There are many different types of brain injury assessments that can be performed post-injury. Here, we have them broken down by short- and long-term assessments.
Short-Term Brain Injury Assessments
Glasgow Coma Scale:
The treatment team will use the Glasgow Coma Scale (GCS) to evaluate a person’s level of consciousness (LOC) and the severity of brain injury by attempting to elicit body movements (M), opening of the eyes (E), and verbal responses (V). Clinicians use the three values separately and collectively to make medical decisions and monitor the patient’s progress. This scale is typically used very early in the treatment process.
Rancho Los Amigos Level of Cognitive Functioning Scale:
| I | No Response: Total Assistance | The individual appears to be in a deep sleep and is unresponsive to any stimuli. |
| II | Generalized Response: Total Assistance | 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: Total Assistance | 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: Maximal Assistance | 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: Maximal Assistance | 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: Moderate Assistance | 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: Minimal Assistance | 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: Standby Assistance | The individual is consistently oriented to person, place and time. They are aware of and acknowledge impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action. Social, emotional, and cognitive abilities may be less than they were prior to injury. |
| IX | Purposeful-Appropriate: Standby Assistance Requested | The individual uses assistive memory devices to recall daily schedule, “to do” lists, and record critical information for later use with assistance when requested. They initiate and carry out steps to complete familiar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks with assistance when requested. They are aware of and acknowledge impairments and disabilities when they interfere with task completion and takes appropriate corrective action but requires stand-by assistance to anticipate a problem before it occurs and take action to avoid it. |
| X | Purposeful-Appropriate: Modified Independent | The individual can handle multiple tasks simultaneously in all environments but may require periodic breaks and is able to independently procure, create and maintain own assistive memory devices. They are able to independently think about consequences of decisions or actions but may require more than usual amount of time and/or compensatory strategies to select the appropriate decision or action. |
The above table contains a modified explanation of the Ranchos Los Amigos Scale. An in-depth breakdown of the scale can be found here. If you are looking for a quick reference guide, BIAA’s Essential Brain Injury Guide contains a visual representation of the scale, which can be found here.
The JFK Coma Recovery Scale- Revised:
This assessment is used when a person is experiencing a disorder of consciousness. It assess auditory, visual, motor, automatic functions, and more. Click here for an explanation of this scale.
Long-Term Brain Injury Assessments
Mayo-Portland Adaptability Inventory (MPAI)
The Mayo-Portland Adaptability Inventory (MPAI) is an evaluation tool designed to assist in the evaluation of individuals after their release from the hospital and to assist in the evaluation and determination of rehabilitative options to serve these individuals.
Participation Assessment with Recombined Tools – Objective (PART-O)
The Participation Assessment with Recombined Tools – Objective (PART-O) is an objective measure of participation for persons with moderate-to-severe brain injuries that is designed to represent how they may function at the societal level. The PART-O has 17 items addressing three domains. The domains are:
- Out and About
- Productivity
- Social Relations
The PART-O was developed to examine long-term outcomes in persons with brain injuries, but is also quite effective in gauging the effectiveness of specific interventions and rehabilitative techniques.
Craig Handicap Assessment and Reporting Technique (CHART)
The Craig Handicap Assessment and Reporting Technique (CHART) provides a simple measure of the degree of impairments or handicaps an individual who has sustained a brain injury may face after their initial rehabilitation. The CHART is made up of 32 questions and covers six domains. The domains are:
- Physical Independence
- Cognitive Independence
- Mobility
- Occupation
- Social Integration
- Economic Self-Sufficiency
The Craig Handicap Assessment and Reporting Technique Short Form (CHART-SF) is a simplified measure – consisting of only 19 items – that yields the same scores as the original CHART across the same six domains.
The list of brain injury assessments shown on this page is not comprehensive. A full list of assessments can be found on the Center for Outcome Measurement in Brain Injury’s website.