Ranchos Levels

Question 1

Level I (1)

Answer 1

Dependent
No response
(Splinting, Positioning, PROM)

Question 2

Level II (2)

Answer 2

Dependent 
Generalized response (always the same i.e. flexion withdrawl) 
Responses can be delayed 
(Splinting, Positioning, ROM)

Question 3

Level III (3)

Answer 3

Dependent 
Localized response (more specific -> turning towards name, respond to discomfort  by pulling on tubes) Responds to family 
(Splinting, Positioning, ROM)

Question 4

Level IV (4)

Answer 4

Max A / Dependent
*Confused & Agitated
Eyes open, considered awake, difficult to manage
Can manage repetative activities with decreased cognitive components
STM issues - increased agitation

Question 5

Level V (5)

Answer 5

Max A
* Confused & Inappropriate- Non agitated
Decreased agitation
Increased processing skills
Agitation is more specific (i.e. w/ challenging tasks)
Not oriented x3
Decreased safety with higher level ADL’s
Pt.s do better with shorter treatment sessions
Difficulty learning new information
Basic ADL;s & light meal prep
Difficulty w/ recall which is agitating/frustrating
Orient them every time you enter the room.
Can begin building strategy development
Difficulty w/ object use (remove all items that are not requierd)
Use cues and structure

Question 6

Level VI (6)

Answer 6

Mod A
Confused & Appropriate
Decreased safety awareness and increase impulsivity
Increased self awareness and orrientation
Attend to familiar task in a quiet environment
IADL’s with higher sills are still limited
Use assitive memory devices
Capatalize on goal directed behaviors
Increase problem solving by using open ended questions

(May be out patient or home health)

Question 7

Level VII (7)

Answer 7

Min A
Automatic and Appropriate
Can use environmental adaptations to increase consistency with orientation
Pt.s lack social awareness - use life skill training & role playing interventions
Attend to a familiar task for 30 minutes
Carryover new learning
Min A safety
Decreased planing for future

Question 8

Level VIII (8)

Answer 8

Stand By A
Purposeful & Appropriate
Ily complete tasks ~1 hr in noisy environment
Use “to do” lists
Need A to increase activities
Pt.s have increased depression & Irability

Question 9

Level IX (9)

Answer 9

Stand by A on request
Purposeful & Appropriate
Shits attention between 2 tasks ~2 hrs
pt. have increased self awarness and corrective action

Question 10

Level X (10)

Answer 10

Mod I 
Purposeful & Appropriate 
Better able to multitask 
More consistant w. memory devices 
Ily initiate household & self-care tasks 
Aware of strengths and weaknesses 
Increased social skills