No response to any of these cues suggests ACL 1.0 because the selections have the highest probability of stimulating a response for most people and both auditory and visual cues were given. Three cues in one minute are not enough to confirm anything about ability to function.

The confounding factors are unknown and severe visual or auditory impairments, unknown names and fragile medical conditions that affect their ability to pay attention. Repeating these attempts to stimulate a response is necessary.

Score

The tentative score is ACL 1.0.

Move the trunk of the person away from the bed so that their head is not supported.

Keep your hands on their shoulders.

Ending the Activity

Wait 30 seconds, or if their head starts to move without control, lay them back against the bed and stop the activity.

Could the person hold their head up for 30 seconds?

Place the person's hands in their lap.

Be quiet, watch and do not move.

Ending the Activity

Wait 30 seconds, or if you need to prevent falling to the side, stop the activity.

Is the person still sitting after 30 seconds?

Remove any pillows from the bed that are positioners for holding them in place.

Place the person so that they are on their back with their arms at their sides. To do their best they need to be awake and looking comfortable.

Watch while you slowly elevate the head of the bed to 75 degrees. If they start to slide, stop and lower the bed.

Be quiet, watch and do not move.

Ending the Activity

Wait 30 seconds, or if you need to prevent falling to the side, stop the activity.

Is the person still sitting after 30 seconds?

Select the behavior that most closely matches your observations:

Your first choice is the set of auditory cues on the phone which consists of nine clicks.

If they did not respond to those cues, the alternative set of cues is calling their name nine times in the same tempo: three words, pause, three words, pause, three words.

While the first set of cues is heard, walk about 1 yard (1 m).

Judge the speed of your changes in position by watching their eyes.

If you lose them, step back to try to regain their attention.

Press "Play" if using the phone or start calling their name.

Place the smiley face in front of their face and follow the arc toward you until the smiley face is near the bed or they stop looking.

Return to the center of their face and move it to the other side of their head.

Judge the speed for moving the smiley face by watching their eyes.

If you lose them, move back to try to regain their attention.

Next Set of Cues

Try for 20 seconds, or if they have stopped following, continue.

Select the behavior that most closely matches your observations:

Hold the smiley face about 14 inches (35 cm) in front of their face.

Call their name again and move the smiley face a little to capture their attention.

Ending the Activity

Wait 20 seconds, or if they respond sooner, continue.

Place the phone at the edge of the bed, in a location that allows you to observe a response.

The response may be opening their eyes, turning their head or directing the pupils of their eyes to a different location.

Press "Play".

(Insert sound)

Next Set of Cues

Wait 20 seconds, or if they respond sooner, press "Pause".