Rancho Los Amigos Scale Adult Neuro Help

Tricks to remembers the RLA levels

- I get into more depth after this flashcard for each

- The first 3 are total assist patients: Coma (I), UWS (II), MCS (III)

- The next 2: IV and V is maximal assistance patients, IV is the confused and agitated patient while V is not agitated but appropriate

- VI is the only mod assist patient they are now able to follow simple commands

- VII is minimal assistance now for ADLs

- VIII is that stand by assist now

- IX is stand by assist by request

- X is modified independent (meaning can be using an assistive device, but doing so independently without cueing or help)

What is Level I?

No Response: Total Assistance

- No response to external stimuli

i. Coma level presentation

What is Level II?

Generalized Response: Total Assistance (physically)

- Responds inconsistently and non-purposefully to external stimuli

- Responses are often the same regardless of the stimulus

i. UWS level presentation

What is Level III?

Localized Response: Total Assistance

- Responds inconsistently and specifically to external stimuli

- Responses are directly related to the stimulus, for example, patient withdraws or vocalizes to painful stimuli

- Responds more to familiar people (friends and family) versus strangers

i. MCS presentation

What is Level IV?

Confused/Agitated: Maximal Assistance (for cognitive behavior issues)

- The individual is in a hyperactive state with bizarre and non-purposeful behavior

- Demonstrates agitated behavior that originates more from internal confusion than the external environment

- Absent short-term memory

i. Confusional State*

Not ready for new learning, ignore and redirect like adding different task.

What is Level V?

Confused, Inappropriate Non-Agitated: Maximal Assistance

- Shows increase in consistency with following and responding to simple commands

- Responses are non-purposeful and random to more complex commands

- Behavior and verbalization is often inappropriate, and individual appears confused and often confabulates

- If action or tasks is demonstrated individual can perform but does not initiate tasks on own

- Memory is severely impaired and learning new information is difficult

- Different from level IV in that individual does not demonstrate agitation to internal stimuli. However, they can show agitation to unpleasant external stimuli.

What is Level VI?

Confused, Appropriate: Moderate Assistance

- Able to follow simple commands consistently

- Able to retain learning for familiar tasks (not for new task) they performed pre-injury (brushing teeth, washing face) however unable to retain learning for new tasks

- Demonstrates increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns

- Responses may be incorrect secondary to memory impairments but appropriate to the situation

What is Level VII?

Automatic, Appropriate: Minimal Assistance for Daily Living Skills

- Oriented in familiar settings

- Able to perform daily routine automatically with minimal to absent confusion

- Demonstrates carry over for new tasks and learning in addition to familiar tasks

- Superficially aware of one’s diagnosis but unaware of specific impairments

- Continues to demonstrate lack of insight, decreased judgment and safety awareness

- Beginning to show interest in social and recreational activities in structured settings

- Requires at least minimal supervision for learning and safety purposes.

Now more carry over for learning, 6 and 7 now can give feedback on their behaviors. Might still need participation assistance, mod. Needing consistent routine.

What is Level VIII?

Purposeful, Appropriate: Stand By Assistance

- Consistently oriented to person, place and time

- Independently carries out familiar tasks in a non-distracting environment

- Beginning to show awareness of specific impairments and how they interfere with tasks, however, requires standing by assistance to compensate

- Able to use assistive memory devices to recall daily schedule

- Acknowledges other’s emotional states and requires only minimal assistance to respond appropriately

- Demonstrates improvement of memory and ability to consolidate the past and future events

- Often depressed, irritable and with low frustration threshold

What is Level IX?

Purposeful, Appropriate: Stand By Assistance on Request

- Able to shift between different tasks and complete them independently

- Aware of and acknowledges impairments when they interfere with tasks and able to use compensatory strategies to cope

- Unable to independently anticipate obstacles that may arise secondary to impairment

- With assistance able to think about consequences of actions and decisions

- Acknowledges the emotional needs of others with stand by-assistance.

- Continues to demonstrate depression and low frustration threshold

SBA on requrest

What is Level X?

Purposeful, Appropriate: Modified Independent

- Able to multitask in many different environments with extra time or devices to assist

- Able to create own methods and tools for memory retention

- Independently anticipates obstacles that may occur as a result of impairments and take corrective actions

- Able to independently make decisions and act appropriately but may require more time or compensatory strategies

- Demonstrate intermittent periods of depression and low frustration threshold when under stress

- Able to appropriately interact with others in social situations

Can do on own with modifications like with kitchen tasks.