Rancho Los Amigos Level of Cognitive Functioning Scale: Difference between revisions
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''Information provided in the above table adapted from Lin K, Wroten M. Ranchos los amigos. 2022.<ref name=":0" />'' | ''Information provided in the above table adapted from Lin K, Wroten M. Ranchos los amigos. 2022.<ref name=":0" />'' | ||
== | == Administering the RLAS-R == | ||
Administering the Ranchos Scale requires practice and mentorship from a healthcare professional experienced in using the Scale. There is also a training manual available for purchase from the Rancho Los Amigos National Rehabilitation Center. Administering the Ranchos Scale involves a healthcare professional’s best subjective assessment. A score or level is assigned based on the examiner’s subjective assessment of the patient’s behavior rather than on performance-based objective measures. | |||
Thorough documentation will support a single practitioner’s rating and will help track a patient’s recovery progress. | |||
{Source} Completing the Ranchos Scale Assessment should only take a few minutes. | |||
Even when comparing two seemly identical brain injuries, patients can demonstrate different symptoms, behaviors and speeds of recovery. Think of the Ranchos Scale as a guide rather than a rule. Not every patient will fit neatly into a single level, they may show aspects or behaviors of multiple categories at the same time. Not all patients will move forward through the levels in a single direction, some will experience “backslides” while others skip levels all together. It all depends on an individual’s neurorecovery - which can be effected by the quality and intensity of their rehabilitation. | |||
For treating rehabilitation therapists and professionals, assessing and assigning a Ranchos Level can come from that day’s treatment interventions and interactions. The real-time nature of therapy interventions provide an ideal opportunity to witness a patient’s abilities and behaviors from day to day. | |||
There is no single expected outcome or timeframe for recovery following a TBI, but the Ranchos Scale can provide some guidance to a individual patient’s progress. | |||
==Psychometric Properties== | ==Psychometric Properties== |
Revision as of 02:36, 30 June 2023
Original Editor - Venugopal Pawar
Top Contributors - Venugopal Pawar, Stacy Schiurring, Kim Jackson, Jess Bell, Redisha Jakibanjar, Naomi O'Reilly, Amrita Patro and George Prudden
Introduction[edit | edit source]
The Rancho Los Amigos Level of Cognitive Funtioning Scale, commonly known as The Ranchos Scale, is an integral and widely used tool in the cognitive and behavioural assessment of persons following a traumatic brain injury (TBI).
The Ranchos Scale, was originally developed by Dr. Chris Hagen and team in 1972 at the Rancho Los Amigos National Rehabilitation Center in Downey, California. It has since been revised several times to more accurately reflect individuals with more independence at higher levels of cognitive recovery. The original Rancho Los Amigos Scale (RLAS) had 8 levels[1] but was expanded to 10 levels and renamed the Rancho Los Amigos Revised Scale (RLAS-R). The Ranchos scale development is based on assumption that proper observation of the nature and quality of a patient’s behavioural responses can be used to estimate the cognitive level at which the patient is functioning during their recovery from.a TBI. [2]
Ranchos Exam Overview[edit | edit source]
The Ranchos Scale is a widely used standardised measure which describes the cognitive and behavioural patterns commonly observed in patients as they recover from a TBI.
- It takes into consideration both (1) the patient’s state of consciousness and the (2) level of assistance they require to complete cognitive and physical functions when rating the patient.[3]
- It can be completed by any trained healthcare professional.[3]
- It can be used to facilitate communication[3] among the multidisciplinary team (MDT) to better understand the patient’s abilities, impairments, and prognosis, which will aid in the creation of a more holistic and inclusive treatment plan.
- It is often used alongside the Glasgow Coma Scale (GCS) during acute care assessment following the initial injury.[3] However, unlike the GCS, the Ranchos Scale can be used throughout the patient’s recovery and rehabilitation journey.
Scale and Interpretation[edit | edit source]
The current iteration of the Ranchos Scale, the RLAS-R, is a 10-level descriptive scale.[3] Not every patient will fit neatly into a single level, they may show aspects or behaviors of multiple categories at the same time. Not all patients will move forward through the levels in a single direction, some will experience “backslides” while others skip levels all together. Progress and regression along the Scale depend on an individual’s neurorecovery - which can be effected by the quality and intensity of their rehabilitation.[4]
Different levels are given below:
Level | Cognitive response/need of assistance | Clinical Features | |
---|---|---|---|
Level I | No response/total assistance |
|
|
Level II | Generalised response/total assistance |
|
|
Level III | Localised response/total assistance |
|
|
Level IV | Confused and agitated/max assist |
|
|
Level V | Confused, inappropriate non-agitated/max assist |
|
|
Level VI | Confused, appropriate/ mod assist |
|
|
Level VII | Automatic, appropriate/ min assist for ADL's |
|
|
Level VIII | Purposeful, appropriate/ stand by assist |
|
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Level IX | Purposeful, appropriate/ stand by assist on Request |
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Level X | Purposeful, appropriate/ modified independent |
|
Information provided in the above table adapted from Lin K, Wroten M. Ranchos los amigos. 2022.[3]
Administering the RLAS-R[edit | edit source]
Administering the Ranchos Scale requires practice and mentorship from a healthcare professional experienced in using the Scale. There is also a training manual available for purchase from the Rancho Los Amigos National Rehabilitation Center. Administering the Ranchos Scale involves a healthcare professional’s best subjective assessment. A score or level is assigned based on the examiner’s subjective assessment of the patient’s behavior rather than on performance-based objective measures.
Thorough documentation will support a single practitioner’s rating and will help track a patient’s recovery progress.
{Source} Completing the Ranchos Scale Assessment should only take a few minutes.
Even when comparing two seemly identical brain injuries, patients can demonstrate different symptoms, behaviors and speeds of recovery. Think of the Ranchos Scale as a guide rather than a rule. Not every patient will fit neatly into a single level, they may show aspects or behaviors of multiple categories at the same time. Not all patients will move forward through the levels in a single direction, some will experience “backslides” while others skip levels all together. It all depends on an individual’s neurorecovery - which can be effected by the quality and intensity of their rehabilitation.
For treating rehabilitation therapists and professionals, assessing and assigning a Ranchos Level can come from that day’s treatment interventions and interactions. The real-time nature of therapy interventions provide an ideal opportunity to witness a patient’s abilities and behaviors from day to day.
There is no single expected outcome or timeframe for recovery following a TBI, but the Ranchos Scale can provide some guidance to a individual patient’s progress.
Psychometric Properties[edit | edit source]
- Interrater reliabilities ranging from 0.87 to 0.94 and test re-test reliability of 0.82.[2]
- Concurrent validity with the Stover Zeiger scale was 0.92[2]
- Predictive validity from admission to discharge 0.57 to 0.68[2]
Links[edit | edit source]
http://www.traumaticbraininjury.com/symptoms-of-tbi/ranchos-los-amigos-scale/ http://www.neuroskills.com/resources/rancho-los-amigos-revised.php
References[edit | edit source]
- ↑ Hagen, C., Malkmus, D., & Durham, P. (1972). Levels of cognitive functioning. Downey, CA: Rancho L.
- ↑ 2.0 2.1 2.2 2.3 Flannery J, Abraham I. Psychometric properties of a cognitive functioning scale for patients with traumatic brain injury. Western journal of nursing research. 1993 Aug;15(4):465-82. available from: https://journals.sagepub.com/doi/10.1177/019394599301500406
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Lin K, Wroten M. Ranchos los amigos. 2022.
- ↑ Schiurring, S. Neuroassessment Programme. Rancho los Amigos Level of Cognitive FunctioningScale. Plus. 2023.