rancho scale
Rancho Level of Cognitive Functioning Scale - Levels:
Level I: No response (Total Assist)
Characteristics: Unresponsive to external stimuli.
OT Focus:
Positioning every 2 hours.
Passive Range of Motion (PROM).
Hand orthosis application.
Family education on care.
Use of JFK Coma Recovery Scale-Revised for evaluation.
Level II: Generalized response (Total Assist)
Characteristics: Inconsistent reaction to stimuli.
OT Focus:
Positioning and PROM.
Application of hand orthosis.
Sensory stimulation across various senses (visual, auditory, tactile).
Family education for support and understanding.
Environmental management strategies to enhance response.
Focus on head control and balance.
Engage in co-treatment sessions (multidisciplinary approach).
Level III: Localized response (Total Assist)
Characteristics: Specific but delayed/inconsistent responses.
OT Focus:
Sensory stimulation to evoke responses.
Continued family education.
Positioning/orthotic management for tone.
Range of motion activities to maintain joint health.
Environmental management for optimal recovery outcomes.
Use Modified Ashworth Scale for assessment.
Level IV: Confused, agitated response (Max Assist)
Characteristics: Bizarre behavior; poor short-term memory; impulsive.
OT Focus:
Sensory stimulation management protocols.
Techniques to enhance attention and safety awareness.
Behavioral management strategies to handle agitation.
Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) practice to promote functional independence.
Motor control and balance activities to improve overall mobility.
Level V: Confused, inappropriate, non-agitated (Max Assist)
Characteristics: Low memory and attention; require supervision.
OT Focus:
Cognitive orientation strategies to promote awareness.
Functional mobility exercises focusing on motor control and balancing.
Social awareness training through relevant activities.
Assistance with ADLs/IADLs to encourage independence.
Continual family education for emotional support.
Level VI: Confused, appropriate response (Moderate Assist)
Characteristics: Reduced memory; may confabulate, difficulty initiating tasks.
OT Focus:
Educating families on strategies for support.
Balance and motor control training to enhance mobility.
Enhancing safety awareness through guided practice.
Providing adaptive equipment as needed.
Engaging in dual-task practice to improve cognitive function during tasks.
Level VII: Automatic, appropriate response (Minimal Assist)
Characteristics: Increased appropriate behavior in familiar settings; decreased judgment.
OT Focus:
Focus on IADLs relative to personal life roles.
Teaching adaptive techniques to manage ongoing deficits.
Strategies for family education to assist rehabilitation.
Community outings to facilitate social integration.
Group activities to enhance social skills.
Level VIII: Purposeful, appropriate response (Stand by Assist)
Characteristics: Appropriate responsiveness; difficulty with abstract thinking.
OT Focus:
Engaging family in education regarding expectations for recovery.
Higher-level cognitive tasks to stimulate brain recovery.
Developing adaptive strategies for coping and problem-solving.
Exploring leisure pursuits to promote mental health and enjoyment.
Level IX: Purposeful, appropriate response: Stand-By Assistance on Request
Characteristics: Ability to transition between tasks; engagement in work opportunities.
OT Focus:
Increase overall occupational performance through guided practice.
Utilize compensatory strategies to address any ongoing issues.
Level X: Purposeful, appropriate response: Modified Independent
Characteristics: May require more time or compensatory strategies; can initiate compensatory techniques.
OT Focus:
Focus on work re-training relevant to job roles.
Engage in higher cognitive tasks necessary for occupational performance.