Rancho Los Amigos Levels – Occupational Therapy

The Rancho Los Amigos Scale is used to evaluate a patient following a brain injury. The levels are based on observations of the patient’s responses to the environment. It provides insight into their progress during recovery and rehabilitation. The occupational therapist supports the team and the patient throughout their recovery based on their level of functioning.

Level I – No Response

  • Patient does not respond to external stimuli
  • Appears asleep

Level II – Generalized Response

  • Patient reacts to external stimuli in nonspecific and inconsistent manner.
  • Limited responses.

Level III – Localized Response

  • Patient responds specifically and inconsistently with delays to simuli.
  • May follow simple commands for motor action.

Level IV – Confused, Agitated Response

  • Patient exhibits incoherent or inappropriate behavior.
  • No short-term memory recall.
  • Short attention span.

Level V – Confused, Inappropriate, Non-Agitated Response

  • Patient gives random responses to complex unstructured stimuli.
  • Follows simple commands consistently.
  • Impaired memory and selective attention.
  • Cannot retain new informaiton.

Level VI – Confused, Appropriate Response

  • Patient gives appropriate goal-directed responses.
  • Dependent upon external input for directions.
  • Carry-over for relearned tasks.
  • No carry-over for new tasks.
  • Memory problems persist.

Level VII – Automatic, Appropriate Response

  • Patient behaviors appropriately ih familiar setitngs
  • Performs daily routines automatically.
  • Shows carry-over for new learning (lower than normal rate).
  • Initiates social interactions.
  • Judment is impaired.

Level VIII – Purposeful, appropriate response

  • Patient is oriented.
  • Responds to the environment.
  • Abstract reasoning abilities are decreased.