Rancho Los Amigos Levels of Cognitive Functioning

Question 1

RLAS

Answer 1

• Predictable sequence of cognitive and behavioral recovery in TBI pt’s
• Levels 1-8
• Levels 1-10 for Revised scale

Question 2

Level 1

Answer 2

• No response

Question 3

Level 2

Answer 3

• Generalized Response
• Inconsistent, nonspecific, nonpurposeful response
• Often same response regardless of stimuli

Question 4

Level 3

Answer 4

• Localized Response
• Specific but inconsistent response to stimuli
• Responses are directly related to the type of stimulus (turning head in response to sound)
• Pt is beginning to interact with environment

Question 5

Level 4

Answer 5

• Confused / Agitated
• Heightened state of activity with bizarre, nonpurposeful, random behavior
• Aggressive tendencies (cursing, striking, violent)
• Pt does not discriminate among persons or objects
• Verbalization’s frequently incoherent / inappropriate / nonsensical
• Gross attention very brief
• No short or long-term recall

Question 6

Level 5

Answer 6

• Confused, Inappropriate (not agitated)
• Able to consistently follow simple commands
• Able to participate, but needs continuous direction
• Fragmented, random responses to complex commands or lack of external structure
• Gross attention to environment but highly distractible
• Verbilization often inappropriate
• Memory Severely Impaired

Question 7

Level 6

Answer 7

• Confused, Appropriate
• Shows goal directed behavior but is dependent on external input or direction
• Follows simple directions and shows carryover for relearned tasks, such as self-care
• Still requires maximum assistance for learning of new tasks with little carryover
• Responses are appropriate but may be incorrect due to memory deficits
• Past memories have more depth and detail than recent memories

Question 8

Level 7

Answer 8

• Automatic - Appropriate
• Appears appropriate and oriented in familiar environments
• Goes through daily routine automatically, but frequently robot-like
• Has shallow recall of activities and slow carryover of new learning
• With structure, able to initiate social / recreational activities
• Judgment remains impaired
• Continues to need supervision for saftey

Question 9

Level 8

Answer 9

• Purposeful - Appropriate
• Able to recall and integrate past and recent events
• Is aware of and responsive to environment
• Carryover of new learning- needs NO supervision once activities are learned
• May continue to have decreased abstract reasoning, tolerance for stress and judgment in emergency or unusual circumstances

Question 10

Favorable Clinical Signs

Answer 10

• Pupillary Re-activity
• Reflexive and spontaneous eye movement
• Earlier return o consciousness (response to stimulation) and / or decrease depth of coma
• Speed of movement through levels of consciousness on Rancho scale may assist in ascertaining rate or cognitive return
• Communication or any kind is a positive sign
  
  • Verbal
  • Signs of understanding (facial expression)

Question 11

Signs of poor Prognosis

Answer 11

• Persistent flaccidity
• Decerebrate rigidity or hyperactive extension reflexes and spasticity
• Deficits with swallowing reflexes
• Deficits with respiration and cardiovascular control
• Deficits with postural reactions (suuporting reactions, TNR’s, tonic labyrinthine reflexes)
• Prolonged coma, low Glasgow scale
• Absent eye movement
• Large Degree of Cognitive disability
• Lesions

Question 12

Large Degree of cognitive disability

Answer 12

• Greatly interferes with recovoery and rehab process

Question 13

Lesions (frontal) causing behavior changes such as..

Answer 13

• Loss of insight
• Disinhibition
• Aggression
• Impaired judgment
• Apathy (lack of interest, enthusiasm or concern)
• Hyperactivity

Question 14

Common Compications

Answer 14

• Seizures
• Hydocephalus
• Aspiration Pneumonia
• Hypertension
• Decubitus
• Urinary tract infection
• Metabolic Imbalances