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Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary
Verifying Scores and Comparable Assessments • Allen Diagnostic Module 2 (ADM-2) : ○ 27 standardized craft-based activities ○ Each assessment is designed to introduce activity demands with an identified range of cognitive complexity within levels 3.0 and 6.0 on the ACL. ○ Administrators collaborate with individuals in selecting an assessment activity that is meaningful and within their expected functional cognitive capacities • Routine Task Inventory (RTI-E) : ○ 25 ADLs and IADLs are divided into four subscales: (1) Physical Scale-ADLs, (2) Community Scale-IADLs, (3) Communication Scale, and (4) Work Readiness Scale ○ Functional cognition is assessed based on therapists’ direct observation of performance in naturalistic contexts or on the perceptions of performance reported by the client or a caregiver MODULE 3 ACL-5: Scores and Interpretations Review • Converting results into therapeutic interventions: ○ Administer and interpret ACL-5 scores ○ Validate scores with additional assessments ○ Create client-centered goals ○ Tailor intervention plan based on results: ■ Mobility and fall risk ■ ADL/IADL performance ■ Swallowing/feeding ■ Safety and prevention ■ Cognitive retraining/skill development • ACL-5 results are scored on a total between 0 and 6 (incrementally on 2) *NOTE: No one scores a 6 (since the test does not measure a person's ability to plan for the future). • Interpretations are made for levels of impairment in global cognition and motor actions • Each level offers recommended assistance between 24-hour total dependent care and no assistance required ACL 0: Coma 0.8 • Generalized reflexive actions ACL 1: Awareness • Global cognition is profoundly impaired. The person responds to internal cues only ACL 2: Gross Body Movements • Global cognition is severely impaired. The person’s awareness is limited to their own postural actions (proprioceptive cues) to move their body in space or overcome the effects of gravity. There is a lack of awareness of the effects that actions have on objects or other people. Maximum assistance is needed when therapists demonstrate actions or use proprioceptive stimulation to elicit postural actions
ACL 3: Manual Actions • Global cognition is severely impaired. People perform spontaneous manual actions in response to tactile cues. Repetitive actions demonstrate an awareness of material objects but lack awareness of cause and effect, end-product, or goal. Their attention span is short (maximum 30 minutes) and actions are unpredictable. Moderate assistance is needed when therapists refocus attention to sustain or complete simple, repetitive actions safely. One-to- one assistance is required to halt perseverance and to prevent unsafe, erratic, or unpredictable actions that interfere with appropriate sequencing ACL 4: Familiar Activity • Global cognition is moderately impaired. A person is aware of tangible cues (see and touch) and understands visible cause-and-effect relationships. Goal-directed actions demonstrate an awareness of a familiar end product but fail to solve new problems, anticipate, or correct mistakes. There is no independent new learning, and they cannot invent new motor actions. They do not recognize errors unless clearly visible and may request help when mistakes are noticed. Their attention span is usually good for up to one hour. Minimum assistance is needed when therapists set up goal-directed activities with tangible results ACL 5: Learning a New Activity • Global cognition is mildly impaired. The person is able to learn new ways of doing things through trial- and-error problem solving. They may make hasty or impulsive decisions or make abrupt changes in their course of action. Standby assistance is needed when therapists adapt a new activity for safe and effective performance because errors and a need for safety precautions are not always anticipated ACL 6: Planning a New Activity • There is no global cognitive impairment. The person anticipates errors and plans actions to prevent errors. No supervision is required ACL-5 Relevance to Occupational Therapy • OTs are essential and equipped to measure functional cognition • OT practitioners utilize ADLs/IADLs and functional mobility to assess and develop interventions regarding functional cognition ACL-5 Relevance to Physical Therapy • Cognitive components of function and mobility are inevitably attached to physical activity • Roughly one in five older adults exhibit symptoms of at least mild cognitive impairment
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