Movement information enters the scale in ACL 1.6. The person becomes aware of gravity and their position in space. They are aware of when they are being moved by caregivers and will assist and cooperate. Rolling is important to the person in ACL 1.6. Being able to continue rolling with the help of gravity is paid attention to. Within ACL 1.8, the person is able to lift a limb or their body part when prompted by caregivers to assist with their self-care tasks.

In ACL 1 High, being upright while being feed arouses attention to eating. A sense of balance is not maintained then and a sense of wellbeing is not formed but signs of distress are apt to be present. Strong sensory information and a sense of being upright captures the person's attention.

The person pays attention to where their body is in space. They may assist caregivers with rolling over when they feel the moving sensation. The person has enough mental energy to be aware of gravity's effects on their body.

The person is aware of another person who is providing care. While being taken care of, the person has a sense of helping the caregiver, which does make taking care of them easier.

See if the person is able to pay attention to where their body is in space. Does the person try to assist with self-care activities by rolling and moving with cues from attendant staff members?

To Verify

To verify ACL 1 High, interview a reliable staff member who assists with their daily care. Does the person assist with rolling when initiated by the staff member? Does the person pay attention to movements in their body position in space? If they are able to assist with moving their body, this confirms ACL 1 High.

What Makes Sense

• I can move with or against gravity.

Expected Task Performance

• The ability to cooperate with rolling activities enters the scale in ACL 1.6.
• The ability to roll is extended to the ability to hold a limb up against gravity in ACL 1.8.
• Sensory stimulation activities captures and sustains the person's attention.

Assistance Required

• Full assistance is required with self-care tasks.

The person can control trunk muscles to hold still, lift their bottom and arm while lying in a bed with bedrails. While seated in a chair with head support, the control of the trunk muscles is for a sense of balance. The chair must support their head and trunk in an upright position that is vertical to the floor.

The caregiver's tactile and verbal commands to move or hold still are apt to arouse their attention when a change of position involves the trunk and arm. Tactile cues and pointing are apt to make more sense to them than words.

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 use their remaining mental energy to engage in. This provides activities which they can engage in and this provides a positive sense of who they are.

Daily passive range of motion exercises are given for a number of reasons, including the protection of skin integrity, facilitation of properly aligned positioning, comfort and a decrease in the risk of contractures.

To see passive range of motion exercises, click here. http://alsworldwide.org/assets/misc/RANGE_OF_MOTION_EXERCISES_WITH_PHOTOS_copy.pdf

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.

The length of the sessions could be affected by the selection of cues. The question is: Is there a difference between the length of sessions when sessions A) alternate positive and negative cues or B) provide all positive cues? The longer sessions are the best for that person.