TBI Outcome Measures - Lab Specific

What setting is the Glasgow Coma Scale best used for?

Acute care

What is the Glasgow Coma Scale an indicator for?

Injury severity

What are the 3 key areas the Glasgow Coma Scale focuses on?

Eye opening
Verbal Response
Motor Response

Glasgow Coma Scale Ratings
Mild = ____
Moderate = ____
Severe = ____

Mild = 13-15
Moderate = 9-12
Severe = 3-8

Decorticate Posturing

Flexion of the arms, wrists and fingers
Extension of the legs

Decerebrate Posturing

Extension and Internal Rotation of the Arms and Legs

What is the purpose of the Ranchos Levels of Cognitive Functioning?

Describes behavioral characteristics and cognitive deficits associated with brain injury

How many levels is the Ranchos?

8

In what setting is the Ranchos recommended to be used for?

All settings

What’s a Mnemonic to help remember the 8 levels of the Ranchos?

No General Located Confused Coin In A CAP - (app)
- No Response
- Generalized Response
- Localized Response
- Confused Agitated
- Confused Inappropriate
- Confused Appropriate
- Automatic Appropriate
- Purposeful Appropriate

Ranchos Level 1 + Meaning

No Response
- No response to external stimuli

Ranchos Level 2 + Meaning

Generalized Response
- Responds inconsistently and non-purposefully to external stimuli
- Responses are often same regardless of the stimulus

Ranchos Level 3 + Meaning

Localized Response
- Responds Inconsistently and Specifically to External Stimuli
- Responses are Directly Related to the Stimulus

Ranchos Level 4 + Meaning

Confused Agitated
- Hyperactive state with bizarre and non-purposeful behavior
- Agitated behavior originating from an internal confusion vs external environment
- Absent short-term memory

Ranchos Level 5 + Meaning

Confused Inappropriate
- Increase in consistently following and responding to simple commands
- Responses are non-purposeful and random to more complex commands
- Behavior and verbalization is often inappropriate, the individual appears confused and often confabulates

Ranchos Level 6 + Meaning

Confused Appropriate
- Follows simple commands consistently
- Able to perform familiar/re-learned tasks but no carryover for new tasks
- Responses may be incorrect due to memory impairment but appropriate to the situation

Ranchos Level 7 + Meaning

Automatic Appropriate
- Oriented in familiar settings with minimal to no confusion
- Performs daily routine automatically
- Carry over for new tasks
- Lacks insight and has decreased judgement and safety awareness

Ranchos Level 8 + Meaning

Purposeful Appropriate
- Consistently orientated to person, place, and time
- Independently carries out learned tasks in a non-distracting environment
- Decreased abstract reasoning, tolerance for stress, and judgement in emergencies or unusual circumstances
- Improvement of memory

Purpose of the Community Balance and Mobility Scale?

Detects high level balance and mobility deficits based on tasks that are commonly encountered in community environments

How is the Community Balance and Mobility Scale Scored?

13 tasks, max score of 96
0 = complete inability
5 = most successful completion