​​A family-focused long-term care residence

Granite House

Granite House

Granite House

Granite House

WHAT IS THE RANCHO LOS AMIGOS SCALE ?


The Rancho Scale defines the level of recovery after brain injury, and it is used by the Minnesota waiver program.  Most rehabilitation programs and housing for people with brain injury will start at level IV, and some specifically exclude patients at lower levels. Granite House specifically includes individuals at Level III.
  • Level I - No response (coma): Patient does not respond to external stimuli and appears asleep.
  • Level II - Generalized response (vegetative state): Patient reacts to external stimuli in nonspecific, inconsistent and non-purposeful manner with stereotypical and limited responses.
  • Level III - Localized response (minimally conscious state): Patient responds specifically and inconsistently with delays to stimuli, but may follow simple commands for motor action.
  • Level IV - Confused, agitated response: Patient exhibits bizarre, non-purposeful, incoherent or inappropriate behaviors; has no short-term recall; has a short and non-selective attention span.
  • Level V - Confused, inappropriate, non-agitated response: Patient gives random, fragmented and non-purposeful responses to complex or unstructured stimuli. Simple commands are followed consistently, but memory and selective attention are impaired and new information is not retained.
  • Level VI - Confused, appropriate response: Patient gives context-appropriate, goal-directed responses, and is dependent upon external input for direction. There is carry-over for relearned tasks but not for new ones, and recent memory problems persist.
  • Level VII - Automatic, appropriate response: Patient behaves appropriately in familiar settings, performs daily routines automatically and shows carry-over for new learning but at lower than normal rates. Patient initiates social interaction but judgment remains impaired.
  • Level VIII - Purposeful, appropriate response: Patient is oriented and responds to the environment, but abstract reasoning abilities are decreased relative to pre-injury levels.

Links to more information and research:  




  •  Joseph T. Giacino et al., “The Minimally Conscious State: Definition and Diagnostic Criteria,” Neurology, Feb.12, 2002. LINK                               
    Dr. Giacino is credited with the introduction of the term “Minimally Conscious State” (MCS) in 1997. He and his colleagues have done extensive studies to understand the levels of consciousness. Through uses of fMRI technology (functional Magnetic Resonance Imaging), he has determined that familiar voices are processed in the brains of people in a minimally conscious state in the same way as unaffected brains. It is his work that has helped people understand the importance of treating these patients as if we knew they were understanding everything we say.
  •  Brainline.org "An Interview with Joseph Giacino, PhD"  by Peter Patrick, PhD, brain injury professional     LINK                                                               Information about Dr. Giacino’s work in an interview in 2009.
  •  Brainline.org "Facts About the Vegetative and Minimally Conscious States After Severe Brain Injury"   LINK               
    A fact sheet about the differences between these two levels of consciousness.
  • The Hastings Center. "Brain Injury: The Vegetative and Minimally Conscious States" by Joseph J. Fins, MD, FACP, chief, division of Medical Ethics, Weill Medical College of Cornell University LINK   
    Another perspective on the differentiation of diagnosis in minimally conscious brain injury patients.
  • The Rancho Los Amigos Scale of Brain Injury LINK
  • "Who’s Helping our Wounded Vets?" LINK  
    From "NOW," PBS’s weekly national news magazine show, aired Nov. 20, 2009.  It is a story about an injured veteran in a minimally conscious state and his wife who cares for him.

​The minimally conscious state (MCS) is a relatively new category of disorders of consciousness, defined in 1997, and is believed to be five to eight times as common as persistent vegetative state (PVS), defined in 1994. By definition, a person in a minimally conscious state is partially conscious, knows the source of sounds and visual stimulation, responds to commands now and then, vocalizes at times, shows emotion and may reach for objects.¹ The MCS is a higher level of consciousness than coma or vegetative state, and patients are more stable and likely to survive for many years-- and even progress. Although at least 80 percent of brain injury survivors will reach the higher levels of recovery, a small percentage will not progress. Functional neuro-imaging studies indicate that these patients retain some high-level cognitive functions and responses.²
¹Giacino, et al. The minimally conscious state: definition and diagnosis criteria. Neurology. 2002 Feb 12; 58(3):349-53

²Monti MN, Coleman MR, Owen AM. Executive functions in the absence of behavior: functional imaging of the mcs. Prog Brain Res 2009; 177:249-260

WHAT IS THE MINIMALLY

CONSCIOUS

STATE?