Ranchos Los Amigos Revised Scale Flashcards
Ranchos Los Amigos assumption
observation of type, nature, and quality of patient’s behavior is representative of cognitive level
cutoff for Agitated Behavior Scale
< 21 - within normal limits
22-28 - mild agitation
29-35 - moderate agitation
> 35 - severe agitation
What is the hallmark transition between RLAS-R 4 and 5?
agitation goes away in level 5
What will a RLAS-R 5 score on agitated behavior scale?
21 or below
At what RLAS-R level does orientation start to come in?
6
What are hallmarks of RLAS-R 6?
become inconsistently oriented and begin to demo carryover for relearned familiar task
- can sit down and do something structured with patient with max assist and max external cues
- poor insight (safety risk)
At what stage is the patient no longer confused?
RLAS-R 7
At what stage does the patient start to have awareness of what their condition but think they are fine?
RLAS-R 7
RLAS-R 7 orientation
consistently oriented to person and place
How would you describe a RLAS-R 7 cognitive responses?
robot/automatic like cognitive responses
What is the difference between RLAS-R 7 and 8 in terms of orientation?
8 is consistently orientated to person, place, and time
What is behavior of RLAS-8?
- depression common - reality is setting in
- similar to a toddler
- defiant and underestimate abilities
- able to recognize inappropriate social behavior and correct w/ min assist
What is a defining factor of RLAS-R 9?
able to realize and ask for help when needed
What is the GOAT? What cutoff scores exist for it?
Galveston Orientation and Amnesia test - determines if person is in state of post-traumatic amnesia (state of disorientation)
normal - 76-100
borderline - 66-75
impaired - < 66
What is the O-Log? What cutoff scores exist for it?
basic A + O exam - determines if person is in state of post-traumatic amnesia (state of disorientation)
- scoring out of 30 and want > 25
How do we determine if someone is no longer in a post-traumatic amnesia state?
> 75/100 on GOAT and > 25/30 on O-log
Post-traumatic amnesia determined by _______ demonstrated even better prediction of rehabilitation outcomes than ______
O-log better predictor than GOAT
What is the MARS?
Moss Attention Rating Scale
- observational scale that measures behavioral responses that affect attention
MARS scoring
- negative items need to be flipped before scoring
- 22-110 scale w/ higher scores = better attention
What are the 3 major factors that the MARS rates?
- irritability
- initiation
- sustained attention
What are the options available to deal with an agitated patient?
talk calmly, quietly, slowly, and short sentences
- turn off lights, close shades, turn off TV, have less people in room, close/crack door
- lessen stimulus
Why are restraints a last-ditch option?
increase risk for delirium, worsening agitation, skin breakdown, and length of stay
At what stage does the patient become consistently oriented?
7 - consistently oriented to person and place in familiar environments; ModA for time
8-10 - consistently oriented to person, place, and time
At what stage does the patient begin to see confusion between STM and LTM?
5
At what stage can the patient distinguish between STM and LTM?
6
At what stage does the patient need maxA with memory device? ModA? SBA?
maxA - 6
modA - 7
SBA - 8
What is the difference between RLAS 9 and 10 in terms of memory?
9 independent w/ memory aide but may need help procuring and maintaining
10 - independent w/ memory aide
At what stage can the patient recall and integrate past/recent events?
8
At what stage of problem solving will the patient be able to demo previous learned tasks, no carryover? What will they need to complete this task?
5 - need max structure and cues
At what stage does the patient start to show improvements in problem solving even though it remains difficult (maxA)? What else can they do at this stage?
6 - maxA w/ learning new tasks but no carryover
At what stage will the patient be able to problem solve through ADLs and other familiar tasks with MinA?
7
What is the difference between RLAS 9 and 10 with problem solving?
9 - initiate and carry out familiar tasks but may need some assistance w/ unfamiliar tasks
10 - independent initiates and carries out steps to familiar and unfamiliar tasks but may need more time or compensatory strategies
At what stage does the patient begin to initiate and carry out familiar tasks independently?
8
What is the difference between RLAS 4 and 5 when it comes to attention?
4 - very brief and non-purposeful movements of sustained and divided attention
5 - highly distractable, tangential
At what stage can you perform a structured activity for the patient? What is the environment like and for how long?
6 - highly familiar tasks in non-distracting environment for short time (< 30 min) w/ assist
At what stage can the patient perform tasks in a distracting environment?
8
What is the difference between RLAS 9 and 10 when it comes to attention?
9 - independently shift back and forth between tasks and complete accurately for 2 hours
10 - independently handle multiple tasks simultaneously in all environments but may require breaks
What type of directions should be used with an RLAS 6?
simple directions
At what level will the patient respond appropriately to simple and multistep directions?
7
behavior of RLAS 4
agitated
- inappropriate crying out, mood swings, uncooperative
- alert and in heightened state of activity
What type of activities will a RLAS 4 perform? Will they be purposeful?
motor activities such as sitting, reaching, walking but w/o purpose or upon another’s request
behavior of RLAS 5
alert, not agitated but may have infrequent outbursts
- lack self monitoring or goal directed behavior
- wander/elope risk
behavior of RLAS 6
emerging awareness of appropriate response to self, family, and basic needs
- unaware of impairments, disabilities and safety risk
behavior of RLAS 7
- superficial awareness of condition but cannot link impairment to disability - unrealistic planning, overestimates abilities
- unaware of other’s needs and feelings and has inappropriate social interactions
- oppositional, uncooperative
At what level does a patient become aware and acknowledge their impairments?
8
behavior of RLAS 8
- aware and acknowledge impairments - need help w/ appropriate action and able to consider consequences w/ min cues
- depression, irritability, low frustration tolerance
- acknowledges other’s needs and feelings and responds w/ Min cues
- can correct inappropriate social interactions
At what level can a patient recognize inappropriate social interactions and correct them?
8
At what level can a patient anticipate with assistance?
9
behavior of RLAS 9
- aware and acknowledges impairments but needs help taking appropriate action independently
- requires assistance to anticipate but able to consider consequences
- acknowledges others feelings w/ SBA
- depression, irritability, low frustration improving
- self-monitors social interactions w/ SBA
