Reactions to alerting sounds such as short bangs, whistles, horns, buzzers and marbles rolling on a glass plate are used to stimulate facial grimaces.

A more positive response may be produced by using a loud voice to call their name. Pitching your voice one octave above normal may be followed by opening their eyes and / or looking toward you. This response is inconsistent and a lack of a response does not mean that the person is unable to function within ACL 1.0.

The information that stimulates each of the five senses is equivalent. The same withdrawal from unpleasant, noxious or painful cues occurs for each of the five senses when those senses are unimpaired. The reactions to pain are quick and should only be done when necessary to detect the presence of any voluntary motor action.

Sustained attention with constant cuing every 20 seconds can be held for about 1 to 5 minutes. The same cue is used for this period of time.

We need data about the length of rest periods in between periods of sustained attention in order to know how to make schedules of staff time.

The response time is about 20 seconds and is usually the same for negative and positive cues. Use a stop watch and press start after you give a direction. Press stop when they complete the action.

Responses to a general sense of comfort are demonstrated by a sense of ease before going into a peaceful period of sleep. Responses to discomfort are displayed by agitation.

The response to pain is a slow development of a sense of discomfort. The discomfort is usually caused by the mattress and their look of agitation or restlessness is noticed by others. Behaviour that supports an observation of sustained attention only occurs when the person is uncomfortable. The typical pattern is short periods of agitation that are repeated until the discomfort is removed.

Resting comfortably or reacting to strong negative stimulus occurs within ACL 1.0.

In the sensing activity, the person does not respond to the smiley face, their name being called at a higher pitch nor the clicker noise.

To Verify

To verify the ability to identify pain, select one unimpaired sensation and an available cue with short-term effects. Only one reaction is required for verification. To verify the sense of comfort, tuck in warm blankets and sooth with deep pressure, while checking fragile skin to prevent damage. The ACLS-6 may be used to verify ACL 1.0.

The person can make a general distinction between pain and comfort and seems to form a sense of comfort when they peacefully fall asleep.

The person will have better ability to move with the tempo of music when functioning at ACL 1.8. Passive and active exercises may be completed with the beat of a metronome to help sustain the person's attention.

The few objects that capture their attention seem to be related to procedural memories. Procedural memories, habits, and automatic actions look the same. Eating is consistently the activity that people do with the highest ability to function; often one cognitive level better than every other activity. A single observation of eating behaviour is a nasty clinical position to be in because the predictive validity of an eating observation is lousy.