The person is aware of their body in relation to their position in space. The may startle if moved quickly without a word of warning and waiting 20 seconds for the person to take in the information.

They can move their whole arm when cued but using their hands intentionally is limited. The feeling of keeping a limb up against gravity is pleasant for the person for a few seconds.

The ability to lift the hands up against gravity is quite an achievement and is enjoyed by the person.

Roll over and hold still is connected to ACL 1.6; lift and hold still is connected to ACL 1.8.

While in bed, they can lift their buttocks for bridging. During a transfer, they can supply about 50% of the effort to sit up or lie down. While sitting, they can imitate range of motion exercises for their upper extremities.

The difficulty with ACL 1.8 is that the effect of gravity is an internal cue. Careful observation is required to verify their awareness of the effects of gravity on their own body.

Two measures of sustained attention may be possible. One measure is the length of time attention can be sustained to a specific cue. The other is the length of a sensory stimulation session. The session could include several cues / responses. Within ACL 1.8, the session may last five or ten minutes.

The response time is about 20 seconds and attention fades away in less than a minute.

A verbal and / or tactile cue to lift and hold captures attention, which can be sustained with constant cuing.

With head support, the person is able to sit up for 3 to 4 hours and engage in pleasant activities.

Without head support, the person has enough head control to sit up for a few minutes, but the rest of the body requires support.

Nursing care is much easier because the person can bridge, which is lifting and holding their buttocks up.

In the sensing activity, the person can follow a sensory cue through the tracking arc, sit for at least 30 seconds with their hands in their lap, they can hold their heads up but for less than 30 seconds.

To Verify

Most of the differences between ACL 1.6 and 1.8 can be verified by a nursing assistant who provides medical necessities. When a reliable report from a nursing assistant is unavailable, demonstrate a range of motion exercises with the upper extremities while in fully supportive seating to add to the ACLS-6, which is done in bed.

Within ACL 1.8, the person can lift parts of their body against gravity. The parts of the body that can be lifted and held up for a few minutes are the head, arms and legs. Arching their body to assist with perineal care may also occur.

Hand-over-hand assistance is provided by placing an object in the person's hand, firmly grasping their hand and the object and guiding the arm movement, i.e. you do 70% to 90% of the work. Range of motion, trunk stability and sustained attention are the benefits. Washing, wiping, painting, and rubbing are familiar movements with obvious effects. Hand-over-hand techniques do not need to be limited to feeding and grooming and their attention may be sustained longer, and with more effort on their part, doing something else with the metronome.