Rancho Levels

Question 1

Common theme for Rancho levels 1-3

Answer 1

Total Assist!

• Little motor movement
• Delayed response

Question 2

Common theme for rancho levels 4-6

Answer 2

Confused

• No learning of with lots of assistance
• No purposeful or goal directed, behavior
• Divided, fleeting, non specific attention

Question 3

Common theme for rancho levels 7 and 8

Answer 3

Automatic/purposeful

• Either automatic or purposeful level
• New learning
• Can correct/modify actions with assistance

Question 4

When are Rancho levels used?

Answer 4

Descriptive measurement of awareness and cognitive function after traumatic injury, scored from level 1 to Level 10

Question 5

Rancho level 1

Answer 5

No response: is completely unresponsive to any stimuli presented

• Appears asleep
• Total A

Question 6

Rancho level 2

Answer 6

Generalized response: exhibits inconsistent and nonpurposeful reactions to stimuli

• Total A
• Gross motor response to pain
• Same response regardless of type and location of stimuli

Question 7

Racho level 3

Answer 7

Localized response: reacts specifically to stimuli, though inconsistently

• Total A
• May turn to/away from auditory stimuli
• May blink when light over visual field
• May track moving object
• Responds directly to stimuli

Question 8

Rancho level 4

Answer 8

Confused and Agitated: has heightened sense of activity with severely decreased ability to process information

• Requires Max A
• May try to crawl out of bed, remove constraints
• Moody, aggressive
• Decreased attention
• Treatment difficult-unable to cooperate

Question 9

How will treatment look when working with a Rancho level 4 pt?

Answer 9

Treatment will be difficult. The patient is confused and agitated and will not be able to cooperate

Question 10

Rancho level 5

Answer 10

Confused, inappropriate nonagitated: appears alert with fairly consistent reactions, although increased complexity of commands causes more random responses

• Requires Max A
• Inappropriate behaviors e.g., wandering with intention of going home, inappropriate use of objects e.g., trying to brush hair with toothbrush
• Able to perform highly familiar tasks with structure and cues
• Responds to simple commands

Question 11

What modifications should be used in tx with a client at Rancho level 5?

Answer 11

The patient is confused, non-agitated, and inappropriate. Is able to perform highly familiar tasks with structure and cues. Use simple commands.

Question 12

Rancho level 6

Answer 12

Confused, appropriate: exhibits goal-directed behavior but is dependent on external input for direction

• Requires mod A
• Able to attend to highly familiar tasks for up to 30 mins.
• Emerging awareness of self and others

Question 13

At what Rancho level does the client first exhibit goal-directed behavior?

Answer 13

Level 6. However, still dependent on external input for direction

Question 14

Rancho level 7

Answer 14

Automatic/appropriate: behaves appropriately and is oriented to place and routine but frequently displays shallow recall
A. Min A (supervision)
B. May be unrealistic in planning for future
-Not very aware of how others feel
-May not be aware of appropriate social behaviors
-New learning with carry over
-Can carry an intelligible conversation

Question 15

At what Rancho level is the client first able to engage in new learning?

Answer 15

Level 7

Question 16

Rancho level 8-10

Answer 16

Purposeful and appropriate: is alert and oriented and able to recall and integrate past and recent events. Each level (8, 9, 10) represents a decreasing need for assistance with routine daily living skills