Ranchos Los Amigos Levels of Cognitive Functioning

Question 1

I. No Reponse

Answer 1

Pt appears to be in a deep sleep is completely UNRESPONSIVE to ANY stimuli

Question 2

II. Generalized Response

Answer 2

• Pt reacts INCONSISTENTLY + NON-PURPOSEFULLY to stimuli in a non-specific manner
• Responses are limited + often the SAME regardless of stimuli (physiological changes, gross body movements, +/- vocalization)

Question 3

III. Localized Response

Answer 3

• Pt reacts SPECIFICALLY, but INCONSISTENTLY to stimuli
• Responses are DIRECTLY RELATED to type of stimulus
• May follow simple commands (close eyes, squeeze hand) in an INCONSISTENT + DELAYED manner

Question 4

Iv. Confused - Agitated

Answer 4

• Heightened state of activity
• Behavior is bizarre + non-purposeful to immediate environment
• Does not discriminate between persons or objects
• UNABLE TO COOPERATE with treatment
• Verbalizations are frequently INCOHERENT +/- INAPPROPRIATE to environment. confabulation may be present
• Gross attention to environment is brief
• Selective attention is often nonexistent
• Pt lacks short + long-term recall

Question 5

V. Confused - Inappropriate

Answer 5

• Able to respond to SIMPLE commands fairly CONSISTENTLY
• Increased complexity of commands or lack of external structure = responses are NON-PURPOSEFUL, random or fragmented
• Gross attention to environment, but highly distractable
• Lacks ability to focus attention on specific task
• With structure - can speak on a social automatic level for a short period of time
• Verbalization is often INAPPROPRIATE + CONFABULATORY
• Memory is SEVERELY impaired
• Inappropriate use of objects
• UNABLE TO LEARN NEW INFO (may be able to perform previous tasks with structure)

Question 6

VI. Confused - Appropriate

Answer 6

• Goal directed behavior, but is DEPENDENT on external input/direction
• Follows simple directions CONSISTENTLY
• Shows carryover for relearned tasks (ex: self-care)
• Responses may be incorrect 2* memory problems, but are appropriate to situation
• Past memories show more depth + detail than recent memory

Question 7

VII. Automatic - Appropriate

Answer 7

• Appropriate + oriented in hospital + home setting
• Daily routine is automatic but robot-like
• Min to no confusion
• Shallow recall of activities
• CARRYOVER FOR NEW LEARNING at decreased rate
• With structure, can initiate social +/- recreational activities
• JUDGMENT REMAINS IMPAIRED

Question 8

VIII. Purposeful - Appropriate

Answer 8

• Can recall + integrate past + recent events
• Is AWARE of + RESPONSIVE to environment
• CARRYOVER FOR NEW LEARNING
• NEEDS NOT SUPV ONCE ACTIVITIES LEARNED
• Decreased ability compared to premorbid level with abstract reasoning, tolerance for stress, + judgment in unusual or emergency situations