Allen's Cognitive Disabilities Model

Where did the theory originally develop from?

for SMI → dementia, schizophrenia, TBI (Acute care)

What is Allen’s Theory?

when completing daily activities uses task analysis to measure and monitor: problem solving and safety

What do interventions in Allen’s theory look like?

interventions match and adapt functional cognitive capacities with activity demands and contexts

• just right challenge

How do Allen’s level help us as OTs?

OT groups often include clients with cognitive differences, so levels help us:

• match activities to abilities

• ensure safety and participation (gives them sense of empowerment)

• focus on meaningful occupations

What does Levels (1,2,3,4,5,6) work on:

Level 1:

Level 2:

Level 3:

Level 4:

Level 5:

Level 6:

Level 1: Automatic actions- reflexive, basic survival

Level 2: Postural actions- gross motor, movement-based

Level 3: Manual actions- hands on, tactile, repetitive

Level 4: Goal-directed actions- purposeful, needs visual cues

Level 5: Exploratory actions- trial and error, impulsive, concrete thinking

Level 6: Planned actions- fully independent

What is the OT role in Allen’s group?

• match activity to the clients ability and reach their goal

• use cues: visual, verbal, tactile- each level has their own space for these cues

• adapt environment for success

• provide graded assistance: facilitate → probe → observe → rescue

Allen’s 4 approaches to cognitive therapy?

1. Task Analysis: breaking down tasks into steps; identify physical and cognitive demands

2. Cues: visual, verbal, tactile prompts to guide performance

3. Attention: match task demands to client’s attention span

4. Action and Speed: allow extra processing time at lower levels; provide step-by-step demonstration

How are assessment and interventions planned?

based on how clients learn and perform tasks

What are 3 categories to consider when doing assessment and interventions

1. Attention: to developmental sensory sequence

• body sensation (position and movement)

• incorporating touch and vision

• using all together

2. Motor actions: observing movement and verbalizations

3. Conscious awareness: increases with each level

What do level 1 clients look like?

• only reflexes

• clients not appropriate for groups

• bedridden

• conscious but only respond to internal cues: hunger and pain (rubbing chest and face shows pain)

• behavior is reflexive and habitual

• arousal may be elicited for seconds

• fully dependent on caregivers

What is the OTPF focus for level 1 clients?

• basic ADLs (eating, toileting, positioning), Rest and sleep

What is the goal for level 1 clients? List some activities you can do with them too

• Goal: engage in 2-3 minutes of sensory based activity with HAND-OVER-HAND support

• Activities: music, sensory stimulation (hands open with towels or massages), hand over hand feeding

What are the best cues for level 1 clients?

tactile and sensory

• hand over hand assistance for basic ADLs

• gently guiding movement (turn head toward sound)

What do OTs do with level 1 clients when they are aggitated?

provide deep pressure, warmth, or texture for comfort

• softly touching hand with washcloth to initiate movement

What do level 2 clients look like?

• client not appropriate for groups

• can be stimulated to perform actions: postural changes with physical cues

• can imitate gross motor actions

• can assist in basic ADLs (can self feed- but messy)

• 24-hour care needed

• Tx: self-care and movement/exercise group

How do you test if a client is a level 2 or level 3?

quick test of 2 or 3 claps

• ask client to imitate 3 claps -if yes then level 3

• if more or less than 3 claps, not a level 3

What is the OTPF focus for level 2 clients?

• ADLs: dressing and grooming

• Health management: movement/exercise

What is the goal for level 2 clients?

participate in 5 minutes of gross motor activity with physical cues

What are some activities for level 2 clients?

stretching, beanbag toss, grooming practice

What are the best cues for level 2 clients?

tactile, kinesthetic (proximal and distal control), auditory rhythm

• demonstrate body movement (stretching or clapping)

How do we use rhythmic cues and physical cues for level 2 clients?

• rhythmic: music, counting, clapping 3x

• physical: gently tap shoulder or arm to prompt movement

• physical: physically guide posture during activity

What do level 3 clients look like?

• groups are appropriate for these clients

• can perform manual actions (movement with hands) with tactile cues (INTENTIONAL MOVEMENT)

• motivational tasks within arms reach may be repeated many times

• attention up to 30 mins (task can be longer)

• basic grooming tasks may be independent with reminders (can do it, but not great)

• mobile but can get lost easily (have to supervise bc safety concernz)

• repetitive work can be done at a 3

• supervision required for clothing, $$, meal prep and following a schedule

• DANGEROUS ITEMS NEED TO BE OUT OF REACH

• tools use supervised used in tx: tools that are extension on hand (toothbrush, fork, paintbrush) are safe to use

What is the OTPF focus for level 3 clients?

• ADLs: grooming, feeding with utensils

• IADLs: simple cooking, laundry

• Leisure: crafts, softing

• higher levels

What is the group goal for level 3 clients?

complete a 2-step familiar task with tactile cues in group

What are group activities with level 3 clients?

bead stringing, sanding wood, hygiene stations, snack prep

What are the best cues for level 3 clients?

tactile, limited visual

• place the object/tool directly in the client’s hand

• tap or point to the next step in a familiar task

• provide repetitive demonstration of hand motions

What do you have to do with level 3 clients during activities?

remove distractions and keep items within arm’s reach

What do level 4 clients look like?

• basic living skills are intact (can brush teeth and dress)

• goal-directed actions can occur with visual cues (see toothpaste/tooth brush = will brush teeth)

• short tasks can be completed: making a sandwich, washing dishes

• attention up to 1 hour

• can perform most self care with A in new situations, anticipating needs or managing $$ (little bit like dif. between $1 and $20)

• heat and electricity may pose danger

• directions for tasks must be visually demonstrated: cannot follow written directions

• familiar tasks need reinforced with new tasks need to be repetitious

• clients can ask for assistance due to increased awareness (asking for help = increased awareness)

What is the OTPF focus for level 4 clients?

• ADLs: bathing and dressing

• IADLs: meal prep and chores

• Leisure/Social: games and crafts

What is the group goal for level 4 clients?

follow visual sequencing to prepare a snack with setip (3 steps, supervision)

What are some group activities you perform with level 4 clients?

sandwich making, wooden trivets, card games

What are the best cues for level 4 clients?

visual, sequencing

• SHOW FINISHED PRODUCT OR VISUAL MODEL (completed craft)

• lay materials in visible sequence: left to right or top to bottom

• use color coding or labeling for steps

• gesture or point to next step without verbal overload

What is the hallmark of what level 5 clients look like?

trial and error is hallmark of 5

What do level 5 clients look like?

• capable of new learning and reasoning

• can imitate new procedures and remember several steps at a time

• new and varied tasks are sought out and explored

• groups: can use choices!

• difficulty with long term consequences of actions

• timing can be a problem (cooking recipes)

• money management is a problem due to saving for anticipated problems

• difficulty with purchasing meals items, laundry and filling prescriptions

• lack of abstract thinking: don’t understand illness or effects of meds

• jobs and social relationships are challenging: self-centered

• interventions should focus on social awareness, relationships and accepting help

• EXPLORATORY ACTIONS

What is the OTPF focus of level 5 clients?

• IADLs: complex cooking, money management

• Work/education: job tasks

• Leisure: advanced crafts, recreation

• Social: peer problem solving

What is the group goal for level 5 clients?

demonstrate safe tool use in craft group with less than or 2 cues

What are some group activities that level 5 clients do?

cooking/baking with safety, mosaics, woodworking, role play

What are the best cues for level 5 clients?

verbal; experimental feedback

CUES for level 5 clients:

Give:

Ask:

Encourage:

Provide:

Give: Give verbal prompts to anticipate safety- “check the stove before turning it on”

Ask: Ask guiding questions- “what could you do next”

Encourage: Encourage reflection on errors or choices

Provide: Provide immediate feedback during trial-and-error learning

What do level 6 clients look like?

• not everyone will reach this level- classify clients on injury (ppl w/o TBI or mental illness not classified)

• absence of disabilitt

• use deductive reasoning and can plan ahead

• future events are anticipated

• behavior is organized

• verbal and written directions can be followed without demonstration

• able to use symbolic cues

What is the OTPF focus for level 6 clients?

all occupations; health management, community participation, prevention and wellness

What is the group goal for level 6 clients?

plan and lead a wellness group independently

What are group activities that level 6 clients participate in?

community outings, wellness planning, leadership roles

What are the best cues for level 6 clients?

symbolic, verbal, written

• written instructions, lists, schedules, planners

• encourage independent problem solving

• discuss abstract consequences

• support with visual checklists for multitask planning

What levels are directive leadership used for?

• OT provides structure, sets goals, selects activities

• appropriate for lower levels (3-4)

What levels are facilitative leadership used for?

• OT shares decision-making with group, supports choices

• best for mid-level clients (4-5)

What levels are advisory leadership used for?

• OT acts as consultant, group largely self-directed

• Most appropriate for higher levels (5-6)