Within ACL 2.8, the person has enough mental energy to focus on grabbing an item as well as walking to a destination. The first interpretation is that the person has a sense of vertical balance and reaches out and grabs on to prevent falling. What many carers experience is a sustained firm, often painful grip, until their attention fades away and they release their grasp.

Most people require hand-over-hand assistance to do push / pull exercises and to use reciprocal pulleys.

Muscle weakness and bone deterioration can be prevented by demonstrating and continuously cuing to do active range of motion (ROM) with their arms, legs, and hips. Assistance to achieve a full ROM will probably be required.

Pushing

A few people enjoy pushing something around, and individuals vary in the objects that appeal to them, which may include a sweeper, broom, dust mop, grocery cart, wheelchair, stationary bike or pedals. They have a tendency to bump into walls, furniture and people. Pushing something around requires a safe space to do it in, which may be related to the time of day when no one else is in the area.

Falls & Getting Lost

Walking exposes these people to the hazards of falling and getting lost, and constant walking leads to dehydration and weight loss. The following precautions are recommended.

The public has no idea about all of the things that these people can do. Activities done in the lobby and the hallway are a great way of providing public demonstrations.

Their constant walking occurs in patterns along the walls or the outside edges of big rooms. They need places to sit down and have something to drink and eat.

These people have a tendency to become phantom figures that move around like ghosts. Personalising what they like to drink and the finger foods they are apt to eat helps to humanise who they are.

The complications of incessant walking can be prevented and loved ones can contribute, which replaces their feelings of helplessness. Upper extremity range of motion exercises, finger foods and fluids are activities that they can safely contribute to with a minimum of education. For those without loved ones, volunteers can be valuable resources.

Their pattern of performance includes several different types of activities that they can do, and a variety of three activities seems to sustain their attention the longest.

Calling them by name in a friendly tone of voice will usually stop their forward motion and capture their attention.

Helping them move around is made easier by their compliance with non-verbal gestures, including come and follow me. Patting the seat on a chair or a sofa seems to be a universal invitation to sit down. Patting on a bench, bed or sofa beside the person may be a universal invitation to scoot over.

Their language includes the names of the rooms and the activities to be done there.

Communicating with someone functioning in ACL 2.6 takes a change of attitude of carers so what matters to the person becomes the focus. The ability to accept that the person has a profound need to walk rather than the need to complete self-care tasks. The person's calling out when they cannot walk or meet their movement needs are often interpreted as pain or negative behaviour.

A seated activity that has been a habit may be started, with a vague use of their hand for a very short period of time.

With linear information, attention may be paid to musical notes. People may enjoy listening to familiar songs, and lyrics with associated actions may amuse them. The intonations in speech sounds may also be heard.