Assessnent Scales
Rancho Los Amigos - Revised
Levels d Cognitive Functioning
Level| - No Response:TotalAssistance
tadile, propdoceptive,
Completeabence of observablec*rangein behaviorwhenpfesentedvisual, audilory,
vestibularor Painfuls{imuli-
o
Level ll -Generalized Respnse: Total Assistance
generalizedreflexresponseto painfulstimuli.
Demonstrates
auditorystimuliwith increasedor decreasedactivity.
d,peated
Respondsto
cfiangasgeneralized,gross body movementard/or not
with phys;iological
stimuli
Respords to er.tumal
purposefu| vocalization.
Flesponsesnotedabove may be sarneregardlessof type ald locationof stirnulation'
Responsesmay be significantlydelayed'
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Level lll - Localized Response: Total Assistance
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DemonstrateswitMnawalorvocalizationto painfulsiimuli.
Tums towardoraway from audltorystimuli'
Blinkswhen strongllglrtcrossesvisualfteH'
Followsmovingobjec'tpassedwithinvisualfield'
Respondsto discomfortby pullingtubes or restraints'
Respondsinconsistentlytosimple cornmards'
Responss direcfly relaiedto type of $imulus'
May respondto some persons(especiallyfamily and fiiends) but not to otheF-
Level lV - Confused/Agitated:MaximalAssistance
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Alert and in heightenedstate of aciivity.
Purposefulattenr$Sto nemoveresilnair{sortubes orcrawl out of bed'
any aprent ptfpose of upon
ttllayperformrnotoracffviliessucfras sittirg, reacirirg ard walkirq hrt without
anothefsrequestditridedattention'
Very bdef and usuallynon-purpo*ful rnomentsof sustainedattemativesard
Absentshort-termmemoryMay cry out or scream out of proportionto stimuluseven after its removal'
May etfiibit aggressiveorflight behavior'
events'
Mood *"V oiig fi,orneu$roricto hoetilewi$r no apparentrelationsfripto environmental
Unableto cooperatewith treatrnentefforts'
to activityor environment'
are fequently incoherentand/orinappropriate
Vetbalizations
Level v - confused, Inappropdate Non'Agitated: Maximal Assishnce
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goirg horne.
Alert, not agitatd h$ may wanderrandomlyor rrith a v4ue intentionof
and/or lack of environrnentalstrueture'
May U*"o*e agitatedin iesponseto e>dernalstirnutration,
No{orientedto person,f,ace ortlme'
sustainedattention.
Freguentbrief periods,non-purposeful
confusionoJmst and presentin reactionto ongoingactivity'
with
severely impaitd recentmernory,
Absentgoal direded, ploblem soMng"self-rnonitotirgbehaviorOften demons*ratesinappropriateuse of o$edswithout extemaldiredion.
providedMay UeaUe io perfom"preVouslyleamd tasks when slrucfuredand ctles
UnaHeto leam new information.
extemalstructuresand cues'
Able to respondappropriatelyto simse commandsfairlyconsistentlywith
in rdation to
Responsesto sirnplewnmards witirouterdemalstructurearc randomard non-pttrposeful
command.
s*ructureand
Abl€ to converseon a social, automaticlevel for brief periodsof time when povided extemal
cues.
eilemalstructureand
verbalizationsaboutpresenteventsbecomeinappropriateand confabulatorywhen
cuesare not Provided.
r
r
Level Vl - Confused,Appropdate: Modeiate Assistance
Inconsistentlyorientd to person,tlme ard dace'
moderaterediredion'
Able to attendto highlyfamiliartasksin nondis{ractingenvironrnentfor 30 minuteswith
Remotememoryhas rnoredepthand detailthanre@ntmemory.
Vague recognitionof some staff.
Aile to use assistivememoryaide with maximumassistance.
Emergingawarenessof appropriatefesponseto ssff, farn*y ard basic needs.
Moderateassistto probleln sofuebaniersto task cunph{ion.
$upervisd for old leaming(e-9.seffcare)'
Shorw calry overfor releamedfamiliartasN€(e'9"self care)'
Maximumassistancefor new leamingwith littleor nor Garryover.
Unawareof impairments,disabilitiesand safety risks'
GonsistentlyfollowssimSe direclionsVerbal expressionsarc appropriatein highlyfamiliarand structuredsitustions-
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lovel Vll -Automatic, AppropriaG: i/linimal Assistance forDaily LMng Skills
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assis{ancefor
Consistenflyorientedto personand place,withinhighlyfamiliarenvironments.Moderate
orientationto time.
with minimal
AHe to atterd to highlyfamiliartasks in a nondistraclion environmentfor at leas 30 mintrte
assistto compleiletasksMinima!supervisionfor new leamirp.
Dernonsilratescany o\ter sf new leaming.
shallowrecaflof
Initiatesand canie! out stepsto compleiefamiliarpersonaland householdroutinebut has
what he/shehas beendoing.
AD[s and modify
Able to monitoraccuracyand completenessof eacfi step in routinepersonaland household
plan with minimalassistanceand the limits
suprficial awarenessof his/herconditionbut unawareof speciftcimpairmentsand disabilities
community,
they placeon h'ls/herabilityto ""r"rv, accuratelyand completelycany out his/herhousehold,
work and leisureADLs'
MinimalsupeMsionforsafety in rcutinehomeand communityactivitiesUnrealisticflanningforthe futureUnableto think about consequenoesof a decisionor aciion.
Overestimatesabillties.
Unawareof others needsand feelings.
OPPositional/uncooPerative.
unable to rccognizeinappropdatesocial interaciionbefiavior.
Level Vlll - Purposerftrl,Appropf#:
Stand.8y lssistance
Consistentlyorientedto person,placeandtirne'
for t hourin dlstnaciingenvironments'
attendstoard completesfarniliartasks
Independen1;y
past
events'
and
recent
Able to recalland integrate
informationfor later
Uses assisilivememo,i devicesto recalldaily sctredule,1o do" lists and recordcritical
use with stan&bYassislance.
rcutines
o Initiatesard canies out stepsto wnplete familiar personal,househokl.community,vrcrk and leisure
assisilancewtth Sand-biasilst"nce ard can moCirytne$an when neededwtth minimal
r Reguinesno assisilane once newtasks/ac{lviliesare learned.
impairmentsand disabilitieswhenthey interferewith task completionbut
o Awareof and acknowledges
rcquiresstarsby assistanceto take appmpdateconeciive aclion-
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of a decisionor actionwith minimalassistanceThinksaboutconsequenoes
Overeslimatesor underestimatesabilities.
Acknowledgesothers' needsand feelingsand respondsappmpriatelywtth minimalassistance.
Depressed.
lnitable.
angered.
Lowfrustrationtolerance/easily
Argumentative.
Self-centered.
Unchanacieristicallydependent/independent'
socialinteractionbehaviorwhileit is occuningand takes
Able to recognizeand acknowtedgeinappropriate
conectiveac'tionwith minimalassis{ance.
Level x - Purposeful, Appropriate: stand€y Assistance on Request
Indeperdenty shifts badr and forth betweentasks and comfletes them amtrately for at least two
consecutivehours.
. Uses assistivememorydevicesto recalldaily schedule,to do" lists and recordcriticalinformationfor lder
usewith assistancewhen reques{ed.
o Initiatesand caniesout stepsto completefamiliarpensonal,household,workand leisuretasksindependently
and unfamiliarpersonal,household,work and leisurctaskswith assistancewhen rcquesiledr Aware of and j"3, otrl"Ogesimpairmentsand disatrililieswhen they interfereruithtask completionand takes
take
appropriateconectiveadion bdt reguiress{and-byassistto anticipatea problernbeforeit occus and
adion to avoid it.
of decisionsor actionswith assistancewhenrequested'
r Able to think aboutconsequences
siand-byassistanceto adiustto task demands.
rcquires
but
atrilities
r Accunatelyestimates
and rwpods appropriatelywith sland-byassistane.
feeliqgs
and
needs
r Acknowledgesothers'
r Depressionmay continue.
. May be easilYinfiabler May have lorvfrulstrationtolerance.
of socialinteractionwith stand-byassis{ance'
o Able to self monitorappropriateness
o
Levet X - Purposeful, Apprcpriate: Modified Independent
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AHe to handlemultige tasks simultaneouslyin all environmentshrt may reguireperiodicbrcaks.
Able to indepndentiy procure,create and maintainown assistivememorydevicesIndeperdentlyinitiatesandcaniesout s{epsto campletefamiliarand unfamillarpersonal,household.
community,work and leisuretasksbut may requiremorcthan usualamountof time and/orcompensatory
$rategies to comPletethern.
actionto
Anticipatesimpactof impairmentsard disabilitieson abilityto corn$ete daily livit€ tasks ard takes
tirne
and/orcompensatory
of
avoid-pouerns beforethey occilr br.ilmay rquire rnorethan usual amount
strategies.
usual
Able to independenilythink about onsequen@s of decisionsor ac*ionsbut nray requiremorethan
action.
or
decision
appropriate
the
strategiesto select
amountof time anAt6rcompensatory
Accuratelyestimatesabilitiesand independentlyadiusfisto task demandsAble to rccognizethe neds ard feelirgs of othersarudautomaticallyrespondin approgide manner'
Perirdic pedodsof deilession may oocurtnilabillty and low frus{rationtolerancewhen sick, fatlguedand/sr underernotienafstress'
Socialinterac{ionbehavioris consistentlyappropriate'
Communfu:ation
Ofiginal Scalecoauttwed by Ctxis Hagen,m.D.,Oanese Malkmus,M-A, Paticia Dwtnm, M-AaN K&ryn
M.A,
Maknus,
Disdars sen*69, R;rldro rosnmigoJrospfrat 1972.Reused 1't/l5t74byDarresa
Sflattdenp,O-LR- Revisedwb 1997by CivisHroBn-