Ranchos Los Amigos Cognitive Scale
The Ranchos Los Amigos Scale measures the level
of recovery a person makes. Recovery from a serious
traumatic brain injury that is accompanied by coma is
a slow process that follows a fairly predictable course.
The Ranchos Los Amigos Hospital Scale (Malkmus,
et al., 1980) divides the progressive return of
cognitive functions into at least eleven levels, eight of
which are summarized below. All levels are intended
for application with closed brain injury patients.
I. No Response
Patient appears to be in a deep sleep and is
unresponsive to stimuli.
II. Generalized Response
Patient reacts inconsistently and non-purposefully to
stimuli in a nonspecific manner. Reflexes are limited
and often the same, regardless of stimuli presented.
III. Localized Response
Patient responses are specific but inconsistent, and
are directly related to the type of stimulus presented,
such as turning head toward a sound or focusing on a
presented object. He may follow simple commands in
an inconsistent and delayed manner.
IV. Confused-Agitated
Patient is in a heightened state of activity and severely
confused, disoriented, and unaware of present events.
His behavior is frequently bizarre and inappropriate
to his immediate environment. He is unable to
perform self-care. If not physically disabled, he may
perform automatic motor activities such as sitting,
reaching and walking as part of his agitated state, but
not necessarily as a purposeful act.
V. Confused-Inappropriate, Non-Agitated
Patient appears alert and responds to simple
commands. More complex commands, however,
produce responses that are nonpurposeful and
random. The patient may show some agitated
behavior it is in response to external stimuli rather
than internal confusion. The patient is highly
distractible and generally has difficulty in learning
new information. He can manage self-care activities
with assistance. His memory is impaired and
verbalization is often inappropriate.
VI. Confused-Appropriate
Patient shows goal-directed behavior, but relies on
cueing for direction. He can relearn old skills such
as activities of daily living, but memory problems
interfere with new learning. He has a beginning
awareness of self and others.
VII. Automatic-Appropriate
Patient goes through daily routine automatically, but
is robot-like with appropriate behavior and minimal
confusion. He has shallow recall of activities, and
superficial awareness of, but lack of insight to, his
condition. He requires at least minimal supervision
because judgment, problem solving, and planning
skills are impaired.
VIII. Purposeful-Appropriate
Patient is alert and oriented, and is able to recall
and integrate past and recent events. He can learn
new activities and continue in home and living
skills, though deficits in stress tolerance, judgment,
abstract reasoning, social, emotional, and intellectual
capacities may persist.
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