Ranchos Los Amigos Scale

Level I: No Response- Total Assistance

No response to external simuli

Level II: Generalized Response- Total Assistance

• Responds inconsistently and nonipurposefully to external simuli

• Responses are ofen the same regardless of the simulus

Level III: Localized Response- Total Assistance

• Responds inconsistently and specifcally to external simuli

• Responses are directly related to the simulus, for example, patient wiithdrawis or vocalizes to painful simuli

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

Level IV: Confused/Agitated- Maximal Assistance

• The individual is in a hyperacive state wiith bizarre and non purposeful behavior

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

• Absent short term memory

Level V: Confused, Inappropriate Non-Agitated- Maximal Assistance

• Shows increase in consistency wiith followiing and responding to simple commands

• Responses are nonpurposeful and random to more complex commands

• Behavior and verbalizaion 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 informaion is difficult

• Different from level IV in that individual does not demonstrate agitation to internal simuli. Howiever, they can show agitation to unpleasant external simuli.

Level VI: Confused, Appropriate- Moderate Assistance

• Able to follow simple commands consistently

• Able to retain learning for familiar tasks they performed pre injury (brushing teeth, washing face) however unable to retain learning for new tasks

• Demonstrates increased awiareness of self, situation, and environment but unaware of specifc impairments and safety concerns

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

Level VII: Automatic, Appropriate- Minimal Assistance

• Oriented in familiar settings

• Able to perform daily rouine automaically wiith minimal to absent confusion

• Demonstrates carry over for newi tasks and learning in addiion to familiar tasks

• Superfcially aware of one’s diagnosis but unawiare of specific impairments

• Continues to demonstrate lack of insight, decreased judgment and safety awiareness

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

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

Level VIII: Purposeful, Appropriate- Stand By Assistance

• Consistently oriented to person, place and ime

• Independently carries out familiar tasks in a nonidistracing environment

• Beginning to show awiareness of specifc impairments and howthey interfere with tasks, however, requires standing by assistance to compensate

• Able to use assistive memory devices to recall daily schedule

• Acknowledges other’s emoional 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

Level IX: Purposeful, Appropriate- Stand By Assistance on Request

• Able to shift between different tasks and complete them independently

• Aware of and acknowiledges impairments when they interfere with tasks and able to use compensatory strategies to cope

• Unable to independently anicipate obstacles that may arise secondary to impairment

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

• Acknowledges the emotional needs of others wiith stand byassistance.

• Continues to demonstrate depression and low frustration threshold

Level X: Purposeful, Appropriate- Modified Independent

• Able to mulitask in many different environments wiith extra time or devices to assist

• Able to create own methods and tools for memory retention

• Independently anicipates 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 wiith others in social situations