Rancho Los Amigos Levels of Cognitive Functioning Scale

Level 8: purposeful - appropriate

Memory has improved but memory for recent events may still be a little impaired. Following severe brain injury, a person may be slow to figure out situations and problems, deal with stress or use good judgment in emergencies or unusual situations. Their behaviour is more appropriate and good enough for the person to function in most social situations. Any problems remaining with thinking and behavour might only be noticeable to close family and friends.

Suggestions for the family for level 8

  1. Allow the person time to do tasks in the home, school or job to the best of their physical and thinking limits. You should help the person to work slowly.
  1. As the person gets better, they can do more complex things such as meal planning and preparation, home tasks, and taking their medication. As much as possible let the person work on their own so that they can learn to be independent.
  1. As they can now learn new information, have them work using money and doing their own banking.
  1. Learning how to ride the bus or subway is very important. You will need to ride with them to provide support, until they can find their own way.
  1. Start and continue a daily routine with activities they can do on their own and with help. This helps the person feel secure in their environment.
  1. Think about the person getting better from the time of the accident and do not say things about how they were before the injury. They may be very different from that and you will need to appreciate the new person who needs your support, love, and company.
  1. You need to be patient; offering a balance between opportunities for independence and providing enough support for safety. Work toward new goals with independence. It is a fine balance and can be hard to achieve. Congratulate yourself whenever you're successful.
  1. At this stage, some people are referred for neuropsychological assessment or tests which look at a person’s overall thinking skills. The tests provide more information about the patient’s progress in areas such as memory, attention, “mental speed” and learning ability. These tests will help to decide when and if someone is ready to return to work or school, full or part-time. Returning too early can be a major source of frustration.
  1. Ask your doctor or medical team when it is safe to return to driving.