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Rancho Los Amigos - Revised

Rancho Los Amigos - Revised

The Rancho Los Amigos Levels of Cognitive Functioning Scale is a renowned clinical tool used to rate how people with brain injury are recovering. The ten levels of recovery noted in the scale also help to decide when a patient is ready for rehabilitation. As patients "wake up" after a head injury, they go through different levels of recovery on the Rancho Scale. Each level describes a general pattern of recovery, with a focus on cognition and behavior.

Levels of Cognitive Functioning


Level I - No Response: Total Assistance


Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular or painful stimuli

Level II - Generalized Response: Total Assistance

Level III - Localized Response: Total Assistance

Level IV - Confused/Agitated: Maximal Assistance

Level V - Confused, Inappropriate Non-Agitated: Maximal Assistance

Level VI - Confused, Appropriate: Moderate Assistance

Level VII - Automatic, Appropriate: Minimal Assistance for Daily Living Skills

Level VIII - Purposeful, Appropriate: Stand-By Assistance

Level IX - Purposeful, Appropriate: Stand-By Assistance on Request

Level X - Purposeful, Appropriate: Modified Independent


Original Scale co-authored by Chris Hagen, Ph.D., Danese Malkmus, M.A., Patricia Durham, M.A. Communication Disorders Service, Rancho Los Amigos Hospital, 1972. Revised 11/15/74 by Danese Malkmus, M.A., and Kathryn Stenderup, O.T.R. Revised scale 1997 by Chris Hagen.