Rancho Los Amigos Cognitive Recovery Scale (RLA)

Question 1

What was the Rancho Los Amigos Cognitive Recovery Scale made for?

Answer 1

Developed to identify stages or levels of brain injury recovery.

Question 2

How many levels are in the RLA?

Answer 2

10

Question 3

Level 1

Answer 3

No response.
Total Assistance.
Appears to be in deep coma or sleep.
Does not respond.

Question 4

Level 2

Answer 4

Generalized response. 
Total A. 
Movement, but no purpose. 
Movement due to deep pain. 
Can open eyes, but no focus.

Question 5

Level 3

Answer 5

Localized Response.
Total A.
Moves eyes to look at specific things.
Can follow simple command like squeeze my hand.

Question 6

Level 4

Answer 6

Confused and Agitated.
Max A.
Confused and agitated about where they are and what is happening.
Motor activities that could be detrimental are attempted.
Safety and deficit awareness are important.

Question 7

Level 5

Answer 7

Confused, Inappropriate, Non-agitated.
Max A.
Does not make sense in convo.
Follow simple directions and tasks for 2-3 miniutes but is easily distracted.

Question 8

Level 6

Answer 8

Confused, Appropriate. 
Mod A. 
Able to do simple dressing, eating, teeth brushing. 
Learning new tasks is difficult. 
Attend a task for 30 minutes.

Question 9

Level 7

Answer 9

Automatic appropriate.
Min A.
Perform all self-care activities and are usually coherent.
Difficulty remembering recent events.
Carry out routine activities.
Rational judgment and solving multistep problems are difficult.
Needs supervision for safety.

Question 10

Level 8

Answer 10

Purposeful, Appropriate. 
SBA. 
Independent for familiar tasks in a distracting enviro for one hour. 
Acknowledges impairments. 
Difficulty self monitoring.

Question 11

Level 9

Answer 11

Purposeful, Appropriate. 
SBA on Request
Shift between tasks for 2 hours. 
Some A to adjust to life demands. 
Emotional & behavioral issues.

Question 12

Level 10

Answer 12

Purposeful, Appropriate: Modified I
Goal Directed, handling multiple tasks and independently using assistive strategies. Prone to breaks in attention and may require additional time to complete tasks.

Question 13

Family Strategies for Level 1-3

Answer 13

Do not interpret agitation as regression. Use calm, reassuring tones. Tell what you do before you do it. Speak short phrases. Allow extra time. One person speak at a time. Speak in concrete terms. Bring familiar things. Gently massage lotion. Touch face, arm or leg with different textures. Use variety of soaps. Keep notebook for visitors to sign (2-3 at a time). Room calm and quiet. Maintain rest periods. Assume person can understand. Sleep 20 hours a day.

Question 14

Family Strategies for Level 4

Answer 14

Tell where they are, assure them they are safe. Bring in personal items. Allow as much movement as is safely possible. Not force into activities. Frequent breaks. Room quiet and calm; if agitated tun off tv. Visitors 2-3 at a time.

Question 15

Family Strategies for Level 5

Answer 15

Avoid reward for inappropriate behavior. Redirect. Not assume they will remember. Repeat Frequently. Keep comments and questions short. Help get organized. Familiar pictures. Visitors 2-3 at a time. Frequent rest periods.

Question 16

Family Strategies for Level 6

Answer 16

Expect unaware of deficits. Increased need for supervision. Redirection may be ineffective. Arguments can be frequent and prolonged. Encourage to stay and participate in rehab. Repeat Frequently. Discuss and journal activities. Help with starting and continuing activities.

Question 17

Family Strategies for Level 7

Answer 17

Can go back to work and school. Treat person same as you did before TBI. Speak normal. Be careful about teasing/slang/humor. Talk through problems and feelings without criticizing. Encourage to continue rehab. tap recording. Note taking.

Question 18

Family Strategies for Level 8

Answer 18

Treat person same as you did before TBI. Speak normal. Be careful about teasing/slang/humor. Talk through problems and feelings without criticizing. Encourage to continue rehab. tap recording. Note taking.

Question 19

Family Strategies for Level 9

Answer 19

Independ. shifts between tasks, completes accurately for 2 hours. Assistive memory device to recall daily schedule. Initiates and carries out familiar tasks independent, unfamiliar with assistance when requested. Aware impairments when interfere with task. Requires SBA when prob before it occurs and to take action. Able to think about consequences of decisions with assistance when requested. Accurately estimates abilities but requires SBA to adjust. Acknowledges others needs, responds approp with SBA. May be easily irritable. Depression may continue. Self monitor approp of social interact with SBA.

Question 20

Family Strategies for Level 10

Answer 20

Independ. shifts between multi tasks simultaneously, may require breaks. Independ create and maintain assistive memory devices. independ Initiates and carries out familiar and unfamiliar tasks may need more time. Anticipates impact of impairments to complete daily tasks and takes actions to avoid problems before they occur. May require more time. Independ think about consequences of decisions may require more time. Accurately estimates abilities but requires SBA to adjust. Able to recognize others needs, responds approp. Periodic periods of Depression. Social interact consist approp.