The Eight Levels of the Rancho Los Amigos Scale for Brain Injury Patients

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doctor assessing unconscious patientBrain injuries affect people in very different ways. One way to assess the extent of a brain injury and to measure a brain injury patient’s progress is through the Rancho Los Amigos Levels of Cognitive Functioning Scale (also known as the Rancho Scale). It was originally developed by the head injury team at the Rancho Los Amigos Hospital in Downey, California, to assess patients emerging from a coma.

Eight Levels of the Rancho Scale

The Rancho Los Amigos Scale consists of eight levels, with level one being the most severe brain injuries and level eight being the least severe brain injuries. The levels include:

  • Level 1: No Response. At this most extreme level of injury, people with brain injuries are unconscious. They appear to be in a deep sleep, and they do not respond to stimuli. Often, they are in intensive care, and they may be attached to breathing machines.
  • Level 2: Generalized Response. Brain injury victims are deemed to be at level two on the Rancho Scale if they are unconscious most of the time but do respond to some stimuli. Their response to stimuli is usually a generalized moan or physical response to pain.
  • Level 3: Localized Response. At level three, people with brain injuries may have more specific reactions to stimuli. For example, they may turn their heads in the direction of noise or respond to simple instructions like being asked to open or close their eyes.
  • Level 4: Confused/Agitated. At this stage, the brain is beginning to wake up, but the person with the brain injury is not able to understand what is going on around him, which leads to confusion and agitation.
  • Level 5: Confusion/Inappropriate. At level five, the person with the brain injury is more active but is still confused. The person may be able to respond to simple commands. However, memory is impacted, it is challenging to learn new things, and wandering is a significant risk.
  • Level 6: Confusion/Appropriate. People at level six still need a lot of support. However, their reactions to stimuli are more appropriate, they can follow simple directions, and they recognize more people. Long term memory will improve at this level, but recent memories are likely still difficult to access.
  • Level 7: Automatic/Appropriate. At first glance, things may seem like they are back to normal for a patient at level seven. Often, people can go about routine daily activities, know where they are, and tell you the date and time. However, problem-solving skills may still be impacted, and making plans is challenging.
  • Level 8: Purposeful/Appropriate. At this least severe stage of brain injury, people are typically independent and functioning in society. However, there may be lasting impacts in stressful situations.

Your loved one may move between levels during the brain injury recovery period.

Talk to a Brain Injury Lawyer After a TBI

If your loved one suffered a brain injury in a motor vehicle accident, because of medical malpractice, or for another reason, we encourage you to contact our experienced Kentucky brain injury lawyers for a free, no-obligation consultation. We will provide you with a thorough case evaluation so that you can make informed decisions about what to do next. Call us or start a live chat with us today to learn more.