Rancho Levels I-III
| Create/Promote | Driving and safe practices Support and education groups Sports injury safety Family coping mechanisms |
| Establish/Restore | Bed and wheelchair positioning Upright posture with full support Increased level of arousal, awareness, response Family education on low level of sensory stimulation Sensory stimulation program Multidisciplinary program Contracture management |
| Maintain | Skin integrity Muscle tone Joint ROM Nutrition and hydration |
| Modify | Environment Decrease over-stimulation Use short and simple verbal cues Bed and wheelchair positioning |
| Prevent | Falls Contractures Decubitus ulcers Dysphagia Aspiration PNA Self-injury |
Rancho Levels IV-V
| Create/Promote | Driving and safe practices Support and education groups Sports injury safety Family coping mechanisms |
| Establish/Restore | Bed and wheelchair positioning Weightbearing, symmetrical posture, trunk control Use of routine, step-by-step instructions Orientation to self and the environment Agitation management Low-stimulating environment |
| Maintain | Muscle tone, strength, and endurance Joint ROM Postural control |
| Modify | Decrease over-stimulation Interactions and instructions to be short and simple Activity demands Therapy duration (short) Positioning |
| Prevent | Self-injury Contractures Decreased muscle strength and functional movements Decubitus ulcers Falls Overstimulation and distractions Aspiration, PNA Further injury |
Rancho Levels VI-VII
| Create/Promote | Safety Fall prevention Driving safety (older adults, reckless driving, drunk driving) Wearing helmets |
| Establish/Restore | Familiar structured routine and schedule Bilateral upper extremity use and weight bearing Use of assistive devices Dynamic standing balance for activities Orientation beyond self and the immediate environment Safety in the environment Family education: cooperation, safety, structure |
| Maintain | Interactions under a controlled environment Carry-over learning Independence with BADLs Familiar cueing Muscle strength and ROM |
| Modify | Over-stimulation Assistive device Activity demands to match with client’s ability Cueing Social environment Inappropriate behavior |
| Prevent | Contractures Deviation from routines Inappropriate social behaviors Falls Suicidal tendencies Stagnate behavior Psychosocial problems |
Rancho Levels VIII-X
| Create/Promote | Safety Fall prevention Driving safety (older adults, reckless driving, drunk driving) Support end educational groups (family and friends) Sports injury safety (concussions) |
| Establish/Restore | Community reintegration and living Increase awareness of residual deficits Executive function: planning, initiation, flexibility Familiar structured schedule and routine Dynamic standing balance for high level activities and sports Support system for long-term management Work-skills and habits Financial management |
| Maintain | Social interaction Cognitive function Carry-over learning Family education (expectations and awareness of client’s condition, deficits, impairments) Healthy lifestyle (physical exercise, diet, nutrition) |
| Modify | Assistive devices Memory and visual aids Home environment for safety (e.g., falls, seizure precautions) Task demands – integration to roles (work, parenting, leisure, etc.) |
| Prevent | Risky behavior Inappropriate social behavior Substance abuse Falls Suicidal tendencies Fatigue and sensory overstimulation Psychosocial problems (depression, emotional distress) Fatigue |
References
Kou, J. 2017. 5-Tier Approach for TBI and Rancho Levels. [Lecture Notes].