The primary goal for the person with a cognitive disability is being able to sit up 3 or 4 hours a day. During that time, they can supply about 50% of the effort to do a range of motion exercises and hold objects placed in their hand or engage in moving objects with hand-over-hand assistance

The person is able to lift their limbs against the effects of gravity. They may follow a short verbal "Hands up" or a sensory cue like tapping on the back of their hands.

The person move to assist with self-care tasks.

Think of your reports as a tool for staff education.

Avoid boring reports that all read alike. These people recognize personal preferences and you should make an effort to include them in your reports because the whole population has been dehumanized.

Loved ones often like to bring food when they come to visit, but the risks of choking requires a policy and supervision.

These people are an invaluable resource in being able to identify personal preferences and can bring meaningful items from home.

The first word to enter the scale is "no" and it is usually said within ACL 1.8. Because it is the only word spoken, the person may not mean no. When asked about their comfort / discomfort or likes / dislikes they always say no. When this problem is discovered, staff members in residential facilities share their awareness of the "no to everything" problem quickly. The usual procedure is to ignore the word and appreciate the effort to communicate.

Their ability to eat finger foods is possible under the following conditions:

Exclude foods that have strings, such as celery and meat.

Include soft foods that melt in their mouth, such as jelly and ice cream.

Include small pieces of steamed vegetables that require very little chewing, such as broccoli, cauliflower and carrots.

Include small pieces of soft ripe fruit such as melon, berries, and bananas.

Include small marshmallows.

Food must be cut up into small pieces.

Note personal preferences and produce opportunities for individual choices.

Their awareness of the parts of the body makes a pat on the leg or arm an effective command to lift that part of the body.

Different fabrics cut into different shapes can be used for rubbing on the person's skin or with hand-over-hand rubbing.

The ordinary items listed in ACL 1.6 may be held and moved when placed in their hand for a short and measurable period of time.

Habitual lifting of hands and feet may be stimulated by sleeves and pant legs. The garment must be held so that they can see the hole where their hand or foot should go. These habits are probably stored in procedural memories because directing a hand or a foot toward other objects is not expected until ACL 3.0.

The person can acknowledge and respond to verbal commands to move body parts. Caregivers should use three words or less, which are repeated. The most frequent may be buns up, bum up or butt up. Caregivers should use a calm clear and firm voice to gain cooperation. The person's response is so slow that patience is a necessity. Hurrying up is not an option because startle and combative reactions are highly likely.