Rancho Los Amigos Levels of Cognitive Functioning Scale
Revised Scale (LOCF-R)
- No response to external stimuli
- Responds inconsistently and non-purposefully to external stimuli
- Responses are often the same regardless of the stimulus
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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