What is the Ranchos Los Amigos Scale?

The Ranchos Los Amigos Scale is also known as the Ranchos Levels of Cognitive Functioning. This scale is used to assess a person with a traumatic brain injury who is coming out of a coma.

Eight Levels on the Ranchos Los Amigos Scale

The Ranchos Levels of Cognitive Functioning has eight levels that measure cognitive and behavioral functions, including:

  • Level one: At this level, there is no response to sounds, sights, touch, or movement.
  • Level two: People classified at level two have a generalized response and begin to respond to sounds, sights, touch, and movement slowly and inconsistently.
  • Level three: Level three indicates a localized response. At this stage, people may begin to be awake on and off during the day, they may start to recognize loved ones, and they may begin to follow simple directions.
  • Level four: By level four, people are generally confused, agitated, and frightened. They may overreact because of confusion and need restraints to keep them safe.
  • Level five: Level five is marked by confusion and inappropriateness. At this stage, agitation decreases, but confusion remains, and the person may tire quickly.
  • Level six: Confusion continues at level six, but responses are now appropriate. At this stage, people may follow a schedule with assistance and have an increased ability to take care of themselves.
  • Level seven: By level seven, people have automatic and appropriate responses. For example, they can follow a routine and handle self-care activities independently. However, they may have continued problems with planning, distractions, and other cognitive functions.
  • Level eight: Level eight indicates purposeful and appropriate responses. While people at this stage may have ongoing needs, they are more independent. For example, they may drive safely or return to work, but they may also continue to be overwhelmed and need support.

People may move between these levels at different speeds. Some people will progress through all eight levels, while others will reach maximum medical improvement at a lower level.

Why the Ranchos Los Amigos Scale Matters

The Ranchos Los Amigos Scale score matters to a person’s medical and rehabilitation team. The score is one factor that helps the medical professionals and rehabilitation therapists design and implement an effective treatment plan.

Additionally, the Ranchos Los Amigos Scale score matters to personal injury attorneys. It provides useful information about how the traumatic brain injury impacted the person’s life and what the person’s medical needs are now and may be in the future. To learn more about what a Wisconsin personal injury lawyer will consider after a brain injury, please contact us today for a free case evaluation.


Jason F. Abraham
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Helping car accident and personal injury victims throughout Wisconsin, Illinois and Iowa since 1993.