Coma levels are commonly assessed by two different scales: the Glasgow Coma Scale and the Ranchos Los Amigos Scale. The Glasgow Coma Scale is a standardized system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The Ranchos Los Amigos Scale rates cognitive functioning and expected behaviors through an assessment of levels one through 10.

How Ranchos Los Amigos Scale Scores Are Assigned

Level I: No response to pain, touch, sound or sight.

Level II: Generalized response regardless of type of location of stimuli.

Level III: Localized response. Blinks to strong light, turns toward or away from sound, responds to physical discomfort, inconsistent response to commands.

Level IV: Confused/ agitated. Alert, very active, aggressive or bizarre behaviors, non-purposeful motor movement, short attention span, inappropriate verbalization.

Level V: Confused/inappropriate/non-aitated. Gross attention to environment, distractible, requires continual redirection, agitated by too much stimuli, inappropriate social interactions.

Level VI: Confused/appropriate. Inconsistent orientation, recent memory attention impaired, follows simple directions, goal-directed with assistance, begins to recall past. Emerging awareness of self.

Level VII: Automatic/appropriate. Performs daily routine in robot-like manner, skills deteriorate in unfamiliar environment, unrealistic planning. Superficial awareness.

Level VIII: Purposeful/appropriate. Stand-by assist. Uses memory device with intermittent assist, over or under estimates abilities, irritable, self-centered, acknowledges other’s feelings with minimal assist, low frustration tolerance, carries out familiar tasks with intermittent assist.

Level IX: Purposeful/appropriate. Stand-by assist on request. Completes familiar tasks independently, independently shifts between tasks, self-monitors and anticipates problems with stand-by assist, uses assitive memory devices to recall schedule.

Level X: Purposeful/appropriate. Modified independence. Handles multiple tasks simultaneously, independently initiates and carries out unfamiliar routines, anticipates impact of impairments, independently thinks about consequences of decisions, social interaction is consistently appropriate.”][/tagline_box]