Allen Cognitive Levels & Rancho Los Amigos Scale Connection
|ACL||Allen Cognitive Levels||RLAS||Rancho Los Amigos|
|ACL 0||Coma||1 No Response
|Patient does not respond to external stimuli.
– No observable change in behavior when presented with any kind of stimuli.
|0.8||Generalized reflexive actions||2 Generalized Response
|Patient reacts to external stimuli in nonspecific, inconsistent, and non-purposeful manner with stereotypic and limited responses.|
• Automatic motor responses. Behavior is mostly reflexive
|1.0||Withdraws from noxious stimulus||3 Localized Response
|Patient responds specifically but inconsistently to stimuli and may follow simple commands for motor actions.
– Reacts to pain by withdrawing or moaning. Blinks at strong light and follows moving objects. Turns toward sound. May respond to simple commands, to family or friends but not other people.
|1.2||Responds to stimuli with one sensory system|
|1.6||Rolls in bed|
|1.8||Raises body parts|
• Can overcome the effects of gravity
|2.0||Overcomes gravity/sits||4 Confused/Agitated
|Patient exhibits bizarre, non-purposeful, incoherent, inappropriate behaviors. Has no short-term recall and attention is short and nonselective. Completes simple, routine tasks with assistance. Overly focused on basic needs, such as eating, going to the bathroom, etc. Has difficulty following directions. Does not understand feelings or what is happening in surroundings.
– Heightened state of activity, may move constantly, movements not purposeful. May run away or become aggressive. Responds to stimuli by acting out– hitting, yelling or screaming, using abusive language, extreme behavior due to confusion, may need restraints to avoid self-injury
|2.8||Uses grab bars|
• Uses hands to manipulate objects.
|3.0||Grasps objects||5 Confused, Inappropriate Non-Agitated
|Alert, not agitated, may wander. No orientation to person, place or time. Absent goal directed, problem solving, self-monitoring behavior. Continues to focus on basic needs. May be able to complete familiar tasks with structure and cuing- needs step by step instructions to complete simple, everyday tasks. Uses objects inappropriately. Consistently follows simple commands. New information is not retained.
-Activity often random with no direction. Cannot learn new tasks. No ability to problem solve or monitor own behavior
|3.4||Sustains actions on objects|
|3.6||Notes effects on objects|
|3.8||Uses all objects|
|Goal Directed Actions
Big step for independence
|4.0||Sequences familiar actions||6 Confused, Appropriate
|Patient demonstrates carry-over for relearned familiar tasks (e.g. self-care) but not for new tasks. Able to follow simple directions. Able to complete familiar activities with supervision. Requires assistance for new activities. Moderate assistance to problem solve during tasks. Able to pay attention to familiar activities for up to 30 minutes with some cueing. Unaware of impairments, safety risk.
– Able to complete familiar activities with supervision. Able to follow a schedule with assistance- may become confused by changes in routine.
|4.2||Differentiates features of objects|
|4.4||Completes familiar goal|
|4.6||Personalizes features of objects|
|4.8||Learns by rote memorization|
• New learning can occur and can generalize skills
|5.0||Comparing and changing variations in actions and objects||7 Automatic, Appropriate
Minimal Assistance for Daily Living Skills
|Patient performs daily routines automatically, and shows carry-over for new learning. Will be able to follow a schedule. Will demonstrate impaired safety awareness and judgment. May express interest in completing an activity, but may require assistance actually completing it.
– Minimal assistance to complete familiar tasks, including self-care and household tasks. Requires minimal supervision for new learning and able to carry over new learning. May have problems planning, initiating, and completing activities.
|5.2||Discriminates parts of activity|
|5.4||Self-directed learning||8 Purposeful, Appropriate
|Patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels. Able to independently complete new tasks once learned. Independently attends to and completes tasks in spite of distractions.|
|5.6||Considers social standards||9 Purposeful, Appropriate
Stand-By Assistance- on request
|Patient able to shift between tasks. Aware of limitations. Able to acknowledge the needs of others and self-monitor social interaction with stand-by assistance. Will consider the point of view of others during conversation.|
|5.8||Consulting with others|
Modified- Complete independence
• No global cognitive impairment
|6.0||Typically functioning adult brain and functional cognitive capacities||10 Purposeful, Appropriate
|Patient independently carries out daily routine, may need extra time/adaptive strategies. Will compensate for memory loss by using adaptive aids or methods. Able to obtain or create own memory aids. Able to multi-task, may need periodic breaks|
Comparing the Allen Scale of Cognitive Levels and Modes with Other Global Measures of Function
Catherine A. Earhart BA, OT Cert., OTR/L and Claudia K. Allen, MA, FAOTA, OT