Understanding the 8 Levels of Traumatic Brain Injury

A traumatic brain injury (TBI) can result from any blow to the head: a punch, a fall, a tackle, an accident on the road. Despite the casual way some have treated it in the past, a concussion is also a kind of TBI. Since the brain is so complex and delicate, a TBI can have many different results, depending on how and where a person was hurt, their age, their health, and how quickly they received medical treatment.

To understand how much damage a brain has suffered and how well a person is recovering, doctors use the Rancho Los Amigos Scale of Cognitive Functioning (also called the RLAS or the Rancho Scale). “Cognitive functioning” refers to how the patient’s brain is working—how well they can use their senses, respond, think, and move.

The Rancho Scale describes separate levels of cognitive functioning following a TBI.

• Level I: No response. The patient cannot respond to sound, sights, sensations, or movement.
• Level II: Generalized response. The patient slowly begins to respond to sound, sight, and other things that they sense, though their responses may be inconsistent. Their responses are general: groans, movements, faster breathing, raised blood pressure levels.
• Level III: Localized response. At this level, the patient may begin to recognize people they know. They can make more specific responses, such as turning toward the source of sounds. They may be able to answer “yes/no” questions and obey single commands, although not consistently.
• Level IV: Confused and agitated. As the patient improves, they become frustrated and fixated on their wants and needs—bed, the bathroom, going home. They may scream, act out, or become verbally abusive. At this level, they can understand some of what is going on around them, but not all of it. Nonetheless, with help, they can begin to do basic tasks such as dressing themselves or following simple instructions.
• Level V: Confused and inappropriate. The patient continues to have difficulty understanding what is happening. They may not know the date or why they are in the hospital, and they may make things up (confabulate) about events in the past or present. They are likely to have gaps in their memory surrounding the accident, and they have difficulty retaining new information. However, they can hold brief conversations and follow instructions with assistance.
• Level VI: Confused and appropriate. The patient’s memory is improving, but it is still poor in the short term. For example, they will know the date and where they are but forget what happened in the morning. They can pay sustained attention for up to 30 minutes. They can handle activities of daily living (ADLs) such as dressing and eating, but they need help with more complex daily activities, like crossing the street.
• Level VII: Automatic and appropriate. The patient has now improved enough to return to familiar daily routines in their household, and they are processing new information. But they continue to have difficulties in responding and adapting, and they do not realize their reduced level of function. They can be stubborn and distractible, and they are likely to make unrealistic plans to return to life as normal.
• Level VIII: Purposeful and appropriate. As recovery continues, the patient begins to understand the ongoing limitations of their TBI. Although they may still be depressed and irritable, they adapt to their situation, using assistive devices and techniques as necessary.

Recently, doctors have added two further stages of recovery (IX and X) to the Rancho Scale to describe patients’ further improvement as they relearn old abilities and adapt to their new ones. It may take days, weeks, or even months for a TBI patient to progress through these stages, depending on how severe the injury was and the patient’s earlier state of health.

The Next Steps for TBI Patients and their Families

The treatment team will provide the TBI patient and their family with further instructions on the help they will need as they progress through the stages of recovery. Even a mild TBI requires time off, assistance, and care. Moderate to severe TBI patients, when they do recover, may have to go through rehabilitation to relearn basic ADLs and daily routines.

They can also suffer prolonged or permanent cognitive damage, leading to long-term issues such as:

• Fatigue
• Memory problems
• Trouble with concentration
• Difficulty maintaining physical balance
• Mental health problems, including emotional difficulties and personality changes

Even when a TBI is not as severe as it might have been, TBI patients and their families will face mounting costs and losses from their injury. These include:

• Medical expenses—emergency care, hospital bills, rehabilitation
• Lost wages
• Future earnings, if the disability is prolonged

If you or your loved one has suffered a TBI, our Georgia personal injury attorneys would be glad to speak to you about how to recover these costs. Depending on the circumstances of the injury, you may be entitled to compensatory damages, not only for your medical expenses and lost earnings but for pain and suffering, emotional distress, and other possible claims. The state of Georgia also maintains a Brain and Spinal Injury Trust Fund for Georgia residents who need additional assistance in living with a TBI.

There is no need to worry about upfront legal fees—you will pay nothing unless we win the case or settle in your favor. Call the Scott Pryor Law Group, Personal Injury & Accident Attorneys, at (404) 474-7122 to set up your appointment today.