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OTD 8102: Week 3 Introduction to Allen's Cognitive Levels FOR

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Rick Davenport

on 30 May 2015

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Transcript of OTD 8102: Week 3 Introduction to Allen's Cognitive Levels FOR

OTD 8102 Course: Foundations of Occupational Therapy
Summer Semester 2015
Week 3

Introduction to Allen's Cognitive Levels FOR
Hartman, D. (2012) Did you find my brain? [Photograph] Retrieved from http://www.flickr.com/photos/29487767@N02/2845044715/
Cole and Tufano (2008) state:
limitations in cognitive ability create predictable safety issues in daily occupations and have been used to guide decisions regarding the client's ability to live independently, demonstrate autonomy in being self directed, and show competence in managing one's own affairs (p.185).
Background
Terminology
Terminology
Focus
FOR
Focus
According to Cole and Tufano (2008)(p.185):
Claudia Allen defines 'cognitive disability' as a global incapacity to do universal human activities. A biologically determined lack of attention impairs awareness of environmental cues but may spare memories of prior knowledge.
Claudia Allen began working on the cognitive levels at Eastern Pennsylvania Psychiatric Institute during the late 1960's
Foundation of Allen's cognitive levels was originally based on:
Piaget theory (1972) of intellectual development
Russian physiologist Alexandr Luria (1966) work.
According to Cole and Tufano (2008) Allen's Cognitive Levels FOR offer occupational therapists:
Detailed guidelines for assessing, assisting, and adapting environments for persons with cognitive disabilities (p.185).
Allen Cognitive Levels apply to all performance areas including: ADLs, IADLs, education, work, play, leisure, and social participation (p.185).
This FOR focuses on the role of cognition (a process skill), the role of habits and routines, the effect of physical and social contexts, and the analysis of activity demand (p. 185).
TEDxPioneerValley. (2012) The Brain Show, [Photograph] Retrieved from http://www.flickr.com/photos/tedxpioneervalley2012/6737976249/in/photostream/
TEDxPioneerValley. (2012) The Brain Show, [Photograph] Retrieved from
http://www.flickr.com/photos/tedxpioneervalley2012/6737976719/in/photostream/
Theory Basics 101:
Models: explain complex relationships between concepts and are overarching theories
Frames of Reference: guide practice by delineating the beliefs, assumptions, definitions, and concepts within a specific area of practice.
A frame of reference delineates evaluation processes and intervention strategies that are consistent with the theoretical base
Therefore we will use the same terminology that Cole and Tufano (2008) use in the text by using the title "Allen's Cognitive Levels FOR" (we will not use the title "Cognitive Disabilities Model")
Claudia Allen's Theoretical Assumptions
Levy's Cognitive Disabilities Reconsidered Model
Continued C. Allen Theoretical Assumptions
Theoretical
Perspectives

When the steps of a task are familiar and practiced routinely, as many self care tasks are (e.g., brushing one's teeth, taking a shower), people perform these tasks in the range of ACL 3) (in a habitual way that does not require much awareness). This is the brain's way of conserving energy for more difficult tasks (Cole & Tufano, 2008, p. 186).
Claudia Allen calls this 'Brain Conservation' It is when the brain tends to expend only the amount of energy necessary to adequately perform a task (Cole & Tufano, 2008, p.186).
Usable task environment
ACL 1. Automatic Actions
Conceptual and complex tasks
6
Allen's Cognitive Levels: 1 to 6
Potential
task environments
ACL 2. Postural Actions
ACL 3. Manual Actions
ACL 6. Planned Actions
ACL 5. Exploratory Actions
ACL 4. Goal-Directed Actions
Allen defines six cognitive levels (ACL 1-6) of performance to define the range of cognitive function and disability (scale of 0.8 to 6.8)(Cole & Tufano, 2008, p.189).
Below level 1.0
basically
comatose
Above level 6.0 is considered normal functioning
ACL 4.6 considered as minimal for living independently
Caveat is that dangerous items in the environment are removed or disabled and some supervision is available.
Description
OT Activities
Immediate task environments
Arm's Reach
Body
Self, internal cues
Visual Field
In a nut shell:
Claudia Allen has provided six clinically defined cognitive levels (ACL 1-6) and 52 cognitive modes to offer occupational therapists detailed guidelines for assessing, assisting, and adapting environments for persons with cognitive disabilities (Cole & Tufano, 2008, p.185).
Allen provides specific guidelines for structuring the task environment at each cognitive level (ACL 1-6) to optimally facilitate a client's best ability to function. (Cole & Tufano, 2008, p.186).
The task environment is the setting in which the task is performed, including furniture and seating, lighting, temperature, placement of supplies, equipment available, and other attributes affecting occupational performance (Cole & Tufano, 2008, p. 186)
According to Allen, as cognitive levels increase, awareness of the environment expands. (Cole & Tufano, 2008, p.186).
1
5
4
3
2
ACL 4 clients are most tuned in to visual cues. This means they learn best by visual demonstrations and by seeing a completed sample of the goal. This does not mean that a client functioning at level 4 does not hear verbal instructions or cannot read written instructions. It simply means that visual cues are the most efficient way for him to learn. (Cole & Tufano, 2008, p. 187).
C. Allen uses the concept of Task Equivalence to identify daily life activities that have similar physical and cognitive demands based on task analysis. Task analysis is a method of determining the complexity of an activity by separating the activity into steps and determining the physical and cognitive functional capacities required to perform each step. (Cole & Tufano, 2008, p.186.
Linda Levy (2005) updates Claudia Allen's Cognititve Levels FOR in two important ways (Cole & Tufano, 2008, p.187).
1) by revising the interactions and categorizations of memory within the information processing model
2) by grounding the ACLs within occupational performance and best practice (Cole & Tufano, 2008, p.187).
Sensory Perceptual Memory:
Levy notes that when deficits exist, little information is transmitted to working memory for processing.
some dementia research has suggested that deficits in visual and auditory perceptions are related to the severe perceptual distortions of hallucinations and delusions that often occur in severe stages of the disease (Leiter & Cummings, 199, in C & T, 2008, p.187).
Working Memory:
Levy states working memory coordinates perceptions with long-term memory

Intact working memory retrieves relevant information stored in long-term memory, while at the same time screening out distracting sensory information so that a person can focus on a task. (C & T, 2008, p.188).

Working memory provides all the information needed for performing occupations.
Long-Term Memory:
Know the differences between
1) Explicit Memory Stores (i.e., semantic and episodic)

2) Implicit Memory Stores (i.e., procedural, perceptual priming, and conditioning)
Prickett, A. (2012). My mom and grandma [Photograph] Retrieved from http://www.flickr.com/photos/andrewprickett/5381737044/
Allen utilizes results from assessment tools such as the:
1) ACL screening (ACLS) assessment - leather lacing stitches,
2) Allen Diagnostic Module (ADM),

to predict which task "equivalent" corresponding daily activity it matches.
Students practicing administering the ACLS.
Concrete tasks
Several-step tasks
Gross-motor, games, dance
Sensory stimulation
Simple, repetitive tasks
Table was distilled from Cole and Tufano (2008) tables titled: Allen's usable task environments at different cognitive levels, and Allen's cognitive levels: 1 to 6 (pgs. 186-189).
Be good to know how to differentiate between all 6 ACL levels
Be good to know how to differentiate between all 6 ACL levels
Be good to know how to differentiate between all 6 ACL levels
Be good to know how to differentiate between all 6 ACL levels
Be good to know how to differentiate between all 6 ACL levels
Be good to know how to differentiate between all 6 ACL levels
The End
Catherine Earhart on Claudia Allen Scale
April 2013
Students from OTD Class of 2015 pictured with Claudia Allen & Dr. Whaley at the AOTA 93rd Annual Conference in San Diego, CA.
Full transcript