The Rancho Scale
The Rancho Scale was developed as a way to describe the stages of cognitive improvement as a person with a brain injury becomes more responsive. It was co-authored by Chris Hagen, PhD., Danese Malkmus, MA, and Patricia Durham, MA at the Rancho Los Amigos Hospital in 1972. The Rancho Scale was first known as The Rancho Los Amigos Level of Cognitive Functioning (LOCF). As it became widely used, it acquired the name of the place where it was devised (Ranchos Los Amigos Hospital). Today it is referred to as the Rancho Scale. The scale originally contained eight levels and was later revised by Malkmus and Kathryn Stenderup, OTR, in 1974 and then again by Hagen in 1997 and now contains ten levels.
The Rancho Scale is not a test. It is a method of organizing and describing observations in a generalized way, to provide families with a language to communicate with rehabiliation specialists. This scale gives the family a sense of predictability so that as the person with brain injury continues to recover, the family knows what to expect at the next level.
| Level I | No Response to Stimulation: Total Assistance |
| Level II | Generalized Response to Stimulation: Total Assistance |
| Level III | Localized Response to Stimulation: Total Assistance |
| Level IV | Confused, Agitated Behavior: Maximal Assistance |
| Level V | Confused, Inappropriate, Nonagitated Behavior: Maximal Assistance |
| Level VI | Confused, Appropriate Behavior: Moderate Assistance |
| Level VII | Automatic, Appropriate Behavior: Minimal Assistance for Daily Living Skills |
| Level VIII | Purposeful, Appropriate: Stand-by Assistance |
| Level IX | Purposeful, Appropriate: Stand-by On Request |
| Level X | Purposeful, Appropriate: Modified Independent |