The importance of changes of light and dark in their room to regulate circadian rhythms is supported by mounting research. I doubt that people functioning within ACL 1.0 are awake long enough to notice. Within ACL 1.2 they might. Lights off at night whenever possible will probably become a universal policy.

The human voice calling your name is a strong auditory cue for most people, but a response is still inconsistent within ACL 1.2

Other alerting sounds may include sirens, buzzers, bells, clickers, a child crying, a fog horn, sneezing, coughing, clapping hands, whistles, duck calls, door slams, door bells and dogs barking. The only response may be to look toward the sound in about 20 seconds.

Their attention is captured by strong sensory cues, one sensation at a time. The definition of strong sensory cues is by example under the following subheadings that are organized by sensation for convenience.

Motor control is limited to the face and includes the eyes (pupils focused on a cue, blinking), nose (sniffs) and mouth. Observations around the mouth include pumping their tongue in and out of mouth, drooling, gag reflexes, salivating, sucking, pursing and retracting their lips. If they turn their head, it will probably be less than sixty degrees, total.

Sustained attention with constant cuing every 20 seconds can be held for about 1 to 5 minutes. The same cue is used for this period of time.

We need data about the length of rest periods in between periods of sustained attention in order to know how to make schedules of staff time.

The response time is about 20 seconds and is usually the same for negative and positive cues. Use a stop watch and press start after you give a direction. Press stop when they complete the action.

A cue to any one of the five senses captures the person's attention. Processing the information produces an experience that the person evaluates as positive or negative. The immediate sensation is compared with past experiences and a decision is made to withdraw or not. A personal choice to continue to pay attention to pleasant sensations is possible but will probably be inconsistent.

All of the five senses are equally operational. The cues that capture attention need to be the strongest you can think of with the sharpest contrasts. Negative cues are included for verification and confirmation purposes only.

In the sensing activity, the person responds to the smiley face, their name being called or the clicker noise but does not follow the tracking arc.

A difference between ACL 1.0 and 1.2 is being able to differentiate between positive and negative sensations. The person is bedridden, not moving or making any noise spontaneously and fed intravenously. Their responses to sensations provide experiences that connect them to their own identity and a relationship with other people.

Supported seating is usually not used as they are only able to sit up for a few seconds. They usually require two staff members to assist with hoisting. It is more beneficial for them to be cared for while resting comfortably in bed.