Allen Cognitive Level Scale

ACL 0 - Coma

Presentation / What You See

• Unresponsive

• Reflexive actions only

• Total assistance required

OT Focus

• General sensory stimulation

• Positioning

• Total caregiver support

ACL 1 – Automatic Actions

What You See

• Basic arousal and reflexive responses

• May withdraw from pain, respond to hunger/discomfort

• Very limited environmental awareness

• Often bedridden

• Needs total assistance

OT Focus

• Sensory stimulation

• Positioning

• Full caregiver support

ACL 2 – Postural Actions

What You See

• Moves body for comfort

• Begins to wander/pace

• No awareness of cause/effect

• Can follow 1-word directions inconsistently

• Requires 24/7 supervision

OT Focus

• Simple gross motor groups

• Establish simple routines

• Safety: gates, locked doors, preventing wandering

ACL 3 – Manual Actions

What You See

• Uses hands to explore objects

• Can imitate simple, repetitive actions

• Very short attention span

• Poor understanding of cause/effect

• Can copy running stitch

OT Focus

• Set-up assistance for ADLs

• Short, simple, structured tasks

• Tactile/manual activities

• Remove safety hazards

ACL 4 – Goal-Directed Actions

What You See

• Follows visual cues

• Can do familiar routines but struggles with new learning

• Basic ADLs are intact

• Needs help with problem solving

• Understands visible cause/effect

• Can do whipstitch (with errors)

• Safety issues if living alone

OT Focus

• Visual cues: labels, color coding

• Structured routines

• Support with new or complex tasks

• Avoid complex instructions

ACL 5 – Exploratory Actions

What You See

• Learns through trial and error

• Can explore new activities and make choices

• Impulsive or risk-taking behavior

• Difficulty anticipating consequences

• Can complete Single Cordovan stitch

OT Focus

• Allow safe trial and error

• Teach strategies for recognizing risks

• Support executive functioning

• Community and social activities

• Role playing for problem solving/safety

ACL 6 – Planned Actions

What You See

• Highest cognition level

• Abstract reasoning, planning, and future thinking

• Understands consequences

• Independent with routines, work, money management

• (Cannot be Level 6 if cognitive impairment is present)

OT Focus

• Higher-level IADLs

• Return-to-work skills

• Independent problem solving

• Health management strategies