In ACL 3 High, observe to see if the person can use lines to organize their actions in coloring and placement activities.

To Verify

The concept of a line is strong in ACL 3 High. Provide the person with a simple picture to color in. Can they color within the line? If they can color within the line or follow the outline of the picture this verifies ACL 3 High.

In the clover or the flower pot activity, see if they form rows or columns or try to fill all spaces. This verifies ACL 3 High.

What Makes Sense

• I can use objects to make a shape.

Expected Task Performance

• Participates in simple actions using familiar objects. Lining objects around edges or coloring within a line helps organize their actions.
• Enjoys folding, sorting, stacking, batting, coloring and stamping activities.

Assistance Required

• Supervision is required for most self-care tasks depending on how many procedural memories remain intact and how well structured the person was prior to their cognitive disability.

Within ACL 3 High, linear information firmly captures the person's attention and guides the person's actions. The person is interested in shapes and containers that have pieces to: put into, take out of, or fill up. While their actions are slow, their attention span may last from 60 seconds to 30 minutes. Keeping them busy, constructively, is a challenge.

Affirmative activities are activities which keeps the person happily occupied. Below are a few suggestions.

Grasp & Release

There are many mini basketball games on the market which encourages people to use their grasp and release skills. You can also quickly make up your own activity by using a tennis size ball and a waste paper bin.

Limited awareness of the physical environment makes them vulnerable to fears for their survival. Self-protective reactions are apt to turn supplies into weapons and that needs to be avoided.

They can write their name without understanding informed consent.

Leaving an unlocked residence and getting lost is a risk that is often prevented by locking the doors.

With nothing to do, they tend to wander around and out of the building. We need to collect data to see if a schedule of activities prevents wandering off and getting lost or other "escaping" attempts.

Programs are less labor intensive when people are scheduled together in small groups. A supply cart on wheels can be rolled any place in or outside; the end of the hallway or the lobby are often available. The point is to get them out of their bedrooms, and let friends, visitors, administrators see what they can still do.

The same safety precautions developed for children under the age of three are important because they will put anything in their mouth and when you least expect it. Spontaneous use of their hands is accompanied by putting everything in their mouth, along with the risk of choking.

Advise friends, family members and other caregivers that they are safer with objects that are about 1 inch (2½ cm) in diameter. Equivalent objects have equivalent, single action verbs such as reach, grasp, release, toss, drop, fold, sort, place, handover, wave and pinch.

Pointing out hazards in the physical environment plays a very limited role in fall prevention with severe cognitive disabilities because the person's ability to be careful is limited. Hazards below the knees can be pointed out, but the person's attention to the hazard and the necessary neuromuscular adjustments to be careful are rarely implemented by the person. Most fall preventions with hazards below the knees are done by another person who provides physical assistance.

Conflicts between the person's procedural memories and the management of their poor balance can escalate into battles if the person is forced to sit down to do things they have always done standing up. The need for force can be prevented by starting the procedure, such as taking off their pants and waiting for the person to experience feeling wobbly. Then, saying "please sit down" is usually greeted with relief to be able to sit down.

The ability to transfer off various surfaces at will reduces the risk of pressure sores.

Caregivers will still require to check for pressure sores due to poor fitting shoes and other clothes.

If the person has reduced sensation, caregivers will need to provide appropriate pressure care as the person is unaware of the secondary consequences of poor pressure care.