Coma
Rancho Scale: Levels of Cognitive Functioning
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The Rancho Scale was first known as the Levels of Cognitive Functioning. As it became widely used, it acquired the name of the place where it was devised, Ranchos Los Amigos Hospital in California. Today it is referred to as the Rancho Scale.
The Rancho scale was developed as a way to describe the stages of cognitive improvement as a person with brain injury becomes more responsive (Hagan, Malkmus, & Durham, 1979). The Rancho Scale is not a test. It is a method of organizing and describing observations in a generalized way, to provide families with a language to communicate with rehabilitation specialists. This scale gives the family a sense of predictability so that as the person with brain injury continues to recover, the family knows what to expect at the next level similar to the Glasgow Coma Scale.
Improvement through the Rancho Scale depends primarily upon the extent and the severity of the brain injury. Some individuals progress through only certain levels while others will progress through all the levels (although they will not necessarily recover to their pre-injury functional level). Progress through the levels may be slow, rapid or moderate. Sometimes recovery may be rapid at first, and then may slow down or plateau. A brief description of the Rancho Scale is presented below:
Level I: No Response to Stimulation: Total Assistance
Level II: Generalized Response to Stimulation: Total Assistance
Level III: Localized Response to Stimulation: Total Assistance
Level IV: Confused, Agitated Behavior: Maximal Assistance
Level V: Confused, Inappropriate, Nonagitated Behavior: Maximal Assistance
Level VI: Confused, Appropriate Behavior: Moderate Assistance
Level VII: Automatic, Appropriate Behavior: Minimal Assistance for Daily Living Skills
Level VIII: Purposeful, Appropriate: Stand-by assistance
Level IX: Purposeful, Appropriate: Stand-by on request
Level X: Purposeful, Appropriate: Modified Independent
At the later stages of brain injury, neuropsychological testing is important and is the best method of providing more detailed and comprehensive information about cognitive capabilities.
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.