Ranchos Los Amigos Revised Scale (RLAS-R)
Levels
Level I: No response
Level 1 is characterized by: no Response and requiring total Assistance1
Patient has no response to external stimuli (visual, verbal, tactile, auditory, noxious stimuli)1
Level II: Generalized response
Level 2 is characterized by a patient requiring total assistance, but demonstrates “Generalized Response”1.
Generalized response refers to a patient who responds inconsistently and non-purposefully to external stimuli. In addition, responses are often the same regardless of the stimulus
Level III: Localized response
Level IV: Confused-agitated
Level V: Confused-inappropriate
Level VI: Confused-appropriate
Level VII: Automatic-inappropriate
Level VII: Automatic, Appropriate: Minimal Assistance for Daily Living Skills
Oriented in familiar settings Able to perform daily routine automatically with minimal to absent confusion Demonstrates carry over for new tasks and learning in addition to familiar tasks Superficially aware of one’s diagnosis but unaware of specific impairments Continues to demonstrate lack of insight, decreased judgment and safety awareness Beginning to show interest in social and recreational activities in structured settings Requires at least minimal supervision for learning and safety purposes.
Level VIII: Purposeful & Appropriate
Level IX: Standby assistance
Level X: Modified independent
Assessing RLAS-R Level
It is especially difficult to assess RLAS level 7-10. Often times, the patients assume the behavior is normal and due to their personality rather than their cognitive impairment.
Often times, these are executive function impairments, such as volition, planning, purposive action, and effective performance.