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Rancho Los Amigos
Scale |
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The Rancho Los Amigos scale was
developed at the Rancho Los Amigos Hospital in California by the Head
Injury Treatment team. This scale is useful to therapists and
families to help understand the behavior and progression of the head
injury survivor as he goes through rehabilitation. These levels are
applicable in the first weeks or months following the injury and are not
intended to predict improvement over the long term. |
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Progress is rapid at first.
The patient will move between the levels quickly. However, as
the months go by, progress will slow and at some point the patient may
seem to plateau around level VI or VII. The level at which the
patient plateaus cannot be predicted beforehand. Patients may also
have characteristics of more than one level at a time. |
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LEVEL
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OUTCOME
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I
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NO RESPONSE:
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Does not respond to voices,
sounds, light, or touch; appears in a deep sleep.
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II |
GENERALIZED
RESPONSE: |
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Limited, inconsistent,
non-purposeful responses; first reaction may be to deep pain; may open
eyes but will not seem to focus on anything in
particular |
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III |
LOCALIZED
RESPONSE: |
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Inconsistent responses but
purposeful in that reacts in a more specific manner to stimulus; may
focus on a presented object; may follow simple
commands. |
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IV |
CONFUSED,
AGITATED: |
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Heightened state of
activity; confusion; unable to do self-care; unaware of present events.
Reacts to own inner confusion, fear, disorientation; excitable behavior
may be abusive or aggressive. |
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V |
CONFUSED,
INAPPROPRIATE, NON-AGITATED: |
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Appears alert; responds to
commands; follows tasks for 2-3 minutes but easily distracted by
environment; frustrated; verbally inappropriate; does not learn new
information. |
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VI |
CONFUSED
APPROPRIATE: |
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Follows simple directions
consistently; needs cueing; can relearn old skills; serious memory
problems but improving; attention improving; self-care tasks performed
without help; some awareness of self and
others. |
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VII |
AUTOMATIC
APPROPRIATE: |
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If physically able, can
carry out routine activities but may have robot-like behavior, minimal
confusion, shallow recall; poor insight into condition; initiates tasks
but needs structure; poor judgement, problem-solving and planning
skills; overall appears normal. |
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VIII |
PURPOSEFUL
APPROPRIATE: |
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Alert, oriented; recalls
and integrates past events; learns new activities and can continue
without supervision; independent in home and living skills; capable of
driving; defects in stress tolerance, judgment; abstract reasoning
persist; many function at reduced levels in society.
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References:
Lake Erie Institute of
Rehabilitation, 137 West Second Street, Erie, Pennsylvania, 16507
Mitiguy, J.S., Thompson, G.T., & Wasco, J. (1990).
Understanding Brain Injury. Massachusetts: New Medico Head Injury
System.
National Head Injury Foundation. "Coma: Its Treatment
and Consequences." |
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