Occupational Therapy Rancho Los Amigos Scales

Front 1

Level I

Back 1

No Response to touch, pain, sound, or sight. (Total Assistance)

Front 2

Level II

Back 2

Generalized reflex response to pain. 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 the same regardless of type and location of stimulation. Responses may be significantly delayed. (Total Assistance)

Front 3

Level III

Back 3

Localized response . Blinks to strong light, turns toward/away from sound, responds to physical discomfort, inconsistent response to commands. Demonstrates withdrawal or vocalization to painful stimuli. Follows moving object passed within visual field. Responds to discomfort by pulling tubes or restraints. Responds inconsistently to simple commands. Responds directly related to type of stimulus. May respond to some persons (especially family and friends ) but not to others. (Total Assistance)

Front 4

Level IV

Back 4

Confused/agitated. Alert, very active, aggressive or bizarre behaviors, performs motor activities but behavior is non-purposeful, extremely short attention span. 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. Absent short-term memory . May cry out or scream out in proportion to stimulus even after its removal. May exhibit aggressive or flight behavior. Mood may swing from euphoric to hostile with no appropriate appropriate relation to environmental events. Unable to cooperate with treatment efforts. Verbalizations are frequently inappropriate incoherent and/or inappropriate activity or enviroment (Maximal Assistance)

Front 5

Level V

Back 5

Confused/non-agitated. Gross attention to environment, highly distractable , requires continual redirection, difficulty learning new tasks, agitated by too much stimulation. May engage in social conversation but with inappropriate verbalizations. Alert, not agitated but may wander randomly or with a vague intention of going home. 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-monintring behavior. Often demonstrates inappropriate of objects without external direction. May be able to perform previously learned tasks when structured and cues are provided. Able to converse on a social, automatic level; for brief periods of time, but verbalizations about present events become inappropriate and confabulation when external structure and cues are not provided. (Maximal Assistance)

Front 6

Level VI

Back 6

Confused/appropriate. inconsistent orientation to time and place, retention span/recent memory impaired, begins to recall past, consistently follows simple directions, goal directed behavior with assistance. Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection. Remote memory has more dept and detail than recent memory . Vague recognition of some staff. Able to use assistive memory aide with maximal assistance. Emerging awareness of appropriate responds to self, family, and basic needs. Moderate assist to problem solve barriers to task completion . Supervised for old learning like self-care. Shows carry over for relearned familiar tasks like self-care. Maximum assistance for new learning with little or no carry over. Unaware of impairments , disabilities, and safety risks. Consistently follows simple directions. Verbal expressions are appropriate in highly familiar and structured situations. (Moderate assistance)

Front 7

Level VII

Back 7

Automatic/appropriate. Preforms daily routines in a highly familiar environment in a non-confused but automatic robot-like manner. Skills noticeably deteriorate in unfamiliar environment. Lacks realistic planning for own future. Consistently oriented to person and place, within highly familiar environments. Moderate assistance for orientation to time. Able to attend to familiar tasks in a non-distraction environment for at least 30 minutes with minimal assist to complete tasks. Minimal supervention for new learning and 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. 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 ADLs. Unrealistic planning for the future. Unable to think about consequences of a decision or action. Overestimates abilities. Unaware of others' needs and feelings. Oppositional /uncooperative. Unable to recognize inappropriate social interaction behavior. (Minimal Assistance)

Front 8

Level VIII

Back 8

Purposeful/appropriate. 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 present events. Able to use assistive Memory devices. 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, argumentative, and self-centered. Low frustration tolerance/easily angered. Uncharacteristically dependent/independent. Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and take corrective action with minimal assistance. (Stand-By Assistance)

Front 9

Level IX

Back 9

Purposeful, appropriate: stand-by assistance on request. Independently shifts back and forth between tasks and completes them accurately for at least 2 consecutive hours. Aware of impairments and disabilities when the interferes with performance 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. Depression, irritability, and low frustration tolerance may continue. Stand-by assist in social interaction. (Stand-By Assistance on Request)

Front 10

Level X

Back 10

Purposeful, appropriate: Modified independent. Periodic periods of depression may occur. Irritability and low frustration tolerance when sick, fatigued and/or under emotional stress. Independent in finding and using assistive memory device. Anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and/or compensatory strategies. (Modified Independent)