Health Information and Tools > After Brain Injury > Recovery and Rehabilitation > The Rancho Los Amigo Scale >  After Brain Injury Guide: The Rancho Los Amigo Scale - Level 5 and 6
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Recovery and Rehabilitation

The Rancho Los Amigo Scale: Level 5 and 6

​Level 5: Confused – inappropriate

Maximum Assistance

  • Is alert and can pay attention to activities around him.
  • Will still have trouble focusing on the important parts of an event.
  • Will have lost of lot of his memory, which affects his new learning.
  • Is easily distracted and can’t focus his attention.
  • May seem to forget how to use objects he knew how to use before the injury.
  • Will confuse the past and present.
  • May be able to follow simple, everyday conversations.
  • May be able to answer, “I’m fine, how are you?” but get “lost” if the conversation becomes harder to follow.
  • May say things that aren’t appropriate (for example, he may swear even though he never swore before).
  • Will depend on others to direct or cue him.
  • May now be able to do simple self-care activities, but will still need some help.

Level 6: Confused – appropriate

Moderate Assistance

  • Behaviour is purposeful.
  • Can follow simple directions.
  • Can follow a schedule with some support but changes in his routine can confuse him.
  • Still needs direction.
  • Problems with memory problems that can lead to poor judgment and errors.
  • Recall of memories he had before the injury are generally accurate.
  • Can pay attention and concentrate better. He usually knows where he is, the time, the date, etc.
  • May now recognize staff. He may become very attached to family members (may phone home often).
  • Is easily overwhelmed with too information.
  • Can’t plan or foresee events.

How you can help: Levels 5 and 6

  • Be patient and repeat information as needed. Help him learns ways to remember things.
  • Go over information about family and friends. Use a photo album to stimulate memories.
  • He may laugh or cry easily and not always appropriately. Usually, the best thing to do is to ignore it, distract him by suggesting another activity, or change the topic until he calms down.
  • Help him with homework or assignments his therapists give him. Encourage him to make his own entries in the journal, phone, or other electronic device.
  • For basic tasks, give him the structure he needs by giving step-by-step instructions.
  • Slowly increase his independence by gradually decreasing the amount of help you give for certain activities.
  • Within limits, use every situation as a learning experience. Everyday tasks will still be hard for him. Help him count money and make change. Ask him about the steps involved in making coffee or doing the laundry, and then have him do the task he has just described.​

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