Rancho Los Amigos Levels of Cognitive Functioning Scale

The LCFS was intended to provide a description of eight stages of cognitive function through which individuals with brain injuries typically progress during their stay in hospital and acute rehabilitative care (Hagen 1982; Hagen et al. 1972). 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). 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: Characteristics of the Rancho Los Amigos Level of Cognitive Functioning Scale

Advantages. 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 (Johnston et al. 1991). Its simplicity and utility have contributed to its widespread use within the United States (Hall 1997; Hall & Johnston 1994).

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 Levels of Cognitive Functioning Scale

Interpretability: The LCFS is used widely in the United States and provides a quick, global presentation 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: Rancho Los Amigos Level of Cognitive Functioning Scale Evaluation Summary


















+ (p-values)


NOTE: +++=Excellent; ++=Adequate; +=Poor; N/A=insufficient information; TR=Test re-test; IC=Internal Consistency; IO=Interobserver; Varied (re. floor/ceiling effects; mixed results).