Awareness of the effects of gravity allows them to hold an object that is placed in their hand or rolled to their hand. They will also notice when it falls out of their hand, but may not be able to tighten their grip to prevent the fall. Precautions about size, cleanliness, etc., need to be taken because anything that goes into their hand may also go into their mouth.

Hand-over-hand assistance with a bean bag and a metronome is the beginning of activities that need to be created for these people. We need more.

Being able to move their limbs against gravity results in the ability to assist with repositioning themselves whilst seated in supported seating. This ability is however momentary.

The person can sit for 3 to 4 hours in supported seating.

The longer duration requires pressure care, provided by shifting the weight over bony prominences. Exercising and doing activities while sitting prevents the problem.

While they can lift finger foods to the mouth and participate in hand-over-hand feeding, they are so slow and can sustain attention for such a short period of time that nutritional intake is insignificant. "Self-feeding" is really an elective activity because they need to be fed. When the experience is pleasant for the person, and loved ones, it can be worth the time and effort. Food within all of the profiles for ACL 1 is for the pleasures of tasting, smelling and moving, and the amounts are small to avoid choking and silent aspirations.

The primary goal for the person with a cognitive disability is being able to sit up 3 or 4 hours a day. During that time, they can supply about 50% of the effort to do a range of motion exercises and hold objects placed in their hand or engage in moving objects with hand-over-hand assistance

The person is able to lift their limbs against the effects of gravity. They may follow a short verbal "Hands up" or a sensory cue like tapping on the back of their hands.

The person move to assist with self-care tasks.

Think of your reports as a tool for staff education.

Avoid boring reports that all read alike. These people recognise personal preferences and you should make an effort to include them in your reports because the whole population has been dehumanized.

Loved ones often like to bring food when they come to visit, but the risks of choking requires a policy and supervision.

These people are an invaluable resource in being able to identify personal preferences and can bring meaningful items from home.

The first word to enter the scale is "no" and it is usually said within ACL 1.8. Because it is the only word spoken, the person may not mean no. When asked about their comfort / discomfort or likes / dislikes they always say no. When this problem is discovered, staff members in residential facilities share their awareness of the "no to everything" problem quickly. The usual procedure is to ignore the word and appreciate the effort to communicate.

Their ability to eat finger foods is possible under the following conditions:

Exclude foods that have strings, such as celery and meat.

Include soft foods that melt in their mouth, such as jelly and ice cream.

Include small pieces of steamed vegetables that require very little chewing, such as broccoli, cauliflower and carrots.

Include small pieces of soft ripe fruit such as melon, berries, and bananas.

Include small marshmallows.

Food must be cut up into small pieces.

Note personal preferences and produce opportunities for individual choices.