The Rancho Los Amigos Scale of Cognitive Functioning

This scale is divided into eight levels and is a universal guide to diagnosis and to communicate a patient's level of functioning. The scale can also be used to guide and develop an individual rehabilitation program. Below is a list of common problems associated with each level.
1. No Response
2. Generalized Response 
3. Localized Response
Aspiration Pneumonia
Urinary Tract Infections
Metabolic Imbalances
Disorders of muscle tone
4. Confused and Agitated
Verbally/physically abusive
5. Confused, inappropriate but not agitated
6. Confused but appropriate
7. Automatic, appropriate
8. Purposeful and appropriate
Readily agitated
Poor selective attention
Apathy/decreased attention
Reduced insight and judgment
Emotional liability
Limited organizational skills
Alterations in body regulations
Perceptual problems
Poor social skills
Memory deficits

Detailed Explanation

Level 1.

The patient appears to be in a very deep sleep or coma and does not respond to voices, sounds, light, or touch.

Level 2.

The patient moves around but movement does not seem to have a purpose or consistency. Patients may open their eyes but do not seem to focus on anything particular.

Level 3.

Patients begin to move their eyes and look at specific people and objects. They turn their heads in the direction of loud voices or noise. They may follow a simple command, such as "Squeeze my hand".

Level 4.

The patient is very confused and agitated about where he or she is and what is happening in the surroundings. At the slightest provocation, the patient may become very restless, aggressive, or verbally abusive. The patient may enter into incoherent conversation.

Level 5.

The patient is confused and does not make sense in conversations but may be able to follow simple directions. Stressful situations may provoke some upset, but agitation is no longer a major problem. Patients may experience some frustration as elements of memory return.

Level 6.

The patient's speech makes sense, and he or she is able to do simple things such as dressing, eating, and teeth brushing. Although patients know how to perform a specific activity, they need help discerning when to start and stop. Learning new things may also be difficult.

Level 7.

The patient can perform all self-care activities and are usually coherent. They have difficulty remembering recent events and discussions. Rational judgments, calculations, and solving multi-step problems present problems yet patients may not seem to realize this.

Level 8.

At this level, patients are independent and can process new information. They remember distant and recent events and can figure out complex and simple questions.

As patients improve after a brain injury, they may move from one level to the next, but often demonstrate characteristics of more than one level at a time. Depending on the extent and type of injury, they may remain at any one level for an extended period.

Using information from this scale, the health care team can begin treatment that will help develop skills and promote appropriate behavior.

Revised: Tuesday, April 30, 2002 03:20 PM