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Recovery and Rehabilitation

The Rancho Los Amigo Scale: Level 4

​Level 4: Confused – agitated


Maximum Assistance

This stage is very different and can be frightening for the family.

  • Will shift from being underactive to overactive.
  • Behaviour can be unpredictable and strange; he may scream or cry for no apparent reason, or he may be aggressive or agitated.
  • May be very confused and frightened. Restraints may have to be used to keep him safe.
  • Speech may be unclear and/or not make sense.
  • Doesn’t remember new information well. The brain may “make up” stories to fill in the gaps (called confabulation). The only memory is for things that happened before the brain injury.
  • Can’t pay attention for very long.
  • Will likely need a lot of help with self-care (like combing his hair).

How you can help: Level 4

  • Remember that this is a stage, a sign that his brain is healing; it’s not a personality change.
  • Remind him often what day and time it is, and where he is. If he argues or doesn’t believe this, don’t argue back. Try changing the subject.
  • Limit visitors to 2 at a time.
  • Cut the number of things going on at any one time. For example, don’t talk to him, play the radio, feed him, stroke his arm, and visit with other visitors all at the same time. He needs structure and order. Too many things happening at one time will confuse him even more.
  • Communication is an important part of recovery. If he isn’t speaking yet, use another consistent way of communicating, such as trying to get him to nod or shake his head or tap his finger to show “yes” or “no”.
  • When he becomes agitated, don’t walk out on him, or ignore him. Having family with him and reassuring him will usually soothe him. Touch him, wash his face or body with warm water, or play soft music.
  • Be patient—he doesn’t usually know what he’s doing or saying. It’s very normal for family to get impatient and frustrated. If he swears at you, or gets agitated and acts out, don’t take it personally. Remember, it’s the brain injury swearing at you, not him.

Taking care of yourself as a family: Level 4 and beyond

By this stage, family members are often tired by the range and strength of emotions they’ve gone through. Feeling the “low” from the fear of losing the person, to feeling the “high” from seeing him start to recover is part of the process.

By this stage, family usually know that he may have some disability because of the brain injury. Family know that his rehabilitation is going to be a very long and slow process.

This awareness may make you feel depressed or afraid. It’s very normal to feel this way. It is quite common for family members to get counselling to help cope and adjust to these changes. You may feel better if you talk about your feelings with a member of the healthcare team.​​​

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