STR 581 CAPSTONE FINAL EXAM PART 1 2026
CERTIFICATION EVALUATION TEST PAPER
QUESTIONS SOLUTIONS GRADED A PLUS
◉ What are the 4 outcome measures to measure agitation and
consciousness?
Answer: 1. Glasgow Coma Scale
2. Agitated Behavior Scale
3. RAAS
4. Rancho Levels of Cognitive Function
◉ When is the Rancho levels of cognitive function used?
Answer: developed for use with patients with closed brain injury
less than 1 year post history
◉ Rancho Level 1
Answer: No response
- no response to visual, tactile, proprioceptive, vestibular, and painful
stimuli
◉ Rancho level 2
Answer: generalized response
,- emerging response
- responses may be slow or delayed or not as expected; can respond
to sounds, touch, or visual stimulus in the same (general) way
◉ Rancho level 3
Answer: Localized response
- intermittently awake
- MORE specific response (moving to positive stimulus and away
from negative stimulus)
- still slow reaction
◉ Rancho level 4
Answer: Confused and agitated
- difficulty processing environment
- limited understanding of what is going on around them
- over-reaction, highly emotional
- pays attention for a few seconds
- difficulty following instructions
◉ Rancho level 5
Answer: Confused and inappropriate
- difficulty paying attention, easily overstimulated, poor memory
,- focused on basic needs
- able to routine tasks with step by step guidance
- pays attention for a few minutes
◉ Rancho Level 6
Answer: Confused and appropriate
- shows goal directed behavior but dependent on external input for
direction
- consistently follows simple directions
- memory of conversations
- shows carryover for re-learned tasks but difficulty with new
learning
- selective attention for 30 min
- impulsive
◉ Rancho level 7
Answer: automatic and appropriate
- follows set schedule
- robot like and performs self care without help
- difficulty starting and following through with simple activities
- poor attention in busy or stressful situations
- rigid or stubborn
, ◉ Rancho level 8
Answer: Purposeful and appropriate
- recognizes problems with memory and will begin to compensate or
utilize strategies
- more flexible/ less rigid
- ABLE TO LEARN NEW THINGS
- lacks good judgement
- Functional in society but may continue to have decrease in rate of
processing, abstract reasoning challenges, appropriate for driving or
job training evaluations
◉ T or F: Do NOT use instructive motor learning early on for TBI
patients. Use sensorimotor adaptation (lower cognitive load) instead
Answer: TRUE
◉ What are negative prognostic factors for TBI? (compensation)
Answer: - prolonged post traumatic amnesia
- GCS < 8
- plateau with rancho levels
- complex trauma; cocomittant injuries
- older age
- limited PLOF/ poor prior brain health
CERTIFICATION EVALUATION TEST PAPER
QUESTIONS SOLUTIONS GRADED A PLUS
◉ What are the 4 outcome measures to measure agitation and
consciousness?
Answer: 1. Glasgow Coma Scale
2. Agitated Behavior Scale
3. RAAS
4. Rancho Levels of Cognitive Function
◉ When is the Rancho levels of cognitive function used?
Answer: developed for use with patients with closed brain injury
less than 1 year post history
◉ Rancho Level 1
Answer: No response
- no response to visual, tactile, proprioceptive, vestibular, and painful
stimuli
◉ Rancho level 2
Answer: generalized response
,- emerging response
- responses may be slow or delayed or not as expected; can respond
to sounds, touch, or visual stimulus in the same (general) way
◉ Rancho level 3
Answer: Localized response
- intermittently awake
- MORE specific response (moving to positive stimulus and away
from negative stimulus)
- still slow reaction
◉ Rancho level 4
Answer: Confused and agitated
- difficulty processing environment
- limited understanding of what is going on around them
- over-reaction, highly emotional
- pays attention for a few seconds
- difficulty following instructions
◉ Rancho level 5
Answer: Confused and inappropriate
- difficulty paying attention, easily overstimulated, poor memory
,- focused on basic needs
- able to routine tasks with step by step guidance
- pays attention for a few minutes
◉ Rancho Level 6
Answer: Confused and appropriate
- shows goal directed behavior but dependent on external input for
direction
- consistently follows simple directions
- memory of conversations
- shows carryover for re-learned tasks but difficulty with new
learning
- selective attention for 30 min
- impulsive
◉ Rancho level 7
Answer: automatic and appropriate
- follows set schedule
- robot like and performs self care without help
- difficulty starting and following through with simple activities
- poor attention in busy or stressful situations
- rigid or stubborn
, ◉ Rancho level 8
Answer: Purposeful and appropriate
- recognizes problems with memory and will begin to compensate or
utilize strategies
- more flexible/ less rigid
- ABLE TO LEARN NEW THINGS
- lacks good judgement
- Functional in society but may continue to have decrease in rate of
processing, abstract reasoning challenges, appropriate for driving or
job training evaluations
◉ T or F: Do NOT use instructive motor learning early on for TBI
patients. Use sensorimotor adaptation (lower cognitive load) instead
Answer: TRUE
◉ What are negative prognostic factors for TBI? (compensation)
Answer: - prolonged post traumatic amnesia
- GCS < 8
- plateau with rancho levels
- complex trauma; cocomittant injuries
- older age
- limited PLOF/ poor prior brain health
