Rancho Los Amigos Levels Of Cognitive Function (Tbi)

Front 1

No response

Back 1

Patient appears to be in a deep sleep and is completely unresponsive to any stimuli.

Front 2

Generalized Response

Back 2

Patient reacts inconsistently and non-purposefully to stimuli in a nonspecific manner.

Responses are limited and often the same regardless of stimulus.

Responses may be physiological changes, gross body movements, and/or vocalization.

Front 3

Localized Response

Back 3

Patient reacts specifically but inconsistently to stimuli.

Responses are directly related to the type of stimulus presented.

May follow simple commands such as closing the eyes or squeezing the hand in an inconsistent, delayed manner.

Front 4

Confused-agitated

Back 4

Patient is in a heightened state of activity.

Behavior is bizarre and non-purposeful relative to the immediate environment.

Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts. Verbalizations frequently are incoherent and/or innappropriate to the environment; confabulation may be present.

Gross attention to environment to very brief; selective attention is often nonexistent.

Patient lacks short and long-term recall.

Front 5

Confused-Inappropriate

Back 5

Patient is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of any external structure, responses are non-purposeful, random, or fragmented.

Demonstrates gross attention to the environment but is highly distractible and lacks the ability to focus attention on a specific task.

With structure, may be able to converse on a social automatic level for short periods of time. Verbalization is often inappropriate and confabulatory.

Memory is severly impaired; often shows inappropriate use of objects; may perform previously learned tasks with structure, but is unable to learn new information

Front 6

Confused-appropriate

Back 6

Patient shows goal-directed behavior, but is dependent on external input or direction.

Follows simple directions consistently and shows carryover for relearned tasks such as self-care.

Responses may be incorrect due to memory problems, but they are appropriate to the situation.

Past memories show more depth and detail than recent memory.

Front 7

Automatic Approriate

Back 7

Patient appears appropriate and oriented within the hospital and home settings; goes gthrough daily routine automatically, but frequently robot-like.

Patient shows minimal to no confusion and has shallow recall of activities.

Shows carryover for new learning, but at a decreased rate.

With structure is able to initiate social or recreational activities; judgment remains impaired.

Front 8

Purposeful-Appropriate

Back 8

Patient is able to recall and integrate past and recent events and is aware of and responsive to environment.

Shows carryover for new learning and needs no supervision once activities are learned.

May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgment in emergencies or unusual circumstances.