The person knows the difference between being upright and moving, and lying down and resting. Both experiences are needed every day to maintain circadian rhythms.

The person is aware of their body's position in space and they want to be upright when they are awake. They will try to stand up and assist with transfers in ACL 2.0. At ACL 2.2, they can make a step and enjoy walking with the assistance of two staff members or with the use of a forearm support frame. At ACL 2.4, the person can walk on their own. They lack a sense of direction and often walk in an arc with no destination in mind. The person pays attention to bold sensory information.

The person can form a sense of safety when they are supported properly. Their sense of pleasure in being upright and moving makes providing the assistance worthwhile. When the person can get up and take a few steps, their sense of who they are as a human being is affirmed.

The person does not have a sense of independence, ownership, social roles, geographic location or direction.

Their sense of identity is restricted to memories of past experiences with sensations and the instinctive need to be independent during bipedal movements.

Assessing to see if someone can pay attention to ACL 2 Low information will require positioning the person so you can see if they can hold their body posture upright against gravitational forces.

To Verify

While seated on the edge of the bed, does the person hold their head up and standup if they can weight bear?

If they cannot weight bear, they should be able to hold their head up for at least 10 minutes. This confirms ACL 2 Low.

What Makes Sense

• I can get out of bed and stand up.

Expected Task Performance

• The person has a need to be upright when awake.
• If they can step forward in ACL 2.2, schedule in opportunities to step forward with support.
• If they can walk in ACL 2.4, the need to be on their feet and moving is very strong and they will walk in a rough arc. Provide a safe environment for the person to walk and wander with sturdy seating for them to rest briefly on. A seating area that looks like a bus/train stop may help.

Within ACL 2 Low, the person is making sense out of the human instinct to be upright and bipedal. This need to be upright and moving is strong, often putting the person at risk of sustaining falls.

In order to provide sensory information, supplies are required. What supplies are used is dependent on your location. Keep in mind the sensation you are wanting to produce while you are carrying out your everyday activities.

To start, experiment with a sequence that begins with a negative cue to arouse their attention and follow with a positive cue that can be appreciated. Teeter tottering back and forth uses their best ability to function. The response times are usually the same length of time for positive and negative cues and this is a good way to measure them.

Affirmative activities are activities which the person can engage in and this provides a positive sense of who they are. Provision of affirmative activities reduces the incidences of problematic behaviors.

The person will respond to the following activities.

Head

The person will turn their head to seek out the pleasant sensory cue.

Eating

The person functioning in ACL 1 High enjoys eating sweet food in pureed or mashed form. Watch their facial expression for signs of pleasure or dislike.

Schedule passive assisted range of motion exercises for all extremities. http://www.alsworldwide.org/pdfs/rom_exercises.pdf

Provide splints / positioners to weak and paralyzed extremities to prevent contractures.

In supported sitting, demonstrate active range of motion exercises to both upper extremities.

When the person is functioning in ACL 1.8, demonstrations of active range of motion exercises maybe provided as part of their activity schedule.

With constant cuing every 20 seconds, attention can be sustained for one to five minutes. We need data about the length of rest periods in between sensory stimulation periods. We also need data on the number of sessions per day that are needed to prevent troublesome behavior.