Interesting objects from home may help sustain attention while sitting and standing. You can teach visitors how to use a metronome on their smartphone, if they have one. If not, metronomes are not very expensive. They can help sustain attention while sitting and standing, but staff members will need to do any transfers. Coordinating the visitors and staff schedules needs you to be in charge, or it probably will not get done.

Years ago, I was fascinated to learn that every language in the world has words for one, two and many. Moving on the count of three seems to be international and no more than three choices seems to be universal for children and older people with cognitive disabilities. The number three seems to be a magical, lucky number that is easy to understand. I have used three whenever a low number was needed for years, and it seems to work.

Everyone needs to understand that the urge to stand is probably programmed into the human DNA. It is not the person's fault that they keep trying to standup.

Sounds are more than a sensation. Common sounds, such as bells ringing and clapping hands, can be translated by the person into forms of communication. The meaning of the sound will probably be related to their personal history and not the current situation.

To standup, they are able to lean forward when firmly touched and told to do so. They will probably provide about 75% of the effort to standup and complete a pivot transfer with the caregiver providing assistance with trunk stability. One person can assist with the transfer from the bed to a wheelchair and from the wheelchair to a standing frame.

Moving on the count of three may be universal. Within ACL 2.0, moving with assistance on the count of three is effective, but the count must be slow, and they will move after the word three is spoken. They may echo counting with you.

Keeping their head upright, changing the position of the body from lying down to sitting up to standing up are postural movement cues that capture their attention. They can acknowledge an opportunity to change their position and answer with a yes or no in about 10 to 15 seconds.

When asked, they are able to move into a ball when lying on a mat or in bed.

The quality of information that the person pays attention to is apt to be influenced by the time of day, when and if the person was able to stand in the standing frame, and when and how long the person was engaged in seated activities. To understand a pattern of performance with a cognitive disability, you need to try to perceive a typical day as the person with a cognitive disability experiences it. A decent quality of life with a cognitive disability should be operationally defined by the activities that the person does during their typical days and their evaluation of those experiences.

Constant cuing is the rate of providing cues, which may be as frequent as every 10 seconds during a pivot transfer that may take a full minute or two to complete.

With one person giving cues every 10 seconds, they may sustain their attention for 30 minutes. The length of sustained attention may be different in different positions: in bed with a tray table, in a standing frame with or without hand-over-hand assistance, while seated in an armchair at a table, or while seated in a wheelchair with a lap tray.

Responses to a command to standup or move a part of the body may take 10 to 15 seconds. The number of internal cues to standup is the problem for caregivers and can be counted as the number of attempts in a time period, such as one hour at different times of the day. This objective data is useful for documenting / explaining needs for assistance and the onset of a new medical condition.

The cue to standup can be an internal urge or a command by someone else. Processing the sensation of standing may take 10 or 15 seconds, and then they are ready to assist with a pivot transfer. They are aware of the position of their head and can hold it up while standing or sitting, but they may not be able to sustain their attention to locking their knees long enough to continue to standup.