Motor control adds eye-hand coordination in small spaces, bilateral hand coordination, learning new uses of their hands and tools to change material objects, and carrying / moving objects (such as wheelchairs) around safely. The person is now able to store mental images in their short-term memory which can last up to about 30 to 45 seconds. Their actions cause effects that are guided by mental cause and effect connections.

People may spontaneously follow a routine for looking at a picture album before going to sleep at night. Within ACL 4, they rarely watch TV and they need something to do to settle down.

Individual albums to look at in the evening may reduce troublesome behavior associated with that time of day because their personal identity is protected by looking at the pictures. Someone to ask questions about their memories may add to their reassurance as they describe them. Telling the same story every day is reassuring for many people. Turn the television off when it is merely a distraction.

The material objects used to do needlepoint use linear information and tension added to the scale in ACL 4.6.

You should be able to translate horizontal, vertical and diagonal information into an analysis of needlepoint stitches.

These book markers are popular but require a lot of preparation. The yarn is precut and the first row is done with a threaded needle.

Making their own greeting cards using their own preferred methods can be a lot of fun. Let the person experiment with paper craft punch shapes and shaped scissors purchased at a discount craft store.

Appearances matter in ACL 4. This tray was meant for entertaining, but the appeal of the tray draws their attention, encourages engagement, and supports their dignity.

The difference between stamps and stickers is in the placement. Stamps are an estimate because you do not have a direct observation of how the stamp is making an impression on the paper. People functioning within ACL 4 High are more likely to be aware of the orientation of the stamps. They are also more likely to not contaminate the stamps by not cleaning the stamps before changing the color. Having two sets of ink pads, one set for ACL 4 Low and another set for people functioning in ACL 4 High helps reduce having muddied stamps for the group who will care.

Stickers with up and down, left and right orientation maybe used for people functioning in ACL 4 High.

Felt and fabric, as material objects, can be cut, glued, stitched, layered, overlapped, and adjusted with pressure and tension.

In ACL 4 High, they can make more complicated projects. The ability to hold an image in their working memory results in the person scanning their environment to find materials.

We have included this ladybird pattern for the person with a cognitive disability to enjoy. The instructions and pattern are downloaded from here.

For storing and set up with stamps, stickers and other multiple, small pieces, your sanity can be preserved by storing items by theme or project within a larger box of similar items.

If you keep using the same objects they will learn, by rote, how to fit them into a box, like a shoe box. When the person is functioning in ACL 4 High, some items may be stored in non-transparent boxes. Having items left in transparent boxes greatly decreases the chances of the items being ignored.

Getting serious about keeping people happily occupied requires serious attention to preparation time. When a person is occupied, they want to be doing something, not watching someone else flutter about doing the preparation work before they can get started. For the person who is conducting the crafts group, that means the details should not dictate how time is spent during the group. Organizing the details takes great planning. Here are some tips for ACL 4 groups that we learned along the way.