Level I – No Response: Total Assistance

• When presented visual, auditory, tactile, proprioceptor, vestibular or painful stimuli there is a complete absence of observable change in behavior.

Level II – Generalized Response: Total Assistance

• In response to painful stimuli, shows generalized reflex.
• By means of increased or decreased activity, responses to repeated auditory stimuli.
• By way of physiological changes and generalized gross body movement responses to external stimuli but in a nonpurposeful manner.
• In spite of type and site of stimulation, responses on above mentioned may be similar.
• Responses may be considerably delayed.

Level III – Localized Response: Total Assistance

• In responds to pain stimulus, withdraws or vocalizes.
• Turns in the direction or away from auditory stimuli.
• Blinks when strong beam crosses visual field.
• Follows moving object that pass within visual field.
• Pulls on sources of discomfort (e.g. Tubes, restraints)
• However, inconsistently and in a delayed manner, may follow simple instructions
• In relation to type of stimulus, responses right away.
• May perhaps respond to a few persons (particularly family and friends) but not to others.

Level IV – Confused/Agitated Response: Maximal Assistance

• Alert and in hyperactive state of activity.
• With purposeful efforts to get rid of restraints or tubes and even crawls out of bed.
• Although devoid of any obvious purpose or upon another’s request, may carry out motor activities such as sitting, reaching and walking.
• Very brief and regularly non-purposeful moments of sustained alternatives and failure to focus.
• Absent or short-term memory.
• May cry out or scream out of proportion to stimulus even subsequent to its removal.
• May display aggressive or flight behavior.
• Without obvious relationship to environmental events, mood may swings from euphoric to hostile.
• Incapable to work together though with treatment efforts.
• To activity or surroundings, verbalizations are often incoherent and/or improper.

Level V – Confused, Inappropriate Response and Non-Agitated: Maximal Assistance

• Alert, not agitated however may wander aimlessly or with an indistinct intention of going home.
• May turn out to be agitated in reaction to external stimulation, and/or lack of environmental structure.
• Not acquainted or familiar to person, place or time.
• Frequent short periods, non-purposeful sustained attention.
• In response to continuing activity with disorientation of past and present. Severely damaged recent memory.
• Deficient goal directed problem solving, self-monitoring behavior.
• With no external direction, frequently demonstrates improper use of objects.
• When structured and cues are provided may be capable to carry out formerly learned tasks.
• Incapable to learn latest information.
• By means of external structures and cues capable to respond properly to simple commands fairly consistently.
• In relation to command, responses to easy commands devoid of external structure are random and non-purposeful.
• Capable to communicate on a social, automatic level for short periods of time when provided external structure and cues.
• When external structure and cues are not provided verbalizations about current events turn into improper and confabulates (substitute fantasy for fact).

Level VI – Confused, Appropriate Response: Moderate Assistance

• Irregularly oriented to person, time and place.
• In non-distracting environment capable to focus to highly recognizable tasks for 30 minutes through moderate redirection.
• Compared to latest memory, remote memory has more depth and detail.
• Indistinct recognition of a number of staff.
• By means of maximum assistance able to use assistive memory aide.
• Emerging consciousness of proper response to self, family and basic needs.
• Moderate assist to problem solve obstacles to task completion.
• Supervised for previous learning (e.g. self care).
• For relearned common tasks (e.g. self care), demonstrates carry over.
• Maximum assistance for latest learning through little or nor carry over.
• Unaware of possible injuries, disabilities and safety risks.
• Follows simple directions consistently.
• In highly recognizable and structured situations, verbal expressions are proper.

Level VII – Automatic, Appropriate Response: Minimal Assistance for Daily Living Skills

• Within highly familiar environments, consistently oriented to person and place. For orientation to time moderate assistance is needed.
• In a non-distraction environment for at least 30 minutes, able to focus to highly familiar tasks through minimal assist to complete tasks.
• Least supervision for new learning.
• Shows carry over of new learning.
• Although patient has low recall of what he/she has been doing, he/she initiates and carries out steps to complete common personal and household routine.
• With minimal assistance, able to monitor correctness and fullness of each step in routine personal and household ADL and revise plan.
• Superficial consciousness of his/her condition however unacquainted of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely accomplish his/her household, community, work and leisure ADL.
• In routine home and community activities, minimal supervision for safety is needed.
• Impractical scheduling for the future.
• Incapable to think about outcome of a decision or action.
• Expects too much of abilities.
• Unconscious of others’ needs and feelings.
• Oppositional/uncooperative.
• Incapable to recognize improper social interaction behavior.

Level VIII – Purposeful, Appropriate: Stand-By Assistance

• Constantly oriented to person, place and time.
• For 1 hour in distracting environments, independently attends to and completes familiar tasks.
• For past and recent events he/she is able to recall and integrate.
• To recall every day schedule, “to do” lists and record critical information for later use; he/she uses assistive memory devices with stand-by assistance.
• With stand-by assistance, initiates and executes steps to complete familiar personal, household, community, work and leisure routines and by means of minimal assistance, can modify the plan when needed.
• Once new tasks/activities are learned he/she requires no assistance.
• Although requires stand-by assistance to take proper corrective action, he/she is aware of and acknowledges impairments and disabilities when they interfere with task completion.
• Through minimal assistance, thinks about consequences of a decision or action.
• Overestimates or underestimates abilities.
• With minimal assistance, acknowledges others’ needs and feelings and responds properly.
• Depressed
• Bad-tempered
• Low disappointment tolerance/easily angered.
• Confrontational
• Self-centered
• Unusually dependent/independent.
• With minimal assistance, able to distinguish and acknowledge improper social interaction behavior while it is occurring and takes corrective action.

Level IX – Purposeful, Appropriate: Stand-By Assistance on Request

• For at least two successive hours, without help shifts back and forth between tasks and completes them correctly.
• To recall daily schedule, “to do” lists and record critical information for later use, he/she uses assistive memory devices with support when requested.
• With assistance when requested, initiates and carries out steps to complete familiar personal, household, work and leisure tasks independently and unfamiliar personal, household, work and leisure tasks.
• Although requires stand-by assist to anticipate a problem sooner than it happens and take action to avoid it, he/she is aware of and acknowledges impairments and disabilities when they interfere with task completion and takes proper corrective action.
• With assistance when requested, able to think about consequences of decisions or actions.
• Even though this patient requires stand-by assistance to adjust to task demands, he/she accurately estimates abilities.
• With stand-by assistance, acknowledges others’ needs and feelings and responds properly.
• Depression may prolong.
• May be easily got irritated.
• May have low disappointment tolerance.
• With stand-by assistance, capable to self monitor aptness of social interaction.

 

Level X – Purposeful, Appropriate: Modified Independent

• Although may necessitate periodic breaks, capable to handle multiple tasks simultaneously in all environments.
• Capable to autonomously procure, create and keep own assistive memory devices.
• To complete familiar and unfamiliar personal, household, community, work and leisure tasks independently initiates and performs steps however may need more than usual amount of time and/or compensatory strategies to complete them.
• Even though may require more than usual amount of time and/or compensatory strategies, anticipates impact of impairments and disabilities on capability to complete daily living tasks and takes action to prevent problems sooner than they take place.
• To choose the suitable decision or action, capable to autonomously think about consequences of decisions or actions however may require more than usual amount of time and/or compensatory strategies.
• Precisely estimates abilities and without help can adjust to task demands.
• Automatically respond in suitable manner while capable to distinguish the needs and feelings of others.
• Intermittent periods of depression may come about.
• When sick, fatigued and/or under emotional stress, displays irritability and low disappointment tolerance.

Social interaction behavior is time and again suitable.