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Introduction

Allen’s cognitive levels demonstrate what a client can do at each level of cognitive function. The assessment tool used is the Allen’s Cognitive Level Screen (ACLS). This assessment method requires that the client use lacing leather to lace different patterns. The results of the assessment demonstrate the client’s cognitive level, which includes their potential to learn and problem-solve. Given the score, the therapist identifies what the client’s capabilities are and safety hazards for the client. In addition, the therapist can determine interventions and adaptive equipment that will suit the client’s cognitive level.

Theory

The Person Environment Occupation (PEO) Model of Occupational Performance assists to identify the relations between the person, environment, and occupation. The person component focuses on the behavior of the person such as: motivation, degree of autonomy, and emotional responses. The environment component is considered from the unique perspective of the person, household, neighborhood, and community. Demands and cues about expected and appropriate behavior are received from the environment continuously. The occupations, self-directed meaningful tasks and activities, will be engaged in throughout the lifespan (Law et al., 1996). For substance abusers, each component of the PEO model is paramount. The interaction of the three components result in occupational performance. PEO is an approach in identifying the deficits intervening with an individual’s occupational functioning. Optimal function or occupational performance results from a good fit between these three components. Maximum fit relates to optimal occupational performance, whereas minimum fit relates to minimum occupational performance, consequently resulting in dysfunction (Law et al., 1996).

Evidence

Due to the ACLS being successful in assessing individuals with various mental health disorders, Mota, Pedrero-Perez, Huertas-Hoyas, Merritt, and MacKenzie (2016) examined if the ACLS can be applied to individuals seeking substance addiction rehabilitation. The authors concluded that the ACLS was useful for individuals with substance addiction. A small percentage of the tested population received a score of being independent. This supports the finding that individuals with substance addiction are cognitively impaired, thus requiring cognitive rehabilitation. Many clients did not reach a level 5, which indicated an impairment in performing tasks daily. The ACLS is useful in identifying cognitive function in clients with substance addiction, in order to create an appropriate intervention plan.

Case Study

Gigi is a 35-year-old woman who overdosed on alcohol. She has been abusing alcohol for about two years, and has been drinking hard liquor at every waking hour for the past month. She was found by her 10 year old daughter passed out on the bathroom floor and called for help. After getting her stomach pumped and being hospitalized for 2 days, she has become disoriented, specifically with the date. After conducting an Allen’s Cognitive Levels screen, Gigi scored as a level 3.8, with 46% cognitive assist, and 10% physical assist. She requires 24-hour supervision for all activities of daily living. She is able to pay attention to cause an effect, can match and can do 3-step sequencing. She’s experiencing limited communication but is able to say “I’m done” when finished. She can also name the activity, but forgets what the activity is. It may take her 3 weeks to learn a new routine, and will need reminders and a lot of verbal cues when bathing time. Since she is unable to follow a daily routine, it is affecting her ability to complete tasks that require more than 3-steps. The hospital’s inpatient occupational therapist has been assigned to her in order to help her reach her goals.

Intervention Plan

Problem Statement:

Gigi is unable to follow a daily routine secondary to deficits in sequencing tasks.

Short-Term Goals:

1. Gigi will verbalize and perform a 4 step self-care task (washing hands, face, teeth) using forward chaining with minimal verbal cue in two weeks.
2. While engaging in an activity, Gigi will accurately name and describe the activity being done 4 out of 5 times correctly when asked by the therapist.
3. Gigi will independently verbalize the current date (i.e. Day, Month, Year) using a calendar to improve temporal orientation in two weeks.

Long-Term Goals:

1. Gigi will perform a 3-task morning self-care routine with minimal verbal cues to increase independence in ADLs in four weeks.
2. Gigi will be independent in self-care with the implementation of environmental modifications to improve occupational performance in four weeks.

Intervention Format:

Individual

Setting:

Gigi will meet with the occupational therapist in the hospital while in inpatient rehab for 1 hour 3x/week for 1 month.

Supplies:

None

Agenda:

• Therapist meets and builds rapport with Gigi (5 min)
• Therapist conducts interview and develops Gigi’s occupational profile with her family (15 min)
• Therapist administers Allen’s Cognitive Levels screening to determine her cognitive level (15 minutes)
  • Gigi scored as a level 3.8, requiring 46% cognitive assistance and 10% physical assistance
• Therapist educates caregiver on importance of safety, home modifications to increase occupational performance, and providing visual and tactile cues (10 min)
• Therapist will provide a summary of the session and elicit feedback (5 min)

Documentation

S: Caregiver reported client had limited communication, and had poor orientation. Caregiver also stated that she cannot complete tasks with more than 3-steps on her own.

O: Client participated in an Allen’s Cognitive Levels screening to test her cognitive status. Results showed client needing 46% cognitive assistance and 10% physical assistance. Therapist educated caregiver on important strategies for safety, home modifications for improvement in occupational performance, and providing visual and tactile cues.

A: Based on screening results, it is evident that client would benefit from interventions that include cognitive adaptations and environmental modifications to improve her current cognitive level.

P: Edie will continue working on following a daily routine in order to improve her deficits in sequencing tasks. Client will continue meeting with the occupational therapist for 1 hour 3x/week for 1 month.

References

—Allen, C.K., Earhart, C.A., & Blue, T. (1995) Understanding Cognitive Performance Modes Ormond Beach FL: Allen Conferences

David, S., Riley, W., (1989) The Relationship of the Allen Cognitive Level Test to Cognitive Abilities and Psychopathy. The American Journal of Occupational Therapy. (44) 493-497. doi:10.5014/ajot.44.6.493.

Mota, G., Pedrero-Perez, E., Huertas-Hoyas, E., Merritt, B., & MacKenzie, D. (2016). Allen Cognitive Level Screen for the Classification of Subjects Treated for Addiction. Scandinavian Journal of Occupational therapy. (24), 290-298. doi.org/10.3109/11038128.2016.1161071

Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1):9-23.