From the Guidelines
The Rancho Los Amigos Level of Consciousness Scale should be assessed in patients with disorders of consciousness, particularly those with prolonged DOC (> 4 weeks), as part of a multimodal evaluation incorporating specialized functional imaging or electrophysiologic studies, as recommended by the AAN and EAN guidelines 1. When evaluating patients with traumatic brain injury or disorders of consciousness, the Rancho Los Amigos Level of Consciousness Scale (RLAS) is a valuable tool for assessing cognitive functioning. The assessment should be performed regularly, typically daily or several times per week, to track progress and guide treatment decisions. Some key points to consider when assessing the RLAS include:
- Initial assessment should begin once the patient is medically stable, usually after emerging from coma, and continue throughout the rehabilitation process 1.
- The scale evaluates cognitive functioning across eight levels, from no response (Level I) to purposeful and appropriate responses (Level VIII).
- Healthcare providers should conduct assessments at consistent times of day when the patient is well-rested to obtain the most accurate results.
- Multiple team members, including physicians, nurses, therapists, and neuropsychologists, should contribute to the assessment for comprehensive evaluation. The RLAS is valuable because it helps clinicians determine appropriate rehabilitation interventions, set realistic goals, communicate effectively with patients at their cognitive level, and provide families with a framework to understand recovery progression in brain injury. In situations where there is continued ambiguity regarding evidence of conscious awareness despite serial neurobehavioral assessments, or where confounders to a valid clinical diagnostic assessment are identified, clinicians may use multimodal evaluations incorporating specialized functional imaging or electrophysiologic studies to assess for evidence of awareness not identified on neurobehavioral assessment that might prompt consideration of an alternate diagnosis, as recommended by the AAN guidelines 1.
From the Research
Assessment of Rancho Los Amigos Level of Consciousness
The provided study 2 does not directly address the assessment of Rancho Los Amigos Level of Consciousness.
- The study focuses on the pH-dependent Soret difference spectra of the deoxy and carbonmonoxy forms of human hemoglobin and its derivatives.
- It discusses the transition from deoxy to oxystructure of hemoglobin A and the changes in the optical absorbance spectra.
- The study determines the pK values of histidine-146beta and valine-1alpha in deoxy-Hb, but does not provide information on the assessment of consciousness levels.
Relevance to Consciousness Assessment
There are no research papers provided to assist in answering the question of when to assess Rancho Los Amigos Level of Consciousness. The study 2 is related to biochemistry and hemoglobin, and does not address the topic of consciousness or its assessment.