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Did Your Newborn Suffer Cerebral
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Our Birth Brain Injury Resource Guide

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Get a FREE guide of resources available throughout Ohio to children and families of children who were born with brain injuries.

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now and in the future.

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Neuropsychological Assessment and Rehabilitation of BI - Neuropsychological Assessment

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Brain Injuries in Children

Thousands of children and teens are injured each year in car accidents, sports-related accidents, falls, and child abuse. The injuries sustained often leave them with some type of damage to their brain. There are times it is immediately evident after the accident if there has been an injury to the child’s brain. In other instances, it does not become visible that the brain has sustained damage until they are in school and a new challenge is introduced.

Elk & Elk

Assessing a Brain Injury

A brain injury should be analyzed on a case-by-case basis for each child a determination is sought for. An assessment will allow doctors to determine as to how severe the trauma is and how best to treat the problem. There are different methods to assess an injury, and the Rancho Los Amigos Scale or Rancho Levels of Cognitive Functioning is an eight-level behavior and response test. It has been continually revised and updated throughout the years as new information is learned about brain injuries and now has ten stages of recovery after damage to the brain (2 more stages have been added since 1972’s original 8).

The Ten Stages of Recovery

The Rancho Levels of Cognitive Functioning take into account that all patients will recover at their rate and gives an idea of what activities the patient will and won’t be able to do based on their injury. It allows physicians to tailor a rehabilitation program based on what is needed to get the injured party back to good health.

The ten levels of the Rancho Levels of Cognitive Functioning and some of the indicators included in each category are:

  • No response = Total Assistance – No change can be observed when stimuli such as visual, auditory, tactile, or painful are presented to them. Coma or vegetative state and lacks a traditional sleep-wake cycle.
  • Generalized Response – Shows a generalized response to pain, responds to an auditory stimulus (increasing or decreasing), response to outside with body movements or vocalization, delayed responses are common.
  • Localized Response = Total Assistance – shows a reaction to pain by withdrawing or vocalizing, turns toward or away from sounds, blinks when light passes by their eyes, follows moving objects when they pass into their sight, inconsistently reacts to easy commands.
  • Confused or Agitated – Alert and active, trying to get free from restraints or get out of bed, can reach, walk, and sit upon request, sometimes shows aggressive or violent behavior.
  • Confuses, Inappropriate, Non-agitated – Responds to simple commands, not able to learn new details, can hold a brief conversation after being prompted and given cues, can’t respond appropriately when cues aren’t given.
  • Appropriate, Confused= In Need of Moderate Assistance – Can occasionally remember people, time, and places, recognizes some staff members, follow simple instructions, can perform familiar actions in a non-distracting area for about half an hour, uses appropriate verbalization.
  • Appropriate Automatic = Requiring Slight Assistance for Daily Living Skills – Starts without prompting and performs familiar household activities with limited memory of what they have done, can watch to make sure they complete personal and household daily activities with a little help, makes unrealistic plans for the future, oblivious to the feelings and needs of others.
  • Appropriate Purposeful = Requiring Stand-By Assistance – Starts and performs familiar routine tasks at home, work, or in the community with assistance, does not need help one new activity is learned, acknowledges the feelings and needs of others and acts accordingly, understands their limitations and disabilities may affect them completing the task, but has to have help to correct the problem.
  • Appropriate Purposeful = Requiring On Request Stand-By Assistance– Understands limitations and disabilities may prevent them from finishing a task, knows what needs to be done to complete, but requires help to put it into action, can make decisions with help.
  • Appropriate Purposeful =Requiring Stand-By Assistance– Can multitask with breaks, can make their memory aids, can complete routine tasks like housework or leisure activities, understands limitations and takes steps to prevent problems from happening, may require more time to correct issues.

These specific assessment levels are used to determine how serious the brain injury sustained by a child is and how it may affect them in their daily life. It is very detailed to allow those preparing a rehabilitation plan the most inclusive information to work to get the child back to their original state or as close to it as possible.