ACL Levels Flashcards
Who is the Allen Cognitive Level Test used for?
-Utilized for populations with psychiatric disorders, acquired brain injury, and/or dementia
What is the Allen Cognitive Level used for?
Used as a screening tool to estimate an individual’s cognitive level
-Involves three leather lacing stitches progressing in complexity
How many leather lacing stitches are used in the ACL levels test? What levels do they represent?
3 stitches. Running stitch (Level 3), Whipstitch (Level 4), Single cordovian stitch (Level 5)
How many levels are in the ACL?
6!
- Level 1=automatic actions
- Level 6=Planned actions
ACL level 1
Level 1: Automatic actions, Total assist
- Limited attention
- Responds to pain
- Automatic actions: swallowing, locating stimuli, rolling in bed, raising body parts
- Motor actions are in response to one-word, near-reflective directions e.g., “sip”
- Needs monitoring to ensure adequate nutrition
- Needs assistance with ambulation and transfers
- Needs passive, active, or assistive ROM for prevention of bed sores, osteoporosis, infections, and contractures
- Dependent on caregiver for ADLs
- Requires constant 24 hours supervision
- Terminal phase of this disease, but death usually occurs before the last stage of this level
How should the environment be adapted for a pt at ACL level 1?
Environment should be consistent, familiar, and modified to elicit orienting experiences
What should tx for ACL level 1 mainly include?
-Sensory stimulation
ACL level 2
Cognitive level 2: Gross body movement
-Thinking highly disorganized
-Attention involves internal cues
-Max A for cognitive assist
-Motor actions are one step, imitated, near reflexive, and familiar and involve gross motor patterns
ADLs can be accomplished by imitating caregiver (e.g., washing the face)
-Spontaneous behaviors are common
-Able to eat finger foods
-Client paces and wanders
-Client should be taken to restroom every 2 hours
-Requires around clock supervision for transfers, ADLs
Treatment for ACL level 2
- Make sure client wears comfortable footwear! He wanders!
- Multi-sensory activities: move to favorite song, dance, calm environment
- Prevent engagement in unsafe environment
- They show righting reactions!
ACL level 3
Level 3: manual actions/repetitive actions
- Think of Miri’s nephew!
- Mod cognitive assistance
- Easily distracted, unpredictable, erratic
- Spontaneous reactions in response to tactile cues
- Attention should be directed to tactile cues (e.g., familiar objects)
- Goals not related to outcomes
- Motor actions limited to one-step, familiar, and action-oriented activities
- Client can’t learn new behaviors
- Adaptive activities should be used that reinforce the connection between predictable tactile effects on the environment and client actions (e.g., walking, washing cars, drying and washing dishes, wiping countertops, vacuuming)
- Client needs routine
- Client should avoid sensory overload
- Able to wash hands and face and brush teeth
- During grooming and bathing, items should be presented to client one at a time, in sequential order of use
- 24 hours supervision
- Running stitch
How much assist does an ACL level 1 pt need?
Total assist! Dependent for all ADLs and transfers
-24 hour supervision
How much assist does an ACL level 2 pt need?
Max A-can completed ADLs by imitating caregiver
-Needs 24 hour supervision
How much assist does an ACL level 3 pt need?
Mod A. Client able to complete some ADLs (wash hands and face and brush teeth)
-Still requires 24 hour supervision
What kind of activities should be used during tx with a client with ACL level 3?
- At Level 3, pt is able to complete some very familiar tasks e.g., washing face/hands
- Attention should be directed at tactile cues
- Limit motor activities to one-step, familiar, and action-oriented activities
- Adaptive behaviors should be used that reinforce the connection between predictable tactile effects on the environment and client actions e.g., walking, washing cars, drying and washing dishes, wiping counters, vacuuming
- Items should be presented to client one at a time, in sequential order of use
- Avoid sensory overload!
ACL level 4
Level 4: goal directed activity
- Requires Min A
- Attention directed to visual and tactile cues
- Client can now understand cause and effect
- Can no longer problem solve
- Can follow two or three step activities
- Activities should be simple, concrete, and supportive of desired social roles
- Labels and pics can be used as reminders
- Task setup for bathing and grooming
- Can eat independently, but supervision needed on amount of food eaten
- Needs protection against safety hazards and wandering
- Needs 24 hour supervision
- Whipstitch
How much assist does a pt with ACL level 4 need?
Min A
-Still needs 24 hour supervision for safety e.g., wandering, amount of food eaten
At what level can a client first live alone?
ACL level 4 (around 4.4)
- Can also begin to walk to familiar places
- Need reminders for chores
- Supported employment
What level of ACL is associated with goal directed activities?
Level 4
-Can understand cause and effect
What activities should be used for ACL level 4?
At ACL level 4, pt can complete goal-directed activities and requires min A
- Can follow 2 to 3 step activities
- Activities should be simple, concrete, and supportive of desired social roles (you can live alone at 4.4)
- Labels and pics used as reminders (think of pic of house as visual cue)
- Task setup for bathing and grooming
- Protection against safety hazards and wandering!
ACL level 5
ACL level 5: exploratory actions
- This is when Miri went rogue and said fuck everyone else and explored the world with poor judgement
- Learn new activities!
- Caregiver standby or supervision needed for cognitive assist
- Client learns through visible, concrete, and meaningful stimuli
- External cueing can be used
- Client explores the effects of self-initiated motor actions on physical objects
- Client uses overt trial-and-error problem solving
- Can follow a 4 to 5 step process and learn new concrete ideas
- Difficulties with judgment, reasoning, planning, semantic memory, episodic memory
How much assist does an ACL level 5 pt require?
Standby assist or supervision
At what ACL level does new learning first occur?
ACL level 5
-New learning, trial and error, poor judgment, impulsive, living alone
ACL level 6
ACL level 5: planned actions
- Client is independent
- Disability is absent
- Anticipates, plans actions, has desires and priorities
How much assistance does An ACL level 6 pt need?
None! Client is independent!
