Rehabilitation outcome evaluation after very severe brain injury

Few centres provide long-term therapy for survivors of very severe brain injury who continue in a minimally responsive state. We report on two outcome evaluation projects in association with one such centre in western Canada. In one project a functional scale to detect subtle changes after long-term therapy with the most severely compromised clients (Rancho levels II and III) is being tested. In the other project outcome indicators of change in quality of life after initiation of community-based rehabilitation have been generated by collecting over 400 critical incidents reported by family members, volunteers, staff and a few higher functioning clients. Our intention in this report is to highlight what can be done in terms of rehabilitation and outcome evaluation with clients who seem to be persisting in vegetative or minimally responsive states.