A lack of motor control reduces circulation and most people functioning within ACL 1.0 are cold. Warmth is comforting and can be provided simply by rubbing their hands, arms and face. Some family members do it naturally and others appreciate being told to go ahead. Showing them how to do a gentle message that prevents damage to fragile skin is something positive for them to do when they come to visit their loved one.

The positive responses with ACL 1.0 are easily seen as a sense of comfort. From a humanitarian perspective, the interpretation can be a sense of peace. The important experience is that the person is still with us and deserves to have a peaceful, comforting day.

With the current system of care, people functioning within ACL 1.0 sleep most of the time. How often and how long comforting sessions would be beneficial is unknown.

Being able to keep the person comfortable is important to the staff members. Documentation on how to keep the person comfortable is appreciated by all staff members.

Loved ones appreciate knowing that the person is comfortably resting and is being well cared for.

The person who is still with us easily becomes an unknown, breathing mass that is taking up space within ACL 1.0. Communications should focus on educating everyone about the person who appreciates comfort and peaceful sleep.

I am unaware of any responses to tasting and would not recommend them within ACL 1.0 because of the concerns about silent aspirations.

Noxious smells are avoided because everyone is offended.

If seeing, hearing and feeling are impaired, rotten eggs and other nasty smells might be the last resort.

Reactions to strong noxious tactile cues include pressing a sharp point to the finger tips and applying ice to the face and hands. Rapid withdrawal is expected.

Responses to moderately painful fingers are usually verbal because voluntary motor control of the hands is usually limited to withdrawal from serious pain. Serious pain should, of course be avoided.

Bright pen lights are often flashed in their eyes to stimulate a blinking reaction.

Visual acuity seems to be limited to making a distinction between light and dark.

Reactions to alerting sounds such as short bangs, whistles, horns, buzzers and marbles rolling on a glass plate are used to stimulate facial grimaces.

A more positive response may be produced by using a loud voice to call their name. Pitching your voice one octave above normal may be followed by opening their eyes and / or looking toward you. This response is inconsistent and a lack of a response does not mean that the person is unable to function within ACL 1.0.