Rancho Los Amigos Scale-Revised (RLAS-R)

Behavioral Description

• No response to external stimuli (sounds, sight, touch, movement)

• Appears to be in a deep sleep and does not outwardly respond to pain or stimulation of the senses.

• Limiting factor: arousal

Behavioral Description

• Responds inconsistently and non-purposefully to external stimuli

• Responses are often the same regardless of the stimulus

• Will sometimes respond to stimulation by becoming more or less physically active. Reaction may be the same to pain, noise, a visual stimulus or any other stimulation encountered. Patient will continue to "sleep" much of the time.

Behavioral Description

• Responds inconsistently and specifically to external stimuli

• Responses are directly related to the stimulus, for example, the patient withdraws or vocalizes to painful stimuli

• Responds more to familiar people (friends and family) versus strangers

• Awake a greater amount of the time and reacts more to what is happening around them. (i.e., the patient may begin to turn toward sounds such as a door closing or to look at objects).

Behavioral Description

• The individual is in a hyperactive state with bizarre and non-purposeful behavior

• Demonstrates agitated behavior that originates more from internal confusion than the external environment

• Absent short-term memory

• May act aggressively and attempt to remove restraints, tubes, or crawl out of bed. Talking may be incoherent and not related to anything around them. The patient has a hard time remembering current events and may only recall what happened prior to the accident.

Behavioral Description

• Shows increase in consistency with following and responding to simple commands

• Responses are non-purposeful and random to more complex commands

• Behavior and verbalization is often inappropriate, and the individual appears confused and often confabulates

• If action or tasks is demonstrated individual can perform but does not initiate tasks on own

• Memory is severely impaired and learning new information is difficult

• Different from level IV in that individual does not demonstrate agitation to internal stimuli. However, they can show agitation to unpleasant external stimuli.

• More alert and beginning to follow simple directions. Situations or activities that are unfamiliar or difficult may trigger restless behavior or outbursts, but this happens less frequently. Concentration improved, but redirection is still needed.

Behavioral Description

• Able to follow simple commands consistently

• Able to retain learning for familiar tasks they performed pre-injury (brushing teeth, washing face) however unable to retain learning for new tasks

• Demonstrates increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns

• Responses may be incorrect secondary to memory impairments but appropriate to the situation

• Beginning to show awareness of the injury and may become frustrated or annoyed when they can't do things they could before the injury. Confused and disoriented at times. Attends activities for up to 30 minutes.

Behavioral Description

• Oriented in familiar settings

• Able to perform

• Daily routine automatically with minimal to absent confusion

• Demonstrates carry over for new tasks and learning in addition to familiar tasks

• Superficially aware of one’s diagnosis but unaware of specific impairments

• Continues to demonstrate lack of insight, decreased judgment and safety awareness

• Beginning to show interest in social and recreational activities in structured settings

• Requires at least minimal supervision for learning and safety purposes.

• Appears appropriate and normal on the surface. Goes through daily routine automatically, but may have little recollection of what has been happening day to day or week to week. Improving awareness.

Behavioral Description

• Consistently oriented to person, place and time

• Independently carries out familiar tasks in a non-distracting environment

• Beginning to show awareness of specific impairments and how they interfere with tasks, however, requires standing by assistance to compensate

• Able to use assistive memory devices to recall daily schedule

• Acknowledges other’s emotional states and requires only minimal assistance to respond appropriately

• Demonstrates improvement of memory and ability to consolidate the past and future events

• Often depressed, irritable, and with low frustration threshold

• Able to complete familiar activities in a distracting environment for short periods of time. Uses memory device with help. May still require supervision for some familiar executive tasks.

Behavioral Description

• Able to shift between different tasks and complete them independently

• Aware of and acknowledges impairments when they interfere with tasks and able to use compensatory strategies to cope

• Unable to independently anticipate obstacles that may arise secondary to impairment

• With assistance able to think about the consequences of actions and decisions

• Acknowledges the emotional needs of others with stand by-assistance.

• Continues to demonstrate depression and low frustration threshold

• Uses memory device independently. Assistance with problem-solving. Occasional help for socially acceptable behavior.

Behavioral Description

• Able to multitask in many different environments with extra time or devices to assist

• Able to create own methods and tools for memory retention

• Independently anticipates obstacles that may occur as a result of impairments and take corrective actions

• Able to independently make decisions and act appropriately but may require more time or compensatory strategies

• Demonstrate intermittent periods of depression and low frustration threshold when under stress

• Able to appropriately interact with others in social situations

• Completes activities from before injury independently with extra time and compensatory techniques. Requires periodic breaks for fatigue. Anticipates and independently solves problems. May still have periods of depression and frustration especially when tired, under stress, or sick.