Cognitive Function Levels after Brain Injury

The Rancho Los Amigos National Rehabilitation Center recently published an online Spanish-language guide for families who have a family member with a brain injury. This guide describes the Rancho Levels of Cognitive Function, a scale developed by researchers to describe stages of consciousness someone recovering from a brain injury may experience. These levels are used as an evaluation tool by rehabilitation professionals to assess function and develop appropriate treatment programs. Each person may progress through the eight cognitive function levels at a different rate, skipping a level or two. Here are some of the cognitive function behaviors that can be observed at each level:

Cognitive Level I:    No response

A person at this level does not response to sound, light, touch, nor movement.

Cognitive Level II: Generalized Response

A person at this level begins to respond to sound, light, movement going on around them; responds slowly, inconsistently, or delayed response; and responds the same way to what they see, hear, and feel.

Cognitive Level III: Localized Response

A person at this level may be awake for periods during the day; has more movement than before; has more specific reactions to what he sees, hears, or feels; slowly or inconsistently responds; begins to recognize family and friends; follows simple directions; and begins to respond to simple questions with a yes or no, or can demonstrate in another way that they comprehend the question asked.

Cognitive Level IV: Confused and Agitated

A person at this level may be very confused and afraid; does not understand what they feel o what is going on around them; over-reacts to what they see, hear, or feel by hitting, yelling, using abusive language or throwing things; are highly focused on their physical needs such as: eating, alleviating pain, going back to bed, etc.; may not understand that people are trying to help them; do not pay attention and are only able to concentrate for a few seconds at a time; have difficulty following instructions; sometimes recognize family and friends; and with help are able to follow a routine including feeding, dressing or speaking.

Cognitive Level V: Confused and Inappropriate

A person at this level is capable of paying attention only for a few minutes; is confused and has may not relate to things that occur outside of himself; does not know the date, where he is, or why he is in the hospital; is not able to begin or finish daily activities like brushing their teeth even though they may be able to do so physically; can become overloaded and restless when he is tired or when there are too many people around them; memory may be poor; and may try to fill the lapses in memory by “inventing things”.

Cognitive Level VI: Confused and Appropriate

A person at this level is somewhat confused about his memory and thinking problems; follows a schedule with help as he may be confused if there are changes to the routine; knows the year and month unless there is a severe problem with the memory; pays attention for about 30 minutes, but has problems with concentration when there is too much noise or when the activity requires too many steps; with help he may participate in activities of daily living; may do or say things more rapidly without thinking about what is being done or said; and is more conscious of his physical problems than of his cognitive problems.

Cognitive Level VII: Automatic and Appropriate

A person at this level may follow an established routine; may have problems planning, starting, and continuing their activities; may have problems paying attention in situations that require a lot of effort, such as family get-togethers, work, or school; does not understand how his problems with thinking and memory may affect his future plans and goals; is inflexible or rigid, and may be stubborn; and thinks slowly in high pressure situations.

Cognitive Level VIII: With Purpose and Appropriate:

A person at this level knows that they have problems with their memory and thought processes; tries to compensate for their problems; their thinking process is more flexible and less rigid; may still feel frustrated when dealing with a difficulty or when in an emergency situation; and may need guidance in making decisions.

Rancho Los Amigos National Rehabilitation Center provides ample information, a calendar of events, publications and services. Perouse through their website to learn more about what they do. If you know of someone who would benefit from the Spanish-language guide dealing with the cognitive function levels, please feel free to share! Visit the Brain Injury Association of America to find an affiliate near you.

About mpgarcia

I'm the Bilingual Information/Media Specialist at NARIC.
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