Pate Environmentally Relevant Program Outcome System: PERPOS


occupational cooking rehab in a kitchen
Real world skills are key

Pate is the exclusive provider of an innovative method to prepare people with brain injuries to return to their real-world environments.

Validated in the peer-reviewed journal NeuroRehabilitation, PERPOS (Pate Environmentally Relevant Program Outcome System) is Pate's proprietary measurement tool that focuses on the complex interactions of the environment and ability.

Pate's founder, neuropsychologist Dr. Mary Ellen Hayden, had a groundbreaking insight. She realized that brain injury treatment must be personally relevant, in surroundings that resembled person's specific real home/work environments, to maximize skills transfer from rehabilitation to home.

Dr. Hayden speculated that understanding the patient's requirements for structure and tolerance for distraction in the real world could improve outcomes. Her pioneering concept was to create a changing rehabilitation environment that could assist the patient's progression by slowly increasing distractions and independence levels over time.


people doing physical therapy in large room
View of high distraction environment

Rather than providing rehabilitation in a controlled environment that was unlike the real world, Dr. Hayden believed that it was the rehabilitation facility itself that should change by better replicating the real life patients would return to.

In other words, Pate treatment should reflect the patient's independence and tolerances, rather than fitting the patients to our program. This was a revolutionary idea in rehabilitation and is integral to our treatment model.

PERPOS allows us to directly measure an individual's ability to re-enter society and maximize transfer of gains made at the treatment facility.


 PERPOS measures:

  1. Amount of structure needed
  2. Distraction tolerated
  3. Overall functional ability


Distraction and Tolerance


The level of distraction and amount of structure present in each patient’s environment are the core elements of our treatment approach.

The PERPOS accurately and precisely measures these elements, and this information informs our therapy teams' evaluations of how well patients perform functional activities within different environments.

PERPOS scores are between 5 - 23 and indicate the level of independence and amount of supervision needed for the patient.

As treatment progresses and more function is regained, therapists can manipulate the environment to enhance skills.


occupational rehab with a woman opening variety locks

High-level Structure, Low-level Distraction – Therapist directed activity provides patient with limited choices in a quiet environment with only the therapist and patient.


Mid-level Structure, Mid-level Distraction – Therapist aided activity in an environment with more people around and more to see. Music may be added.




Low-level Structure, High-level Distraction – Replication of real life situations such as grocery shopping that provides a highly distracted environment in which the patient may be structuring him/herself with little to no input from the therapist.






Using PERPOS scale, our Clinical Team initially assesses each patient to determine his or her individual needs. Areas evaluated during the first week of treatment are speech, occupational, cognitive ability, physical/motor skills, and a functional assessment.

During the first week of treatment, we will evaluate:

  • Speech
  • Self-care
  • Physical/motor and cognitive abilities
  • Daily life skills

Lower PERPOS scores represent a greater degree of impairment, while higher scores represent a lesser degree of impairment.

Going forward, PERPOS scores are determined during bi-weekly treatment team meetings, which include the treatment teams' observations on patients’ abilities, distraction tolerance, and need for structure.

As scores change, we frequently adjust treatment goals accordingly to better assist patients’ ability to return to their home and work environments. Our teams are made up of neuropsychologists, physical therapists, occupational therapists, speech language pathologists, and case managers.


PERPOS Also helps us with:

  • Forecasting effective length of stay
  • Therapists’ treatment planning
  • Justification of progress to payor
  • Patient insight development
  • Progress monitoring (data bi-weekly)



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