Rancho Scale/Allen Scale/Glasgow Flashcards
Glasgow Coma Scale
traditional method to assess levels of TBI
scores range from 3-15
Glasgow Come Scale - Scores below 8
indicate severe brain injury
Glasgow Come Scale - Scores between 9-12
indicate moderate brain injury
Glasgow Come Scale - Scores above 14
indicate minor brain injury
Glasgow Come Scale - Motor responses assessed
No response (1 pt)
response to pain
movement to painful stimulus
obeys commands
Glasgow Come Scale - Verbal responses assessed
No response (1 pt) incomprehensible speech inappropriate words confused conversation but able to answer oriented to person, place, time
Glasgow Come Scale - Eye opening responses assessed
No response (1 pt)
to pain only
when asked w/lout voice
eyes open on own
Rancho Los Amigos Scale
awareness/cognitive function after TBI
Rancho Los Amigos Scale - Level I (no response)
no response to any stimuli
Rancho Los Amigos Scale - Level II (generalized response)
inconsistent /non-purposeful reaction to stimuli
Rancho Los Amigos Scale - Level III (localized response)
reaction specifically to stimuli but inconsistent
Rancho Los Amigos Scale - Level IV (confused/agitated)
heightened state of activity w/severely decreased ability to process info
- short attention span
- limited short term memory
Rancho Los Amigos Scale - Level V (confused/inappropriate non-agitated)
appears alert w/fairly consistent reaction, although increased complexity of commands causes more random responses
- overstimulated by environment
- wander
Rancho Los Amigos Scale - Level VI (confused/appropriate )
goal-directed behavior but dependent on external input for direction
- may show carry-over for tasks he has relearned
- able to attend a 30 min structured task
- aware of need for food, thirst, toileting
Rancho Los Amigos Scale - Level VII (automatic/appropriate)
appears appropriate and oriented to place/routine but frequently displays shallow recall
- oriented x3
- mannerisms are robot-like
- limited judgement
Rancho Los Amigos Scale - Level VIII (Purposeful/appropriate)
client is alert/oriented and able to recall and integrate past/recent events.
- needs no supervision once activities are learned
- indep in home/community
- decreased tolerance for stress, abstract reasoning, judgement in emergencies
Allen’s cognitive disabilities groups
level 1 - pts would not benefit from the group
level 2 - pts would be successful in situations in which they can move around/copy movement that is modeled
level 3 - pts focus on elements of repetition/manipulation
level 4 - pts work on goal-directed activities such as crafts
level 5 - pts engage in activities w/a graded structure (clay modeling/mosaic project.
Dementia effects on occupational performance - Early Stage
- ADLs remain intact
- first signs of memory loss happen in IADLs
- affects orientation to place
- learning/reading become hard
- social withdrawal
Dementia effects on occupational performance - Middle Stage
- the person can no longer live alone
- no longer attend to ADLs
- weight loss occurs
- IADLs are neglected
- dependent in community mobility
- safety is a concern
Dementia effects on occupational performance - Late Stage
- All areas of occupations are lost
- dependent in all ADLs
- can no longer ambulate safely
- communication is lost
Claudia Allen’s Cognitive Disability Theory - Cognitive Level 6 - Planned actions
-client is indep
Claudia Allen’s Cognitive Disability Theory - Cognitive Level 5 - exploratory actions
- supervision is needed
- pt learns through visible, concrete, meaningful stimuli
- pt explores the effects of self-initiated motor actions on physical objects
- pt uses trial-error problem solving
- pt has problems w/judgement, reasoning, planning
Claudia Allen’s Cognitive Disability Theory - Cognitive Level 4 - goal directed activity
- pt needs min cognitive assistance
- attention is to visual/tactile cues
- can no longer problem solve
- can follow two/three step activities
- activities must be simple, concrete, supportive
- labels/pictures
- task setup
- eat indep but needs supervision for amount of food
- 24 hour supervision
Claudia Allen’s Cognitive Disability Theory - Cognitive Level 3 - manual actions
- mod cognitive assistance
- cannot learn new behaviors
- activities (wiping countertops, vacuuming, walking)
- needs routine
- should avoid sensory overload
- able to wash hands/face and brush teeth
- during bathing items presented to client one at a time
- 24 hour supervision
Claudia Allen’s Cognitive Disability Theory - Cognitive Level 2 - postural actions
- max cognitive assistance
- motor actions are near reflexive
- ADLs can be done by imitating the caregiver
- spontaneous behaviors
- able to eat finger goods
- paces/wanders
- taken to bathroom every 2 hours
- around the clock supervision
Claudia Allen’s Cognitive Disability Theory - Cognitive Level 1 - automatic actions
- total cognitive assistance
- motor actions are in response to one-word
- needs assistance w/ambulation and transfers
- needs PROM, AROM to prevent bed sores/contractures
- constant 24 supervision
- terminal phase
