The Rancho Los Amigos Levels of Cognitive Functioning (RLA) were designed to measure and track an individual’s progress early in the recovery period. The RLA scale describes levels of functioning and is used to assess the efficacy of treatment programs. It has been used as a means to develop “level-specific” treatment interventions and strategies designed to facilitate movement from one level to the next. A RLA level is based on behavioral observations. The RLA scale designates eight levels of functioning:

  1. NO RESPONSE:
    The individual appears to be in deep sleep and is completely unresponsive to any stimuli.
  2. GENERALIZED RESPONSE:
    The individual reacts inconsistently and non-purposely to stimuli. Responses are limited in nature and are often the same regardless of the stimuli presented. Responses may include gross motor movements, vocalization, and physiologic changes. Response time is likely to be delayed. Deep pain evokes the earliest response.
  3. LOCALIZED RESPONSE:
    The individual responds specifically but inconsistently to stimulus. Responses are directly related to the type of stimuli presented. For example, an individual’s head will turn toward a sound or his/her eyes will focus on an object when presented.
  4. CONFUSED-AGITATED:
    The individual is in a heightened state of activity with severely decreased ability to process information. Behavior is non-purposeful relative to the immediate environment. The individual requires maximum assistance to perform self-care activities. An individual may sit, reach, or walk, but will not necessarily perform these activities upon request.
  5. CONFUSED-INAPPROPRIATE:
    The individual appears alert and responds to simple commands fairly consistently. Agitation, which is out of proportion (but directly related) to stimuli, may be evident. Lack of external structure results in random or non-purposeful responses. Inappropriate verbalizations and high distractibility are common. Memory is severely impaired, but the individual may self-feed with supervision and requires assistance for self-care activities only.
  6. CONFUSED-APPROPRIATE:
    The individual shows goal-oriented behavior but is dependent upon external input for direction. Response to discomfort is appropriate. Responses are incorrect due to memory problems, but are appropriate to the situation. Simple commands are followed consistently and carry-over for relearned activities is evident. Orientation is inconsistent but awareness of self, family, and basic needs is increased.
  7. AUTOMATIC-APPROPRIATE:
    The individual appears appropriate within hospital and home settings, goes through daily routine automatically but is robot-like, with shallow recall of activities performed, and has absent-to-minimal confusion and lacks insight. The individual frequently demonstrates poor judgement and problem solving and expresses unrealistic future plans. With structure, the individual is able to initiate tasks or social and recreational activities.
  8. PURPOSEFUL-APPROPRIATE:
    The individual is alert and oriented, able to recall and integrate past and recent events and is aware of and responsive to the environment. Independence in the home and community has returned. Carry-over for new learning is present, and the need for supervision is absent once activities have been learned. Social, emotional and cognitive abilities may still be decreased.