Within ACL 1.8, the person can lift parts of their body against gravity. The parts of the body that can be lifted and held up for a few minutes are the head, arms and legs. Arching their body to assist with perineal care may also occur.

Hand-over-hand assistance is provided by placing an object in the person's hand, firmly grasping their hand and the object and guiding the arm movement, i.e. you do 70% to 90% of the work. Range of motion, trunk stability and sustained attention are the benefits. Washing, wiping, painting, and rubbing are familiar movements with obvious effects. Hand-over-hand techniques do not need to be limited to feeding and grooming and their attention may be sustained longer, and with more effort on their part, doing something else with the metronome.

Music has always been a powerful tool for capturing and sustaining attention, but the reason why has been unclear. An analysis of musical information clarifies the use of tempo as a movement cue. The tool you need is a metronome, which can be downloaded to most smart phones.

To start, take your pulse and set the metronome to match your heart rate. Tap your hand on your knee in rhythm with the beat. Increase and decrease the speed and tap your hand at the various speeds so that you can experience what a change in tempo feels like to you.

Within ACL 1.6, ordinary things that are safe to see and hold are recognized with pleasure. Lists of everything you can think of are a big help to family and friends who would like to bring something with them when they come to visit.

The most difficult part of working with people within ACL 1.6 is coming up with sensory stimulation activities that they can do safely while in fully supported seating.

The benefits of this program depend on staff and family members understanding the person's internal sense of their position in space. The benefits of the rocking chair may be the easiest way to teach the concept.

The person may sit in fully supported seating for 2 to 3 hours per day. The hours will need to be divided into several sessions with different things to do and constant cuing.

If partially supported seating, without head support, is tried, the time should be limited to a few minutes to avoid fatigue. The consequences of over-fatigue can last for several hours of troublesome, agitated behavior.

The personal benefit of moving with the effects of gravity is being able to sit up with full head and trunk support for 2 to 3 hours a day.

The need to be upright is rarely satisfied by spending the whole time being passive, i.e. being fed or taken care of. Data is needed to establish the percentage of time up that needs to include active engagement in pleasant sensations. To start, I would suggest 50%. Sensory stimulation would ideally occur mid-morning and mid-afternoon.

They will move spontaneously to prevent pressure sores. The limbs slide or shift along the bed or chair and do not really overcome the effects of gravity.

As a rule, people pay more attention to their hands than their feet. About 25% of the effort will be made to move their hands, to move from a sitting to a lying position and to roll.

Think of your reports as a tool for staff education.

Reports should be individualized because the person is able to make choices.

Inform administration that reports cannot be individualized without a variety of carefully selected supplies.

Use the visitor's book to keep track of the objects that family and friends bring when they come to visit. Coordinating their visits with time to sit up and do something besides eating can be greatly appreciated by the family and a big help in preventing bed sores and sun downing.