Rancho Los Amigos Scale for Assessing Severe Brain Injury

Rancho Los Amigos Scale

The Rancho Los Amigos Scale is the most commonly used assessment tool for those who are emerging from coma. While the Glasgow Coma Scale will be the first tool used, it has little value after the survivor begins to emerge.  There are eight Rancho Los Amigos Scale levels:

  • I. No Response: a person at this level will not respond to sounds, sights, touch or movement
  • II. Generalized Response: a person at this level will begin to respond to sounds, sight, touch or movement;or respond slowly, inconsistently or after a delay; and/or respond in the same way to what he hears, see or feels.  responses could include chewing, moaning, breathing faster, increase in blood pressure or moving.
  • III. Localized Response:  a person at this level will be awake on and off during the dayand/;or make more movements than before;and/or react to what he see, hears or feels; or react slowly and inconsistently;or begin to recognize people; or follow directions; and/or begin to respond to yes or no questions.
  • IV. Confused-Agitated: a person at this level with become agitated or frightened;and/ or not understand his/her soundings;and/or overreact to simple things; or have to be restrained so not to hurt themselves; and/or have difficulty following directions.
  • V. Confused-Inappropriate, Non-Agitated:  a person at this level will be confused;and/or  not know where they are;and/ or get fatigued quickly with too much stimulation;and/ or try to fill in gaps of memory by making things up; or
  • VI. Confused-Appropriate: a person at this level will have an attention span of about 30 minutes; and/or follow a schedule with assistance; or be somewhat confused because of memory or thinking problems; and/or be able to perform grooming activities; and/or be aware of physical problems but not necessarily thinking problems.
  • VII. Automatic Appropriate: a person at this level will be able to follow a set schedule; and/or be able to routine take care of themselves;and/ or have problems planning, starting and following through with activities; and/or having problems paying attention or easily distracted in stressful situations.
  • VIII. Purposeful Appropriate: a person at this level will realize he/she has a problem; and/or begin to compensate for his/her problems; and/or can still become overloaded; and/or need gu

The pace at which progression from level to level after coma emergence is difficult to predict, as well as the extent of full recovery.

An understanding of the characteristics of each of the eight Rancho Los Amigos Scale Levels is helpful when families and professionals must deal with the behaviors demonstrated by patients following head injury. The descriptions listed below provide insight into the expected progression during recovery and rehabilitation.

For the full Rancho Los Amigos Scale, click here.


NEXT: Brain Injury Prognosis.