Traumatic Brain Injuries (TBI)

Glasgow Coma Scale

Score of 3-15, 3 = bad, 15 = good

3-8 = severe head injury

• H8 to be severe

9-12 = moderate head injury

13-15 = mild head injury

• lucky number 13 to be mild

RLA Level 1 & interventions

No response

Appears asleep (coma)

Positioning & ROM to prevent contractures

RLA Level 2 & interventions

General response to stimulation

Not localized

Same as level 1

RLA Level 3 & interventions

Localized response to stimuli

STILL DEPENDENT ON ADL’s

Attempting to get localized response/attention

AAROM

RLA Level 4 & interventions

Confused-agitated

Assist with simple ADLs

Restraints may be necessary (physician’s orders required)

RLA Level 5 & interventions

Disoriented/Confused-inappropriate

Build habits of self-orienting, checking external sources

Multi-step tasks

RLA Level 6 & interventions

Confused-appropriated

Uses cues

Task re-learning, utilizing external self-cueing

RLA Level 7 & interventions

Automatic-appropriate

Limited judgment

Working on IADLs, role-playing useful

RLA Level 8 & interventions

Purposeful-appropriate minimum assistance

Problem solving

Routine tasks are fine

difficulty with one-off problems

Ranchos Los Amigos Scale Keyline

• Response (stimulation)

• Response (stimulation)

• Response (stimulation)

• Agitated (restraints per physician’s order)

• No Clue

• Check your watch (task relearning)

• Hang of basics (IADL practice, role-play)

• One off problems (problem solving)