Responses to a general sense of comfort are demonstrated by a sense of ease before going into a peaceful period of sleep. Responses to discomfort are displayed by agitation.
The response to pain is a slow development of a sense of discomfort. The discomfort is usually caused by the mattress and their look of agitation or restlessness is noticed by others. Behaviour that supports an observation of sustained attention only occurs when the person is uncomfortable. The typical pattern is short periods of agitation that are repeated until the discomfort is removed.
Responses to pain and comfort are nearly impossible to measure because there is no start time for the internal cues.
Self-protective reactions include withdrawal and startle reactions that are stimulated by external cues. Most motor control and verbal sounds are limited to self-protective reactions.
Daily assessments to elicit a positive ACL 1.2 response should be done when the medical condition is expected to improve ability to function or when the person could be in a drug induced stupor.