What are the 10 Recovery Stages After a Brain Injury?

Recovering from a brain injury can be a long process. Patients go through various stages of rehabilitation and recovery. Patients that can transition through each stage increase the likelihood of healing, with the ultimate goal of moving the patient as close as possible to their pre-injury condition.

Generally, there may be ten stages that a patient with a traumatic brain injury (TBI) may experience or progress through. Of course, every patient is different, and some stages may not apply to every patient. That said, this article will focus on the stages based on the Rancho Los Amigos Levels of Cognitive Functioning.

1. Coma

A coma allows the brain to heal; uninterrupted. With a severe injury, the patient may remain in a coma for some time. This is considered the first stage of recovery. 

What is a coma? It is the deepest state of unconsciousness. Generally, coma patients have no eye movement, no purposeful movement, and lack speech and communication. The patient is unresponsive to the environment and does not wake, even with stimulation. 

Comas can last from weeks to months or even years.

After awakening from a coma, the patient may move through further stages towards recovery. 

2. Vegetative state

Comas and a vegetative state are not the same as they are different states of consciousness. Neurological responses differ. Patients in a coma have no neurological response, while those in a vegetative state may have regained some reflexes. 

In a vegetative state, the patient may appear awake. You may see eye movement and reaction to stimulation. The cause is from responses in the brain that remain intact after injury. But also because areas of the brain have begun to heal. 

Once patients react and can communicate, they move to the next stage of recovery. 

3. Minimally Conscious

Patients may come in and out of consciousness when they are in this stage. The significant improvement seen in this stage is awareness of people and surroundings. When in this stage, medications can help stimulate the brain to regain consciousness. 

As the patient responds to instructions and communication, they move toward recovery. 

4. Post-Traumatic Amnesia

Post-traumatic amnesia is the stage after the patient emerges from a coma. They may experience a state of amnesia upon awakening. 

There are two types of amnesia:

  • Retrograde amnesia with the inability to remember past events
  • Anterograde amnesia where there is the inability to form new memories, including of day to day events

Some patients may show behavior changes in this stage. They may be aggressive or show other signs of inappropriate behavior. Patients can lose their sense of inhibition, especially if the frontal lobe experienced an injury. 

Once patients can consistently remember daily events and amnesia diminishes, the patient is then usually ready to begin neurorehabilitation at a rehab facility where true healing and recovery begins. 

5. Inappropriate Behaviors

While in this stage, patients can have difficulty focusing on tasks and may be confused. It can be challenging for them to respond during communication or express inaccurate communication that may not make sense. 

If you would like to learn more about inappropriate behavior after TBI, check out our blog post on brain injury and inappropriate behavior.

6. Confusion 

During this stage, the patient may be able to follow more commands from staff and communicate. Memory issues often still exist, and focusing on tasks can be challenging. 


7. Automatic and Appropriate

When a patient advances to this stage in their recovery, they can begin to follow a schedule and complete some daily life activities independently. This is an essential stage in post-acute rehabilitation as they can participate in important rehab recovery efforts, including physical therapy, occupational therapy, and speech therapy.  


8. Purposeful

At this stage, the patient has had improvement in awareness and memory. Patients may continue to struggle with social interaction, reaction time, and handling unexpected situations that are not part of their routine. 

That said, they often have made much improvement in coping skills and sometimes may be able to graduate from a rehabilitation facility and return home. 

rehabilitation for brain injury

9 and 10: Purposeful and Independence

The TBI patient has gained function in the final stages and can perform most tasks independently. They likely will need to have continued rehabilitation for brain injury but do not require the full assistance of a neurorehabilitation center. 

During this final stage, some patients have a full recovery and can handle daily life activities on their own. However, their cognition may remain slower than pre-injury they usually do well with and can participate in outpatient neuro services if necessary. 


Why Choose Neulife for Inpatient Neuro Rehabilitation?

Neulife Rehab is one of Florida's most extensive brain injury facilities and the southwest United States. Neulife is CARF-accredited (Commission on the Accreditation of Rehabilitation Facilities) in Brain Injury Specialty Programs and Residential Rehabilitation. 

Through rehabilitation, medical management, psychiatric, neurophysical services, occupational, speech, and cognitive therapies, and much more, we provide the best in care so your loved one has the BEST POSSIBLE recovery. 

Schedule a tour to see our facility to decide if it may be appropriate for your loved one. We are always here to answer questions. Please reach out to us at 1-888-626-3876.



The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment.  Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health


Dedicated to providing the highest caliber of care to individuals with brain injuries, NeuLife Rehabilitation is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).
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