The behavioral change between ACL 1.8 and 2.0 is a noticeable improvement in head control and the urge to standup.

The urge to stand up is powerful and persistent all day long, every day, while they are awake. Distracting their attention from the urge to standup is often easier after they have been in the standing frame.

While seated on the edge of the bed, the person holds their head up and can standup, if they can weight bear. If they cannot weight bear, they should be able to hold their head up for at least 10 minutes.

To Verify

To verify, start with three seated activities, one of which should be upper extremity range of motion (UE ROM) exercises with head supports. If the person can do UE ROM exercises and has head control, try placing them in a standing frame.

The internal need to stand is so strong that the person is constantly trying to pop up. When they do get up, their knees bend, so after a few seconds they will fall, often taking other people down with them. They are a high risk for falls.

Repeated falls do not decrease their constant attempts, nor do explanations of their inability to stand. The repeated attempts to stand-up are similar to a child learning to stand, but the falls can have serious consequences for adolescents, adults and the elderly.

Bilateral upper and lower extremity range of motion exercises can be done while the person is seated. Attention is captured by the changes in the position of their extremities. They will probably learn to grasp the dowel stick and spontaneously follow the pattern of reaching to the chin and sky in a few sessions. Sessions with rest periods may be scheduled for 30 to 45 minutes twice a day.

Exercises can include the use of a theraband, with pushing and pulling against the resistance.

Having an object to grab while walking around is very important for the person. If they have nothing to hold onto when they are walking around they are likely to grab another person's wrist or arm. Their grip is very strong, objects which they grab must be strong and non-breakable.

Providing a variety of interesting objects to grab ranging from soft toys or beach blow up balls will keep the person's attention from targeting other people.

Grabbing Mistakes

Misinterpretations of why the person grabs and hangs on tight for so long are common. Any moving object within reach may be perceived as a projectile that threatens their survival. When they grab onto another person and hurt them, the other person will naturally feel like they have been assaulted. Their instinct is a fight or flight reaction. Trying to get away is apt to make the person functioning within ACL 2.8 feel unsteady, so they hold on tighter. Fighting will probably put both people on the floor because the person's balance is unsteady.

Because these people fit into a stereotype of a dangerous person, public education about automatic grasp and an inability to consciously release needs to be ongoing. Their imaginations are apt to be much worse than the reality.

Staff members who have been hurt have good reasons for being afraid of these people. Educate staff members that the person may not be intentionally hurting them. If they hold still for 20 seconds the person will relax and let go. Staff members can provide a variety of safe objects the person can hold. Prevention is really important to them.

Their loved ones are your best resource for finding objects that will be meaningful to the individual because they know the person's activity history. You will probably need to help them understand the safety requirements.

If the grabbing problem is not solved, these people become isolated because everyone is afraid of them.

The person can follow familiar instructions using a few words like "come here".