Rancho Levels Flashcards
Rancho Level 1 Description
No response
What is the client capable of at Rancho Level 1
nothing, basically in a coma
Rancho Level 2 Description
Generalized response
What is the client capable of at Rancho Level 2
inconsistent/non-purposeful/delayed reaction to stimuli
What to do with a Rancho Level 2 pt
monitor skin
gentle PROM of joints to prevent contracture
positioning: side lying/prone is best (supine may lead to extensor response); supported sitting as tolerated
sensory stim
Rancho Level 3 description
Localized response
What is the client capable of at Rancho Level 3
inconsistently answers questions with yes/no
reponds to visual, tactile, and audio stimuli
follow simple commands
delayed, inconsistent reactions
what to do with rancho level 3 pts
look up in book
Rancho level 4 description
confused/agitated
What is the client capable of at Rancho Level 4
max assist
bizarre/non purposeful behavior
lacks short term memory
will try to remove tubes or crawl out of bed
what to do with rancho level 4 pt
behavior mgmt -minimize restraints -provide activities they are likely to be successful in minimize overstim increase physical activity -ROM, gross motor -simple ADLs- wash face, dressing increase safety educate family
Rancho level 5 description
confused, appropriate
What is the client capable of at Rancho Level 5
- *Where rehab process can really begin
- attend for short periods of time (1-2 minutes)
- follow simple short, step-by-step commands
- may use items inappropriately if not instructed
- may become agitated as a result of external stimuli
- will not be orientated to time and date
what to evaluate with rancho level 5 pt
tone reflexes ROM MMT endurance dysphagia vision visual-perceptual cognition/executive function
OT goals at rancho 5
remediate strength/ROM/endurance/etc orient client prior to session (introduce self) increase cognitive skills engage in familiar everyday tasks provide breaks as needed
Rancho level 6 description
confused, appropriate
What is the client capable of at Rancho Level 6
able to tolerate unpleasant stimuli when need is explained
follow simple directions
carryover of tasks that are relearned
begin to become aware of impairments
vague recognition of staff
increased awareness of self, family, and basic needs
oriented to time and place
OT eval at rancho level 6
interview
cognitive screenings
performance-based assessments
visual-perceptual assessments
OT goals at rancho level 6
increase attention to specific tasks and stimuli
increase immediate and short-term memory
increase processing and sequential organization
increase independence in self-care tasks
establish safe functional ambulation and transfer techniques
incorporate cognitive strategies
decrease assistance and cuing
what to do with rancho level 6 pt
keep tx under 30 min needs mod-max assist journal activities for the day to improve memory repetition provide increased supervision try to decrease amount of cuing gradually increase speed and complexity of tasks visual scanning simple puzzles
Rancho Level 7 description
automatic, appropriate
about Rancho level 7
appropriate and oriented in home and hospital
goes through daily routine, but robot-like
-can follow set schedule
can do routine self care without help
minimal confusion
increased awareness of self, body, people, environment
aware of condition, but lacks insight into
decreased judgement and problem solving
lacks realistic planning for future
shows carryover of new learning, but slow
requires minimal supervision in home and community for safety
able to initiate social interaction
easily distracted
tends to overestimate abilities
Goals for Rancho Level 7
increase attention/memory improve problem solving independence in self-care coping for frustration safe transfer skills
tx for Rancho Level 7
participation in community outings
establish daily routines
restore joint mobility and motor function
home modification
create visual schedules and visual cues
promote social interaction with other TBI pts
Rancho Level 8 description
purposeful-appropriate with standby assist
about Rancho 8
alert and oriented can be independent in home and community can drive can recall and integrate past and present can carry over learning can be independent with learned tasks
problem area of rancho level 8
judgement managing stress abstract reasoning irritable argumentative depression social/emotional intellectual abilities
OT goals for rancho level 8
promote ability to live independently
decrease stress and emotional outbursts
maintain and promote safety
promote social participation
OT evaluation for Rancho Level 8
ROM MMT Sensation coordination balance trunk control tone endurance swallowing cognition vision perception ADLs/IADLs Driving Vocational
OT tx for Rancho Level 8
keep instructions simple safety training modify home facilitate community integration increase social participation establish routines driver rehab home exercise program to maintain physical abilities caregiver education stress reduction fatigue management
Rancho Level 9 description
Purposeful-appropriate (with standby assistance upon request)
Rancho Level 10 description
purposeful-appropriate (modified independent)
about Rancho level 9
- independently shifts between tasks and accurately completes them for at least 2 consecutive hours
- uses assistive memory devices
- initiates and carries out steps to complete familiar tasks independently
- aware of and acknowledges impairments when they interfere with task completion
- able to think about consequences of actions with assistance
- acknowledges others’ feelings and needs with stby assistance
- may be easily irritable with low frustration tolerance
- monitor appropriate social interactions with stby assist
about Rancho Level 10
- able to handle multiple tasks simultaneously in all environments, but my require periodic breaks
- independently make own assistive memory devices
- independently initiates and carries out steps to complete familiar and unfamiliar tasks and avoid problems before they occur, but may require more time and/or compensatory strategies
- independently think about consequences of actions, but may require more time for decision making
- periodic periods of depression
- low stress tolerance
- social behavior consistently appropriate
OT eval for Rancho 9/10
ROM tone vision perception coordination MMT vocational testing work eval driving eval
OT goals for Rancho 9/10
prevent substance abuse maintain use of memory aids reduce depression and frustration rebuild desired occuptions and social roles return to work
OT tx for Rancho 9/10
energy conservation asstive tech role play problem solving scenarios coping skills for frustration social skills training support group educate employer/educational system vocational rehab work modifications/work hardening
