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Physical and Rehabilitation Medicine P&RM
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The Rancho Los Amigos Scale of Cognitive Functioning,4 developed in a rehabilitation centre of the same name in California, is a graded scale, assessing TBI patients with closed injury, on a score of 1–10, based on cognition and behaviour. This can be used in combination with the OBR assessment tools and assists the family members to understand the stages of recovery in TBI (Table 20.2).
Life Care Planning for Acquired Brain Injury
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
David L. Ripley, Roger O. Weed
Recovery from brain injury is a highly variable process. Severely injured patients recover in general along a set of stages, classified as the Rancho Los Amigos Scale of Cognitive Functioning (see Table 13.3). Patients do not always progress through each stage in a stepwise fashion; some patients may skip one or more stages. This scale has its greatest usefulness in communicating with other team members about the condition of the patient, although at times it is helpful for family members, particularly when patients are in an agitated state. Some families find it somewhat comforting to know that the agitated state is part of a normal recovery process following TBI.
Melodic Intonation Therapy with Brain-Injured Patients
Published in Gregory J. Murrey, Alternate Therapies in the Treatment of Brain Injury and Neurobehavioral Disorders, 2017
Susan Schaefer, Martha A. Murrey, Wendy Magee, Barbara Wheeler
The patient in this case was admitted to the rehab facility four months post-TBI (traumatic brain injury). She was involved in a car accident that caused a head injury from hitting the windshield and a metal steering-wheel lock (which was projected from the back seat into the back of her skull). Upon admittance, she had a Rancho Los Amigos scale score of level one (no response). She would respond minimally to stimuli with general eye opening and occasional verbalization of a moan. Music was introduced at specific times during the day (9:00 to 9:30 a.m.), with therapy scheduled at other times. During therapeutic sessions, simple commands were introduced with a specific rhythm/pattern. This was continued for one to two months. She began to turn her head to the rhythmic pattern, and began to attempt some purposeful response motorically with range of motion tasks. She also began to attempt verbal responses to stimuli, though this was often unintelligible. As therapy progressed she was able to answer simple questions with yes or no responses when asked in a rhythmic tone. Her family was also able to utilize this method to communicate basic needs with her.
The value of social networks to individuals with a severe traumatic brain injury: a mixed methods approach
Published in Disability and Rehabilitation, 2022
Anette Lykke Hindhede, Ingrid Poulsen
This study is part of a larger study in which we draw our data from the nationwide clinical quality database: Danish Head Trauma Database (DHD) [3]. The database provides data from approximately 1700 survivors with severe TBI. In 2016, we analysed data from the DHD for working-age individuals (aged 18–60) who had experienced a TBI between 2010 and 2012 and who were able to participate in both a survey and an interview. To assess if survivors were able to decide participation, we used Rancho Los Amigos scale (RLA) [17]. RLA is a scale assessing level of cognitive functioning and is included in the DHD when the survivors are visiting the departments at 12 months follow-up after TBI. In addition, the first author (a social science researcher with more than 20 years of experience) conducted in-depth interviews with the 20 respondents who responded “yes” in the survey to participate in this part of the project. The timeline for our study design is depicted in Figure 1.
An assistive technology program for enabling five adolescents emerging from a minimally conscious state to engage in communication, occupation, and leisure opportunities
Published in Developmental Neurorehabilitation, 2022
Fabrizio Stasolla, Alessandro O. Caffò, Sara Bottiroli, Donatella Ciarmoli
All the participants were rated by their neurologist at the sixth level (i.e., confused and appropriate behaviors) of the Rancho Cognitive Functioning Scale (also known as the Rancho Los Amigos Scale-Revised (RLAS-R)).31 Additionally, based on caregiver and family member report, and confirmed by initial informal observations, each participant was capable of small hand closures. The aforementioned scale is a validated clinical tool used to evaluate how individuals with TBI are recovering. Thus, once the patient “wakes-up” following a TBI they advanced through different recovery levels of the scale based on clinical observations. Each level of the RLAS-R summarizes a general (i.e., behavioral, motor, and cognitive) pattern of recovery. Overall, 10 levels are included from the lowest up to the highest level of recovery. The study was conducted in five different rehabilitative medical centers where the participants were hospitalized during the baseline and intervention phases, and in the participants’ homes during the follow-up phase (see experimental conditions below). The participants never interacted with one another.
Post-acute rehabilitation effects on functional outcome and discharge disposition of people with severe traumatic brain injury
Published in Brain Injury, 2019
The time between injury and admission to the post-acute rehabilitation program ranged from 13 to 365 days (M = 105.22, SD = 60.65, Median = 94) for the 271 study participants. The combined average acute hospitalization and rehabilitation duration of greater than three months provides confirmation that participants’ initial injury severities were within the moderate to severe range. However, because the post-acute rehabilitation program required engagement in an average of four to six h of treatment daily, no participants were ventilator dependent or exhibited behaviors consistent with disordered consciousness upon admission. Participants were representative of people exhibiting behaviors consistent with Level IV: Confused-Agitated, Maximal Assistance, Level V: Confused-Inappropriate-Non-agitated, Maximal Assistance, Level VI: Confused-Appropriate, Moderate Assistance, or occasionally Level VII: Automatic-Appropriate, Minimal Assistance, of the 10-level Rancho Los Amigos Scale (20,21). Regarding mobility, participants ranged from wheelchair dependent to independent ambulation with or without assistive devices; however, even those ambulating independently exhibited deconditioning and fatigue due to extended hospitalization.