Rancho Levels

Question 1

Rancho Level 1 Description

Answer 1

No response

Question 2

What is the client capable of at Rancho Level 1

Answer 2

nothing, basically in a coma

Question 3

Rancho Level 2 Description

Answer 3

Generalized response

Question 4

What is the client capable of at Rancho Level 2

Answer 4

inconsistent/non-purposeful/delayed reaction to stimuli

Question 5

What to do with a Rancho Level 2 pt

Answer 5

monitor skin
gentle PROM of joints to prevent contracture
positioning: side lying/prone is best (supine may lead to extensor response); supported sitting as tolerated
sensory stim

Question 6

Rancho Level 3 description

Answer 6

Localized response

Question 7

What is the client capable of at Rancho Level 3

Answer 7

inconsistently answers questions with yes/no
reponds to visual, tactile, and audio stimuli
follow simple commands
delayed, inconsistent reactions

Question 8

what to do with rancho level 3 pts

Answer 8

look up in book

Question 9

Rancho level 4 description

Answer 9

confused/agitated

Question 10

What is the client capable of at Rancho Level 4

Answer 10

max assist
bizarre/non purposeful behavior
lacks short term memory
will try to remove tubes or crawl out of bed

Question 11

what to do with rancho level 4 pt

Answer 11

behavior mgmt
-minimize restraints
-provide activities they are likely to be successful in
minimize overstim
increase physical activity
-ROM, gross motor
-simple ADLs- wash face, dressing
increase safety
educate family

Question 12

Rancho level 5 description

Answer 12

confused, appropriate

Question 13

What is the client capable of at Rancho Level 5

Answer 13

• *Where rehab process can really begin
• attend for short periods of time (1-2 minutes)
• follow simple short, step-by-step commands
• may use items inappropriately if not instructed
• may become agitated as a result of external stimuli
• will not be orientated to time and date

Question 14

what to evaluate with rancho level 5 pt

Answer 14

tone
reflexes
ROM
MMT
endurance
dysphagia
vision
visual-perceptual
cognition/executive function

Question 15

OT goals at rancho 5

Answer 15

remediate strength/ROM/endurance/etc
orient client prior to session (introduce self)
increase cognitive skills
engage in familiar everyday tasks
provide breaks as needed

Question 16

Rancho level 6 description

Answer 16

confused, appropriate

Question 17

What is the client capable of at Rancho Level 6

Answer 17

able to tolerate unpleasant stimuli when need is explained
follow simple directions
carryover of tasks that are relearned
begin to become aware of impairments
vague recognition of staff
increased awareness of self, family, and basic needs
oriented to time and place

Question 18

OT eval at rancho level 6

Answer 18

interview
cognitive screenings
performance-based assessments
visual-perceptual assessments

Question 19

OT goals at rancho level 6

Answer 19

increase attention to specific tasks and stimuli
increase immediate and short-term memory
increase processing and sequential organization
increase independence in self-care tasks
establish safe functional ambulation and transfer techniques
incorporate cognitive strategies
decrease assistance and cuing

Question 20

what to do with rancho level 6 pt

Answer 20

keep tx under 30 min
needs mod-max assist
journal activities for the day to improve memory
repetition
provide increased supervision
try to decrease amount of cuing
gradually increase speed and complexity of tasks
visual scanning
simple puzzles

Question 21

Rancho Level 7 description

Answer 21

automatic, appropriate

Question 22

about Rancho level 7

Answer 22

appropriate and oriented in home and hospital
goes through daily routine, but robot-like
-can follow set schedule
can do routine self care without help
minimal confusion
increased awareness of self, body, people, environment
aware of condition, but lacks insight into
decreased judgement and problem solving
lacks realistic planning for future
shows carryover of new learning, but slow
requires minimal supervision in home and community for safety
able to initiate social interaction
easily distracted
tends to overestimate abilities

Question 23

Goals for Rancho Level 7

Answer 23

increase attention/memory
improve problem solving
independence in self-care
coping for frustration 
safe transfer skills

Question 24

tx for Rancho Level 7

Answer 24

participation in community outings
establish daily routines
restore joint mobility and motor function
home modification
create visual schedules and visual cues
promote social interaction with other TBI pts

Question 25

Rancho Level 8 description

Answer 25

purposeful-appropriate with standby assist

Question 26

about Rancho 8

Answer 26

``` alert and oriented can be independent in home and community can drive can recall and integrate past and present can carry over learning can be independent with learned tasks ```

Question 27

problem area of rancho level 8

Answer 27

``` judgement managing stress abstract reasoning irritable argumentative depression social/emotional intellectual abilities ```

Question 28

OT goals for rancho level 8

Answer 28

promote ability to live independently decrease stress and emotional outbursts maintain and promote safety promote social participation

Question 29

OT evaluation for Rancho Level 8

Answer 29

``` ROM MMT Sensation coordination balance trunk control tone endurance swallowing cognition vision perception ADLs/IADLs Driving Vocational ```

Question 30

OT tx for Rancho Level 8

Answer 30

``` keep instructions simple safety training modify home facilitate community integration increase social participation establish routines driver rehab home exercise program to maintain physical abilities caregiver education stress reduction fatigue management ```

Question 31

Rancho Level 9 description

Answer 31

Purposeful-appropriate (with standby assistance upon request)

Question 32

Rancho Level 10 description

Answer 32

purposeful-appropriate (modified independent)

Question 33

about Rancho level 9

Answer 33

- independently shifts between tasks and accurately completes them for at least 2 consecutive hours - uses assistive memory devices - initiates and carries out steps to complete familiar tasks independently - aware of and acknowledges impairments when they interfere with task completion - able to think about consequences of actions with assistance - acknowledges others' feelings and needs with stby assistance - may be easily irritable with low frustration tolerance - monitor appropriate social interactions with stby assist

Question 34

about Rancho Level 10

Answer 34

- able to handle multiple tasks simultaneously in all environments, but my require periodic breaks - independently make own assistive memory devices - independently initiates and carries out steps to complete familiar and unfamiliar tasks and avoid problems before they occur, but may require more time and/or compensatory strategies - independently think about consequences of actions, but may require more time for decision making - periodic periods of depression - low stress tolerance - social behavior consistently appropriate

Question 35

OT eval for Rancho 9/10

Answer 35

``` ROM tone vision perception coordination MMT vocational testing work eval driving eval ```

Question 36

OT goals for Rancho 9/10

Answer 36

``` prevent substance abuse maintain use of memory aids reduce depression and frustration rebuild desired occuptions and social roles return to work ```

Question 37

OT tx for Rancho 9/10

Answer 37

``` energy conservation asstive tech role play problem solving scenarios coping skills for frustration social skills training support group educate employer/educational system vocational rehab work modifications/work hardening ```