TBI 2

Level I: Stages of Cognitive Recovery

No Response: Total Assistance

• •No response to external stimuli            

Level II: Stages of Cognitive Recovery

Generalized Response: Total Assistance

•Responds inconsistently and non-purposefully to external stimuli

•Responses are often the same regardless of the stimulus

Level III: Stages of Cognitive Recovery

Localized Response:  Total Assistance

•Responds inconsistently and specifically to external stimuli

•Responses are directly related to the stimulus, for example, patient withdraws or vocalizes to painful stimuli

Responds more to familiar people

Level IV: Stages of Cognitive Recovery

Confused/Agitated: Maximal Assistance

• The individual is in a hyperactive state with bizarre and non-purposeful behavior

• Demonstrates agitated behavior that originates more from internal confusion than the external environment

• Absent short-term memory

Level V: Stages of Cognitive Recovery

Confused, Inappropriate Non-Agitated:  Maximal Assistance

• Behavior and verbalization is often inappropriate, and individual appears confused and often confabulates

• demonstrate lack of insight, decreased judgment and safety awareness

• Beginning to show interest in social and recreational activities in structured settings

• Requires at least minimal supervision for learning and safety purposes.

Level VI: Stages of Cognitive Recovery

Confused, Appropriate: Moderate Assistance

• Able to follow simple commands consistently

• Able to retain learning for familiar tasks they performed pre-injury

•Demonstrates increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns 

Level VII: Stages of Cognitive Recovery

Automatic, Appropriate: Minimal Assistance for Daily Living Skills

• •Oriented in familiar settings

  •Able to perform daily routine automatically with minimal to absent confusion

  •Demonstrates carry over for new tasks and learning in addition to familiar tasks

  •Superficially aware of one’s diagnosis but unaware of specific impairments

  •Requires at least minimal supervision for learning and safety purposes.

Level VIII: Stages of Cognitive Recovery

Purposeful, Appropriate: Stand By Assistance

•Consistently oriented to person, place and time

• •Independently carries out familiar tasks in a non-distracting environment

  Beginning to show awareness of specific impairments

• Often depressed, irritable and with low frustration threshold

Level IX: Stages of Cognitive Recovery

Purposeful, Appropriate: Stand By Assistance on Request

• •Able to shift between different tasks and complete them independently

  •Aware of and acknowledges impairments when they interfere with tasks and able to use compensatory strategies to cope

  •Unable to independently anticipate obstacles that may arise secondary to impairment

  •With assistance able to think about consequences of actions and decisions

Level X: Stages of Cognitive Recovery

Purposeful, Appropriate: Modified Independent 

•Able to multitask in many different environments with extra time or devices to assist

•Able to create own methods and tools for memory retention

•Independently anticipates obstacles that may occur as a result of impairments and take corrective actions

•Able to independently make decisions and act appropriately but may require more time or compensatory strategies

•Demonstrate intermittent periods of depression and low frustration threshold when under stress

Initiation

•Generate ideas or plans

•Begin activities without procrastination

Inhibition

•Control impulses, actions, or automatic tendencies

•Think before acting

•Ignore distractions

Working memory

•Hold, update, & manipulate mental information

•Keep track of information within an activity

Cognitive flexibility

•Transition or move easily between tasks

•View situations from different perspectives

•Revise plans

•Adapt to new or changing circumstances