The Rancho Los Amigos Scale of Cognitive
- 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
The patient appears to be in a very deep sleep or coma
and does not respond to voices, sounds, light, or touch.
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
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".
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
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.
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.
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.
At this level, patients are independent and can process new
information. They remember distant and recent events and can figure out complex and simple
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
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