In ACL 5 High, training becomes easier as information is stored their long-term memory. Re-learning is however still harder as they need to inhibit the old habits or procedural memory. With a physical disability, new techniques and equipment maybe required to maximize the person's independence. Within ACL 5 High, the person does recognize the benefits of using physical aids and equipment.

Abstract cues are common but are often ignored by people within ACL 5 High. Hints and verbal explanations of such cues may also be ignored. Make use of an authoritarian instructions such as "this is the Dr's orders" or "these are the house rules". Abstract cues are intangible and include unseen things like the feelings of other people. Unseen forces such as electricity, chemical reactions and heat which should be paid to attention maybe ignored with their negative consequences like electrocution, poisoning and fire risks.

Tangible secondary consequences are paid attention to. Secondary consequences of surface appearances are paid attention to in ACL 5.6 and secondary consequences of spatial fit are attended to in ACL 5.8.

Abstract information such as some one's feelings are not paid attention to. Sometimes the person are seen as being mean when they have ignored the feelings of their friends and family members.

Within ACL 5 High, the person may remember discovered solutions to problems and persevere with tedious tasks. Within ACL 5 High, verbal or written instructions are usually adequate.

They understand and will follow safety procedures such as turning pot handles inward, or unplugging appliances after use, or angling cuts away from fingers.

Memory aides maybe used to prompt the person to carry out activities like attend to an appointment on time. Many of these memory aids are common and readily available. The difference between a person with a cognitive disability versus someone functioning in level 6 or higher is that without these aides, they have a higher chance than normal of forgetting these appointments. Some memory aides are wall calendars, diaries, and electronic apps on the person's smart phone.

ACL 5.6

Range of motion exercises maybe followed from written or verbal instructions.

They can count to 20 repetitions with someone correcting improper positioning.

Incorporate desired actions in familiar activities, especially bilateral motions to prevent "guarding" affected extremity.

Supervise the exercise program to anticipate potential complications and check for the effects of impaired sensations.

Varies pace of exercise in response to a time constraint or other factors (e.g. heat, air pollution, state of health).

Non-Weight-Bearing Adherence

The person may have a better ability to inhibit their actions which is required for non-weightbearing compliance. Non-weight bearing boots may still be used to remind them to not weight bear if adherence to non-weight bearing protocol is crucial.

Their learning of a transfer sequence is much quicker and easier within ACL 5 High. They may understand and follow verbal and written instructions without the need of a demonstration. Reminders are required less to follow safety procedures like locking brakes.

Much of occupational therapy's value has been dependent on knowledge about adaptive equipment that is readily available to the general public now. The general public does not know when the purchase of a piece of equipment is valuable or a waste of money. The following guidelines suggest when the use of a piece of equipment should be explored.

Adapted Bathing

Written or verbal instructions are required to learn how to:

The impairments associated with a physical disability are regarded as an addition to a cognitive disability.

Without any other complications, within ACL 5 High, the person can usually obtain a drivers' license or continue to drive when licensed. They can process information quick enough and judge the speed of how quickly an object is heading towards them to make difficult turns. They can better handle stressful driving conditions such as busy areas and unfamiliar roads as they have better, quicker and more accurate decision making. They may also be less impulsive.