Rancho Levels and Neuro-Rehabilitation Review

Vocabulary-style flashcards covering terminology, Rancho Los Amigos levels, attention types, and neuro-rehabilitation complications based on the lecture notes.

Arousal

A physiological and psychological state of being awake where the RAS, autonomics, and endocrine system are functioning, even if at a low level.

Consciousness

A state of being aware and alert that is defined through the use of tools like the JFK-CRS to assess responses to stimuli, rather than by cognitive abilities.

Primitive Responses

Involuntary movements (e.g., suck, root, grasp) that cease to be elicited by stimuli following CNS maturation; their presence indicates a loss of descending inhibitory control.

Generalized Response

An undifferentiated response elicited by a stimulus without higher cortical control, where the same or similar response (e.g., changes in vital signs or eye blinking) is seen for all stimuli.

Decorticate Posturing

A flexed upper extremity position with an extended neck and lower extremities, signifying upper midbrain damage above the Red Nucleus and affection of the Lateral Corticospinal Tract.

Decerebrate Posturing

Rigid extension of the trunk and limbs with internal rotation, signifying upper pontine damage below the Red Nucleus; it is considered more severe than decorticate posturing.

Opisthotonos

A severe decerebrate posture characterized by a severely arched spine and cervical extension where only the back of the head and heels touch the ground.

Fencing

A brief period where forearms extend or flex and arms stay in the air, indicative of a concussion or the first position in a more severe TBI, caused by reactivation of the ATNR at the brainstem level.

Localized Response

A differentiated, purposeful, and intentional movement involving higher cortical control, such as eye or head turning toward a speaker.

Consistent Response

A response occurring greater than $80\%$ of the time following a stimulus presentation.

Inconsistent Response

A response occurring less than $80\%$ of the time following a stimulus presentation.

Rancho Los Amigos Level I

No Response/Coma; patient shows no observable change to stimuli and an absence of sleep-wake cycles on EEG.

Rancho Los Amigos Level II

Generalized Response/Unresponsive Wakefulness Syndrome (UWS); patient shows generalized reflexive behavior to stimuli and has evident sleep/wake cycles.

Rancho Los Amigos Level III

Localized Response/Minimally Conscious; patient responds appropriately but inconsistently to stimuli and begins to track objects or people.

Rancho Los Amigos Level IV

Confused-Agitated; patient is in a heightened state of activity with mood swings, minimal attention, and no retention of new information.

Rancho Los Amigos Level V

Confused-Inappropriate; patient has a short attention span, is easily distracted, and not oriented, though they may follow simple commands.

Rancho Los Amigos Level VI

Confused-Appropriate; patient is goal-directed but requires external drive, and can hold attention for approximately $30$ minutes.

Rancho Los Amigos Level VII

Automatic-Appropriate; patient can perform daily routines without external drive but is often inflexible in thinking.

Rancho Los Amigos Level VIII

Purposeful-Appropriate; patient is able to complete new learning and is responsive to the environment.

Rancho Los Amigos Level IX

Purposeful-Appropriate (Stand-by Assistance on Request); patient independently shifts between tasks for $>2$ hours and acknowledges BI-related issues when they interfere but cannot anticipate them.

Rancho Los Amigos Level X

Purposeful-Appropriate (Modified Independent); patient handles multiple tasks simultaneously with breaks, anticipates limits, and recognizes the needs of others.

Dysautonomia (Storming)

A condition in severe injury characterized by increased body temperature, sweating, increased RR, BP, and HR, often elicited by overstimulation.

Heterotopic Ossification (HO)

Bone formation in soft tissue often near the hip, elbow, or shoulder; symptoms include redness, warmth, swelling, decreased ROM, and a hard end feel.

Agitated Behavior Scale (ABS)

A basic measure of agitation and its associated behaviors used to monitor a patient throughout the day.

Sustained Attention

The ability to maintain a continuous repetitive activity without cues to continue, such as eating a meal.

Selective Attention

The ability to stay on task despite distractions, such as focusing on a conversation in a restaurant.

Alternating Attention

The ability to perform one task for a period of time and then switch to another task (e.g., $5$ minutes on task A, then switch to task B).

Divided Attention

The ability to complete two tasks successfully at the same time, such as walking and talking.

Metacognition

The executive function defined as thinking about thinking.

Procedural Memory

A type of implicit memory involving the unconscious recall of how to perform tasks.