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Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary
MODULE 2 The ACLS-5, LACLS-5, and LACLS-5[D] provide an estimate of functional cognition (available cognitive mental functions) for engaging safely in valued everyday activities. These scores are established through observations of what individuals pay attention to in their external and internal or personal environments and their performance skills as they engage in activities, and from analysis of the cognitive complexity of activity demands, activity patterns, and contextual and environmental supports that appear to fit with the person's cognitive mental functions and desired activities and occupations they need and want to do. PSYCHOMETRIC PROPERTIES • Reliability : The interrater reliability evidence across all versions and forms of the ACLS that were developed between 1978 and 2007 has been high, with reported correlations ranging from r = 0.91 to 0.99 • Improvements from the ACL-3 : In the ACL-5, administrators are instructed to continue to next stitching task whether the person being tested completes three correct stitches or not in the preceding task (unless the individual refuses or appears sufficiently stressed) Testing Supplies • 1 standardized ACLS leather tool • 1 large eye steel needle • 2 permalok needles • 72" waxed linen thread for running stitch task and replacements • 60" of 3/32-inch-wide leather lace for the whipstitch and single cordovan stitch tasks *NOTE: Some testing supplies are latex-based. Difference Between ACL-5 and LACL-5 • LACL-5: Large Allen Cognitive Level Screen, 5th Edition • The primary difference is that the LACL-5 is the size of materials. It is a larger, adapted version of the ACLS designed specifically for individuals with vision or hand function impairments, allowing them to complete the cognitive assessment more easily • Disposable LACL-5- Kit comes with disposable tools for individuals who require infection control options • LACLS-5 is a valid performance-based measure for evaluating functional cognition Script *Deviating from the script can result in poor and inaccurate scoring, which means poorly matched interventions to improve functional performance.
• Initial task (running stitch) : ○ Instructions: “Please make a running stitch by threading the needle through the holes in this direction” ○ Observation points: Ability to follow basic instructions, hand-eye coordination, and consistent stitch pattern ○ Similar script is provided for whipstitch and cordovan stitch tasks ○ The administrator should continue to the next stitching task whether or not the person completes the previous task, unless they refuse or show significant stress • Minimal verbal prompts : ○ Only provide necessary cues to guide the individual, avoiding excessive prompting that could influence their performance • Observe behaviors : ○ Note any difficulties the individual shows: confusion, frustration, inability to follow instructions, or excessive need for visual cues • Scoring : based on test taker’s performance, points are assigned Error-Correcting Task Between the whipstitch task and the cordovan stitch task, the administrator will perform the cross-in-the-back error. The administrator then instructs the test taker to correct the error according to the standardized script. It is designed to assess problem-solving abilities and cognitive flexibility. Next, the administrator will perform a second error called the “twisted lace mistake.” The administrator will then ask the test-taker to correct the error according to the standardized script. Both error- correcting tasks are also calculated into the final scores. Administration Setup • Environmental considerations: ○ Good lighting ○ Minimal distractions ○ Can be done in sitting, bedside, and standing ○ Administrator must sit close enough for hearing efficiency and observing facial expressions • End administration or administering is contraindicated if: ○ Completion of all three stitching tasks ○ Refusal ○ Signs of excessive and unnecessary stress ○ Clients less than the age of 6 Calculating and Interpreting Scores • Scoring is based on two primary components: ○ The number of correct stitches ○ The difficulty of each stitch • Scoring ranges from 0 to 6, 0 being comatose • Scores are established by providing another standardized assessment within the cognitive disabilities model (CDM) to confirm the person’s cognitive level/mode
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