An incorrect sense of independence is not a problem within ACL 1, 2, and 3 when the person cannot act on it. When they wander off and get lost, a sense of independence does not occur to them.

With little to no language ability, we must rely on those emotional expressions and gestures that the person can make. Their perspective is directly connected to the quality of information that captures their attention and the effects that they are able to cause.

Within ACL 3 Low, equivalent information includes linear, movement and sensory information that is synthesized to create what the person experiences as their sense of identity. Causing an effect with an object makes sense to the person when their grasp and release is intentional.

In ACL 3 Low, you are seeing if the person can use their hands to grasp and release objects.

To Verify

Can the person sustain their attention to grasp, release and with different objects and motions? If the person can consistently grasp and release different objects this verifies ACL 3 Low.

To Rule Out

To rule out ACL 3 High, you simply need to see if the concept of a line captures their attention strongly enough so that they can color within a line and up to the line.

What Makes Sense

• I can use objects.

Expected Task Performance

• Participates in simple actions using simple grasp and release and well learnt procedural memories.

Assistance Required

• Hands-on assistance and constant cueing is required for most self-care tasks with the person able to complete some well learnt or simple tasks, such as toileting.
• Provide material objects that stimulate well learnt manual action activities.
• Constant supervision is required to keep the person safe from falls, abrasions, choking or other

Within ACL 3 Low, the person has a sense of causing an effect by doing something with an object held in their hand. Scribbling with a crayon or a pencil is the classic but any object in their hand can be moved that way, e.g. bar of soap, wash cloth, dust cloth, or toothbrush.

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. The materials must also be safe for the person to use.

Within ACL 2 High their sustained attention is so short that leaving the supplies at bedside seems to be a necessary means of reducing the hassle of setting up several times a day.

Activities which lets the person use their mental capacity to build a positive sense of who they are affirmative. These affirmative activities keep the person happily occupied and reduces problematic behaviors. As their attention span is short, the activities also need to be short.

Within ACL 2.6, the person likes to walk in a direction or following a path.

Within ACL 2.8, the person likes to grasp and hold objects in their hands. Try using safe shampoo bottles, vinyl covered bean bag toys, large blow up beach balls.

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.

Managing the person's constant walking and protecting them from exhaustion is a real challenge. Designing an environment where they can keep walking with plenty of sturdy seating at regular intervals with regular drink and meal breaks will help balance their need for movement information and their other needs.