Rancho Los Amigos Scale of Cognitive Functioning




Level I – No Response

Unresponsive; appears to be in a deep sleep

Show affection.

  • Kiss your child.
  • Hold your child's hand.
  • Rub lotion on your child's skin.

Speak calmly and slowly.

  • Assume your child can hear.
  • Be sensitive to what is said near your child.

Level II – Generalized Response

Non–purposeful body movement in response to pain or touch, or to familiar sound or smell

Bring in familiar things, such as:

  • special blanket or stuffed animal
  • tape recordings of voices or music

Level III – Localized Response

Localized, specific body movement

  • pulling at tubes or catheters
  • inconsistently follows simple commands

Recognize and point out new responses to your child and health care provider.

Don't be discouraged if responses come and go.

Level IV – Confused/Agitated


  • constant movement
  • thrashing about in bed
  • extra sensitive to movement, light, noise


  • may not make sense
  • very short attention span
  • may be rude or aggressive
  • unsafe

Take care of yourself.

  • Take a break and get away.
  • Accept help.

Minimize distractions.

  • Keep the room quiet and limit visitors.
  • Speak slowly and allow time for your child to answer.

Help keep environment safe for child.

Don't try to reason or argue with child.

Don't be embarrassed by child's behavior.

Level V – Confused/Inappropriate

Appears alert

Follows simple commands most of the time

Easily distracted


  • memory severely impaired
  • unable to separate past from present
  • may wander off


  • agitated behavior remains
  • conversations disjointed

Be your child's memory.

  • Share details of your child's past.
  • Discuss events of the day.
  • Identify visitors and caregivers for your child.
  • Clarify the past from the present.
  • Reorient your child to the present environment.

Provide and protect scheduled times of rest.

Be patient; avoid pushing child to perform.

Level VI – Confused/Appropriate

Behavior is less bizarre and more appropriate

Follows simple directions

Performs simple previously learned tasks

Newly learned tasks quickly forgotten

Things learned before injury clearer

Becomes confused in unfamiliar settings

Be consistent.

Give clear directions.

Repeat, repeat, repeat!

Encourage and allow increasing independence with simple daily tasks.

Level VII – Automatic/Appropriate

Performs daily routine automatically

Unsafe without supervision in unfamiliar settings

  • difficulty making decisions and solving problems
  • poor judgment and planning skills
  • lacks understanding of limitations resulting from injury

Remembers new things, but at a slower pace

Supervise child's reintroduction into community.

Provide opportunities for increased independence.

  • Give your child chores to do at home.
  • Discuss and practice situations your child will encounter outside the home.

Avoid teaching unnecessary skills.

Level VIII – Purposeful/Appropriate

Alert and oriented

Remembers past and present events

Uses new skills appropriately

Independent with age–appropriate activities

May exhibit ongoing deficits

  • decreased ability to learn; slower thought processing
  • limited tolerance for stress
  • difficulty with reasoning and judgment
  • confusion in new or unusual situations
  • easily fatigued

Recognize and accept child's strengths and weaknesses.

  • allow independence in areas of strength
  • provide structure and supervision for weakness

Communicate regularly with child, outpatient rehabilitation team, and school to monitor progress.

Identify and utilize community resources benefiting your child and family.

Advocate for what your child needs.