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Marjorie De Leon

on 11 February 2015

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The Allen Cognitive Level Screen (ACLS)
help to identify the Allen Cognitive Levels of clients with Alzheimer's disease, dementia and other cognitive disabilities.
Running Stitch
3.0 Grasps leather or pushes it away. May not attempt to grasp the lacing or may grasp the leather lacing when handed to the person and moves leather lacing in a random manner.
3.2 Pushes needle through at least one hole, which can be the wrong location. May skip holes.
3.4 Completes at least 3 running stitches with no more than two demonstrations. Does not skip holes.

How to Use This Cognitive Assessment Tool
The screen consists of learning three visual-motor tasks (leather lacing stitches) with increasingly complex activity demands. Completion of the three tasks requires that the person attend to, understand and use sensory and motor cues from the material objects (leather, lace and needles), the administrator's verbal and demonstrated instructions and cues and feedback from motor actions while making the stitches.
General Notes
Start with the small ACLS and switch to the LACLS to compensate for impairments such as vision problems, hand tremors or hemiplegia.

Check the person’s vision by asking “Can you see the holes?” When beginning the whipstitch, check vision again.

"Once you understand someone's cognitive level, you know how to care for them" - Kim Warchol
also referred to as the
leather lacing tool
used to obtain a quick measure of
global cognitive

processing capacities
learning potential
performance abilities
and to detect unrecognized or unsuspected problems related to functional cognition.
The scores obtained are interpreted using the Allen Cognitive Scale of levels and modes of performance. The screen is available in two forms: the standard Allen Cognitive Level Screen (ACLS) and a larger form (LACLS) for person with vision or hand function problems.
The client is asked to complete three progressively difficult stitches.
The test is scored according to criteria provided in the test manual, based on the most complicated stitch the client was able to complete and the type of mistake(s) made.

This test evaluates only cognitive levels 3 to 5.8. if he or she can complete three consecutive cordovan stitches correctly without assisstance, a score of 5.8 is given.
The first is a running stitch, which is demonstrated and the client asked to replicate.
The second stitch ( whip stitch) is also demonstrated and the client asked to do a similar one.
Then, the therapist make a cross in the back of the stitch by holding the lacing below the hole in the back and pushing the needle through from front to back.
The client is asked if he or she can recognize the mistake and correct it. If he or she can, the therapists twist two stitches and asks the client if he or she can find and correct the mistake.

If the mistake is located and corrected, the client is next asked to figure out and replicate a cordovan stitch (the most complicated stitch in the rest) by looking at some stitches previously made by the therapist.
Allen Cognitive Level Screen Scoring Guidelines, 2000
3.6 Does at least one whipstitch in the correct location; no skipped holes.
3.8 Does not recognize twist, cross errors in back when cued. Does recognize running stitch error, but is unconcerned about error. May continue until out of space. May say,” Am I done?”
4.0 Does recognize twists or the cross in back as an error when pointed out. Does not attempt to correct twist or cross errors. Corrects running stitch errors on back when pointed out.
4.2 Corrects twist by redoing the last stitch. Does not untwist while lacing is still in the hole. Corrects errors in cross in back.
4.4 Can untwist at least one whipstitch without pulling it out. Stop after 3 stitches.
Single Cordovan Stitch
5.8 Complete 3 single cordovan stitches without a demonstrations or verbal cue by examining the sample stitches and using trial and error.
5.6 Completes 3 single cordovan stitches without a demonstration but requires a cue (verbal or pointing to location of error) to do the stitch correctly.
5.4 One (but only one) demonstration is given. Corrects errors in directionality, tangled lacing, or tightening in sequence without a second demonstration by altering actions two or more times.

It is permitted to hold the leather for persons who have the use of one hand. Be careful not to rotate the leather to show the person errors on the back. Tell the person to turn it as they want. If the person is using the non-dominant hand, the person may be slow. Reassure the person that it is not a timed screen and the person can take as long as the person needs.

Throughout the screen you may offer words of encouragement: “ Take your time; you are doing fine; I appreciate your efforts” Be careful not to give cues on how to do the stitch.
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