Rancho Los Amigos Levels of Cognitive Functioning

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TBI Flashcards on Rancho Los Amigos Levels of Cognitive Functioning , created by Rachel Layton on 05/10/2018.
Rachel Layton
Flashcards by Rachel Layton, updated more than 1 year ago
Rachel Layton
Created by Rachel Layton over 5 years ago
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Question Answer
What does the Ranchos Los Amigos Scale measure? The Ranchos Los Amigos Scale measures the levels of awareness, cognition, behavior and interaction with the environment of a pt following a TBI.
What are the 10 levels? Level I: No Response TA Level II: Generalized Response TA Level III: Localized Response TA Level IV: Confused-agitated Max A Level V: Confused-inappropriate Non-Agitated Max A Level VI: Confused-appropriate Mod A Level VII: Automatic-appropriate Min A for ADL's Level VIII: Purposeful-appropriate SBA Level IX: Purposeful-appropriate SBA on request Level X: Purposeful-appropriate Mod I
Level II - Generalized Response: Total Assistance Demonstrates generalized reflex response to painful stimuli Responds to repeated auditory stimuli with increased or decreased activity Responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization Responses noted above may be same regardless of type and location of stimulation Responses may be significantly delayed
Level I - No Response: Total Assistance Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular or painful stimuli
Level III - Localized Response: Total Assistance Demonstrates withdrawal or vocalization to painful stimuli Turns toward or away from auditory stimuli Blinks when strong light crosses visual field Follows moving object passed within visual field Responds to discomfort by pulling tubes or restraints Responds inconsistently to simple commands Responses directly related to type of stimulus May respond to some persons (especially family and friends) but not to others.
Level IV - Confused/Agitated: Maximal Assistance Alert and in heightened state of activity Purposeful attempts to remove restraints or tubes or crawl out of bed May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another's request Very brief and usually non-purposeful moments of sustained alternatives and divided attention Absent short-term memory May cry out or scream out of proportion to stimulus even after its removal May exhibit aggressive or flight behavior Mood may swing from euphoric to hostile with no apparent relationship to environmental events Unable to cooperate with treatment efforts Verbalizations are frequently incoherent and/or inappropriate to activity or environment
Level V - Confused, Inappropriate Non-Agitated: Maximal Assistance Alert, not agitated but may wander randomly or with a vague intention of going home. May become agitated in response to external stimulation, and/or lack of environmental structure. Not oriented to person, place or time. Frequent brief periods, non-purposeful sustained attention Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity Absent goal directed, problem solving, self-monitoring behavior Often demonstrates inappropriate use of objects without external direction May be able to perform previously learned tasks when structured and cues provided Unable to learn new information Able to respond appropriately to simple commands fairly consistently with external structures and cues Responses to simple commands without external structure are random and non-purposeful in relation to command Able to converse on a social, automatic level for brief periods of time when provided external structure and cues Verbalizations about present events become inappropriate and confabulatory when external cues and structures are not provided
Level VI - Confused, Appropriate: Moderate Assistance Inconsistently oriented to person, time and place Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection Remote memory has more depth and detail than recent memory Vague recognition of some staff Able to use assistive memory aide with maximum assistance Emerging awareness of appropriate response to self, family and basic needs Moderate assist to problem solve barriers to task completion Supervised for old learning (e.g. self care) Shows carry over for relearned familiar tasks (e.g. self care) Maximum assistance for new learning with little or nor carry over Unaware of impairments, disabilities and safety risks Consistently follows simple directions Verbal expressions are appropriate in highly familiar and structured situations
Level VII - Automatic, Appropriate: Minimal Assistance for Daily Living Skills Consistently oriented to person&place, within highly familiar environments. Mod assistance for orientation to time Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with min A to complete tasks Min supervision for new learning Demonstrates carry over of new learning Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what he/she has been doing Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work & leisure ADLs Min supervision for safety in routine home & community activities Unrealistic future planning Unable to think about consequences decision/action Overestimates abilities Unaware of others' needs /feelings. Oppositional/uncooperat Unable to recognize inappropriate
Level VIII - Purposeful, Appropriate: Stand-By Assistance Consistently oriented to person, place and time. Independently attends to and completes familiar tasks for 1 hour in distracting environments.Able to recall and integrate past and recent events.Uses assistive memory devices to recall daily schedule, "to do" lists and record critical information for later use with stand-by assistance.Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance Requires no assistance once new tasks/activities are learned Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action. Thinks about consequences of a decision or action with minimal assistance. Overestimates or underestimates abilities. Acknowledges others' needs and feelings and responds appropriately with minimal assistance Depressed, Irritable, Low frustration tolerance/easily angered, Argumentative. Self-centered,Uncharacteristically dependent/I.
Level IX - Purposeful, Appropriate: Stand-By Assistance on Request (I) shifts back and forth between tasks & completes them accurately for at least 2 consecutive hours Uses assistive memory devices to recall daily schedule, "to do" lists and record critical information for later use with assistance when requested Initiates and carries out steps to complete familiar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks with (A) when requested. Aware of and acknowledges impairments and disabilities when they interfere with task completion & takes appropriate corrective action but requires stand-by assist to anticipate a problem before it occurs and take action to avoid it Able to think about consequences of decisions or actions with assistance when requested. Accurately estimates abilities but requires SBA to adjust to task demands. Acknowledges others' needs and feelings & responds appropriately with SBA Depression may continue, May be easily irritable, May have low frus tolerance, Able to self monitor appropriateness of social interaction c SBA
Level X - Purposeful, Appropriate: Modified Independent Able to handle multiple tasks simultaneously in all environments but may require periodic breaks. Able to (I) procure, create and maintain own assistive memory devices. (I) initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work & leisure tasks but may require more than usual amount of time and/or compensatory strategies to complete. Anticipates impact of impairments and disabilities on ability to complete daily living tasks & takes action to avoid problems before they occur but may require more than usual amount of time and/or compensatory strategies Able to (I) think about consequences of decisions or actions but may require more than usual amount of time and/or comepensatory strategies to select the appropriate decision or action Accurately estimates abilities and independently adjusts to task demands Able to recognize the needs and feelings of others and automatically respond in appropriate manner. Periodic periods of depression may occur. Irritability/low frustration tolerance when sick,/fatigued. Appropriate social behavior.
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