Allen Cognitive Disabilities Model (ACLs)
- Based on Claudia Allen’s observation of adult patients with persistent mental disorders.
- Focuses on understanding functional cognition.
- Mental illness often results in the diminished ability to perform ADLs and to function in the community.
- Cognitive impairment may be temporary or permanent.
- Approaches
- Modifying activities
- Modifying environments
- Establishing and restoring performance skills and activity patterns, e.g., routines
- Maintenance and prevention of the client’s best ability to function
ACL
- Provides a tool to assess client’s cognitive functioning via sensorimotor observation.
- Involves replicating three increasingly complex stitching patterns.
- There are 6 levels in Allen’s model of cognitive levels.
- Each level provides a description of the client’s level of functioning for familiar activities and to learn new ones.
- Each increase in cognitive level is cumulative and assumes the abilities of the prior levels.
- Standardized face-to-face test
- Remains one of the most widely utilized tools for OTs to assess clients, e.g., dementia
- Stitches
- Running (task 1): requires 3 correct running stitches in consecutive holes.
- Whip (task 2): requires 3 correct whip stitches in consecutive holes and recognizing cross-in-back and twisted lace errors.
- Single Cordovan (task 3): requires 3 correct single Cordovan stitches in consecutive holes.
Level 1 – Automatic Actions
- Arousal to external cues
- Mostly instinctual behavior
- Examples: swallowing, diverting attention to stimuli
- Requires total assistance
Level 2 – Postural Actions
- Characterized by gross movement in response to proprioceptive cues.
- Behavior is driven by comfort vs. discomfort.
- Clients are unaware of the effects of their behavior on their surroundings.
- Involves aimless pacing and wandering.
- Requires maximum assistance.
Level 3 – Manual Actions
- Clients grasp and use objects.
- Increased ability to discriminate the external from the self.
- Impaired global condition
- May acquire new behaviors (learning) with repetitive long-term training.
- Lack of concentration and requires frequent redirection for tasks.
- Needs 24-hour supervision.
- Requires moderate assistance.
Level 4 – Goal-directed Actions
- Clients can recognize the effects of their actions on their surroundings.
- Relies on visual cues to learn and carry out goal-directed activities.
- Have difficulty recognizing finer details.
- Lack of cognitive skills to identify and problem-solve errors.
- No new learning or generalizing of tasks.
- Requires minimal assistance and supervision.
- Examples: preparing a snack, following a familiar route.
- 4.6: independent living
Level 5 – Exploratory Actions
- Uses trial-and-error for problem-solving.
- Learn by emulating demonstrated actions.
- May apply learning to other activities and situations.
- Limited ability to organize, anticipate, and plan.
- Have poor judgment and are impulsive.
- Benefits from external cues via supervision for planning.
- Requires stand-by assistance.
Level 6 – Planned Actions
- No global cognitive impairment.
- Normal functioning.
- Anticipates and prevents errors.
- May still have physical limitations.
- Independent
Modes
Each cognitive level (1-6) is further divided by 5 additional modes of performance: .0, .2, .4, .6, and .8 (even-numbered).
Scoring
Care Partners Pathway ACL Screen Presentation: Pages 47-49 [Official Link] [Mirror]
Compensatory Techniques
- Level 1: Sensory stimulation
- Level 2: Preventing getting lost or going into unsafe areas
- Level 3: Assistance with self-care
- Level 4: Maintaining the home
- Level 5: Planning and supervision
- Level 6: None needed
Further Reading
References
Kang JR, Tadi P. Allen Cognitive Level. [Updated 2021 Mar 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556125/
Austin, S. A. (2009). Hierarchies of abilities and activity demands in the Allen Diagnostic Module 2nd Ed.: A validity study (Unpublished doctoral dissertation.). University of Illinois, Chicago.
Cole, M. (2012). Group dynamics in occupational therapy: The theoretical basis and practice application for group intervention (4th ed.). Thorofare, NJ: SLACK Incorporated.
Allen Cognitive Group. (n.d.). Core Concepts. Retrieved from https://allencognitive.com/core-concepts/
Pye, A., Charalambous, A. P., Leroi, I., Thodi, C., & Dawes, P. (2017). Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review. International Psychogeriatrics, 29(11), 1771-1784.