Allen Cognitive Level Screen

Week 5

ACLS- 5

Based on Allen’s Cognitive Disabilities Model

Uses visuomotor task as screening tool to estimate global cognitive functioning, learning potential, and ability to perform functional activities

Can be completed with adults with disruption in cognition

Structure of Assessment

Offers a performance context to view a person’s available cognitive
abilities as they are applied to the demands of three leather-lacing
tasks of increasing complexity
• Tasks span a range of abilities associated with levels 3.0-5.8 on the
Allen scale
➢ Level 3 – running stitch
➢ Level 4 – whipstitch
➢ Level 5 – single cordovan stitch
• Introduced in order of complexity
• Follows a script with instructions and cues

Task #1: Running Stitch

First and simplest task

Uses round lace

Verbal instructions are provided alongside demonstration

Completion criteria: 3 correct running stiches in consecutive holes

Task #2: Whipstitch

Uses two sided lace

two correction: cross in back and twisted lace

completion criteria: 3 correct whipstitches in consecutive holes + correcting 2 errors

Task #3: Single Cordovan Stitch

Try first to problem solve without any instructions or demonstration

Assistance starts w 1 verbal cue then demo

Completion criteria: 3 correct single cordovan stitches in consecutive
holes

Ending Assessment

When the person….
➢ Completes all three stitching tasks or
➢ Fails to correct an error in single cordovan stitch after a 2nd
demo and problem solving is ineffective or
➢ Refuses the 1st or 2nd demo for the single cordovan stitch or
➢ Requests that the assessment ends or declines to proceed or
➢ Expresses significant verbal or non-verbal anxiety and
frustration

Assigning a Score

Based on the administrator’s observation of the person’s pattern of
behavior and performance then compared to the rating criteria in the
scoring tables
• Assign the highest score possible based on the observation that best
matches the behaviors in the rating criteria
• Additional skilled observation of task performance or other standardized
assessments provide valuable info to verify an ACLS score
• Once the score is assigned, you can interpret it using the Cognitive
Disabilities Model to guide intervention

Level 1: Automatic Actions

Global functional cognition is profoundly impaired

Responds to internal cues only

Level of arousal is a specific response to external stimulus

Able to perform very basic tasks

Total assistance needed when introduced external stimuli

Level: Automatic Actions

1.0: Withdrawing from Noxious Stimuli
1.2 Responding to Stimulation
1.4: Locating Stimulation
1.6 Rolling in Bed
1.8: Raising Body Part

Level 2: Postural Actions

Global functional cognition is severely impaired

Awareness is limited to postural actions to move body in space or overcame effects of gravity

Lack of awareness of effects actions have on objects or others

Might be easily agitated or resistant

Maximum Assistance needed when OTPs demo actions or use proprioceptive stimulation for postural actions

Level 2: Postural Actions

2.0: Overcoming Gravity

2.2: Righting

2.4: Aimless Walking

2.6: Directed Walking

2.8: Grabbing

Level 3: Manual Actions

ACLS score start

Global cognition is severely impaired

Persons perform spontaneous manual actions in response to tactile cues
• Awareness of material objects but lack of awareness of cause and effect or goal
• Attention span is short (maximum 30 minutes)
• Actions are unpredictable and may seem purposeless
• Moderate Assistance is needed when therapists re-focus attention to
sustain/complete simple, repetitive actions safely. (Can be higher if needed to prevent unsafe actions)

Level 3: Manual Actions

• 3.0: Grasping objects
• 3.2: Distinguishing objects
• 3.4: Sustaining actions on objects
• 3.6: Noting effects on objects
• 3.8: Using all objects

Level 4: Goal-Directed Actions

Global cognition is moderately impaired
• Awareness of tangible cues (see and touch) and understands visible cause-and-effect
• Aware of end-product but can’t solve new problems, anticipate, or correct mistakes
• No independent new learning
• Difficulty recognizing errors unless clearly visible and may request help when mistakes are noticed.
• Attention span is usually good for up to one hour
• Minimum Assistance is needed when therapists set up goal-directed activities with tangible results. Situation-specific training is required to learn new activities, with no generalization

Level 4: Goal Directed Actions

4.0: Sequencing familiar actions
4.2: Differentiating features of objects
4.4: Completing a goal
4.6: Personalizing features of objects
4.8: Learning by rote memorization

Level 5: Exploratory Actions

Global cognition is mildly impaired
• Able to learn new ways of doing things through trial-and-error, new learning is recognized and repeated during the process of doing an activity
• Can imitate a series of new directions
• May have poor judgment and impulsivity with limited planning or anticipating potential mistakes
• Concrete relations are understood, although they have trouble with abstraction
• Standby Assistance is needed when therapists adapt a new activity for safe and effective performance

Level 5: Exploratory Actions

5.0 Comparing and Varying Actions and Objects

5.2 Discriminating Among Sets of Actions and Objects

5.4 Self-directed Learning

5.6 Considering Social Standards

5.8 Consulting with Others

Level 6: Planned Actions

No global functional cognitive impairment
• Anticipates errors and plans actions to prevent errors in novel tasks
• Verbal instructions of new procedures can be given without demonstration
• Considers new information, imagines and reflects on possibilities, and exhibits original approaches to task performance
• Can make sense of symbolic cues and abstraction
• No supervision required. Hazardous situations are anticipated and avoided, or help is sought when needed. Mobility, communications, and maintenance of adaptive equipment is self-monitored
• Practitioner as consultant

Level 1 Strategies

One word commands

Familiar cues

Level 2 Strategies

Imitate gross motor actions and simultaneously provide simple verbal directions ex. watch me and then you try

Focus is on gross motor movements

Level 3 Strategies

Imitate object use ex. brushing teeth

Repetition of routine tasks

Manually guided instructions

Level 4 Strategies

One step instructions

Visual Demonstration

Make all objects clearly visible

Level 5 Strategies

Memory and planning aids

Use concrete explanations and examples
Assist with planning ahead