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Skip to Rancho Los Amigos Levels of Cognitive
Functioning
Using the Glascow Coma Scale and the Rancho Los Amigos Levels of
Cognitive Functioning can identify measuring the severity of the
traumatic brain injury and tracking the progress made following
the injury.
|
| |
Examiner |
Patient Response |
Score |
| Spontaneous Speech |
Opens eyes on own |
4 |
| |
Opens eyes when
asked to in a loud voice |
3 |
| Pain |
Opens eyes when
pinched |
2 |
| Pain |
Does not open eyes |
1 |
| |
Commands |
Follows simple
commands |
6 |
| Pain |
Pulls examiner's
hand away when pinched |
5 |
| Pain |
Pulls part of body
away when examiner pinches patient |
4 |
| Pain |
Flexes body inappropriately
to pain - decorticate posturing |
3 |
| Pain |
Body becomes rigid
in an extended position when examiner pinches victim - decerebrate
posturing |
2 |
| Pain |
Has no motor response
to pinch |
1 |
| |
Speech |
Carries on a conversation
correctly & tells examiner where he is, who he is, and
the month and year |
5 |
| Speech |
Seems confused
or disoriented |
4 |
| Speech |
Talks so examiner
can understand victim but makes not sense |
3 |
| Speech |
Makes sounds that
examiner can't understand |
2 |
| Speech |
Makes no noise |
1 |
Scores are determined as response is tested. Total score is determined
by adding the three categories. Highest possible score is 15. This
score would indicate a person who is awake, oriented, and following
commands. Lowest score is 3. This score would indicate a person
deeply unconscious. A score of 8 or lower generally indicates a
person with a severe Brain Injury.
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The Rancho Los Amigos Levels of Cognitive Functioning (RLA) were
designed to measure and track an individual's progress early in
the recovery period. They have been used as a means to develop "level-specific"
treatment interventions and strategies designed to facilitate movement
from one level to another. A RLA level is determined based on behavioral
observations. The RLA scale designates eight levels of function:
The individual appears to be in deep sleep and is completely unresponsive
to any stimuli.
The individual reacts inconsistently and non-purposefully to stimuli.
Responses are limited in nature and often the same regardless of
the stimuli presented. Responses may include gross motor movements,
vocalization, and physiologic changes. Response time is likely to
be delayed. Deep pain evokes the earliest response.
The individual responds specifically but inconsistently to stimulus.
Responses are directly related to the type of stimuli presented.
For example, an individual's head will turn toward a sound or his/her
eyes will focus on an object when presented. The individual may
follow simple commands and may respond better to some people (i.e.
family and friends) than others.
The individual is in a heightened state of activity with severely
decreased ability to process information. Behavior is non-purposeful
relative to the immediate environment. Attempts to climb out of
bed, remove restraints, and hostility are common. The individual
requires maximum assistance to perform self-care activities. An
individual may sit, reach, or walk, but will not necessarily perform
these activities upon request.
The individual appears alert and responds to simple commands fairly
consistently. Agitation, which is out of proportion, (but directly
related) to stimuli may be evident. Lack of external structure results
in random or non-purposeful responses. Inappropriate verbalizations
and high distractibility are common. Memory is severely impaired,
but the individual may self-feed with supervision and requires only
assistance for self-care activities.
The individual shows goal-oriented behavior, but is dependent upon
external input for direction. Response to discomfort is appropriate.
Responses are incorrect due to memory problems, but are appropriate
to the situation. Simple commands are followed consistently and
carry-over for relearned activities is evident. Orientation is inconsistent
but awareness of self, family, and basic needs is increased.
The individual appears appropriate within hospital and home settings,
goes through daily routine automatically but is robot-like, with
shallow recall of activities performed. Has absent-to-minimal confusion
and lacks insight. The individual frequently demonstrates poor judgment
and problem solving and expresses unrealistic future plans. With
structure the individual is able to initiate tasks or social and
recreational activities.
The individual is alert and oriented, able to recall and integrate
past and recent events and is aware of and responsive to the environment.
Independence in the home and community has returned. Carry-over
for new learning is present, and the need for supervision is absent
once activities have been learned. Social, emotional and cognitive
abilities may still be decreased.
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