Learn the 10 Stages of the Rancho Brain Injury Recovery Scale

Learn the 10 Stages of the Rancho Brain Injury Recovery Scale

Brain injury recovery is a long and often frustrating process. But what does this process look like?

Well, that’s what this article is here to show you!

Many neuro-rehab centers use a brain injury recovery scale to rate how well their patients are recovering. This scale lets patients know exactly what to expect and what they should be doing at each stage of recovery.

This article is going to do the same thing. We will show you the most widely used brain injury recovery scale, and guide you through all of the stages of recovery it describes.

The scale covers everything from initial injury, to full recovery.

Let’s get started!

What Is the Brain Injury Recovery Scale?

A brain injury recovery scale measures a patient’s cognitive functioning to assess their recovery and suggest the best treatment option available.

The most widely used scale is the Rancho Los Amigos Levels of Cognitive Functioning Scale, called the “Rancho Scale” for short.

It is named after a well-known brain injury rehab hospital in California, where it was created.

The Rancho Scale has ten levels of cognitive functioning, each corresponding to a different stage of brain injury recovery.

We will take a closer look at each of these levels next.

Level 1. No Response: Total Assistance

coma is the first stage on the brain injury recovery scale

The Rancho Scale describes this stage as “a complete absence of observable change in behavior when presented with stimuli.”

This is when the person is initially unconscious after their injury and cannot respond or wake up. Those who are in a coma after brain injury are at this level of function.

Level 2. Generalized Response

At this level, a person begins to respond to light, sound and touch. But their response is generalized and automatic. They are not conscious or aware of their surroundings yet.

People in vegetative states are at this level.

Level 3. Localized Response

woman waking up from tbi in stage 3 of the recovery scale

At this stage, the person will begin to respond to commands and make more specific movements in response to what they hear and see. They will drift in and out of consciousness.

What should loved ones do during cognitive levels 1,2 and 3?

When your loved one is in these stages, you should try talking to them as normally as possible.

Hearing a loved one’s voice and listening to familiar music has been shown to help improve responsiveness in people in comas, so even if your loved one is at the lowest level of function, your visits are still important.

You can also massage their arms and legs and start doing passive range-of-motion exercises. This will help prevent stiffening and loss of function, and make recovery go smoother.

After a person fully regains consciousness, they enter the fourth level of the brain injury recovery scale.

Level 4. Confused/Agitated

confused man at forth stage of brain injury recovery scale

A person at this level has regained consciousness, but cannot understand what they feel or what is happening.

They may be very confused and frightened, and might even overreact by screaming and thrashing about.

They will not be able to concentrate on anything, and they have no short-term recall. They will need help doing simple activities, such as feeding and dressing, and will most likely have difficulty speaking.

Family and friends at this stage should reassure the person they are safe, and keep the room as quiet and calm as possible.

When the doctor has given approval, you can try doing relaxing activities like taking them for a walk in their wheelchair or listening to music. Do not force the person to do anything though, and be sure to allow them lots of rest.

Level 5. Confused/Inappropriate: Maximal Assistance

At this stage, memory and concentration have improved slightly so that a person can follow simple commands, but they still cannot focus enough to carry on a normal conversation.

Some of their responses may be random and inappropriate, because they are still not fully in control of their actions.

Level 6. Confused/Appropriate: Moderate Assistance

tbi patient covering her face in the late stages of brain injury recovery

When a person reaches this level, they have begun to regain control of their actions.

They can make appropriate responses and carry on a short conversation, though they still have some confusion and memory problems.

They will have trouble concentrating on new activities when it is noisy or if an action involves multitasking. For example, they could not focus enough to carry on a conversation while walking and staying aware of their surroundings.

The person will also not realize that they have any cognitive deficits or understand the full extent of their injuries.

Because they do not fully understand their condition, they may resist all types therapy at first. You should encourage them strongly to use any therapy available.

Lastly, the person may need you to repeat things several times to help them remember. Be patient with them. Their executive functioning will be damaged as well so they will need your help keeping a schedule and initiating activities.

Level 7. Automatic/Appropriate

tbi patient exercising during recovery stages

At this level, the person is fairly independent; they can follow a strict schedule, and if their physical abilities have returned they can feed and dress themselves on their own.

But their cognitive skills are still very negatively affected. They have problems planning and initiating an activity, they cannot pay attention in distracting or stressful environments, and their self-awareness and judgment is extremely impaired.

Their reactions are also slowed considerably, and it takes them much longer to process information than it used to. Social cues and expectations are not easily understood.

All this means the person is still in need of supervision and assistance, and is not yet able to live on their own.

They also may seem inflexible and stubborn at times, and be unable to accept any change of plans. This behavior is not completely under their control though, so be patient and understanding.

Emotional and behavioral problems are one of the many effects of traumatic brain injury that a person can experience. Luckily, these can be managed effectively with the help of a trained neuropsychologist.

Level 8: Purposeful/Appropriate: Stand-By Assistance

woman looking peaceful during the final stages of the brain injury recovery scale

At this level the person is still affected by many of the issues in Level 7, but they are aware of their difficulties and have started to adapt.

Their memory is good enough that they only need minimal assistance for remembering things. They can initiate and plan familiar activities.

They still need help planning and starting new tasks, but once they learn it they do not need help.

They are more aware of themselves and others, but still need help understanding appropriate social behavior.

They still have trouble with unexpected or new situations, but they are learning methods to help them cope.

Depression is common at this stage as well, since the person now knows they have some disabilities related to their injury, but feels like there is nothing they can do to fix it. They may often feel isolated and unable to connect to others.

How can loved ones help?

Here is some advice for friends and family members of those with a cognitive function level of 7 or 8 on the brain injury recovery scale:

  • Show respect. It’s is important to treat the person with respect and talk to them as an adult. Don’t simplify your language, because they will notice. Even when the person is being stubborn or irrational, be patient and try to offer guidance without being condescending.
  • Problem solve. Talk to your loved one about any issues they may be having, and see if you can brainstorm ideas to help them overcome it. Make sure you emphasize their problems are not their fault, but a result of their injury.
  • Encourage therapy. Try to encourage them to continue with therapy, even when they think they don’t need it. Physical and cognitive therapy can help them regain abilities they might think were lost forever. The brain is like a muscle, if you don’t use it you’ll lose it.

Levels 9 and 10: Purposeful/Appropriate: Modified Independent

happy woman at the last stage of the brain injury recovery scale regaining independence

In levels 9 and 10 of the Rancho Brain Injury Recovery Scale, the person continues to regain abilities and find new ways to adapt, until they are functionally independent.

They can handle multiple tasks simultaneously in any environment, initiate new tasks on their own, and adjust to unexpected circumstances with only a little bit of frustration.

They can anticipate how their impairment might affect their task and make adjustments. It might sometimes take them a little longer than a person without a brain injury to solve a problem, but they are still able to do it without much help.

They are also able to recognize the feelings of others and respond appropriately.

Basically, a person at these levels has made a full recovery and is able to live on their own without assistance.

Using the Brain Injury Recovery Scale as a Guide for Your Recovery

So there you have it! These are the ten levels of the Rancho Brain Injury Recovery Scale. We hope it has given you a good idea of what to expect during your (or your loved one’s) recovery.

Of course, not every person will progress through all of these stages. Some people will halt at a certain level, and some will not perfectly fit into one particular level or another.

The Rancho Scale is not a blueprint that describes every brain injury recovery. Think of it more as a guide that gives you a general idea of the major milestones that you’ll need to achieve as you recover.

It’s important to know that even if you or a loved one seems stuck on a certain level for a long time, this does not mean you will never make more progress or regain more abilities.

The brain is an amazing organ that has the ability to rewire and repair itself even years after an injury, which is why you should always keep up with your therapy and exercise programs. You never know what improvements you will make.