. With structure, the individual is able to initiate tasks or social and recreational activities. |
| VIII | Purposeful-Appropriate | The individual is alert and oriented, able to recall and integrate past and recent events, and is aware of and responsive to the environment. Independence in the home and community has returned. Carryover for new learning is present, and the individual has no need for supervision once activities have been learned. Social, emotional, and cognitive abilities may be less than they were prior to injury. |
