Ranchos Levels
The individual is in a hyperactive state with bizarre and non-purposeful behavior
Demonstrates agitated behavior that originates more from internal confusion than the external environment
Absent short-term memory
Level IV: Confused, agitated - Max A.
Responds inconsistently and specifically to external stimuli
Responses are directly related to the stimulus, for example, patient withdraws or vocalizes to painful stimuli
Responds more to familiar people (friends and family) versus strangers
Level III: Localized Response - Total Assistance
- Tremors
- involuntary muscle movements
- abnormal increase in tone
- difficulty initiating movement
Damage to basal ganglia
- emotional, behavior control, personality
- Broca's aphasia
- olfaction affected
Frontal lobe
- Afferent gag reflex
- posterior tongue sensation and taste
CN IX
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 VII: Automatic, appropriate - Min A. for Daily Living skills
Able to shift between different tasks and complete them independently
Aware of and acknowledges impairments when they interfere with tasks and able to use compensatory strategies to cope
Unable to independently anticipate obstacles that may arise secondary to impairment
With assistance able to think about consequences of actions and decisions
Acknowledges the emotional needs of others with stand by-assistance.
Continues to demonstrate depression and low frustration threshold
Level IX: Purposeful, Appropriate - Stand By Assistance on Request
- damage to caudate nucleus and putamen
- personality changes
- involuntary movements (chorea)
- slurred speech, weight loss
Huntington's disease
- Hearing
- Language comprehension
- Wernicke's aphasia
Temporal lobe
- Moves tongue
CN XII
Responds inconsistently and non-purposefully to external stimuli
Responses are often the same regardless of the stimulus
Level II: Generalized Response - Total A.
No response to external stimuli
Level I: No Response: Total Assistance
- balance problems, vertigo or dizziness
- nystagmus
- ataxia
- decreased muscle tone
- dysarthria
- tremors
Damage to cerebellum
- Perceptual disorders
- Loss of sensory perception and integration
- spatial neglect, hemi-neglect
Parietal lobe
- blindness
- myopia
- presbyopia
CN II
Shows increase in consistency with following and responding to simple commands
Responses are non-purposeful and random to more complex commands
Behavior and verbalization is often inappropriate, and individual appears confused and often confabulates
If action or tasks is demonstrated individual can perform but does not initiate tasks on own
Memory is severely impaired and learning new information is difficult
Different from level IV in that individual does not demonstrate agitation to internal stimuli. However, they can show agitation to unpleasant external stimuli.
Level V: Confused, Inappropriate Non-Agitated - Maximal Assistance
Able to follow simple commands consistently
Able to retain learning for familiar tasks they performed pre-injury (brushing teeth, washing face) however unable to retain learning for new tasks
Demonstrates increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns
Responses may be incorrect secondary to memory impairments but appropriate to the situation
Level VI: Confused, Appropriate - Moderate Assistance
- result of injury to basal ganglia
- slow, writhing, continuous worm-like movements of limbs or trunk
- seen in many forms of CP
- visual processing
- depth perception, facial recognition
- memory formation
Occipital lobe
- Medial strabismus
CN VI
Able to multitask in many different environments with extra time or devices to assist
Able to create own methods and tools for memory retention
Independently anticipates obstacles that may occur as a result of impairments and take corrective actions
Able to independently make decisions and act appropriately but may require more time or compensatory strategies
Demonstrate intermittent periods of depression and low frustration threshold when under stress
Able to appropriately interact with others in social situations
Level X: Purposeful, Appropriate - Modified Ind.
Consistently oriented to person, place and time
Independently carries out familiar tasks in a non-distracting environment
Beginning to show awareness of specific impairments and how they interfere with tasks, however, requires standing by assistance to compensate
Able to use assistive memory devices to recall daily schedule
Acknowledges other’s emotional states and requires only minimal assistance to respond appropriately
Demonstrates improvement of memory and ability to consolidate the past and future events
Often depressed, irritable and with low frustration threshold
Level VIII: Purposeful, Appropriate - Stand By Assistance
- result of certain anti-medications (anti-depressant, anti-seizure, anti-parkinson, etc.)
- involuntary twitches, lip smacking, jerking, facial movements
Tardive dyskinesia
Anosmia
CN I
- ptosis
- impaired dilation of pupils
CN III