Descriptions of basic and instrumental activities of daily living need to be individualized. The profiles have a typical description and common intervention methods. I cannot state enough that these need to be specific for each individual case.

Another disclaimer can be applied to last minute referrals, such as:

• After thirty minutes of trying to learn how to use a sock aid to follow hip precautions, the person's ability to learn and anticipate secondary effects was not evident. On-site supervision to follow hip precautions is recommended.

The face validity of the observed activity is the strength of the report. Select an obvious action or activity that is connected to the reason for the referral. The common questions and answers are:

When I write my reports, I like to use pictures. These are easily available through our cell phones. A picture tells a thousand words. The pictures can show what type of quality of information the person was able to pay attention to copy. I record how often the person refers to the sample as this tells me how long they can hold a mental picture. I also record how long the person was able to pay attention to the task. This allows me to establish a pattern of performance on their sustained attention.

The ACLS-6 is used to record the person's pattern of performance using standardized activities. Being in an updatable App format means that clinicians around the world may use the same activities and same measurement methods to discuss their observations. New activities may be added without huge shipping costs and materials may be printed relatively inexpensively.

A report is usually written to justify funding request for support recommendations. These cannot be done quickly and can be considered malpractice when inappropriate recommendations are made and the person is injured unnecessarily.

Going home with a new cognitive disability is a shock to most people who have never been around anyone with a similar condition. "You'll be fine when we get home" is wishful thinking and can provide a sense of false hope. Help and advice that was refused in the hospital is greeted with a hundred questions one or two weeks later. Most people need time to recognize the reality of a cognitive disability because the problem is not visible until after two or three weeks.

The person with a cognitive disability is dependent on other people to provide the actions and activities that they can do while supervised:

• Avoids steps that they cannot do.
• Adapts contents, steps or supplies to meet their obsolete identities.
• Prevents accidents or injuries.

Their dependency on other people adds the caregiver's needs into necessary considerations. Long-term caregivers are depended on to set-up, direct, and supervise the actions or activities. Their efforts need to make sense to them too. An appreciation for the value of doing enjoyable actions and activities is best developed by watching an expert demonstrate how to do it and identifying with the person's pleasure. When you demonstrate, have them observe the person first and then teach them the details about the set-up. The goal is pleasure in doing something.

A safe and effective activity plan only works right when the methods are tailored to fit the cognitively disabled person into the complexities of real life. The necessary modifications are identified in the familiar biopsychosocial framework.

Ideally, discharge recommendations and program planning should be based on evidence based predictions about patterns of activity performance in another setting. The data gathered should be based on standards of practice, with measurements that you trust to generalize from one location to another and from one action or activity to another. To meet those ideals, you need to know what you are supposed to do during the treatment process.

To set up and sustain actions or activities that the person enjoys doing for months and years, the following process is recommended: