Rancho Los Amigos Congitive Scale

Rancho Los Amigos Congitive Scale is a medical scale intended to assess the level of recovery of brain injury patients and those recovering from coma. The scale is from one to eight, eight being the highest mental level. It was developed by the head injury treatment staff at the Rancho Los Amigos Hospital in Downey, California, the Rancho Los Amigos Scale.

Rancho Los Amigos Cognitive Scale is a very complex analysis of post-brain injury cognitive function. Like the Glasgow Coma Scale, the Rancho Los Amigos Scale enables doctors to determine a traumatic brain injury victim’s state of consciousness, extent of brain damage and prognosis. Aside from that, it also allows neurologists and brain injury rehabilitation experts to evaluate a victim’s behavior as he or she progresses through the treatment.

The scale describes eight levels of post-brain injury cognitive function and these levels describe a person’s reliance on assistance to carry out cognitive and physical functions. Levels of patient recovery from brain injuries are often measured in rehabilitation programs with the use of the Rancho Los Amigos Scale.


Rancho Los Amigos Level of Cognitive Functioning Scale

Rancho Level Clinical Correlate
I No response to pain, touch, sound or sight. Patient does not respond to external stimuli and appears asleep.
II Generalized reflex response to pain. Patient reacts to external stimuli in nonspecific, inconsistent, and nonpurposeful manner with stereotypic and limited responses.
III Localized response. Patient responds specifically and inconsistently with delays to stimuli, but may follow simple commands for motor action.
IV Confused – agitated. Patient exhibits bizarre, nonpurposeful, incoherent or inappropriate behaviors, has no shortterm recall, attention is short and nonselective.
V Confused – inappropriate. Patient gives random, fragmented, and nonpurposeful responses to complex or unstructured stimuli – Simple commands are followed consistently, memory and selective attention are impaired, and new information is not retained.
VI Confused – appropriate. Patient gives context appropriate, goal-directed responses, dependent upon external input for direction. There is carry-over for relearned, but not for new tasks, and recent memory problems persist.
VII Automatic – inappropriate. Patient behaves appropriately in familiar settings, performs daily routines automatically, and shows carry-over for new learning at lower than normal rates. Patient initiates social interactions, but judgment remains impaired.
VIII Purposeful and appropriate. Patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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