Toronto ABI Network

ABI Conference 2012

Info for Families

Referral Forms

Inpatient Referral Criteria

There are two streams of acquired brain injury (ABI) inpatient rehabilitation programs available in Toronto: regular stream and slow-to-recover. The general criteria for the two streams are listed below.

Please note that each application/client need is determined on an individual basis. If you have any questions regarding a specific referral, please contact the Toronto ABI Network office at 416-597-3057.


Regular Stream – General Admission Criteria

  • Presents at Level V or higher on Rancho Los Amigos Scale: Confused, inappropriate but not agitated. The patient is confused and does not make sense in conversations but may be able to follow simple directions. Stressful situations may provoke some upset, but agitation is no longer a major problem. Patients may experience some frustration as elements of memory return.
  • Medically stable:  i.e., a client’s medical condition should not preclude him/her from actively participating in therapy sessions. Individuals with pre-existing co-morbid conditions are eligible, but depending on the stability of the conditions or resources within the facility, these clients may be more appropriate for other programs, e.g., geriatric program.
  • Tolerance: Clients should be able to engage in therapy sessions for 45-60 minutes, 2-3 times per day for 5-6 days per week.
  • 18 years or older: However, those younger than 18 will be considered on an individual basis.
  • Identified rehabilitation goals.
  • Demonstrate potential for improvement: i.e., demonstrate some ability for new learning.
  • Time since onset: Admission within 12 months of injury. Exceptions may be made based on individual need.
  • In need of 24-hour care: i.e., clients whose needs cannot be met on an out-patient basis.

Clients with the following are not appropriate candidates for inpatient rehabilitation programs:

  • Psychiatric needs: Clients who require acute psychiatric care.
  • Physical aggression: Clients who demonstrate behaviours that pose a threat to the safety of themselves or others through directed physical aggression. West Park Healthcare Centre offers an inpatient and outreach ABI behaviour program that may be better suited to the needs of these clients.

For additional information on managing difficult behaviours, see Alternatives to Restraint Use.


Slow-to-Recover  – General Admission Criteria

Slow-to-recover ABI rehabilitation is an intensive, interdisciplinary program for individuals who:

  • have sustained a severe acquired brain injury
  • have complex cognitive, physical and nursing needs, and
  • demonstrate a slower rate of recovery.

The wait may be long (e.g., months) to access slow-to-recover programs, as there are a limited number of these beds in Toronto and lengths of stay may vary.

Allof the following are taken into consideration when reviewing ABI slow-to-recover applications:

  • Severe Brain Injury: If applicable, clients typically present at Rancho Los Amigos Scale levels between III-V, i.e., demonstrate a localized response but which may be inappropriate. They often demonstrate confusion, decreased attention span, limited continuous memory, i.e., still experiencing post-traumatic amnesia.
  • Complex Needs: Clients typically have complex physical, medical and cognitive needs requiring a specialized ABI rehab program and significant nursing care.
  • Attention/Responsiveness: Clients are able to participate in 10-15 minute sessions, several times per day and demonstrate meaningful responses to their environment, i.e., able to communicate via verbal or non-verbal means; able to visually track and focus and able to demonstrate a consistent, purposeful motor response.
  • Slower Rate of Recovery: Typically, there is a greater amount of time from the date of injury to the date of readiness for rehab (i.e., a few months). Clients demonstrate improvement/progress in the acute/sub-acute phase of recovery. Clients’ length of rehab stay may vary widely and is determined by the progress demonstrated towards established goals appropriate for an inpatient rehabilitation setting.
  • Medically stable: i.e., a client’s medical condition should not preclude him/her from actively participating in therapy sessions.
  • Multiple pre-existing co-morbid conditions: These clients may be suitable, though depending on the stability of these conditions, clients may be more appropriate for other programs, e.g., geriatric program.
  • Plan for discharge post rehab: Should be in place prior to admission and letter of return is often requested.
  • 18 years or older: However, those younger than 18 will be considered on an individual basis.

Clients with the following are not appropriate candidates for slow-to-recover inpatient rehabilitation programs:

  • Psychiatric needs: Clients who require acute psychiatric care.
  • Physical aggression: Clients who demonstrate behaviours that pose a threat to the safety of themselves or others through directed physical aggression. West Park Healthcare Centre offers an inpatient and outreach ABI behaviour program that may be better suited to the needs of these clients.

For additional information on managing difficult behaviours, see Alternatives to Restraint Use.

For information regarding other ABI programs, please contact the Toronto ABI Network at 416-597-3057.

Additional Resources: