I: No response to pain, touch, sound or sight.
Level II: Generalized reflex response to pain.
Level III: Localized response. Blinks to strong
light, turns toward/away from sound, responds to physical
discomfort, inconsistent response to commands.
Level IV: Confused/Agitated. Alert, very active,
aggressive or bizarre behaviors, performs motor activities but
behavior is non-purposeful, extremely short attention span.
Level V: Confused/Non-agitated. Gross attention
to environment, highly distractible, requires continual redirection,
difficulty learning new tasks, agitated by too much stimulation. May
engage in social conversation but with inappropriate verbalizations.
Level VI: Confused/Appropriate. Inconsistent
orientation to time and place, retention span/recent memory
impaired, begins to recall past, consistently follows simple
directions, goal-directed behavior with assistance.
Level VII: Automatic/Appropriate. Performs daily
routine in highly familiar environment in a non-confused but
automatic robot-like manner. Skills noticeably deteriorate in
unfamiliar environment. Lacks realistic planning for own future.
Level VIII: Purposeful/Appropriate.
Level IX: Purposeful, Appropriate: Stand-By
Assistance on Request.
Level X: Purposeful, Appropriate: Modified
Original Rancho Los Amigos
Cognitive Scale co-authored by Chris Hagen, Ph.D., Danese
Malkmus, M.A., Patricia Durham, M.A., Rancho Los Amigos Hospital,
Rancho Los Amigos Scale
Glasgow Coma Scale
Hunt and Hess Stroke Scale
Links to Brain Injury Scales