Reason for Services
What is Sam’s current Rancho level?
Level VI: Confused–Appropriate.
What job did Sam hold before his injury?
Auto mechanic.
Who is Sam’s primary caregiver?
His wife, Ingrid.
How has Sam’s attention improved at Level VI?
He can sustain attention for simple tasks up to 30 minutes with moderate cuing.
What self-care goal is appropriate now?
Complete grooming tasks independently with occasional cueing.
What is a hallmark of Level VI behavior?
Shows goal-directed behavior but needs external direction.
What leisure occupations were important to Sam pre-injury?
Cooking meals with his wife and walking outdoors.
How can Ingrid now support Sam’s therapy goals?
By encouraging structured independence with supervision.
What memory challenges does Sam still face?
Difficulty with recent memory and generalization of new learning.
What safety goal should Sam work toward?
Demonstrate awareness of safety hazards with supervision.
How has Sam’s assistance needs changed at this stage?
Requires moderate assistance for ADLs.
How can therapy leverage Sam’s past leisure activities?
Incorporate simple cooking tasks and community outings for therapy goals.
What environmental changes could help Sam progress?
Providing simple, step-by-step written or visual instructions at home.
What problem-solving skill is emerging?
Ability to recognize errors when prompted.
How can therapy support Sam’s community reintegration?
Supervised participation in simple community outings.
Why is structured cueing still necessary?
Sam has emerging awareness but impaired memory and new learning.
Why is tapping into Sam’s prior social roles critical?
To build motivation and foster personal identity during recovery.
What social supports continue to be available?
Family, friends, church community.
What risk remains when Sam engages in novel activities?
Impaired judgment and difficulty anticipating consequences.
Why is goal-setting participation important now?
Sam is beginning to recognize therapy goals and can participate in basic planning.
What therapy focus becomes more prominent now?
Developing carryover of learned strategies and improving problem-solving.
How does past successful routines impact new learning?
Familiar tasks create opportunities for memory carryover and confidence building.
How might the transition home need to be modified now?
Increasing supervised practice with ADLs and beginning light IADLs (laundry, light meal prep).
What strategy supports functional carryover at Level VI?
Consistent, repeated practice in natural contexts.
What long-term emotional goal remains important?
Building confidence in independent living and social reintegration.