The Rancho Los Amigos Scale (RLAS), also known as the Ranchos Scale, is a widely accepted medical scale used to describe the cognitive and behavioral patterns found in brain injury patients as they recover from injury. It was originally developed by the head injury team at the Rancho Los Amigos Hospital in Downey, California to assess patients emerging from a coma.
It is often used in conjunction with the Glasgow Coma Scale during the initial assessment of a brain injury patient. However, unlike the Glasgow Coma Scale, it is used throughout the recovery period and not limited to the initial assessment. It takes into account a patient’s state of consciousness as well as their reliance on assistance to carry out their cognitive and physical functions.
The original scale consisted of eight levels, with level 1 representing the lowest level of function and level 8, the highest level of function. As a patient progresses to higher levels, they demonstrate improved cognitive and behavioral states and move toward greater independence. Individuals move through the different levels in a sequential pattern. However, the amount of time spent in each level and the maximum level achieved is variable among individuals. Individuals can also demonstrate an overlap of behaviors between two different levels and they can skip levels during their recovery.
The original scale has since been revised and is known as the Rancho Los Amigos Revised Scale (RLAS-R). One of the limitations of the original eight level scale was that it did not accurately reflect the individuals with higher levels of recovery. Two more levels were added to the initial eight level Ranchos Scale to create a more comprehensive ten level scale named the Rancho Los Amigos Revised Scale (RLAS-R). Each level will be further described in detail below.
Level III: Localized Response: Total Assistance
Level V: Confused, Inappropriate Non-Agitated: Maximal Assistance
The Rancho Los Amigos Scale-Revised (RLAS-R) is a ten level descriptive scale that provides a standardized measure that healthcare professionals can use to understand a brain injury patient's abilities, impairments, and prognosis better, as they move through the stages of recovery. It facilitates communication among treating healthcare professionals and aids in treatment planning.
The RLAS-R is often used in conjunction with the Glasgow Coma Scale (GCS) to provide an early assessment of cognitive function in brain injury patients. Differing from the GCS, the RLAS-R is helpful in evaluating a patient's recovery beyond the initial emergence from coma. Earlier screening of cognitive function plays an important role in the prediction of recovery outcomes and facilitates rehabilitation planning in a clinical setting.
The Ranchos Los Amigos Scale was shown to have high inter-rater reliability and concurrent, predictive value. It is often used in conjunction with the GCS.
The Rancho Los Amigos Scale-Revised (RLAS-R) is a ten level descriptive scale that provides a standardized measure that healthcare professionals including nurses, therapists and physicians can use to understand a brain injury patient's abilities, impairments, and prognosis better, as they move through the stages of recovery. It facilitates communication among treating healthcare professionals and aids in treatment planning
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