Within ACL 4 Low, the person will likely be functioning very slowly. The dependency on matching to complete a task results in them needing to match to the sample multiple times. This can be very tiring work for the person and they may stop and require a rest before being prompted to continue the task.

When the person is functioning within ACL 4 Low, memory aids must only allow one course of action and be very easy to follow. Written signs and instructions are likely to be ignored. Memory aids like an automatic pill dispenser which has an audible alarm and flashing light that does not switch off until the person tips the pill dispenser have more chance of success. Perimeter alarms and smoke detectors with caregivers directing the person is what is required for someone who is unable to store information in their working memory.

Standby assistance during exercises is required when the person has had a medical problem that has secondary consequences, e.g. hip and knee replacements, unhealed fractures, etc. They are not apt to comprehend the consequences, nor are they apt to follow precautions.

ACL 4.0 - 4.2

One action at a time may be followed in range of motion and strengthening exercises. Their counting of repetitions may be limited to 5 or 10. Someone will need to demonstrate the motion, count with them, and correct improper positioning.

Retraining on how to correctly use walking aids requires constant prompting and supervision as they are relying on their procedural memory. Patience is required by caregivers. The use of bed and chair alarms to alert caregivers is required if supervision and assistance is needed to prevent falls.

Non-Weight-Bearing Adherence

Within ACL 4 Low, many people realize that their normal activity performance is impaired by a physical disability. They will usually cooperate with alternatives to walking.

Much of occupational therapy's value has been dependent on knowledge about adaptive equipment that is readily available to the general public now. The general public does not know when the purchase of a piece of equipment is valuable or a waste of money. The following guidelines suggest when the use of a piece of equipment should be explored.

Adapted Bathing

Long-term repetitive training might include learning how to:

The impairments associated with a physical disability are regarded as an addition to a cognitive disability.

Driving is the thorny issue for people functioning within ACL 4 Low. The inability to store an image in their working memory or scan the environment means that they are unsafe driving a motor vehicle. A power wheelchair maybe used with an attendant control in a safe environment with wall guards in place. Mixing power wheelchair users with other frail walkers is very dangerous.

They may prefer a traveling companion on familiar public transportation routes and may need a guide to new locations throughout ACL 4.

Known public transportation routes may also be used, but they will probably become anxious or confused if something unexpected occurs.

Within ACL 4.0, the person can usually make their way around the neighborhood when they are able to use familiar landmarks to guide themselves.

While ambulatory, someone will need to cue them to alter pace and redirect their attention when they become distracted. Most people must be accompanied to prevent getting lost outside of the immediate neighborhood. If they get lost, they rarely know how to retrace their steps to reorient themselves.

Transportation is a generic category for moving about in the community.