When family and friends are involved, the visitor books are useful. It will become part of your job to keep a flow of communication going in the visitor books if they are to be useful. Simply handing them out will do no good whatsoever. A major change in orientation to visitors is required to make use of their engagement with their loved ones. In many instances, the people who enable the use of affirmative activities, are visitors and they are your best source of feedback.

Within ACL 1.6, the person is usually aware of the fact that someone is feeding them and that some food is sticky. They can also drink from a cup when it is placed at their lips. Short recognition of hand-over-hand feeding may occur, but total assistance to maintain grasp and guide the motion will be required. Attention is rarely sustained longer than a minute or two.

People who enjoyed favorite flowers, perfumes, or colognes may recognize and enjoy the confirmation of their identity. Many of the commercially prepared aroma diffusers may not be strong enough to be noticed within ACL 1.6.

Attention may be captured by placing soft, furry, cuddly textures in their hands. Look for small stuffed animals and dolls without eyes or other small attachments that can be pulled off. The international labels on toys as being "unsuitable for children under the age of three" are a well-recognized need for concern. Explaining that the same problem occurs with a cognitive disability helps family members understand the need to be careful.

The visual field is a tunnel about as wide as their shoulders and extending out about as far as their hands can reach, which is about 1 yard or meter in front of their face.

They may hold an object that is placed in their hand until it drops or falls out of their hand without being noticed.

Visitors can be encouraged to bring familiar things from home or outdoors. You will need to warn them that, even though it is rare within ACL 1, people do put anything that is in their hands into their mouths unexpectedly.

Many people functioning within ACL 1.6 enjoy listening to music and are able to tolerate headphones for a limited amount of time.

A word of precaution needs to be passed on to all caregivers because their sensory awareness often receives a message from the tone of voice but not the content of the words spoken. Angry and negative tones of voice are frightening. Shouting at them to hurry up is also frightening. Saying nice things loud and fast can be worse than saying nothing at all.

Postural awareness extends along the length of their body, from their heels to the top of their head. Shifting body parts and rolling also brings more awareness to changes in position while being transferred. When unprepared for changes in position, fears of falling and startle reactions are inevitable.

Engaging the person's ability to roll with gravity, with the caregivers initiating the movement, allows the person to assist where they can. Even if they are being hoisted, a rolling motion can be used to assist with positioning the sling.

The person usually continues to roll to their side when the motion is started by the caregiver. Once the arm is hooked over the bed rail, they will probably hold still for a few minutes when asked to do so. The person can assist with dressing by rolling, holding their arm over bed rail, and following the direction to "hold still."

Transfers to shower beds or tilt-in-space chairs are easier when you start rocking motions to sit up in bed.

When a tilt-in-space chair is propelled over toilet / shower commode, the person usually cooperates by holding still.

Use the pattern of performance to find ideas for something to do while they are in supported seating. Their responses are limited to rocking, tracking, facial expressions and hand-over-hand use of objects. The value and variety of hand-over-hand use of objects has been underestimated. My guess is that it is this technique that will reduce over sedation.

The sustained attention is often only for the length of a short movement. Once the movement of rolling over is achieved, you are likely to lose their attention and their postural tone will drop.