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Terms in this set (45)
Confused & Agitated
Confused & Inappropriate (non-agitated)
Confused & Appropriate
Level I- No Response
Patient does not respond to external stimuli (i.e. pain, voice, touch) and appears asleep.
Level II- Generalized Response
Patient reacts to external stimuli in nonspecific, inconsistent, and non-purposeful manner with
stereotypic and limited responses (e.g. opens eyes but can't focus)
Level III- Localized Response
Patient responds specifically (i.e. can focus on specific ppl/objects) and inconsistently with delays to stimuli, but may follow simple commands for motor action
Level IV- Confused & agitated
Patient exhibits bizarre, nonpurposeful, incoherent or inappropriate behaviors (i.e. can become easily aggressive), has no short term recall, attention is short and nonselective. *Sleep issues common and temporal concept is impaired
Level V- Confused & Inappropriate
Patient gives random, fragmented, and nonpurposeful responses (e.g. blurts out stuff) to complex or unstructured stimuli - Simple commands are followed consistently, memory and selective attention are impaired, and new information is not retained
Level VI- Confused & appropriate
Patient gives context appropriate, goal-directed responses, dependent upon external input for
direction. There is carry-over for relearned, but not for new tasks, and recent memory problems persist.
Level VII- Automatic Appropriate
Patient behaves appropriately in familiar settings, performs daily routines automatically, and
shows carry-over for new learning at lower than normal rates. Patient initiates social
interactions, but judgment remains impaired.
Level VIII- Purposeful Appropriate
Patient oriented and responds to the environment but abstract reasoning abilities are
decreased relative to premorbid levels. *Only SBA assistance needed when new tasks are learned
Level 1 assist level
Level 2 Assist Level
Level 3 Assist Level
Level 4 Assist Level
Level 5 Assist Level
Level 6 Assist level
Level 7 assist level
Level 8 Assist level
Stand by assist
Level 6 can do max 30 mins Tx: True/False?
Level 8's still get distracted by environment: True/False?
what are the Rancho levels designed to indicate?
-the behavior and progression of the survivor as they go through treatment
-they are applicable the 1st few months or weeks following the injury
-are not intended to predict improvement over the long term
-progress is rapid at first
-as months go by, progress will slow and at some point the pt may seem to plateau around level VI or VII
-may have characteristics of more than 1 level at a time
What do rancho stages I-III deal with?
-deals with emergence from coma, persistent vegetative state or minimally conscious state
What do rancho levels IV-VI deal with?
individuals who are in the process of regaining orientation and memory skills necessary for full consciousness
What do rancho levels VII-X deal with?
persistent cognitive, social and emotional changes
Which rancho level tends to be dangerous?
Jerry may open his eyes but will not seem to focus on anything in particular, his first response he seemed to be in pain and his responses are inconsistent and limited- What level?
Kelly will focus on an object when it is presented, is following simple commands (i.e. squeeze my finger) and is beginning to react to stimulus purposefully as they are presented- what level?
Cali is unable to do her own self-care, is very unaware and fearful of her environment. She is not recognizing her family members and is extremely combative at times- what level?
Randy is able to follow tasks for 2-3 minutes but is frequently and easily distracted. He can respond to commands but still requires max assistance and bursts into uncontrollable laughter when he cannot learn a new task- What level?
Amanda is relearning how to brush her teeth but may need some cuing. She frequently forgets and needs reminders to complete her daily routines. She keeps telling the therapist "I can't wait to go back to work when I get out of the hospital."- What level?
Karen is able to perform her daily routines with minimum assistance, but requires structure and organization. Her movements are very rigid and "robot like". She frequently indicates she will be driving soon even though the Drs. do not think she will ever drive again. Karen demonstrates poor judgement and problem solving strategies- what level?
Larry lives on his own and is able to drive himself to his dr appointments. He works part time as a cashier but his manager complains that when it gets busy, Larry gets stressed and cannot keep up with the customers- What level?
On the rehabilitation unit Charles is argumentative and is not easily re-directed. His voice will quickly escalate in volume and he will begin yelling. He makes less sense when he is agitated. Unfortunately, he cannot be physically re-directed as he will strike out at staff or attempt to pull them in to bite them. His most clear vocalizations are shouted profanity which is disturbing to others on the unit- what level?
What are some ways you can treat an individual at RLA-I?
* play music, provide pictures, call pt by name
1. sensory stimulation techniques for arousal through 5 senses (latency, consistency, duration & intensity of response)
2. prevent loss of ROM
3. positioning to prevent ulcers & increase arousal
What are some ways you can treat an individual at RLA-II and RLA-III?
* simple 1 step directions, allow for additional response time, speak at eye level to pt
1. remove external sources of agitation (i.e. quiet room)
2. numerous brief tx sessions
3. exercise to improve ROM, tone, kinesthetics
4. gross motor activities & mat activities
What are some ways you can treat an individual at RLA-IV and RLA-V?
* provide frequent orientation, limit distractions, speak simply & slowly, correct inaccurate information gently, redirection, disregard & discourage inappropriate behaviors
1. increase response to simple commands
2. automatic gross motor activities
3. simple repetitive strength & coordination
4. functional training (transfers, WC mobility, ambulation)
What are some ways you can treat an individual at RLA-VI?
* maintain routine (keep calendar/daily log), decrease amount of help, speak normally to pt
1. orientation activities
2. strength & coordination (simple, repetitive, progressive)
3. functional training (transfers, WC mobility, ambulation)
What are some ways you can treat an individual at RLA-VII?
* limit sarcasm/jokes
1. facilitate increase of self-judgement
2. encourage formulation of LTG & STG
3. increase physical endurance
4. family education
What are some ways you can treat an individual at RLA-VII?
* encourage remembering & note-taking, discuss dangerous home situations & precautions
1. evaluate general work skills, vocational considerations
2. explain & clarify residual deficits to family
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