Determining Catastrophic Impairment: The GOS-E Approach

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As of June 1, 2016, the Glasgow Outcome Scale – Extended (GOS-E) Interview is the new assessment measure that, according to the SABS, must be used to evaluate whether adult clients who have sustained a traumatic brain injury (TBI) meet the catastrophic threshold. The GOS-E is a functional outcome measure that considers the functional consequences of the TBI and its impacts on a client’s activities of daily living. The GOS-E Assessment requires both a medical examination and clinical observation of the client’s daily life.

The Pain & Disability Assessment Centre (PDAC) offers Determination of Catastrophic Impairment Assessments using the GOS-E approach for both plaintiff and defence lawyers. A GOS-E Assessment uses the GOS-E Structured Interview as a guide, harnessing the expertise of two assessors, an experienced OT and a neuropsychologist (or physiatrist), all of them with CAT certification.

The medical practitioner’s role is to diagnose a TBI, classify its severity and provide information about the client’s neuro-cognitive profile. The OT uses that data to assess the functional repercussions of the client’s neuro-cognitive difficulties and their effects on activities of daily living.

The OT performing the Structured Interview must evaluate the client’s level of independence inside and outside the home, their ability to return to work, and their social and leisure functioning. Only disabilities stemming from the brain injury are considered. The goal is to judge to what degree the client is able to initiate and maintain routines and activity levels as they did before the accident.

The client’s personal safety is a major consideration of the assessment. Reasoning, judgement, memory and problem-solving abilities are key factors in determining whether the client is able to complete daily activities independently.

The assessment can be administered at six months or more post-accident. At one year or more after the accident, if the client does not meet criteria in the earlier six-month assessment, the GOS-E can be re-administered in the context of the person’s ability to return to a previous job and/or to assess the degree of change in their leisure and social functioning. PDAC works with several OTs, neuropsychologists and physiatrists who are qualified to perform GOS-E assessments under the SABS. For more information or to schedule an assessment, please contact PDAC.

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