The Rancho Los Amigos Scale is a medical evaluation tool used to assess individuals after experiencing a traumatic brain injury (TBI). The scale is based on cognition and behavior in a patient as he/she emerges from a coma following a severe TBI. It is also commonly referred to as the Rancho Los Amigos Levels of Cognitive Functioning Scale (LOCF).
LOCF was developed at the Rancho Los Amigos National Rehabilitation Center in Downey, California. It can define the severity of deficit in cognitive functioning using eight separate stages through which a recovering TBI patient typically progresses as he/she awakens from a coma following a severe injury. The scale is widely accepted in clinical settings and is often used in patient records to communicate levels of functionality, coinciding with initial assessments based on the Glasgow Coma Scale.
Rancho Los Amigos Levels of Cognitive Functioning Scale – Overview of Stages
Doctors using the Rancho Los Amigos scale typically assess the patient with a score from one to eight, indicating the initial stage from which a patient may begin his/her progression through recovery.
- Level I (No reaction) The TBI patient remains unconscious and does not react to any stimuli. This comatose state can last for minutes, days, or months.
- Level II (General reaction) A patient shows some reaction to stimuli, but reactions are inconsistent. Reactions often include broad body movement or garbled words/sounds.
- Level III (Local reaction) Indicates improvement in the condition. A TBI patient will react more specifically to different stimuli, but reactions may still be inconsistent. A patient may look in the direction of a speaker’s voice or even be able to follow very simple commands.
- Level IV (Confusion/Agitation) The patient becomes noticeably more active but does not yet understand the circumstances. Bizarre behavior may be exhibited, such as crying out or pulling at a feeding tube. Confusion in the brain may make a person seem hostile or uncooperative.
- Level V (Confusion/Inappropriate) Agitation fades away in the patient. Reactions to simple commands become more consistent. Complicated commands may still yield confusion or incorrect reactions. Noisy or busy environments may trigger agitation. The patient reacts to body aches, to their own comfort, and to close family members. Memory impairment is severe at this stage and an ambulatory patient is at-risk of “wandering off” if left unsupervised.
- Level VI (Confusion/Appropriate) The patient’s self-motivation improves, but still depends on others for guidance and direction. Reactions are more appropriate and consistent, such as complaining of discomfort. Long-term memory begins to improve and he/she begins recognizing staff members while becoming much more self-aware.
- Level VII (Automatic/Appropriate) Actions become more specifically appropriate in the hospital and/or at home. The TBI patient knows who and where they are. Much improvement is evident, but not perfect. Daily routines, such as hygiene, can be executed habitually but the patient still needs guidance. Judgment and problem-solving are still damaged and the patient cannot make realistic plans for the future.
- Level VIII (Purposeful/Appropriate) A TBI patient at this stage can pair the past with the present and future. Independence is regained and non-dependent functionality returns them to a relatively normal existence. Patients may still struggle with advanced reasoning and judgment, particularly in high-stress or emergency situations. Patients at this level may also be actively involved in a vocational rehabilitation program.
For more information on the Rancho Los Amigos Scale please see the references below.
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