Ranchos Los Amigos Scale – A Brain Injury Help Tool

Ranchos Los Amigos Scale

While the Glasgow Scale is the first scale used to determine the severity of a coma the Ranchos Los Amigos scale will be the second.  This tool is used once a patient starts to emerge from a coma.  The Ranchos Los Amigos scale consists of 8 different levels.  The levels of the Ranchos Los Amigos scale are described as follows:

  1. No Response : Does not respond to any kind of stimulus.
  2. Generalized Response:  Patient starts to respond to visual, sounds or touch.  Responds slowly or delayed and inconsistently.  The patient may start to make subtle movements such as chewing or making sounds such as moaning.
  3. Localized Response:  The patient will start to wake up, off and on during the day and respond to sight, sound and touch.  They may start to follow directions when asked to move certain body parts.  Movements start to be more consistent than before but still have inconsistencies. The patient also may start to recognize faces.
  4. Confused and/or Agitated: The patient at this level will become easily agitated, confused and even frightened.  Some may have to be restrained because of the level of agitation to protect them from hurting themselves.  Confusion with their surroundings is often a factor.  Following directions also may be very difficult for them.
  5. Confused- Inappropriate, Non-agitated: The patient at this level is easily confused, not recognize their surroundings and fabricate things trying to fill in the gaps of memory loss. The patient will become easily fatigued.
  6. Confused Appropriate: The patient at this level will have a short attention span, can follow a schedule with assistance.  The patient will be confused because of their memory and thinking problems.  The patient will start to be able to perform grooming activities.  They may be aware of their physical problems but not necessarily their cognitive issues.
  7.  Automatic Appropriate:  The patient at this level will start to be able to take care of themselves and start to follow a set schedule.  They may still have problems with becoming distracted and concentration problems.  They should be able to follow through with activities.
  8. Purposeful Appropriate: A patient at this level will realize that they have deficits and start to try to deal with such deficits and compensate for them. They can still become overwhelmed and need guidance to help with some circumstances.

Each patient is different on how they go from one level to the other after coma emergence.  There isn’t any way to predict on how long it will take for recovery or whether there will be full recovery or not.

The Ranchos Los Amigos scale and each of its levels can be very helpful for both physicians and caregivers when dealing with a survivor of brain injury.  Understanding each level will help in the patients care and hopeful recovery.

To see the Full Rancho Los Amigos Scale Click Here:

Next: Physical Deficits After Brain Injury


Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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One Comment

  1. Dawn Campbell
    Apr 13, 2014 @ 15:48:56

    I just wanted to let you know how happy I arm I found your site! My 24 yr old daughter was in a serious car accident on Feb.1 of this year & has Brain Trauma! She is such a different person! She also has lost pituitary gland function, so the 2 together, really affect her emotions, feelings and sense of well being! She is so different & as a parent, this is very difficult to accept! She is my only child. She has a young son & he has lots of ?’s to that now I can hopefully answer! Please keep leaving info fir parents & families like me! It’s very challenging to understand where they are in their minds, after the Dr’s have put the body back together physically! She was already a very complicated child to raise & suffered w/ bi-polar disorder, which she chose as she got olderz, not to treat! Talk about hard to live with ?! Again, Thank you for your information! Blessings!


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