Brain Injury:

Ranchos Los Amigos Scale

Named after the Rancho Los Amigos National Rehabilitation Center, the Rancho Los Amigos Scale measures the level of recovery in brain injury patients. The scale measures awareness, cognition, interaction and behavior of brain injury patients. 

1. No Response

  • No response to touch, sounds, sights or movement

2. Generalized Response

  • Starts to respond to touch, sounds, sights or movement
  • Delayed response, slow response, or inconsistent response

3. Localized Response

  • Awake on and off
  • Begins to move more frequently
  • Follows simple actions, such as “squeeze my hand”
  • Reacts specifically to noises, touches and sights
  • Slowly recognizes family members and friends

4. Confused-Agitated

  • Confused and frightened
  • Overacts to sights, sounds etc.
  • Has difficulty following directions
  • Can perform simple activities, such as dressing or talking, with assistance
  • Does not understand people are trying to help him
  • Can only concentrate for a few seconds

5. Confused-Inappropriate, Non-Agitated

  • Can pay attention for a few minutes
  • May get stuck on a particular activity
  • Fills in memory gaps by making things up
  • Cannot start or complete everyday activities, such as dressing
  • Becomes restless when tired or when too many people are present
  • Unaware of date, reason they are in the hospital

6. Confused-Appropriate

  • Can remember main points of a conversation, but forgets or confuses specific details
  • Pays attention for 30 minutes, but cannot concentrate in noisy situations
  • Can brush teeth, dress and eat with help
  • Knows he was hospitalized for an injury, but cannot understand the problems associated with the brain injury
  • Becomes aware of physical problems
  • Associates his problems with being in the hospital
  • Knows the month and year

7. Automatic-Appropriate

  • Can follow a set schedule
  • Can dress, feed, brush teeth, etc. without assistance
  • Has trouble concentrating in stressful or distracting situations
  • Needs supervision because of decreased safety awareness
  • Stubborn
  • Has difficulty planning, starting and following through with activities

8. Purposeful-Appropriate

  • Can drive or train for a job
  • Shows poor judgment in new situations
  • Needs guidance in decision-making
  • Realizes there is a problem with his memory and thinking
  • Can slowly learn new tasks
  • Starts to compensate for his problems
  • Becomes more flexible and less rigid in thinking