Rancho Los Amigos Level of Cognitive Functioning Scale: Difference between revisions
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== Introduction == |
== Introduction == |
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The Rancho Los Amigos Scale |
The Rancho Los AmigosLevel of Cognitive FuntioningScale,commonlyknown asTheRanchos Scale, is an integral and widely used tool inthe cognitive andbehavioural assessment of persons following a traumaticbrain injury(TBI). |
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The scale |
The Ranchos Scale,was originally developed byDr. Chris Hagen andteamin 1972at the Rancho Los AmigosNational Rehabilitation Centerin Downey, California. It has since been revised several timestomore accurately reflect individuals with more independence at higher levels of cognitive recovery.The original Rancho Los Amigos Scale (RLAS)had 8 levelsHagen,C., Malkmus, D., & Durham, P.(1972).Levels of cognitive functioning.Downey, CA: Rancho L.but was expanded to 10 levels and renamed the Rancho Los Amigos Revised Scale (RLAS-R).TheRanchosscaledevelopment isbased on assumption thatproperobservation of the nature and quality ofapatient’sbehaviouralresponses can be used to estimate the cognitive level at which the patient is functioningduring their recovery from.a TBI. Flannery J, Abraham I. Psychometric properties of a cognitive functioning scale for patients with traumatic brain injury. Western journal of nursing research. 1993 Aug;15(4):465-82. |
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available from: https://journals.sagepub.com/doi/10.1177/019394599301500406 |
available from: https://journals.sagepub.com/doi/10.1177/019394599301500406 |
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==Ranchos Exam Overview== |
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The Ranchos Scale isawidely used medical standardised measure which describes the cognitiveand一般行为模式中观察到病人as theyrecover from a TBI.
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* It takes both the patient’s state of consciousness and the level of assistance they require to complete cognitive and physical functions into consideration when rating the patient.
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* It can be completed by any trained healthcare professional.
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* The Ranchos Scale can be used to facilitate communication among the multidisciplinary team (MDT) to better understand the patient’s abilities, impairments, and prognosis, which will aid in the creation of a more holistic and inclusive treatment plan.
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*It is often used alongside the Glasgow Coma Scale during acute care assessment following the initial injury. However, unlike the GCS, the Ranchos Scale can be used throughout the patient’s recovery and rehabilitation journey.
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== Method of Use >Lin K, Dulebohn SC. Ranchos Los Amigos.
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Available from : https://www.ncbi.nlm.nih.gov/books/NBK448151/
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In the Ranchos Los Amigos Scale, each level is presented as a behavioral description in narrative form and the rater must decide which level best describes the patient’s present behaviors. Different levels are given below: |
In the Ranchos Los Amigos Scale, each level is presented as a behavioral description in narrative form and the rater must decide which level best describes the patient’s present behaviors. Different levels are given below: |
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Revision as of 21:44, 26 June 2023
Original Editor-Venugopal Pawar
Top Contributors-Venugopal Pawar,Stacy Schiurring,Kim Jackson,杰斯贝尔,Naomi O'Reilly,Redisha Jakibanjar,George PruddenandAmrita Patro
Introduction[edit|edit source]
The Rancho Los Amigos Level of Cognitive Funtioning Scale, commonly known as The Ranchos Scale, is an integral and widely used tool in the cognitive and behavioural assessment of persons following a traumatic brain injury (TBI).
The Ranchos Scale, was originally developed by Dr. Chris Hagen and team in 1972 at the Rancho Los Amigos National Rehabilitation Center in Downey, California. It has since been revised several times to more accurately reflect individuals with more independence at higher levels of cognitive recovery. The original Rancho Los Amigos Scale (RLAS) had 8 levels[1]but was expanded to 10 levels and renamed the Rancho Los Amigos Revised Scale (RLAS-R). The Ranchos scale development is based on assumption that proper observation of the nature and quality of a patient’s behavioural responses can be used to estimate the cognitive level at which the patient is functioning during their recovery from.a TBI.[2]
Ranchos Exam Overview[edit|edit source]
The Ranchos Scale is a widely used medical standardised measure which describes the cognitive and behavioural patterns commonly observed in patients as they recover from a TBI.
- It takes both the patient’s state of consciousness and the level of assistance they require to complete cognitive and physical functions into consideration when rating the patient.
- It can be completed by any trained healthcare professional.
- The Ranchos Scale can be used to facilitate communication among the multidisciplinary team (MDT) to better understand the patient’s abilities, impairments, and prognosis, which will aid in the creation of a more holistic and inclusive treatment plan.
- It is often used alongside the Glasgow Coma Scale during acute care assessment following the initial injury. However, unlike the GCS, the Ranchos Scale can be used throughout the patient’s recovery and rehabilitation journey.
Method of Use[3][2][edit|edit source]
In the Ranchos Los Amigos Scale, each level is presented as a behavioral description in narrative form and the rater must decide which level best describes the patient’s present behaviors. Different levels are given below:
Level I: No Response: Total Assistance[edit|edit source]
- No response to external stimuli
Level II: Generalized Response: Total Assistance[edit|edit source]
- Responds inconsistently and non-purposefully to external stimuli
- Responses are often the same regardless of the stimulus
Level III: Localized Response: Total Assistance[edit|edit source]
- Responds inconsistently and specifically to external stimuli
- Responses are directly related to the stimulus, for example, patient withdraws or vocalizes to painful stimuli
- Responds more to familiar people (friends and family) versus strangers
Level IV: Confused/Agitated: Maximal Assistance[edit|edit source]
- The individual is in a hyperactive state with bizarre and non-purposeful behavior
- 演示s agitated behavior that originates more from internal confusion than the external environment
- Absent short-term memory
Level V: Confused, Inappropriate Non-Agitated: Maximal Assistance[edit|edit source]
- Shows increase in consistency with following and responding to simple commands
- Responses are non-purposeful and random to more complex commands
- Behavior and verbalization is often inappropriate, and individual appears confused and often confabulates
- If action or tasks is demonstrated individual can perform but does not initiate tasks on own
- Memory is severely impaired and learning new information is difficult
- Different from level IV in that individual does not demonstrate agitation to internal stimuli. However, they can show agitation to unpleasant external stimuli.
Level VI: Confused, Appropriate: Moderate Assistance[edit|edit source]
- Able to follow simple commands consistently
- Able to retain learning for familiar tasks they performed pre-injury (brushing teeth, washing face) however unable to retain learning for new tasks
- 演示s increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns
- Responses may be incorrect secondary to memory impairments but appropriate to the situation
Level VII: Automatic, Appropriate: Minimal Assistance for Daily Living Skills[edit|edit source]
- Oriented in familiar settings
- Able to perform
- Daily routine automatically with minimal to absent confusion
- 演示s carry over for new tasks and learning in addition to familiar tasks
- Superficially aware of one’s diagnosis but unaware of specific impairments
- Continues to demonstrate lack of insight, decreased judgment and safety awareness
- Beginning to show interest in social and recreational activities in structured settings
- Requires at least minimal supervision for learning and safety purposes.
Level VIII: Purposeful, Appropriate: Stand By Assistance[edit|edit source]
- Consistently oriented to person, place and time
- Independently carries out familiar tasks in a non-distracting environment
- Beginning to show awareness of specific impairments and how they interfere with tasks, however, requires standing by assistance to compensate
- Able to use assistive memory devices to recall daily schedule
- Acknowledges other’s emotional states and requires only minimal assistance to respond appropriately
- 演示s improvement of memory and ability to consolidate the past and future events
- Often depressed, irritable and with low frustration threshold
Level IX: Purposeful, Appropriate: Stand By Assistance on Request[edit|edit source]
- Able to shift between different tasks and complete them independently
- Aware of and acknowledges impairments when they interfere with tasks and able to use compensatory strategies to cope
- 无法独立预测的障碍may arise secondary to impairment
- With assistance able to think about consequences of actions and decisions
- Acknowledges the emotional needs of others with stand by-assistance.
- Continues to demonstrate depression and low frustration threshold
Level X: Purposeful, Appropriate: Modified Independent[edit|edit source]
- Able to multitask in many different environments with extra time or devices to assist
- Able to create own methods and tools for memory retention
- Independently anticipates obstacles that may occur as a result of impairments and take corrective actions
- Able to independently make decisions and act appropriately but may require more time or compensatory strategies
- 演示intermittent periods of depression and low frustration threshold when under stress
- Able to appropriately interact with others in social situations
Psychometric Properties[edit|edit source]
- Interrater reliabilities ranging from 0.87 to 0.94 and test re-test reliability of 0.82.[2]
- Concurrent validity with the Stover Zeiger scale was 0.92[2]
- Predictive validity from admission to discharge 0.57 to 0.68[2]
Links[edit|edit source]
http://www.traumaticbraininjury.com/symptoms-of-tbi/ranchos-los-amigos-scale/http://www.neuroskills.com/resources/rancho-los-amigos-revised.php
References[edit|edit source]
- ↑Hagen, C., Malkmus, D., & Durham, P. (1972). Levels of cognitive functioning. Downey, CA: Rancho L.
- ↑2.02.12.22.32.4Flannery J, Abraham I. Psychometric properties of a cognitive functioning scale for patients with traumatic brain injury. Western journal of nursing research. 1993 Aug;15(4):465-82. available from:https://journals.sagepub.com/doi/10.1177/019394599301500406
- ↑Lin K, Dulebohn SC. Ranchos Los Amigos. Available from :https://www.ncbi.nlm.nih.gov/books/NBK448151/