While the Glasgow Coma Scale (GCS) is the most widely used tool to grade severity and prognosis of traumatic brain injury (TBI), the Rancho Los Amigos Scale (RLAS), also known as the Rancho Scale, is the most accepted test to measure how your recovery from head trauma progresses.
This article explains the levels of the Rancho Los Amigos Revised Scale (RLAS-R), which medical providers use to track your cognitive, behavioral, and physical functioning as you recover from TBI.
The Rancho Scale and the scores received serve as evidence to negotiate a fair personal injury or workers compensation settlement for head trauma causing brain injury.
Read on for more information.
If you have questions about your medical treatment or legal options, call a top-ranked traumatic brain injury lawyer at (757) 810-5614 or (804) 251-1620. We have a statewide practice helping accident victims and injured employees.
The original Rancho Scale had eight levels.
The new, revised Rancho Los Amigos Scale has ten levels. These added levels reflect head trauma patients with higher recovery levels.
Healthcare professionals score you based on your:
Level 1 is the lowest level of cognitive functioning after brain injury, while Level 10 is the highest level of function. As patients move to higher levels on the Rancho Scale, they show improved behavior, cognitive ability, and independence.
Below is an explanation of each level.
At this level, the patient does not respond to stimuli and needs total assistance.
Medical providers will focus on stabilizing the patient, minimizing contractures, and stimulating the senses.
Patients may open their eyes or move slightly in response to stimuli at this level. However, the reaction is often the same regardless of the stimulus, and the movements are inconsistent and lack focus or purpose. Further, delayed responses are common.
Medical treatment for patients in this vegetative state is like those in a coma. The only difference is the need to watch responses to mobilization.
Level 3 improves from Level 2 because a patient’s response becomes more specific to the stimulus.
At this level, the patient may:
Total help is still needed.
This level is often the most challenging for caregivers of brain-damaged patients.
At this level, patients show confusion and anger about where they are and what is happening.
They may:
Patients at Rancho Scale Level 4 cannot perform self-care.
At this level, the patient acts calmer. Anger is no longer a frequent problem.
However, Level 5 patients are still confused and respond inappropriately to stimuli.
Common characteristics at this stage of the Rancho Los Amigos Scale include:
Level 5 patients can perform self-care with help if demonstrated to them.
At this level, brain injury patients stay confused but start to respond appropriately to stimuli.
For example, Level 6 patients:
In addition, these head trauma patients can start to eat and get dressed independently.
These patients can perform familiar tasks for at least 30 minutes with minimal help but have difficulty with memory recall, judgment, empathy, and social interaction.
These patients can complete familiar tasks for about an hour in a distracting environment without taking a break. In addition, Level 8 patients can remember past events, use a “to-do” list, and follow routines.
At this level, the TBI patient starts to understand their impairments and disabilities better and recognize the consequences of their actions.
However, with this awareness of limitations, Level 8 patients may become depressed and irritable.
Stand-by aid is necessary.
Level 9 patients can perform tasks and activities correctly for at least two hours.
Assistive memory devices are still important; however, these patients are independent and need only stand-by help to solve problems.
Frustration, irritability, and depression remain.
TBI patients who reach Level 10 can multi-task in all environments but may require unscheduled breaks.
At this level, the patient must check their response to stress and social interactions, creating strategies to handle challenges and prevent problems from becoming bigger.
Every patient is different.
The Rancho Scale is the typical sequence of progression from brain damage.
Generally, you will go through all the levels if you have a moderate or severe brain injury.
However, you may skip some levels on the Rancho Scale if you have a mild TBI or if your recovery from moderate or severe TBI has periods of significant improvement.
On the other hand, your treatment may plateau so that you never reach the highest Rancho Scale level after suffering brain damage.
The time spent at levels differs based on severity and the healing process.
Your Rancho Scale score matters for two reasons.
First, the score helps your doctors prescribe medical treatment and rehabilitation to continue your improvement.
Second, your personal injury attorney can use the Rancho Scale score and the time spent at each level to prove impairment, disability, and pain and suffering in your TBI claim.
Medical providers often use the Rancho Scale with the Glasgow Coma Scale because these tests provide different information.
For example, both TBI grading scales assess cognitive function soon after the injury.
However, the Rancho Los Amigos Scale is more valuable after the first assessment and throughout recovery from the brain injury. Frequent monitoring of cognitive function and the help needed to complete specific tasks as you heal help doctors make treatment plans.