TBI

Ranchos Los Amigos (RLA) - # of stages / general outline

8 stages

R - Response (1-3)

C - Confused (4-6)

A - Appropriate (7-8)

Response (1-3)

1 - none

2 - general

3 - local

Confused (4-6)

4 - agitated

5 - inappropriate

6 - appropriate

Appropriate (7-8)

7 - automatic

8 - purposeful

RLA 1

No response - coma

RLA 2

General response - Non-purposeful whole body response; inconsistent vocals

RLA 3

Local response -

• Purposeful but inconsistent, local and specific

• Follows simple commands (close eyes, squeeze hands)

What RLA level can the pt follow simple commands (close eyes, squeeze hands)

RLA 3

Treatment for RLA levels 1-3

PROM (gentle), positioning, family edu, postural drainage/suction

RLA 4

Confused and Agitated -

• aggressive, incoherent, uncooperative, confabulations (make up stories)

• Attention = no selective attn

• Memory = no long/short-term

RLA 4 - Treatment

Orient pt & keep consistent (same routine/people)

Give options, no yes/no or open-ended Q’s

Distract

Calm, closed environment

RLA 5

Confused & Inappropriate -

• Responds consistently to simple commands, inconsistently to complex commands

• structured socialization (short period)

• memory = impaired; inappropriate use of objects; can’t learn new task

RLA 6

Confused & Appropriate

• consistently follows simple instructions

• goal oriented behavior w/ external input

• memory = carryover of previous skills-

RLA 5 & 6 - Treatment

same goals as level 4; can’t follow complex commands; avoid complex open environments

Which RLA stage do pt’s begin to socialize?

5

RLA 7

Automatic & Appropriate

• oriented in home and hospital

• daily routine (automatic routine; don’t understand why they’re doing it)

• judgement impaired

• social = able to initiate w/ structure

RLA 8

Purposeful & Appropriate

• carryover of new skills

• judgement impaired in emergency

• abstract reasoning

• reduced tolerance for stress

RLA 7 & 8 - Treatment

focus on re-entry to work/community

emphasize problem solving and social skills

trial independent living

school/work adaptations