The Cognitive and Linguistic Scale (CALS) is an assessment instrument developed by Kennedy Krieger Institute (USA) that can quantify cognitive and linguistic functioning following an Acquired Brain Injury (ABI) during inpatient rehabilitation for children as young as 2 years of age through to adulthood.


The CALS was developed for serial administration to track recovery and assess outcome during inpatient rehabilitation. The CALS has adequate reliability and validity and is sensitive to change in children who are admitted to inpatient rehabilitation with limited responsiveness.

Target Users 

  • Neuropsychologists
  • Speech and Language Pathologists

Key Goals

  1. Assess neurobehavioral functioning at admission to assist with treatment planning/goal setting
  2. Track recovery over inpatient rehabilitation
  3. Assess neurobehavioral functioning at discharge

How The Tool is Used

The CALS includes 20 items measuring a range of neurobehavioral functions including lower level skills such as arousal and responsivity, to higher level skills such as complex language and problem solving. To maximize novelty and minimize practice effects, alternate versions are available for some items such as simple and complex planning.

CALS administration time is between 20 and 30 minutes. Items scores range from 1 to 5; the total score ranged from 20 (floor) to 100 (ceiling); they are rated based on behavioral observation, performance on specific tasks or responses during a semi-structured interview.

Key Outcomes 

  • Improves understanding of the cognitive and linguistic profile of children with brain injury, at all levels of functioning, throughout inpatient rehabilitation to assist in initial goal setting
  • Allows for systematic, detailed tracking of cognitive and linguistic recovery during inpatient rehabilitation by comparing each child to that child’s own functioning earlier in admission, to inform ongoing treatment planning and evaluate interventions on the basis of early trajectory of recovery
  • Early scores predict later outcomes to allow for better prognostication and to inform discharge planning
  • Use by multiple inpatient treatment team members promotes clarity and consistency in description of cognitive and linguistic deficits which facilitate communication among team members, patients, and families and facilitate interdisciplinary team process
  • Enhances program evaluation; used in conjunction with other benchmarks to ensure a facility’s brain injury population is making adequate progress during admission


  1. Slomine BS, Eikenberg J, Salorio CF et al. Preliminary evaluation of the cognitive linguistic scale: A measure to assess recovery in inpatient rehabilitation following pediatric brain injury. J Head Trauma Rehab 2008;23(5):286-293. doi:10.1097/01.HTR.0000336841.53338.2f
  2. Kramer ME, Suskauer SJ, Christensen JR et al. Examining acute rehabilitation outcomes for children with total functional dependence after traumatic brain injury: A pilot study. J Head Trauma Rehab 2013;28(5):361-370. doi:10.1097/HTR.0b013e31824da031
  3. Pham K, Kramer ME, Slomine BS et al. Emergence to the conscious state during inpatient rehabilitation after traumatic brain injury in children and young adults: a case series. J Head Trauma Rehab 2014;29:E44-8. doi: 10.1097/HTR.0000000000000022
  4. Slomine BS, Grasmick PH, Suskauer SJ et al. Psychometric properties of the Cognitive and Linguistic Scale: A follow-up study. Rehab Psychol. 2016; 61(3), 328-35. doi: 10.1037/rep0000096
  5. Svingos AM, Suskauer SJ, Slomine BS, Chen HW, Ellis-Stockley ME, Forsyth RJ. Rasch Properties of the Cognitive and Linguistic Scale and Optimization for Outcome Trajectory Modeling in Pediatric Acquired Brain Injury. Arch Phys Med Rehabil. 2022 May;103(5):908-914. doi: 10.1016/j.apmr.2021.10.009. Epub 2021 Oct 30. PMID: 34728191; PMCID: PMC9054937.