RANCHO SCALE

Level I:  No response or coma

Level II: Generalized response, the patient will sometimes respond to stimuli by becoming more or less physically active. It is the same response for pain, noise or any stimuli. They continue to sleep most of the time.

Level III: Localized response, awake more and tends to react more to what is happening around him or her. turns towards sounds or recognizes familiar faces.

Level IV: confused/agitated, behavior may appear bizarre and out of character. They may act aggressive attempt to remove restraints, tubes and get out of bed. talking may be incoherent and not related to anything around them. They are suffering from confusion within and may scream, strike and even use foul language, even if they have never done so before. This stage is very difficult but is part of recovery.

Level V: Confused-inappropriate non-agitated, more alert able to follow simple commands. Situations or activities that are unfamiliar or difficult may trigger restless behavior or outbursts. concentration improves but they continue to need reminders and redirection for the activity they are doing. They often cannot remember from one moment to the next what they are doing. example after easting a meal they may ask for food forgetting they have just eaten even though the empty plate is in front of them.

Level VI: Confused-appropriate. they now follow simple commands consistently. they show awareness of their  injury and may become frustrated or annoyed when they cannot do things they could before the accident. They are still confused about where they are what happened and the time of day, date or year. they may keep their attention on an activity for as long as 30 minutes at this time.

Level VII:  Automatic-appropriate, they appear appropriate and normal on the surface. they go through the normal daily routine automatically but may have little recollection of what has been happening from day to day or week to week. increased self awareness of what is going on within themselves and their environment around them. they may continue to fatigue very easily,  judgment and concentration skills remain to poor to safely drive a car. they could return to work if not for these factors.

Level VIII: Purposeful-appropriate stand-by assistance; they are aware of time, place, personal information, and his or her situation; attention skills are improving and they can complete familiar routines in a distracting environment; they can use their memory device with occasional help. may still need supervision to carry out familiar personal, household, community and leisure activities; they have difficulties anticipating problems and changing plans when a problems arises. Depression, irritability and increased frustration are more likely during this stage as they become more aware of the changes as a result of the brain injury.

Level IX: Purposeful-appropriate stand-by assistance request, attention skills continue to improve; they can shift back and forth between activates without help. able to use their own memory device reusing help when needed; they may still have problems anticipating problems; they show more realization of others feelings and the consequences of their actions with occasional help. may show signs of occasional depression and low frustration tolerance and may need occasional help for socially acceptable behavior.

Level X: Purposeful-appropriate modified independent; they can complete previous activities without help, but may require more time and different ways of completing them; they may complete several tasks at the same time without help but needs several breaks to prevent fatigue they can anticipate problems and make decisions about the problems without help; recognizes the needs and feelings of others and responds in a usual, customary fashion. The individual may have periods of depression, irritability and frustration especially when he or she is tired under stress or sick.