When people have cognitive disorders of any type, the degree of these disorders and the remaining abilities need to be assessed. The results of such an assessment help operational therapists plan a course of treatment and give personalized recommendations for proper care. One of the ways to do it is to use the Allen Cognitive Levels (ACL). Let’s see what the ACL levels are and in what way they can be useful.
The Allen Cognitive Scale includes six levels that are numbered in the following way: level 1, level 2, level 3 and so on.
To understand the set of ideas better, let’s have a look at this Allen Cognitive Levels chart:
|Level number||Description of a person’s abilities||Required amount of care|
|ACL 1||Just awareness based on sensory interventions like a flashing light, a sound, etc. (automatic actions)||Total assistance with a round-the-clock supervision (turning in bed, feeding or assisting with eating, voiding, bathing)|
|ACL 2||Gross body movements (the person can move, yet, without understanding the effects these movements have on the people or objects nearby)||Maximum assistance with a round-the-clock supervision (providing food, assisting with walking, preventing aimless wandering, stabilizing furniture, etc.)|
|ACL 3||Manual actions (the person can manipulate different objects but is easily distracted and is unable to learn new patterns of behavior)||Moderate assistance in daily activities with a round-the-clock supervision (providing everything necessary for essential activities, removing dangerous objects, reminding of the necessity to go through all the steps, making decisions)|
|ACL 4||Familiar activity (the person can live alone provided he or she is given cues to follow)||Minimum assistance with daily visits (reminding something, solving problems connected with changes in ordinary routine)|
|ACL 5||Learning new activity (the patient is capable of learning to do something new, though he or she can make errors in the process of learning)||Distant supervision with weekly visits and verbal cuing (checking the safety, giving advice)|
|ACL 6||Planning new activity (the person can make plans that are in line with the goals)||Independent|
Claudia Allen, the developer of this system, divided the levels into several sub-levels, the so-called cognitive modes of performance. The modes (4.4, 5.2, etc.) serve the purpose of characterizing a person’s cognitive functioning more specifically. There are five of them in each level, except ACL 6, so the Allen Cognitive Levels include 26 points. They show how a person’s brain moves from level to level.
The modes ending with zero (.0) give general information for the whole level, including some information from the previous one. The modes ending with two (.2) characterize time and place when people get overwhelmed. The ones ending with four (.4) describe the level. Any mode that ends with six (.6) touches upon an individual’s ability to shift his or her thoughts to the next ACL level. For example, mode 1.6 (ACL 1) refers to a person’s ability to roll in bed without being stimulated by the caregiver, which means that this person’s thoughts are close to ACL 2. But unlike people who are at ACL 2, they usually do it without any purpose. These are just automatic actions.
What concerns the modes ending with eight (.8), they describe a person’s ability to understand information from two different levels, though they cannot recognize and explain how this information fits together. Thus, being at sub-level 3.8, a person uses all senses and any objects to perform an activity (ACL 4 the characteristic feature of which is goal-directed activity), though often with errors.
Normal ACL Levels
While the Allen cognitive levels 1, 2, 3, 4 and 5 imply that the patient has cognitive disorders which range from severe to subtle and to this or that extent is dependent on a caregiver, the ACL level 6 means the absence of cognitive impairments. People whose level of performance has been defined as ACL 6 are considered to have normal cognitive abilities since they are capable of considering several plans and determining criteria for choosing the best plan and are independent in everything.