Chapter 7: Rancho Levels of Cognitive Functioning

Question 1

Level I,II, & III “Rodger”

“Need Green Limes”

Answer 1

Level I “Need” = No Response = Total Assisst

• No behavioral response to any stim; looks like they are asleep

Level II “Green” = Generalized Response = Total Assist

• general reflex response to pain
• some activity to repeated auditory stim
• gross movement with stim
• slow responses

Level III “Limes” = Localized Response = Total Assist

• Withdraws from pain
• turns toward auditory stim
• blinks with strong light
• follows objects in visual field
• pulls at drains and tubes if uncomfortable
• sometimes responds to simple commands
• responds to some people and not others

Question 2

Levels IV, V, & VI

“CCC”

Answer 2

Level IV: Confused/Agitated = Max Assist

• very alert; not oritened at all; trying to get out of bed/pull off restrains
• mood swings
• overeactions
• random motor acitivties
• unable to cooperate with treatment efforts
• no short-term memory

Level V: Confused/ Inappropriate (non-agiated) = Max Assist

• Without structure and cues person is confused; wandering around room or ward
• May still become aggitated by enironmental stim
• can do some automatic things but might not be appropriate to situation ie brush teeth with hair brush
• not A&Ox3
• not learning new info
• still has impaired memory and very spotty attention

Level VI: Confused/ Appropriate = Mod Assist

• More focused attention 30 min of highly familar task
• Inconsistenly A&Ox3
• Some awareness and recognition of staff; some improved memory
• Still may be unaware of imparient, safety risks etc
• Can complete basic familar tasks with supervision and mod assist for carry over, max assist for new tasks
• can consistenly follow simple directions
• verbal expression is mostly appropriate in familar/structured situations

Question 3

Level VII

“AA” and Robotic

Answer 3

Automatic/Appropriate = Min Assist for ADLs

• Consistently A&Ox2 - may need assist with time
• with min assist can perform highly familar tasks for about 30 min
• min supervision for learning new tasks and carries over new learning
• Initiates and performs amilar I/ADLs with min assist but may not be able to recall what they were just doing
• Some awareness of self and limitations
• Still needs some supervision for safety purposes
• Predicting consequences of an action are not present
• Unrealistic future planning
• Unaware of other’s feelings and needs
• oppositional/uncooperative
• Not able to recognize innaprropriate social interactions

Question 4

Level VIII

“PA/SBA”

Answer 4

Purposeful, Appropriate = Stand-by-Assist

• Consistently A&Ox3
• Can complete familar tasks for about 1 hour
• Has meory recall from past, present, future
• Using AT and other strategies (to-do list) to recall daily schedule
• Completes I/ADLs with SBA and can modify with min assist
• Does not need assist once tasks are learned
• Aware of limiations and impairments but needs SBA for corrective action
• Thinks about consequences of an action with min assist
• Still over estimates abilities
• Aknowledges other’s needs and feelings and responds appropriatly with min assist
• can be irratable, low frustration level, self centered, may be too dependent or independent

Question 5

Level IX

PA/SBA-R

Answer 5

Purposeful, Approriate = SBA with request

• Can shift attention between tasks and sustian attentin for about 2 hours
• Uses AT and other strategies with assist as requested
• May be depressed, irratable. low frustation tolerance
• Able to self monitor

Question 6

Level X

PA @MI

Answer 6

Purposeful, Appropriate: Modified Indep

• Can handle multiple tasks but may require breaks
• Is indep with AT and strategies
• Knows how their imprairments with impact tasks and self corrects for them
• May still be peridocialy depressed as well as low frustation tolerance/emotional when under extra stress or sick