"Once you understand someone's cognitive level, you know how to care for them" - Kim Warchol
Goes U P !
Why is knowing functional outcomes useful?
Quality of life
and feeling of
value
- measure change in ability to function
- set up home program and teach caregiver how compensations work
- help caregiver understand how much change can be expected
- acknowledge if problem is acute or chronic:
- possible improvement: CVA's, TBI's
- stable: Alzheimer's old CVA's , TBI's 3-6 mo post
Claudia Allen
When dealing with disabled people, most can't do what they used to be able to do...
How the functional levels work
Allen's Cognitive Levels
MOTIVATION IS IMPORTANT
The Levels
So...
If we know how a mentally disabled person perceives their environment, we can help enhance behavioral responses
0.8 - Coma
1 - Awareness
2 - Gross Body Movements
3 - Manual Actions
4 - Familiar Activity
5 - Learning New Activity
6 - Planning New Activity ("normal")
Allen Cognitive Level Screen
And...
ACL's at TNC
- utilize "functional cognition"
- what brain pays attention to
- how it determines what it needs to do tasks
- learn how brain, through processing signals from environment, controls actions
- mainly determined by parts of environment brain is paying attention to
- assets and limitations both recognized
Remaining abilities can be put to use doing activities that are interesting to the person
- OT at Eastern Pennsylvania Psychiatric Institute -1960's
- Patterns of performance difficulties in mental disorders
- Understand and better serve needs
- Described hierarchical sequence of 6 sensori-motor abilities - the cognitive levels
- Became basis of the Allen Battery Assessment
Sub Levels/Modes
Each has 3 components:
- attention
- motor control
- verbal performance
- An Allen Battery Assessment tool
- AKA the leather lacing test
- 3 visual-motor tasks of increasing complexity
- Screen functional cognition for persons whose cognitive abilities appear to be in range of 3.0-5.8
- ACL screen is done upon patient admission
- Objective measure for problem solving to get FIM score
- Functional Independence Measure
- Scale to measure progress of ADL skills
- ACL score has a correlating FIM score
- FIM given to insurance companies as predictor of length of stay
- low score - longer stay
- high score - shorter stay
- Guides OT interventions at the level of activity demands, performence skills and occupations
.0 - Bits of information of whole level
.2 - Distinctive characteristics of time and place; easily overwhelmed
.4 - Repeated use of information- classic description of level
.6 - Open to next level; thought orientation shifts up
.8 - Infor added from the next level but can't understand how the pieces fit together; inflexible.
Function and Abilities
Function = combo of what the person:
- CAN do
- realistic abilities, limited by disabilities
- WILL do
- relevant abilities, psychological and limited by motivation
- MAY do
- possible abilities, limited by care givers and financial means