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1.3.3 BRAIN INjURy SEVERITy
Long term prognosis in people with brain injuries correlates to different extents with various factors including
levels of consciousness, duration of post-traumatic amnesia, age, gender and pre-injury education and
employment. The most widely used index of injury severity is the Glasgow Coma Score (GCS) which classifies
injuries into mild, moderate or severe categories based on level of consciousness post injury (see Table 1). It
should be noted that severity of symptoms associated with an injury may not correlate perfectly with severity
of injury as defined by GCS, so that patients with a severe brain injury may experience many of the same
symptoms as patients with a mild injury, although these may be longer lasting or result in greater disability.
Table 1: Definition of mild, moderate and severe brain injury by GCS score
Degree of brain injury GCS score
Mild 13-15
Moderate 9-12
Severe 8 or less
Throughout this guideline definitions of injury severity have been used which match those used in the
studies which support each section, therefore, there may be some variation between the characterisation
of the terms mild, moderate and severe between different sections.
1.3.4 MULTIDISCIPLINARy AND INTERDISCIPLINARy WORkING
In the evidence reviewed for this guideline, the terms multidisciplinary and interdisciplinary are often used
synonymously, although they are not consistently defined. They both imply a holistic approach to patient
care, maximising the resources (knowledge, experience, financial and physical) available to work towards
a common goal. However, multidisciplinary and interdisciplinary are methods of practice on a continuum
ranging from discipline-specific to transdisciplinary. Given the complexity of the cases with which practitioners
will be working, the guideline development group recommends that, in the majority of cases, the integrative
approaches of interdisciplinary practice across professions and sectors would most benefit patients and
their families. It is acknowledged that there are occasions when uni-disciplinary practice is required, but the
method of sharing information and goal setting will remain interdisciplinary.
1.3.5 GOAL SETTING
1 • Introduction
Goal setting in brain injury rehabilitation is used by a range of professionals to maximise patient-centred and
therapy-focused goals. Ideally, the patient should be involved in the goal setting at all times and their family
or carers included at appropriate points. These goals can also be used to aid communication and to structure
planning and decision making. The goals set should be in context for the person involved and should be
reviewed and documented regularly. Engaging patients and families in goal setting increases the number of
goals set in a wider range of areas and in particular areas that are less common in global outcome measures. 10
A range of tools may be used to assist in the assessment and subsequent setting of goals, for example
the Canadian Occupational Performance Measure, 11 the Functional Independence Measure/Functional
Assessment Measure (FIM/FAM) 12 or the Barthel Index. 13
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