Rancho Los Amigos Congitive Scale

Rancho Los Amigos Cognitive Scale (REVISED)

 

Rancho Los Amigos Level of Cognitive Functioning Scale (REVISED)

Rancho Level Clinical Correlate
I No Response: Total Assistance 

  • Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular or painful stimuli.
II Generalized Response: Total Assistance 

  • Demonstrates generalized reflex response to painful stimuli.
  • Responds to repeated auditory stimuli with increased or decreased activity.
  • Responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization.
  • Responses noted above may be same regardless of type and location of stimulation.
  • Responses may be significantly delayed.
III Localized Response: Total Assistance 

  • Demonstrates withdrawal or vocalization to painful stimuli.
  • Turns toward or away from auditory stimuli.
  • Blinks when strong light crosses visual field.
  • Follows moving object passed within visual field.
  • Responds to discomfort by pulling tubes or restraints.
  • Responds inconsistently to simple commands.
  • Responses directly related to type of stimulus.
  • May respond to some persons (especially family and friends) but not to others.
IV Confused/Agitated: Maximal Assistance 

  • Alert and in heightened state of activity.
  • Purposeful attempts to remove restraints or tubes or crawl out of bed.
  • May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another’s request.
  • Very brief and usually non-purposeful moments of sustained alternatives and divided attention.
  • Absent short-term memory.
  • May cry out or scream out of proportion to stimulus even after its removal.
  • May exhibit aggressive or flight behavior.
  • Mood may swing from euphoric to hostile with no apparent relationship to environmental events.
  • Unable to cooperate with treatment efforts.
  • Verbalizations are frequently incoherent and/or inappropriate to activity or environment.
V Confused, Inappropriate Non-Agitated: Maximal Assistance 

  • Alert, not agitated but may wander randomly or with a vague intention of going home.
  • May become agitated in response to external stimulation, and/or lack of environmental structure.
  • Not oriented to person, place or time.
  • Frequent brief periods, non-purposeful sustained attention.
  • Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity.
  • Absent goal directed, problem solving, self-monitoring behavior.
  • Often demonstrates inappropriate use of objects without external direction.
  • May be able to perform previously learned tasks when structured and cues provided.
  • Unable to learn new information.
  • Able to respond appropriately to simple commands fairly consistently with external structures and cues.
  • Responses to simple commands without external structure are random and non-purposeful in relation to command.
  • Able to converse on a social, automatic level for brief periods of time when provided external structure and cues.
  • Verbalizations about present events become inappropriate and confabulatory when external structure and cues are not provided.
VI Confused, Appropriate: Moderate Assistance 

  • Inconsistently oriented to person, time and place.
  • Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection.
  • Remote memory has more depth and detail than recent memory.
  • Vague recognition of some staff.
VII Automatic, Appropriate: Minimal Assistance for Daily Living Skills 

  • Consistently oriented to person and place, within highly familiar environments. Moderate assistance for orientation to time.
  • Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with minimal assist to complete tasks.
  • Minimal supervision for new learning.
VIII Purposeful, Appropriate: Stand-By Assistance 

  • Consistently oriented to person, place and time.
  • Independently attends to and completes familiar tasks for 1 hour in distracting environments.
  • Uses assistive memory devices to recall daily schedule, “to do” lists and record critical information for later use with stand-by assistance.
  • Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance.
  • Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance.
IX Purposeful, Appropriate: Stand-By Assistance on Request 

  • Independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours.
  • Initiates and carries out steps to complete familiar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks with assistance when requested.
  • Aware of and acknowledges impairments and disabilities when they interfere with task completion and takes appropriate corrective action but requires stand-by assist to anticipate a problem before it occurs and take action to avoid it.
X Purposeful, Appropriate: Modified Independent 

  • Able to handle multiple tasks simultaneously in all environments but may require periodic breaks.
  • Able to independently procure, create and maintain own assistive memory devices.
  • Independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work and leisure tasks but may require more than usual amount of time and/or compensatory strategies to complete them.

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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