Within ACL 3.0, how the person moves is connected by paying attention to the size, shape, location, and speed of external objects.
They still have a need to walk around and their awareness of being in a confined space can be even more pronounced than in ACL 2.6 and 2.8. The feeling of confinement can be decreased by disguising exits and scheduling pleasant activities just after visiting hours.
While walking around, they may pick up an object that catches their interest or sit at a table to do something with their hands. These behaviours are connected by their selective attention to external objects that they can grasp and release.
With intentional grasp comes the ideas that they have hand strength that can be increased.
Stimulating Grasping and Releasing
Intentional grasp consistently uses procedural memories to automatically grasp familiar objects such as pencils, crayons, tooth brushes, popsicle sticks, small lotion bottles, exercise cones, squeeze balls and cork sanding blocks. Give them these items to grasp and release.
Soft rubber and foam balls, and bean bags are automatically associated with grasp, release and throwing.
Select hand sized objects, with rounded edges, and universal shapes e.g. ovals, circles, hearts, teddy bears or happy faces. Soft and washable materials are important because some people can reduce their agitation by banging and others drool a lot.
Their attention is captured better by hand size objects that they can easily grasp and release. Objects that they recognise from their activity history form nice comparisons with their current experiences with similar objects. When favourable comparisons are made, those objects tend to sustain attention longer.
Expect grasp to follow the normal child growth and development sequence, such as holding a spoon, in ACL 1 and 2. Because grasp is automatic and habitual, it is not a reliable evaluation criteria within ACL 3.0. A more reliable evaluation would be based on imitation of a new grasp, but I cannot imagine what that would be. Chopsticks occurred to me, but they are too complicated for people within ACL 3.0.
Intentional Grasp
The differences between intentional grasp and automatic grasp are probably differentiated by the cerebral cortex. The automatic grasp observed within ACL 2.8 might not reach the cortex and is probably unrelated to the intended use of the object. Adjusting the type of grasp applied to an object, according to the habitual use of the object, is infrequent within ACL 2.8. They usually grasp anything within reach with palmer grasp.
Within ACL 3.0, intentional grasp is adjusted to the intended use of the object. Evidence of attention to grasp can be observed in the different forms of grasp associated with common objects such as pencils, hammers, scissors and spoons. When a new object is introduced, the person will usually try to imitate a demonstration of a new grasp. However, different forms of pinch are too complex for people functioning within ACL 3.0. Pinch will probably be limited to the thumb and index finger, and middle finger.
When asked to "Hold this", the person is asked to combine intentional grasp with reaching out, taking the object and holding it in their lap or on a table. When holding is analysed, it is a complex process.
Intentional Release
Release is intentional when the person follows an instruction to let go, sets an object down on a surface, throws an object at a target, or deliberately drops something to watch it fall.
Carers are relieved when the request to "Let go" is followed by intentional release because a failure to do so can be painful within ACL 2.8.
Release usually consists of loosening their grip and allowing the object to be taken.
Intentional Reach / Target
The direction to "Hand it to me" asks the person to reach out. Handing an object to another person is more complicated because attention must be paid to the location of the person (target), reaching out, and loosening their grip.
Intentional reaching, within ACL 3.0, forms a link between the hand and the object that is formed in the cerebral cortex of the person. Evidence that verifies the cerebral connection usually requires a repetition of several intentional actions to eliminate chance or the force of gravity.
Intentional Manual Actions
Within ACL 3.0, a number of universal, fundamental human actions that control the hand are added to the scale.
Basic directions are routinely turned into games with infants and people with a cognitive disability enjoy them too:
- Take this.
- Hold this.
- Throw this.
- Kick this.
- Let go.
- Hand it to me.
- Shake my hand.
- High five.