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The student will:

  1. Describe behaviors consistent with each level of the Rancho Los Amigos Levels of Cognitive Functioning Scale.

  2. Demonstrate appropriate strategies to address cognitive and behavioral barriers to physical therapy; contrast these to inappropriate responses.

  3. Appropriately document goals, including the use of goal-modifiers, for a client with brain injury.

  4. Describe and demonstrate recommended standardized measures, according to the Academy of Neurologic Physical Therapy Outcome Measures Recommendations for traumatic brain injury (TBI).

  5. Appropriately educate a client’s family member (acted by classmate) in strategies to treat cognitive and behavioral impairments which are common after brain injury.

Activity 1. Addressing Cognitive and Behavioral Barriers

Students practice formulating and performing treatment strategies to respond to common impairments related to brain injury.

Activity 2. Brain Injury Cases

Students apply their knowledge to four client cases, including goal writing, assessment of cognitive functioning, prioritizing PT treatments, and integrating appropriate strategies. All cases require students to integrate behavioral and cognitive treatment strategies with interventions for functional deficits.



  1. We recommend that students watch a video depicting clients with brain injury in the different Ranchos levels of cognitive function (Appendix 24-1). We recommend the video on the Craig Hospital website (if available):

  2. Prior to attending lab, watch the video above (or the one chosen by your instructor) and identify the cognitive and behavioral impairments you see with each client. Use the appendices for a reference list as needed.

  3. Read each of the cases provided for this lab. Identify the likely stage of cognitive functioning according to the Rancho Los Amigos Levels of Cognitive Functioning Scale. Write two short-term and two long-term goals for client in his/her respective level of care. (Answers provided in Activity 2 in worksheet key.)


How cognitive skills “build” on one another.

Individuals have to have some underlying cognitive skills in order to perform higher level skills.

Skills that could be considered foundations would be awareness, level of alertness and memory. Higher level processing skills would be problem solving and critical thinking.

In order to perform problem solving or critical thinking an individual must be conscious and alert, allowing him/her to take in his/her environment and obtain information. It is then necessary to have some ability to remember recent events in order to use these in the problem solving process.

While these cognitive domains do not build in a step-wise fashion, it is clear that a foundation of skills such as awareness, alertness, and memory are necessary to optimize higher-level cognitive skills.

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