Moderate to Severe TBI

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Assessment of Children With Moderate to Severe TBI
Rancho Los Amigos Cognitive Recovery Scale

This multi-level scale of cognitive recovery ranges from 1 (no response) to 10 and is used:

• for assessment of recovery
• for communication between health care professionals and facilities
• in research

Levels of Cognitive Functioning

1. No Response

   
   Patient is completely unresponsive to any environmental stimuli
   
   

2. Generalized Response

   
   Patient reacts inconsistently and nonspecifically to the environment; patient is awake, but not aware
   
   

3. Response

   
   Patient reacts specifically but inconsistently to stimuli; he may respond to discomfort by pulling at tubes and may seem to respond better to familiar persons such as family members
   
   

4. Confused/Agitated

   
   Patient is confused and excited and cannot process all that is being said and done; if talking, what he says may not make sense to others; attention span is short; patient may be unable to cooperate with treatment procedures and tire easily
   
   

5. Confused/Inappropriate Non-Agitated

   
   Patient is alert and able to respond to simple commands fairly consistently; responds best to familiar routines and people; needs a great deal of external structure; may wander; memory is impaired
   
   

6. Confused/Appropriate

   
   Patient shows goal-directed behavior but still needs external structure; shows ability to learn new information but may require frequent repetitions and may not generalize to new situations or people; has increased awareness of own needs and of the environment
   
   

7. Automatic/Appropriate

   
   Patient can go through his daily routine automatically but cannot deal with unexpected situations; he has a superficial understanding of his condition but no real insight and is likely to be unrealistic about the future
   
   

8. Purposeful/Appropriate

   
   Patient may not function as well as before the injury but is alert, oriented and needs no supervision once he has learned a skill; he is functional in society, but may still have difficulty dealing with unexpected or stressful situations
   
   

9. Purposeful/Appropriate (Standby Assistance on Request)

   
   Patient independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours; patient is aware of and acknowledges impairments when they interfere with task completion and takes appropriate corrective action but requires standby assistance to anticipate a problem before it occurs and take action to avoid it; depression may continue; patient may be easily irritable and have a low frustration tolerance
   
   

10. Purposeful/Appropriate (Modified Independent)

    
    Patient is able to handle multiple tasks simultaneously in all environments but may require periodic breaks; anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than the usual amount of time and/or compensatory strategies; able to independently think about consequences of decisions or action but may require more than the usual amount of time and/or compensatory strategies to select the appropriate decision or action; occasional periods of depression may occur; irritability and low frustration tolerance may persist when feeling sick, fatigued and/or under emotional distress.

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Scott Porter Ph.D.
Neuropsychology

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