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Health Information and Tools > After Brain Injury > Recovery and Rehabilitation > The Rancho Los Amigo Scale >  After Brain Injury Guide: The Rancho Los Amigo Scale - Levels 1, 2, 3
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Recovery and Rehabilitation

The Rancho Los Amigo Scale: Levels 1, 2, 3

​Level 1: No response


Total Assistance

  • Will seem to be asleep. Isn’t suffering or in pain.
  • Doesn’t respond to sound, touch, or see things.
  • Will likely be in the intensive care unit (ICU).

Level 2: Generalized response


Total Assistance

  • Will still seem to be asleep most of the time, but does sometimes respond (but not on purpose) to some stimulation, such as sound or touch.
  • Responses are limited and often the same, even to very different stimulation. Pain will likely cause the first response.
  • Thoughts or feeling aren’t well developed.

Level 3: Localized response


Total Assistance

  • Will seem more alert for short periods.
  • Will begin to respond more consistently to general stimulation.
  • May follow simple commands, such as closing his eyes or squeezing your hand.
  • Will begin to respond to discomfort (for example, by turning away when being suctioned or by pulling at the catheter or feeding tubes).

How you can help: Level 1, 2, and 3

The first 3 levels are usually a time of low activity. The goal is to first begin to develop responses to sensory information (touch, sound, smell, and sight) and then to slowly increase how often he shows a response, how often, how long the response lasts, and what type of response it is. Go slowly—over-stimulating won’t make the brain heal any faster. Your healthcare team can help you decide how to do this.

  • Talk to him in a calm, slow, normal voice. Say the things that are important to both of you. Don’t expect him to remember the things you say.
  • Each time you see him, say who you are. Tell him the day and the date and that he’s in the hospital. Tell him how he was hurt and that now he is getting better.
  • Explain what you are about to do before you do it (for example, “I’m going to move your leg.”).
  • Speak in reassuring tones. Hearing often comes back before understanding. The tone of voice is more important than what’s being said. Even though it may be hard to have a relaxed tone of voice in these early stages, this can be more meaningful than it may seem.
  • Even though he can’t understand everything being said, don’t talk about him or his condition as if he isn’t there. It’s a bad habit to start.
  • Show affection in whatever way you can.
  • Talk to him about people and things he knows, names of family, friends, school, etc.
  • Play the radio music he enjoys once in a while. Don’t leave it on all the time as it can be over-stimulating to a brain that is still healing.
  • Keep a journal so you keep track of his progress. The journal can also be a way for the family and the healthcare team to communicate.

Taking care of yourself as a family: Level 1, 2, and 3

  • Especially in the very early stages of his recovery, you may be afraid to leave the hospital because you’re worried and you want to help or you may be afraid that he won’t survive. Take care of yourself.
  • It’s important to learn to pace yourself early. Get enough sleep. Do some things that you find relaxing, and get some exercise. Remember to eat healthy meals every day.
  • Work out visiting schedules with other family members and friends so that you don’t have to be there all the time. Let people help you with things that they can do, like making meals ahead of time and freezing them.​



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