RLA Level of Congnitive Function (LOCF)Scale

Original Editor - Venugopal Pawar

Top Contributors


The Ranchos Los Amigos Scale measures the levels of awareness, cognition, behavior and interaction with the environment.

Intended Population

Head Injury

To diagnose the symptoms of Traumatic Brain Injury

Method of Use

AKA Level of Cognitive Functioning Scale (LCFS)

  • (1) Level I - No Response.

Patient does not respond to external stimuli and appears asleep.

  • (2) Level II - Generalized Response.

Patient reacts to external stimuli in nonspecific, inconsistent, and nonpurposeful manner with
stereotypic and limited responses.

  • (3) Level III - Localized Response.

Patient responds specifically and inconsistently with delays to stimuli, but may follow simple
commands for motor action.

  • (4) Level IV - Confused, Agitated Response.

Patient exhibits bizarre, nonpurposeful, incoherent or inappropriate behaviors, has no shortterm
recall, attention is short and nonselective.

  • (5) Level V - Confused, Inappropriate, Nonagitated Response.

Patient gives random, fragmented, and nonpurposeful responses to complex or unstructured
stimuli - Simple commands are followed consistently, memory and selective attention are
impaired, and new information is not retained.

  • (6) Level VI - Confused, Appropriate Response.

Patient gives context appropriate, goal-directed responses, dependent upon external input for
direction. There is carry-over for relearned, but not for new tasks, and recent memory
problems persist.

  • (7) Level VII - Automatic, Appropriate Response.

Patient behaves appropriately in familiar settings, performs daily routines automatically, and
shows carry-over for new learning at lower than normal rates. Patient initiates social
interactions, but judgment remains impaired.

  • (8) Level VIII - Purposeful, Appropriate Response.

Patient oriented and responds to the environment but abstract reasoning abilities are
decreased relative to premorbid levels.



Advantages / Limitations 


The LCFS is a quick and simple way to present an individual’s level of recovery. It is also useful for making quick comparisons between groups 1. Its simplicity and utility have contributed to its widespread use within the United States 2.


At present there is no standardized method to derive an LCFS rating. Variable inter-observer agreement has been reported suggesting that standardized rating methods might serve to improve reliability 3


The LCFS is used widely in the United States and provides a quick, global presentation of level of recovery.


Ratings are derived from observation and represent little or no patient burden. Use of collateral information to derive ratings has not been evaluated.


The LCFS is short and simple. It is available free of charge. The LCFS has been evaluated for use in longitudinal assessments.




Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)


  • 1)Johnston et al. 1991
  • 2)Hall 1997; Hall & Johnston 1994
  • 3)Beauchamp et al. 2001.