CBIS Certified Brain Injury Specialist
Exam (2026) | Exam-Style Questions,
Study Guide & Practice Test | Verified
Answers | Grade A
Q1 A 28-year-old male sustained a severe traumatic brain injury (TBI) 3 months ago with
a Glasgow Coma Scale score of 5 at the scene. He is now in post-acute rehabilitation and
demonstrates inconsistent command following, eye opening to voice, and occasional
purposeful movement. What is the most accurate Rancho Los Amigos level at this time?
A) Level III – Localized Response B) Level IV – Confused/Agitated C) Level V –
Confused, Inappropriate, Non-Agitated D) Level VI – Confused, Appropriate
A) Level III – Localized Response
Rationale: Rancho Level III is characterized by inconsistent but definite responses to
stimuli (e.g., following simple commands inconsistently, purposeful movement). The
patient is past coma (Level I–II) but not yet showing agitation or confusion (Level IV+).
GCS 5 at onset indicates severe TBI, and current presentation fits emerging
consciousness.
Q2 Which of the following is the most common cause of acquired (non-traumatic) brain
injury in adults in the United States?
A) Stroke B) Anoxia/hypoxia C) Brain tumor D) Encephalitis/meningitis
A) Stroke
Rationale: Cerebrovascular accident (stroke) is the leading cause of acquired brain injury
in adults, far exceeding anoxia (cardiac arrest, near-drowning), tumors, and infectious
causes per CDC and BIAA epidemiology data.
Q3 A client with a moderate TBI 4 weeks ago is exhibiting emotional lability, impulsivity,
and poor insight into deficits. These behaviors are most consistent with damage to which
brain region?
A) Occipital lobe B) Frontal lobe / prefrontal cortex C) Temporal lobe D) Parietal lobe
B) Frontal lobe / prefrontal cortex
,Rationale: The frontal lobes, particularly the prefrontal cortex, are responsible for
executive functions, impulse control, emotional regulation, and self-awareness. Damage
here is classic for disinhibition, lability, and anosognosia after TBI.
Q4 During interdisciplinary team rounds, the occupational therapist reports that the client
with TBI demonstrates apraxia during ADL tasks. The CBIS should explain to the family
that apraxia is best defined as:
A) Inability to recognize familiar objects B) Inability to carry out purposeful, learned motor
acts despite intact strength and sensation C) Inability to name common objects D)
Inability to understand spoken language
B) Inability to carry out purposeful, learned motor acts despite intact strength and
sensation
Rationale: Apraxia is a motor planning disorder common after left-hemisphere or frontal
injury in TBI. Strength and sensation are preserved, but the client cannot sequence the
movements needed for tasks (e.g., brushing teeth).
Q5 A client with a severe TBI is 6 months post-injury and remains minimally conscious
(MCS). The family asks about prognosis for functional recovery. The CBIS should explain
that the majority of meaningful recovery typically occurs within:
A) The first 3 months B) The first 6–12 months C) The first 2 years D) There is no
predictable timeline
B) The first 6–12 months
Rationale: Most functional gains in severe TBI occur in the first 6–12 months, with
slower, smaller improvements possible up to 2 years. After 2 years, recovery plateaus in
most cases (per CDC and BIAA longitudinal data).
Q6 Which of the following is the gold-standard tool for assessing level of consciousness
in the acute phase of TBI?
A) Rancho Los Amigos Levels of Cognitive Functioning B) Glasgow Coma Scale (GCS)
C) Coma Recovery Scale-Revised (CRS-R) D) Disability Rating Scale (DRS)
B) Glasgow Coma Scale (GCS)
Rationale: GCS is the most widely used and validated tool for initial severity assessment
and prognosis in acute TBI. Rancho is used in rehabilitation, CRS-R for disorders of
consciousness, and DRS for disability tracking.
, Q7 A client with a right-hemisphere TBI demonstrates left-sided neglect. During ADL
training, the occupational therapist should place items:
A) Directly in front of the client B) On the right side of the client C) On the left side of the
client D) Randomly around the client
B) On the right side of the client
Rationale: Left neglect (hemi-inattention) is common after right-hemisphere injury.
Placing items on the right (non-neglected) side promotes success and gradually trains
attention to the left.
Q8 A client with diffuse axonal injury is 3 months post-trauma and remains in a vegetative
state. The family asks about prognosis. The CBIS should explain that the likelihood of
meaningful recovery after 3 months in vegetative state due to traumatic etiology is
approximately:
A) >90% B) 50–60% C) 15–20% D) <5%
C) 15–20%
Rationale: Per Multi-Society Task Force on PVS (1994, reaffirmed in recent literature),
recovery from traumatic vegetative state after 3 months is ~15–20% for meaningful
functional improvement.
Q9 Which of the following is the most common endocrine dysfunction seen after
moderate-to-severe TBI?
A) Diabetes insipidus B) Hypopituitarism (especially growth hormone and gonadotropin
deficiency) C) Hyperthyroidism D) Primary adrenal insufficiency
B) Hypopituitarism (especially growth hormone and gonadotropin deficiency)
Rationale: Post-traumatic hypopituitarism occurs in up to 25–50% of moderate-severe
TBI survivors, with GH and gonadotropin axes most commonly affected due to pituitary
stalk injury.
Q10 A client with TBI is exhibiting agitation, restlessness, and attempts to remove
restraints. The interdisciplinary team determines the least restrictive intervention is:
A) Four-point soft restraints B) Chemical restraint with haloperidol C) Environmental
modification and redirection D) One-to-one continuous observation
C) Environmental modification and redirection
Exam (2026) | Exam-Style Questions,
Study Guide & Practice Test | Verified
Answers | Grade A
Q1 A 28-year-old male sustained a severe traumatic brain injury (TBI) 3 months ago with
a Glasgow Coma Scale score of 5 at the scene. He is now in post-acute rehabilitation and
demonstrates inconsistent command following, eye opening to voice, and occasional
purposeful movement. What is the most accurate Rancho Los Amigos level at this time?
A) Level III – Localized Response B) Level IV – Confused/Agitated C) Level V –
Confused, Inappropriate, Non-Agitated D) Level VI – Confused, Appropriate
A) Level III – Localized Response
Rationale: Rancho Level III is characterized by inconsistent but definite responses to
stimuli (e.g., following simple commands inconsistently, purposeful movement). The
patient is past coma (Level I–II) but not yet showing agitation or confusion (Level IV+).
GCS 5 at onset indicates severe TBI, and current presentation fits emerging
consciousness.
Q2 Which of the following is the most common cause of acquired (non-traumatic) brain
injury in adults in the United States?
A) Stroke B) Anoxia/hypoxia C) Brain tumor D) Encephalitis/meningitis
A) Stroke
Rationale: Cerebrovascular accident (stroke) is the leading cause of acquired brain injury
in adults, far exceeding anoxia (cardiac arrest, near-drowning), tumors, and infectious
causes per CDC and BIAA epidemiology data.
Q3 A client with a moderate TBI 4 weeks ago is exhibiting emotional lability, impulsivity,
and poor insight into deficits. These behaviors are most consistent with damage to which
brain region?
A) Occipital lobe B) Frontal lobe / prefrontal cortex C) Temporal lobe D) Parietal lobe
B) Frontal lobe / prefrontal cortex
,Rationale: The frontal lobes, particularly the prefrontal cortex, are responsible for
executive functions, impulse control, emotional regulation, and self-awareness. Damage
here is classic for disinhibition, lability, and anosognosia after TBI.
Q4 During interdisciplinary team rounds, the occupational therapist reports that the client
with TBI demonstrates apraxia during ADL tasks. The CBIS should explain to the family
that apraxia is best defined as:
A) Inability to recognize familiar objects B) Inability to carry out purposeful, learned motor
acts despite intact strength and sensation C) Inability to name common objects D)
Inability to understand spoken language
B) Inability to carry out purposeful, learned motor acts despite intact strength and
sensation
Rationale: Apraxia is a motor planning disorder common after left-hemisphere or frontal
injury in TBI. Strength and sensation are preserved, but the client cannot sequence the
movements needed for tasks (e.g., brushing teeth).
Q5 A client with a severe TBI is 6 months post-injury and remains minimally conscious
(MCS). The family asks about prognosis for functional recovery. The CBIS should explain
that the majority of meaningful recovery typically occurs within:
A) The first 3 months B) The first 6–12 months C) The first 2 years D) There is no
predictable timeline
B) The first 6–12 months
Rationale: Most functional gains in severe TBI occur in the first 6–12 months, with
slower, smaller improvements possible up to 2 years. After 2 years, recovery plateaus in
most cases (per CDC and BIAA longitudinal data).
Q6 Which of the following is the gold-standard tool for assessing level of consciousness
in the acute phase of TBI?
A) Rancho Los Amigos Levels of Cognitive Functioning B) Glasgow Coma Scale (GCS)
C) Coma Recovery Scale-Revised (CRS-R) D) Disability Rating Scale (DRS)
B) Glasgow Coma Scale (GCS)
Rationale: GCS is the most widely used and validated tool for initial severity assessment
and prognosis in acute TBI. Rancho is used in rehabilitation, CRS-R for disorders of
consciousness, and DRS for disability tracking.
, Q7 A client with a right-hemisphere TBI demonstrates left-sided neglect. During ADL
training, the occupational therapist should place items:
A) Directly in front of the client B) On the right side of the client C) On the left side of the
client D) Randomly around the client
B) On the right side of the client
Rationale: Left neglect (hemi-inattention) is common after right-hemisphere injury.
Placing items on the right (non-neglected) side promotes success and gradually trains
attention to the left.
Q8 A client with diffuse axonal injury is 3 months post-trauma and remains in a vegetative
state. The family asks about prognosis. The CBIS should explain that the likelihood of
meaningful recovery after 3 months in vegetative state due to traumatic etiology is
approximately:
A) >90% B) 50–60% C) 15–20% D) <5%
C) 15–20%
Rationale: Per Multi-Society Task Force on PVS (1994, reaffirmed in recent literature),
recovery from traumatic vegetative state after 3 months is ~15–20% for meaningful
functional improvement.
Q9 Which of the following is the most common endocrine dysfunction seen after
moderate-to-severe TBI?
A) Diabetes insipidus B) Hypopituitarism (especially growth hormone and gonadotropin
deficiency) C) Hyperthyroidism D) Primary adrenal insufficiency
B) Hypopituitarism (especially growth hormone and gonadotropin deficiency)
Rationale: Post-traumatic hypopituitarism occurs in up to 25–50% of moderate-severe
TBI survivors, with GH and gonadotropin axes most commonly affected due to pituitary
stalk injury.
Q10 A client with TBI is exhibiting agitation, restlessness, and attempts to remove
restraints. The interdisciplinary team determines the least restrictive intervention is:
A) Four-point soft restraints B) Chemical restraint with haloperidol C) Environmental
modification and redirection D) One-to-one continuous observation
C) Environmental modification and redirection
