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Rancho Los Amigos Scale

Levels 1, 2, and 3

The first 3 levels are usually a time of low activity. The goals are to:

  • develop responses to sensory information (what they feel, hear, smell, and see)
  • respond more often, for longer amounts of time, and have different types of responses

Level 1

When someone is level 1, they:

  • will look asleep
  • don't respond to sound, touch, or seeing things
  • will likely be in the intensive care unit (ICU)
  • need help for all care

Level 2

When someone is level 2, they:

  • will look asleep most of the time, but will sometimes respond to sound or touch (but not on purpose)
  • often respond the same way to what they hear, feel, or see
  • don't have well-developed thoughts or feelings
  • need help for all care

Level 3

When someone is level 3, they:

  • will look awake for short amounts of time
  • will respond more regularly to things they feel, hear, and see
  • may follow a simple task, like closing their eyes or squeezing your hand
  • will respond to discomfort, like looking away during procedures by the healthcare team (such as suctioning or handling a catheter or feeding tubes)
  • need help for all care

How to help during levels 1, 2, and 3

Go slowly. Giving many things to feel, hear, smell, and see (overstimulation) won’t make the brain heal any faster. The following are tips to help your loved one during levels 1, 2, and 3. You can also talk to their healthcare team for more information and tips.

  • Talk to them in a calm, slow, and normal voice. Say things that are important to both of you. Don’t expect them to remember what you say.
  • Each time you see them, say who you are. Tell them the day and the date and that they’re in the hospital. Tell them how they were hurt and that they’re getting better.
  • Tell them what you’re going to do before you do it. For example, “I’m going to move your leg.”
  • Use a comforting tone. They’ll hear you before they understand you. This is why your tone of voice is more important than what you say during these levels.
  • Even though they can’t understand everything you say, don’t talk about them or their condition like they’re not in the room with you.
  • Show affection in ways that feel right to you.
  • Talk to them about people and things they know, like names of family, friends, and their school or work.
  • Play music they enjoy but don’t leave it on all the time. Leaving music on all the time can be too much information for the brain as it heals.
  • Keep a journal to track their progress. A journal can also be a way for the family and the healthcare team to share information.

Caring for yourself during levels 1, 2, and 3

Take care of yourself. This can be hard in the very early stages of recovery, especially if you’re worried they won’t survive. But it’s important to care for yourself too.

  • Learn to pace yourself. Get enough sleep, do things you find relaxing, and get some exercise.
  • Eat healthy meals every day.
  • Talk to family members and friends about making a schedule to be with your loved one, so you don’t have to be there all the time.
  • Let others help you make meals and do other tasks.​

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