According to Bharat Bhise, the brain injury recovery stages are classified according to the Rancho Los Amigos Scale which is based on the level of cognitive function the survivor experiences. It is only a general guideline since the recovery process will vary in length and will be a different experience for everyone.

The Stages

Here are the stages of brain injury recovery:

1. Coma (No Response, Total Assistance) – Coma is considered the deepest state of unconsciousness and the first stage of traumatic brain injury. Comas usually last for a couple of weeks and allow the brain to heal without interruption. During this stage, the patients are observably unresponsive to their environment and cannot wake up even when stimulated.

The defining characteristics of a coma include a lack of eye movement, speech, and other forms of communication, and no purposeful movement.

2. Vegetative State (Generalized Response, Total Assistance) – Many people believe that comas and vegetative states are the same, but they are two separate states of consciousness since the neurological responses of the survivor vary.

Unlike when in a coma, a patient has regained some of their reflexes when they reach the vegetative state. And, although they are not yet truly conscious, they can appear to be awake since sometimes their automatic responses are still intact or begin to heal. Thus, sometimes, they may react to pain, and loud noises, and even open or close their eyes.

3. Minimally Conscious State (Localized Response, Total Assistance) – During this stage, the patient has regained a minimally conscious state where they have limited awareness of their surroundings. Thus, the person can start to communicate and react in a purposeful way.

During this period, the doctor can prescribe medicines to stimulate the brain of the patient and allow them to regain full consciousness until they can communicate and respond verbally and/or non-verbally.

4. Post-Traumatic Amnesia (Confused/Agitated, Maximal Assistance) – During this stage, the brain of the patient is in a severe stage of amnesia. They cannot remember day-to-day events, where they are, and how they got there.

Thus, during the post-traumatic amnesia stage, the patient suffers from retrograde amnesia where they cannot remember past events, and anterograde amnesia where they cannot form new memories. As a result, the patient can display inappropriate or aggressive behavior and appear erratic. This is because damage to the frontal lobe can cause individuals to lose their inhibition.

5. The later stages of brain injury recovery – Most survivors can recover through the initial 4 stages of brain injury recovery. And, depending on the level of injury, they might be able to go through the last 6 stages of brain injury. They are as follows:

  • Confused/Inappropriate, Non-agitated (Maximal Assistance)
  • Confused/Appropriate (Moderate Assistance)
  • Automatic/Appropriate (Minimal Assistance)
  • Purposeful/Appropriate (Standby Assistance)
  • Purposeful/Appropriate (Standby Assistance on Request)
  • Purposeful/Appropriate (Modified Independent)


Bharat Bhise suggests you don’t lose hope if you have suffered from a traumatic brain injury and are stuck in a particular recovery stage. The best way to accelerate recovery is to continue your therapy and activate neuroplasticity, which is the brain’s ability to repair neural connections and reassign functions to the undamaged portions of the brain.