Rancho Los Amigos Scale Flashcards
Level I
No response
The individual appears to be in a deep sleep and is completely unresponsive to any stimuli presented
Level II
Generalized response
The individual reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner. Responses are limited in nature and are often the same, regardless of the stimulus presented. Responses may be physiologic changes, gross body movements, or vocalization. Often the earliest response is to deep pain. Responses are likely to be delayed.
Level III
Localized response, total assist
Reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented, as in turning the head toward a sound or focusing on an object presented.
May withdraw an extremity or vocalize when presented with a painful stimulus.
May follow simple commands in an inconsistent, delayed manner, such as closing the eyes, squeezing, or extending an extremity. After external stimulus is removed, the individual may lie quietly.
May show a vague awareness of self and body by responding to discomfort by pulling at a nasogastric tube or catheter or resisting restraints.
May show bias by responding to some people (especially family and friends) but not to others.
Intervention ex: sensory stim activities
Level IV
Confused, agitated; Max assist, seconds
In heightened state, severely decreased ability to process information. ** seconds of attention
Detached from present ; responds primarily to own internal confusion.
Behavior often bizarre and nonpurposeful relative to the immediate environment. **
The individual may cry out or scream out of proportion to the stimuli; may exhibit aggressive behavior, attempt to remove restraints or tubes, or crawl out of bed in a purposeful manner. Does not discriminate among people/objects & unable to cooperate directly w/ treatment.
Verbalization is frequently incoherent and inappropriate to the environment.
Confabulation may be present; the individual may be euphoric or hostile.
gross attention is very short, and selective attention is often nonexistent.
lacks short-term recall and may be reacting to past events.
**unable to perform self-care (eg, feeding and dressing) w/o max assist. **
may perform motor activities (eg, sitting, reaching, and ambulating), but not as a purposeful act or on request.
Level V
Confused, inappropriate, Max assist, 30 seconds
The individual appears alert and is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of any external structure, responses are nonpurposeful, random, or at best fragmented toward any desired goal. The individual may exhibit agitated behavior, not on an internal basis (as in level IV), but rather as a result of external stimuli and usually out of proportion to the stimuli. He or she has gross attention to the environment but is highly distractible and lacks the ability to focus attention on a specific task without frequent redirection back to it. With structure, the individual may be able to converse on a social, automatic level for short periods. Verbalization is often inappropriate; confabulation may be triggered by present events. Memory is severely impaired, with confusion of past and present in the reaction to ongoing activity. The individual lacks initiation with regard to functional tasks and often shows inappropriate use of objects without external direction. He or she may be able to perform previously learned tasks when they are structured for him or her, but the individual is unable to learn new information. He or she responds best to self, body, comfort, and often family members. The individual can usually perform self-care activities with assistance and may accomplish feeding with maximal supervision. Management on the unit is often a problem if the individual is physically mobile because he or she may wander off either randomly or with the vague intention of going home.
Level VI
Confused, appropriate, mod assist, 30 Minutes
The individual shows goal-directed behavior but is dependent on external input for direction. The response to discomfort is appropriate, and the individual is able to tolerate unpleasant stimuli (eg, nasogastric tube) when the need is explained. The individual follows simple directions consistently and shows carryover for tasks that have been relearned (eg, self-care). He or she is at least supervised with old learning but is unable to maximally assist in new learning with little or no carryover. Responses may be incorrect because of memory problems, but they are appropriate to the situation. Responses may be delayed, and the individual shows a decreased ability to process information with little or no anticipation or prediction of events. Past memories have more depth and detail than recent memory. The individual may show beginning awareness of his or her situation by realizing that he or she doesn’t know an answer. The individual no longer wanders and is inconsistently oriented to time and place. Selective attention to tasks may be impaired, especially with difficult tasks and in unstructured settings, but the individual is now functional for common daily activities (30 minutes with structure). He or she shows at least vague recognition of some staff members and has increased awareness of self, family, and basic needs (eg, food), again in an appropriate manner, in contrast to level V.
Level VII
Automatic, appropriate, min assist, 30 minutes
Appropriate & oriented in hospital/home settings; goes through the daily routine but frequently robot-like. Minimal confusion but difficulty recalling what they have been doing. Increased awareness of self, body, family, foods, people, and interaction in the environment. The individual has superficial awareness of, but lacks insight into, his or her condition, demonstrates decreased judgment and problem solving, and lacks realistic planning for the future. shows carryover for new learning, but at a decreased rate. At least minimal supervision for learning & safety purposes; Independent in self-care and supervised in home and community skills for safety. With structure the individual is able to initiate tasks in social and recreational activities. Judgment remains impaired, such that the individual is unable to drive a car. Prevocational or avocational evaluation and counseling may be indicated.
Level VIII
Purposeful & appropriate, SBA, 1 hour, assistive memory devices
The individual is alert and oriented, is able to recall and integrate past and recent events, and is aware of and responsive to his or her culture. He or she shows carryover for new learning if it is acceptable to him or her and his or her life role. Needs no supervision for learned activities, independent in home & community skills, inc. driving. Vocational rehabilitation is indicated, to determine ability to return as a contributor to society (perhaps in a new capacity). may continue to show decreased ability, in reasoning, tolerance for stress, judgment in emergencies, or unusual circumstances. Social, emotional, and intellectual capacities may continue to be at a decreased level but functional for society.
