The length of time it takes to recover after a brain injury is different for each person. The Ranchos Los Amigos Scale is used to describe recovery after a brain injury.

How long does it take to recover after a brain injury?

It is difficult for the rehabilitation team to know exactly how long recovery will take, especially at the beginning. Recovery is usually fastest in the early weeks and months. If your child is unconscious, they will rarely wake up suddenly. Rather, they usually wake up and recover gradually.

The Ranchos Los Amigos Scale is used to describe recovery after a brain injury. When someone is recovering from a brain injury, they may go through some or all of the stages. It is important to remember that your child may show signs from more than one level at a time. They may also reach a level in their recovery and stop.

Stage 1 (No response)

• The child or young person appears to be in a deep sleep and doesn't respond to sounds or stimulation. This is referred to as 'coma'.
• While in coma, the brain is not functioning at the normal level. There is a limited ability to take in information or respond to light, sound or touch.

Stage 2 (Generalised response)

• The child or young person begins to react to loud noises or painful sensations by making noise or moving their arms or legs. This response may not happen often and they may still appear to be asleep most of the time.

Stage 3 (Localised response)

• The child or young person may respond by moving away from uncomfortable procedures such as injections.
• They may turn towards sounds or try to watch people around them.
• The person may respond to simple instructions such as 'close your eyes'.

Stage 4 (Confused - agitated)

• Behaviour is variable during this stage. The child or young person may be inactive or restless, loud or agitated. Though this can be distressing, it is important to remember that they cannot control this behaviour.
• The child or young person may be confused and try to wander. They may need to be watched closely during this time as they may not know where they are going.
• Their attention span is short and they may forget things that have happened to them.
• Although they are more aware of what is going on, they can't make sense of it all.

Stage 5 (Confused - inappropriate)

• Children and young people are usually calmer at this stage and can do simple things for themselves.
• They may become agitated if they are overstimulated or asked to do something they can't do.
• They will start to talk more clearly, but what they say might seem inappropriate.

Stage 6 (Confused - appropriate)

• The child or young person may still be confused but will be starting to behave more appropriately.
• They will start to have memories of simple day-to-day things such as the names of staff.
• They may be able to work at tasks in therapy sessions for longer periods.

Stage 7 (Automatic - appropriate)

• The child or young person is able to do normal activities with only a little help.
• They may be able to learn things but may find it slower and harder than before.
• The child or young person gets tired easily.

Stage 8 (Purposeful - appropriate)

• The child or young person is able to recall past information and recent events.
• They may better understand what has happened to them and may get upset.
• They may still have changes in their thinking, concentration, memory and social skills compared to before the accident.

Key points to remember

• The amount of time it takes to recover from a brain injury is different for everyone.
• Recovery is usually fastest in the early weeks and months.
• The Ranchos Los Amigos Scale is used to describe the eight stages of recovery after a brain injury. 
• A child may go through all or some of the stages.

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of fact sheets listed under 'Brain injury'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.