The person may be able to coordinate the movements for bending over, trunk or torso rotations and upper and lower extremity exercises.
Their interest in diagonal lines generalises to crossing the midline of their body when doing exercises.
Their balance is usually dependable on stairs when railings are available.
The changes in causing effects that the person makes while using tools tend to be extensions or rotations of the movements of their arm, e.g. pounding nails with a hammer, turning screws with a screwdriver, stirring with a long spoon.
Causing a different effect is explored and discovered, one cause and effect connection at a time.
The form of grasp and pinch may be changed and rotated, usually with one hand, to cause a different effect.
The standard for judging effects is a personal choice about fitting into the pattern. When other standards of performance are suggested, the alternatives are apt to be ignored, shrugged off, rejected, or fought about. Conforming to alternatives is rare, and dire threats are scarcely ever effective.
Preventing negative investments of time and energy in social conflicts can be done if other people will avoid verbal arguments and threats to the person's dignity. If the person will do activities that they can still do, their time and energy can be engaged in positive experiences and diverted from causing trouble.
Tool Use
The following example uses a tool, held on a diagonal, to open a can of paint. A primary lever is held on the diagonal. Within ACL 5.0, the person usually places the screw driver on the diagonal and presses down. If the lid does not come up, more pressure may be applied to the same spot or the screwdriver may be moved to a different spot. The cause and effect connections may be retained as images in memory. When the person has done this before, those memories may be mentioned if the lid is stuck. However, verbal directions about what to do for a stuck lid are usually ignored because they do not understand them.
Opening a can of paint was selected to serve two purposes. One, diagonal lines are not limited to crafts. We learn about levers in physics and crossing the mid-line in kinesiology. Elementary concrete information is being used in ACL 5 in many different activities.
Two, a cognitive disability reduces what the person can do with elementary information. The person can do just so much, and that is all. They have a right to do what they can do, but we do not have a right to push them to do more than that. Pushing can become mean therapy. Best ability to function aims at objectively measuring how much they can do. Hopes for the person have a slippery tendency to get nasty when they turn into nagging demands that they do better than they can. Within that context, the need for an objective, sensitive and accurate assessment is clear.