Hospital  >  Care Programs  >  Tory Trauma Program  >  Trauma  >  Trauma patient education  >  Rancho Scale - Brain Injury Recovery

Rancho Los Amigos Levels of Cognitive Functioning Scale



This guide will give you and your family helpful information about brain injury recovery. It explains how people with a brain injury recover from a cognitive and behavioural point of view.

COGNITION is the word we use to describe the brain’s thinking skills, such as memory, attention, problem solving, judgment, and someone’s awareness of what has happened to them.

BEHAVIOUR is the word that describes how the patient with a brain injury is acting in daily situations. Some behaviours may be safe and appropriate, and other behaviours may present a danger to the patient/others.

At Sunnybrook, we use a scale to describe these patterns of recovery, called the Rancho Los Amigos Levels of Cognitive Functioning Scale.

A few facts about the Rancho Scale and using this guide » 

  • The Rancho scale was developed by a very well-known brain injury rehabilitation hospital in California.
  • It is used to rate how people with brain injury are recovering.
  • There are eight levels of recovery.
  • This guide will go through each level and tell you what you might expect to see as your loved one recovers.
  • It will give you examples of what you can do to help your family member or friend when you visit.
  • We also use this scale to help decide when the patient is ready for rehabilitation. Your health care team will give you more information about rehabilitation when the time is right.

Every patient’s brain works differently. Even when the exact same injury happens to two different brains, people may show different symptoms, behaviors, and speeds of recovery. The Rancho Scale is used as a guide only, not everyone fits perfectly into one particular level. Some patients may demonstrate aspects and behaviours of more than one level at a time.

Often patients will show signs of recovery first to loved ones and family. This is normal. The goal of recovery is for the patient with the brain injury to have the same responses at different times of the day, consistent with all the people involved in their care. You, as a loved one, are an important part of the care team. Please help us by telling us anything you notice about your loved one’s responses to the environment.

Please write down your observations and any questions you may want to ask your healthcare team.

Information about traumatic brain injury (TBI) »

  • A TBI is when the brain is hurt by an external force, such as a fall or a knock to the head. The injury may be mild, moderate or severe.
  • The amount of harm to the brain can be small, such as a headache. If the injury is severe, the patient may not be able to move, eat or take care of themselves without a lot of help.
  • Understanding the patterns and levels of recovery can help you to understand what to expect while your loved one is in the hospital.
  • It is important to remember that everyone does not recover in the same way.
  • Medications to calm the head-injured patient are used as little as possible. This is because medication can slow the thinking process and in some cases can make confusion worse.

Levels of recovery »

As the patient with a head injury starts to “wake up” they usually go through different levels of recovery on the Rancho Scale.

How long can it take for the patient to “wake up” and recover? This will depend on:

  1. How serious the patient’s head was injured
  2. How long it took to get medical help
  3. How serious the patient’s other injuries and complications are
  4. The age and general health of the patient before the injury
  5. The involvement of family/friends

Resources »

Happy young woman
  • Brain Injury Society of Toronto
  • Ontario Brain Injury Association
  • Ontario Neurotrauma Foundation
      • Guidelines for Pediatric Concussion
      • Guidelines for Concussion/mTBI & Persistent Symptoms: Second Edition

Adapted from »

  • The Thomas Rehabilitation Hospital, North Carolina
  • Rancho Los Amigos National Rehabilitation Center, California