Coma
Rancho Levels I - III - Family Strategies for Interaction
Last Updated:
Rancho Levels I, II, and III, the person’s behavior is characterized by No Response, Generalized Response and Localized Responses to Stimulation.
· No Response: person is unresponsive to any stimulation that is presented.
· Generalized Response: person reacts inconsistently and nonpurposefully to stimulation; responses are the same regardless of the kind of stimulation presented.
· Localized Responses to Stimulation: person reacts inconsistently to specific kinds of stimulation, such as turning the head toward a sound or focusing on an object. Person may follow simple commands in an inconsistent, delayed manner.
When relating to a person at Rancho Levels I, II, or III, family and friends should:
• Use calm, reassuring tones, and in a normal tone of voice
• Tell the person what you are going to do before you do it. For example, "I'm going to move your leg."
• Speak in short phrases, keeping comments and questions short and simple. For example, instead of saying, "Can you turn your head to me?" say, "Look at me."
• Allow the person extra time to respond. Sometimes responses are inconsistent, do not always occur, or are not correct.
• Have one person speak at a time.
• Tell the person who you are, where they are, why they are in the hospital, and what day it is.
• Speak in concrete terms. Discuss things that are happening near the person.
• Bring in favorite belongings and pictures of family members and close friends.
• Bring in familiar activities, such as favorite music, talking about family and friends, reading favorite magazines or books out loud, watching favorite TV shows or videos to stimulate senses and memory.
• Gently massage lotion on the person’s arms, legs, back and stomach. This not only increases the person’s tactile awareness but helps prevent skin breakdown.
• Touch the person on the face, arm, or leg with various textures like a wash cloth, fuzzy toy, flannel, plastic, rubber, etc. for sensory stimulation.
• Use a variety of soaps, fragrances and lotions to stimulate smell.
• Keep a notebook nearby for family and visitors to sign. Instruct them to log in any noticeable responses to stimuli.
• Limit the number of visitors to 2-3 at a time.
• Keep the room calm and quiet.
• Maintain rest periods.
• Always assume the person with brain injury can understand what is being said. Never discuss subjects that may be upsetting in front of the person.
Dr. Kiefel holds both a Masters and Doctoral degree in psychology with a specialty in clinical neuropsychology. Her specialty training in clinical child psychology was completed at Mount Sinai Medical Center in New York City and postdoctoral training completed at Childrens Hospital in Columbus, Ohio. Dr. Kiefel, a licensed a Psychologist in Georgia has been on staff at Children's Healthcare of Atlanta since 1996.
References
Some information obtained from Family Guide to The Levels of Cognitive Functioning, Communication Disorders Department, Rancho Los Amigos Medical Center.