Allen Cognitive Levels Flashcards
ACL 1
Automatic actions:
1. Conscious; impaired awareness
3. Demo’s reflexive/instintive responses
4. Performs basic habits (eating/drinking)
5. Maybe bedridden; sits with support, or moves trunk/limbs only
ACL 1: Treatment
- Activities should reduce the number of stimuli
- Provide only planned stimulation of sensory systems
**3. Use one-word commands - Provide familiar cues**
ACL 2
Postural action
1. Aware of movements of muscles and joints
2. Watches movement of others
3. Seeks movements that are pleasurable or comfortable
4. Resistive or easily agitated
5. Client stands, has rigthing actions, walks, names body parts, steps up/over, and pushes/pulls
ACL 2: Treatment
- Activities should allow for planned gross motor actions
- Imitate gross motor movement with simultaneous simple verbal directions
ACL 3
Manual actions
1. Able to attend to the external environment
2. Responds to tactile cues
3. Able to manipulate objects
4. Easily distracted
5. Client demonstrates grasp/release, repetitive actions, speaks in short phrases, looks at effects of actions, and follows cues to complete the next step
ACL 3: Treatment
- Activities are simple with repetitive actions
- Imitate manipulation of objects
Provide repetitive action of routine tasks
Use manual guiding
ACL 4
Goal-directed actions
1. Responds to visual motor cues
2. Attention directed to one cue at a time
3. Capable of goal-directed actions
4. Difficulty correcting error
5. Can attend to 1-hour group activity
6. Client is independent in doing routine activities, identifies and sustains goals for 1 hour, locates supplies, learns new structured procedure
ACL 4: Treatment
- Activities promote working with other patients to accomplish a shared goal
**2. Provide visual demonstration - Limit instruction to one step at a time**
- Make all objects clearly visible
- Provide visual comparison
- Situation-specific training
ACL 5
Exploratory actions
1. Understands concrete relations
2. Difficulty with abstraction
3. Uses exploratory actions
4. Capable of trial-and-error problem solving
5. Cannot anticipate problems
6. Client discovers how to improve actions through overt trial and error, but demonstrates impulsivity and poor judgment
ACL 5: Treatment
- Activities permit variation, allowing results to be easily seen and corrected
- Visual demonstration with verbal explanation
- Select or modify task to reduce problem solving
**4. Use concrete examples - Assist with planning ahead**
ACL 6
Planned actions
1. Capable of symbolism and abstraction
2. Can plan ahead
3. Anticipates errors in mental problem solving
4. Able to think of potential problems
5. Client understands safety precautions, uses information gained by reading, and anticipates consequences
ACL 6: Treatment
- Activities permit variation in the selection and planning of steps
- Client is encouraged to have choice to stimulate problem-solving, sharing of plans, and working with others
- Use verbal and written instructions, diagrams, and drawings
- Can carry out instructions from previous sessions
An OT is evaluating an individual with a cognitive disability. The ability to complete a tile trivet following a sample is demonstrated, and an inability to utilize written instructions is observed. Which one of the following jobs would be the MOST appropriate assignment in an employment training program?
A] Sorting plastic utensils into separate containers.
B] Assembling packets that include a knife, fork, spoon, and napkin based on a sample.
C] Selecting matching shoelaces from a mixed pile an lacing them into a display card
D] Gluing labels on cans and placing them in an appropriate container according to color.
B] Assembling packets that include a knife, fork, spoon, and napkin based on a sample.
-At ACL 4, pt. able to copy demonstrated directions presented one step at a time and may find it easier to copy a sample than to follow directions or diagrams.
A] reflects ACL 3, at which pt. is capable of using their hands for simple, repetitive tasks and sorting tasks, but are unlikely to produce a consistent end product. The pt. is capable of performing at a higher level.
C] reflects ACL 5, because they can identify the relationships between objects and generally perform 3- step tasks.
D] reflects ACL 6, gluing labels on cans and placing them in an appropriate container according to color describes a task that can be performed by an individual who has the ability to anticipate erors and plan ways to avoid them. This is generally a more complex task and requires attention to details.
An OTR® wants to develop a group activity for clients with personality disorder in an inpatient psychiatric facility. The group has Allen Cognitive Level (ACL) scores ranging from 5.0 to 5.4. What activity would be MOST appropriate to use with these clients in the initial stages of the group?
Volunteer activities in the community
Long-term budgeting for house repairs
Vocational retraining and job seeking
Role playing social interactions
Solution: The correct answer is D.
People with personality disorders and people with an ACL in the** low 5s have difficulty with social interactions** because they are egocentric. Role playing social interactions would be best option when initiating a group with these clients. Improving social interaction will form the basis for the rest of the interventions appropriate for this group.
A: Volunteer activities would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for lower levels.
B: Long-term budgeting and house maintenance would be more appropriate for clients at ACL 5.6 and above. The tasks involved would be too complex for lower levels.
C: Vocational retraining and job seeking would be appropriate for clients at ACL 5.2 and above, but job seeking would be more appropriate for clients at ACL 5.4 and above, and levels for vocational training could vary. Clients at ACLs from 5.2 to 5.4 would need more repetition in training to solve problems and create solutions so that they would not have to problem-solve independently.
A client with dementia quits bathing routines before completing them and has difficulty measuring shampoo and lotion. The areas of the body that are usually washed are more distal (hands, arms). The client might attempt to wash the back, but not consistently. At what stage is this client, according to the Allen Cognitive Level Screen?
4.0
3.8
3.6
3.4
Solution: The correct answer is C.
At Level 3.6, the client will be able to wash most distal portions of the body and those that are easily seen but will not always follow the sequence thoroughly. The client may quit before completion and may have difficulty with measuring soaps, lotions, and deodorant.
A, B: At Levels 4.0 and 3.8, the client will typically recognize the need for a bath and will bathe thoroughly as long as no major problems develop during the bathing process (i.e., lack of soap).
D: At Level 3.4, the client will typically wash only areas easily seen and reached. The client may wash one area repetitively and may forget to rinse or dry off.
