The response time is about 20 seconds and is usually the same for negative and positive cues. Use a stop watch and press start after you give a direction. Press stop when they complete the action.

Responses to a general sense of comfort are demonstrated by a sense of ease before going into a peaceful period of sleep. Responses to discomfort are displayed by agitation.

The response to pain is a slow development of a sense of discomfort. The discomfort is usually caused by the mattress and their look of agitation or restlessness is noticed by others. Behavior that supports an observation of sustained attention only occurs when the person is uncomfortable. The typical pattern is short periods of agitation that are repeated until the discomfort is removed.

Resting comfortably or reacting to strong negative stimulus occurs within ACL 1.0.

In the sensing activity, the person does not respond to the smiley face, their name being called at a higher pitch nor the clicker noise.

To Verify

To verify the ability to identify pain, select one unimpaired sensation and an available cue with short-term effects. Only one reaction is required for verification. To verify the sense of comfort, tuck in warm blankets and sooth with deep pressure, while checking fragile skin to prevent damage. The ACLS-6 may be used to verify ACL 1.0.

The person can make a general distinction between pain and comfort and seems to form a sense of comfort when they peacefully fall asleep.

The person will have better ability to move with the tempo of music when functioning at ACL 1.8. Passive and active exercises may be completed with the beat of a metronome to help sustain the person's attention.

The few objects that capture their attention seem to be related to procedural memories. Procedural memories, habits, and automatic actions look the same. Eating is consistently the activity that people do with the highest ability to function; often one cognitive level better than every other activity. A single observation of eating behavior is a nasty clinical position to be in because the predictive validity of an eating observation is lousy.

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 boney 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.