Skip to main content

The 10 Levels of TBI Recovery


In the emergency room, health care providers can diagnose a traumatic brain injury (TBI) by using imaging tests; the Glasgow Coma Scale to measure the patient's ability to open their eyes, speak, and move; and measurement levels to determine the severity of the TBI. During the recovery process, patients progress through levels of recovery, but not everyone progresses through the stages the same way—or may never recover past a certain stage.

If you or a loved one acquires a TBI resulting from impairment to the head caused by an accident, sports injury, fall, or assault; or due to a tumor, infection, or lack of oxygen to the brain, seek emergency medical care.

Levels of Recovery

The terms "mild," "moderate," or "severe" may be used to describe the effect of the injury on brain function. "Most patients we see fall in the moderate to severe TBI category," explains Casey Liveris, MOT, an occupational therapist at Craig H. Neilsen Rehabilitation Hospital. "Every patient is different and will not always fit perfectly into each category."

Neilsen Rehabilitation Hospital's treatment team uses the Rancho Los Amigos Scale (RLAS), which describes 10 stages of recovery typically seen after a brain injury. Some patients will progress through each of the 10 levels, while others may reach a certain level and fail to reach a higher level.

Early Stages I to III

If your loved one falls in the range of Rancho Levels I-III, they can present in a coma-like state with no response to stimuli and gradually progress to inconsistently responding to external stimuli such as noise, light, voices, and touching. At these stages, patients will require a caregiver or hospital staff to complete all their basic needs. These patients cannot feed themselves and will typically require the use of a feeding tube.

Mid Stages IV to VI

These patients are in the middle of the Rancho scale. When your loved one is in stage IV, these patients can be very confused, agitated, or not agreeable. These patients may not act like themselves, and it can be very difficult to see. In these mid-stages, patients can become more agreeable and more like themselves; however, they may not have great recollection of events and may still be impulsive with poor safety and judgment.

Late Stages VII to X

When your loved one is in the later stages of the Rancho scale, these patients have a better ability to remember day-to-day and week-to-week events but may still require the use of a memory aide or might be more frustrated or irritable. Progressing through these stages, the patient can start to multitask with increased time to complete tasks. They can interact more appropriately in social situations but are at an increased risk for depression.

Populations at risk

Certain groups are at higher risk for TBI, according to Liveris. Men are more likely to get a TBI—and have a serious TBI—than women. Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI. Children, especially newborns to 4-year-olds, and young adults between ages 15 and 24, are also at a higher risk to suffer from a TBI.

Prevention of TBI

Here are a few steps you can take to prevent head injuries and TBIs:

  • Always wear a seatbelt and use car seats and booster seats for children.
  • Never drive under the influence of drugs or alcohol.
  • Wear a properly fitting helmet when riding a bicycle, skateboarding, and playing sports such as hockey and football.
  • Make your house safer by installing railings on stairs, getting rid of tripping hazards, and using safety gates for young children. Improve your balance and strength with regular physical activity to help prevent falls.
  • Pay attention to your surroundings. Don't drive, walk, or cross the street while using your phone, tablet, or any smart device.