ABIEBR :: 17.18 Rancho Los Amigos Levels of Cognitive Functioning Scale (LCFS)

17.18 Rancho Los Amigos Levels of Cognitive Functioning Scale (LCFS)

The Rancho Los Amigos Levels of Cognitive Functioning Scale (LCFS) was intended to provide a description of 8 stages of cognitive function through which brain injured patients typically progress during their stay in hospital and acute rehabilitative care (Hagen et al., 1972, Hagen 1982).  It was not developed as a scale and is not considered to be an outcome measure.  Rather, it is a global index used to describe awareness, environmental interaction and behavioural competence (Timmons et al. 1987, Zafonte et al. 1996).  It is used to monitor recovery and classify outcome in patients with brain injury (Gouvier et al. 1987).  The LCFS is presented below (Table 17.33).

Table 17.42  Rancho Los Amigos Levels of Cognitive Functioning


No response: Total assistance


Generalized response: Total assistance


Localized response: Total assistance


Confused-agitated: Maximal assistance


Confused-inappropriate, non-agitated: Maximal assistance


Confused-appropriate: Moderate assistance


Automatic-appropriate: Minimal assistance for daily living skills


Purposeful-appropriate: Stand-by assistance


Purposeful-appropriate: Stand-by assistance on request


Purposeful-appropriate: Modified independent

Hagen et al. 1972. Items in italics are included in the revised Rancho Scale (Hagen, 1997) 

LCFS rating forms for the original 8-level LCFS are available for download from http://tbims.org/combi.  Detailed item descriptions are also available from the website. 

Table 17.43 Characteristics of the Rancho Los Amigos Scale



  • Test-retest: r=0.82 (Gouvier et al. 1987)
  • Interobserver reliability: average r=0.89 (Gouvier et al. 1987); r=0.84, overall reliability index = 0.91, k=0.31 (Beauchamp et al., 2001)


  • Concurrent validity: -LCFS ratings correlated with Stover & Zeiger ratings at admission (r=0.92) and discharge from rehabilitation (r=0.73), discharge LCFS ratings also correlated significantly with discharge Glasgow Outcome Scale (GOS) scores (0.76) and expanded GOS scores (0.79) (Gouvier et al. 1987); LCFS ratings and scores on the functional cognition index (FCI) correlated at admission (r=0.79) and discharge (r=0.77) from inpatient rehabilitation (Labi et al. 1998); GCS and LCFS ratings significantly correlated (r=0.329; p<0.05; Hall et al. 1993)
  • Construct validity (known groups): LCFS ratings could discriminate between groups based on categories of vocational recommendations (return to work, vocational training, supported work and continued remedial therapy; p<0.0001), LCFS ratings accounted for 51% variance between cell means (Mysiw et al. 1989)
  • Predictive validity: -initial LCFS ratings correlated with Stover & Zeiger ratings (0.65), GOS (r=0.57) and E-GOS (0.73) scores collected at the time of discharge from rehabilitation (Gouvier et al., 1987); LCFS at admission to and discharge from rehabilitation as well as LCFS change scores were significantly associated with employment status at one year post-injury (Cifu at al. 1997); initial and discharge LCFS ratings significantly related to vocational status up to 26 months post injury (Rao & Kilgore, 1997) 


  • on longitudinal evaluation of treatment medications, LCFS ratings demonstrated significant change (p<0.001) (Rosati et al. 2002); functional improvement in Rancho ratings seen from  3 to 6 months and 6 to 12 months post injury – improvement typically corresponded to improvements in functional performance (Timmons et al., 1987)

Tested for ABI/TBI patients?

Specific to brain injury.

Other Formats

  • a revised version incorporates levels of assistance and includes 2 additional levels of Purposeful-appropriate that incorporate varying levels of assistance requirements (Hagen, 1997)

Use by proxy?


Advantages.  The LCFS is a quick and simple way to provide a snapshot of an individual’s level of recovery.  It is also useful for making quick comparisons between groups (Johnston et al. 1991).  Its simplicity and utility have contributed to its widespread use within the United States (Hall and Johnston 1994, Hall 1997).   

Limitations.  At present there is no standardized method to derive an LCFS rating.  Variable interobserver agreement has been reported suggesting that standardized rating methods might serve to improve reliability (Beauchamp et al. 2001). 

The LCFS provides a quick and simple description of global behaviour from which level of cognitive functioning is inferred.  It focuses on the impact of cognitive dysfunction on arousal and overall behaviour, but does not provide information regarding specific domains of cognitive impairment (Labi et al. 1998). 
There is relatively little published evidence to support the reliability or validity of the LCFS.

Summary – Rancho Los Amigos Level of Cognitive Functioning Scale

Interpretability: The LCFS is used widely in the United States and provides a quick, global picture of level of recovery. 
Acceptability:  Ratings are derived from observation and represent little or no patient burden.  Use of collateral information to derive ratings has not been evaluated. 
Feasibility:  The LCFS is short and simple.  It is available free of charge.  The LCFS has been evaluated for use in longitudinal assessments.  

Table 17.44  LCFS Evaluation Summary

















+ (p-values)


NOTE: +++=Excellent; ++=Adequate; +=Poor; n/a = insufficient information; TR=Test re-test; IC= internal consistency; IO = Interobserver;