Rancho Los Amigos Scale

If you’ve been caring for a patient who was in a coma and is now recovering from it, use the Rancho Los Amigos Scale to assess their cognitive functioning level!

By Matt Olivares on Jul 05, 2024.


Fact Checked by Ericka Pingol.

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Rancho Los Amigos Scale PDF Example
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What is the Rancho Los Amigos Scale?

The (can also be referred to as the Ranchos Scale or the Level of Cognitive Functioning Scale) is an assessment that was developed by the Rancho Los Amigos Hospital’s head injury team to gauge the cognitive functioning of their patients who just woke up from a coma.

It’s a good tool for healthcare professionals to gauge how a patient is doing as they recover from the head injury or traumatic brain injury that caused them to slip into a coma.

The scale is composed of eight levels of cognitive functioning. These levels describe the stages of recovery that a patient goes through after getting treated for a TBI and/or awakening from a coma. The healthcare professional will simply observe the patient's behavior, behavioral responses, capabilities, and current impairments (if there are any) as they undergo the recovery process. Depending on what they see, they will rate the patient accordingly by ticking their current cognitive functioning level.

It’s a nifty and inexpensive tool that doesn’t require much effort from the professional because they only need a copy, a pen (or not if they are using a digital version), and their observation skills to accomplish the scale.

How to use the Rancho Los Amigos Scale

Before one fills out a Rancho Los Amigos Scale, the healthcare professional who will use it must observe the patient. You can do so during an appointment with them, whether in your clinic or if you’re conducting a house call.

You will observe the following:

  • Their arousal and awareness
  • Their motor responsiveness
  • Their cognitive ability

To see how they are, you can try to interact with them and see if they can open their eyes when they are nudged or talked to, or if they can just open their eyes spontaneously or not.

If they are able to respond to your voice, you can check if they are oriented or disoriented, if they are able to converse or not, and if they are able to form coherent sentences or if they make incomprehensible sounds. You can also observe their mood and see if they are calm or irritable (if it’s the latter, they are probably prone to say inappropriate words), as well as if they do inappropriate or bizarre things.

You may also ask them to do things so that you can observe their motor responsiveness and see if they can carry out tasks or not. The tasks don’t have to be complex. In fact, you can opt for simple ones, like handing you a piece of paper or something.

Once you have observed all that you think you need to observe from the patient, you can rate them with any one of the following:

  • Level I - No Response
  • Level II - Generalized Response
  • Level III - Localized Response
  • Level IV - Confused, Agitated Response
  • Level V - Confused, Inappropriate, Non-agitated Response
  • Level VI - Confused, Appropriate Response
  • Level VII - Automatic, Appropriate Response
  • Level VIII - Purposeful, Appropriate Response

How to score the Rancho Los Amigos Scale

The Rancho Los Amigos Scale is so easy to use that you don’t have to calculate anything. The score will be the level designation you will assign to your patient. Here are the scoring designations so you know which level to pick as your rating:

  1. Level I - No Response
  • Your patient did not respond to external stimuli, and they appear to be asleep.
  1. Level II - Generalized Response
  • Your patient reacts to external stimuli in non-specific, inconsistent, and non-purposeful manners with stereotypic and limited responses.
  1. Level III - Localized Response
  • Your patient responds specifically and inconsistently with delays to stimuli, but they may also follow simple commands for motor action.
  1. Level IV - Confused, Agitated Response
  • Your patient exhibits bizarre, non-purposeful, incoherent, or inappropriate behaviors, has no short-term recall, and their attention is short and non-selective.
  1. Level V - Confused, Inappropriate, Non-agitated Response
  • Your patient gives random, fragmented, and non-purposeful responses to complex or unstructured stimuli. They are able to follow simple commands consistently, but their memory and selective attention are impaired, and new information is not retained.
  1. Level VI - Confused, Appropriate Response
  • Your patient gives context-appropriate, goal-directed responses and is dependent upon external input for direction. There is carry-over for relearned tasks, but not for new tasks, plus, recent memory problems persist.
  1. Level VII - Automatic, Appropriate Response
  • Your patient behaves appropriately in familiar settings, is able to perform daily routines automatically, and shows carry-over for new learning at lower than normal rates. They are able to initiate social interactions, but their judgment remains impaired.
  1. Level VIII - Purposeful, Appropriate Response
  • Your patient is oriented and responds to the environment, but their abstract reasoning abilities are decreased relative to pre-morbid levels.

Rancho Los Amigos Scale Example

Now that you know what this assessment is all about, how it is used, and how it is scored, it’s time for you to see what it looks like. Here’s a filled-out Rancho Los Amigos Scale sample.

Download this Rancho Los Amigos Scale Example (Sample) here:

Rancho Los Amigos Scale Example

This is adapted from the Rancho Los Amigos Scale of The Center for Outcome Measurement in Brain Injury.

If you like what you see here and believe it’s a good way to assess patients recovering from TBI, feel free to download this template for your work, and you can do so for free! You can choose to print it or, if you would rather go paperless, just fill out the editable fields! We also added an Additional Comments section so you can explain your decision as to why you rated your patient a certain level.

When is it best to use the Rancho Los Amigos Scale?

The best time to use the Rancho Los Amigos Scale is always when a patient who suffered a head injury or traumatic brain injury is on their way to recovery. This scale will first be used as an assessment tool to gauge what the patient is like after suffering TBI or if they have woken up from a coma that was caused by the TBI. The results should help guide healthcare professionals to determine what should go into the treatment plan for the patient.

Do note that the Rancho Los Amigos Scale is not a diagnostic tool and should not be used under any circumstance to diagnose the patient with anything. It can assist with making an official diagnosis by being part of a larger and more comprehensive examination that includes other tests that will assess their brain, cognition, and physical capabilities. The results of this scale can be shared with other members of a wider team so they know what level the patient is on, which will help them pick the necessary tests to conduct.

The scale can also monitor the patient after a treatment plan is implemented. This is so you can check if the patient is getting better, which should also give the professional an idea if the treatment plan is effective, partially effective, or not effective at all.

Who can use the Rancho Los Amigos Scale for their work?

Since the Rancho Los Amigos Scale was designed to assess patients who have sustained head injuries or traumatic brain injuries, any healthcare professional who specializes in treating neurological disorders, cognitive and behavioral issues, and certain physical disabilities can definitely include this in their roster of tools.

An example of professionals that can use this scale would be neurologists. These professionals are highly trained in assessing, diagnosing, and treating neurological issues, including traumatic brain injuries.

Another one would be psychologists and psychiatrists. These professionals are equipped to gauge and analyze a patient’s cognitive and behavioral problems. Neurological problems like TBI can negatively impact a person’s cognitive and behavioral problems.

Those who suffer serious head injuries or traumatic brain injuries also have to deal with some of their physical capabilities being impacted. Physical and occupational therapists and rehabilitation specialists can help develop and provide interventions and care plans for patients. These will rehabilitate them and hopefully restore their strength and motor functions to tip-top shape.

It’s also not surprising if a patient who suffered a TBI is unable to speak properly or not at all. In order to help them speak properly again, speech therapists can help by providing exercises.

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What are the benefits of using the Rancho Los Amigos Scale?

It creates a baseline for all members of a team to work with.

It normally takes a team to treat a person recovering from a traumatic brain injury. Since this scale will have you designate a cognitive functioning level for a patient, everyone in the team can use that rating as a baseline to inform what specific things each member must do for the comprehensive examination of the patient.

It can guide treatment plans.

Speaking of knowing what to do for the comprehensive examination of the patient, the Rancho Los Amigos Scale can be used to determine what kind of treatment a patient needs, especially when used alongside the results of other tests. It can identify areas of strength in the patient and which of the patient's aspects require more attention. Can they spontaneously move their eyes and interact with others, but cannot complete their sentences or thoughts? Do they have slurred speech? Can they perform certain tasks or not? These are things that you will be able to identify when observing the patient.

It can be used to educate not only the patient but also their loved ones.

Once you are done observing the patient and you have provided your rating via the Rancho Los Amigos Scale, you can talk to the patient’s loved ones about your observations all while educating them about traumatic brain injuries and what they can expect when caring for and living with someone who is recovering from TBI. This way, the loved ones become involved in the treatment process in the sense that they will be told what they can do to cope and how they can provide the kind of care that the patient needs (of course, with the help of your team).

Why use Carepatron for neurology and trauma-related work?

Since we mentioned this particular scale could create a baseline for an entire team to work with and give ideas as to what particular tests should be part of a comprehensive patient examination, we’d like you to know that we can help with that! Carepatron houses a super cool repository of resources, which contains worksheets, assessments, surveys, general treatment plans, progress note templates, and a whole lot more!

The repository also covers a wide variety of healthcare fields, especially psychology and physical therapy, which are things that you will likely be covering since you’re dealing with a patient who has suffered a traumatic brain injury and/or has recently recovered from a coma. You’re bound to find cognition-related assessments and physical therapy tests that you can use to rehabilitate your patient’s cognition, behavior, and physical capabilities.

Feel free to download as much as you want and need! They’re all for free, too! You can even store fully-accomplished assessments and worksheets (including the Rancho Los Amigos Scale) with us if you wish! We have a storage system that allows you to store your clinical documentation in a HIPAA-compliant manner, essentially creating digital backups of your files. You can even set access permissions, so make sure to give access to your team! That way, you’ll be able to upload and share results with each other in a safe way!

We’re all about helping healthcare professionals with their work, so take advantage of our platform so we can help streamline your workflows and help you preserve your work!

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How long does it take to accomplish this scale?
How long does it take to accomplish this scale?

Commonly asked questions

How long does it take to accomplish this scale?

The length will be dependent on how long you think it will take you to observe what you need to observe when interacting with your patient. It might take you 15 minutes, or maybe even 30. But do note that this may take as long as an hour or two, if needed, so don’t be surprised if it takes that long, given that you are dealing with a patient who suffered a traumatic brain injury.

Is it possible for the scale to predict patient outcomes based on observations?

No. It can only go so far as to determine what treatment your patient needs right now based on your observations and rating. One person’s recovery process and speed are different from another’s, so some patients might get better, while some might get worse.

Can I use the scale as the sole assessment for a patient’s examination and treatment?

No. The scale will help you designate a level based on general things that you can observe. It doesn’t necessarily assess certain problems caused by traumatic brain injuries. That’s why it’s recommended that you include this as part of a larger and more comprehensive examination in order to cover more ground.

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