week 11: coma scales (ranchos)

what is level 1 of the ranchos scale?

no response (total assistance)

what does level 1 of the ranchos scale look like?

- complete absence of change in behavior when presented sensory stimuli (ex. pain)

what is level 2 of the ranchos scale?

generalized response (total assistance)

what does level 2 of the ranchos scale look like?

- demonstrates generalized reflex to painful stimuli

- responds to repeated auditory stimuli

- responds to external stimuli

- responses may be significantly delayed

what is level 3 of the ranchos scale?

localized response (total assistance)

what does level 3 of the ranchos scale look like?

- demonstrates withdrawal to painful stimuli

- turns toward/away from auditory stimuli

- blinks when strong light crosses visual field

- follows moving object passed through visual field

- pulls tubes/restraints

- responds inconsistently to simple commands

what is level 4 of the ranchos scale?

confused/agitated (maximal assistance)

what does level 4 of the ranchos scale look like?

- alert/heightened state of activity

- purposefully remove restraints/tubes

- exhibits aggressive or flight behavior

- inappropriate verbalizations

- short attention span

what is level 5 of the ranchos scale?

confused, inappropriate non-agitated (maximal assistance)

what does level 5 of the ranchos scale look like?

- alert, but not agitated

- may wander randomly (vague intention of going home)

- not oriented

- may respond to simple commands

- unable to learn new information

- inappropriate use of objects

what is level 6 of the ranchos scale?

confused, appropriate (moderate assistance)

what does level 6 of the ranchos scale look like?

- inconsistently oriented

- able to do highly familiar tasks for 30 minutes (moderate redirection)

- consistently follows simple directions

- problem solving issues

what is level 7 of the ranchos scale?

automatic, appropriate (minimal assistance)

what does level 7 of the ranchos scale look like?

- consistently oriented

- able to do highly familiar tasks for 30 minutes (minimal assist)

- minimal supervision for new learning

- overestimates abilities

- oppositional

what is level 8 of the ranchos scale?

purposeful, appropriate (stand-by assistance)

what does level 8 of the ranchos scale look like?

- independently attends and completes familiar tasks for 1 hour

- irritable and depressed

- uses assistive memory devices to recall daily schedule (to do lists)

- some reasoning skills

what is level 9 of the ranchos scale?

purposeful, appropriate (stand-by assistance with request)

what does level 9 of the ranchos scale look like?

- independently shifts between tasks for at least 2 hours

- good with familiar tasks from memory

what is level 10 of the ranchos scale?

purposeful, appropriate (modified independent)

what does level 10 of the ranchos scale look like?

- handles multiple tasks simultaneously (with breaks)

- maintains assistive devices

- recognizes feelings and needs of others in appropriate manner

- social interaction is consistently appropriate