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Allen Cognitive Levels & Rancho Los Amigos Scale Connection

ACL Allen Cognitive Levels  RLAS Rancho Los Amigos
ACL 0 Coma 1   No Response 

Total Assistance

Patient does not respond to external stimuli.
– No observable change in behavior when presented with any kind of stimuli.
0.8 Generalized reflexive actions 2    Generalized Response

Total Assistance

Patient reacts to external stimuli in nonspecific, inconsistent, and non-purposeful manner with stereotypic and limited responses.

Total Assistance

Automatic Actions

Automatic motor responses. Behavior is mostly reflexive
Minimal awareness of and reaction to the external environment
• Arousal and response elicited for only a few seconds at a time

1.0 Withdraws from noxious stimulus 3    Localized Response

Total Assistance

Patient responds specifically but inconsistently to stimuli and may follow simple commands for motor actions.
Reacts to pain by withdrawing or moaning. Blinks at strong light and follows moving objects. Turns toward sound. May respond to simple commands, to family or friends but not other people. 
1.2 Responds to stimuli with one sensory system
1.4 Locates stimuli
1.6 Rolls in bed
1.8 Raises body parts

Max Assistance

Postural Actions

Can overcome the effects of gravity
• Can imitate gross motor actions
There is a lack of awareness of the effects that actions have on objects or other people
Maximum assistance with all activities
May assist caregiver with simple tasks – can assist with hygiene and dressing, and feed self with finger food
• ADLs can be accomplished by imitation
Safety risk for wandering

2.0 Overcomes gravity/sits 4   Confused/Agitated

Max Assistance

Patient exhibits bizarre, non-purposeful, incoherent, inappropriate behaviors. Has no short-term recall and attention is short and nonselective. Completes simple, routine tasks with assistance. Overly focused on basic needs, such as eating, going to the bathroom, etc. Has difficulty following directions. Does not understand feelings or what is happening in surroundings.
– Heightened state of activity, may move constantly, movements not purposeful. May run away or become aggressive. Responds to stimuli by acting out– hitting, yelling or screaming, using abusive language, extreme behavior due to confusion, may need restraints to avoid self-injury
2.2 Righting reactions/stands
2.4 Aimless walking
2.6 Directed walking
2.8 Uses grab bars

Mod Assistance

Manual Actions

Uses hands to manipulate objects. 
• Responds to tactile cues to perform manual actions
Emergence of cause and effect, but actions are disorganized
Performs familiar ADL tasks (e.g. basic grooming) independently with some reminders
• Attention span is short (maximum 30 minutes). Easily distracted by environmental stimuli

3.0 Grasps objects 5   Confused, Inappropriate Non-Agitated

Max Assistance

Alert, not agitated, may wander. No orientation to person, place or time. Absent goal directed, problem solving, self-monitoring behavior. Continues to focus on basic needs. May be able to complete familiar tasks with structure and cuing- needs step by step instructions to complete simple, everyday tasks. Uses objects inappropriately. Consistently follows simple commands. New information is not retained.
-Activity often random with no direction. Cannot learn new tasks. No ability to problem solve or monitor own behavior
3.2 Distinguishes objects
3.4 Sustains actions on objects
3.6 Notes effects on objects
3.8 Uses all objects

Min Assistance

Goal Directed Actions

Big step for independence
Activities are purposeful and able to perform short tasks
Minimal assistance with familiar, goal directed activities
May be able to carry out established routines- basic ADLs are intact, may ask for assistance
Unable to cope with unexpected events or changes in routine
Difficulty learning new tasks and generalizing skills.
• Relies heavily on visual cues. Requires visual demonstrations for tasks because cannot follow verbal and written directions
Needs assistance with new tasks, for anticipating needs

4.0 Sequences familiar actions 6   Confused, Appropriate

Moderate Assistance

Patient demonstrates carry-over for relearned familiar tasks (e.g. self-care) but not for new tasks. Able to follow simple directions. Able to complete familiar activities with supervision. Requires assistance for new activities. Moderate assistance to problem solve during tasks. Able to pay attention to familiar activities for up to 30 minutes with some cueing. Unaware of impairments, safety risk. 
– Able to complete familiar activities with supervision. Able to follow a schedule with assistance- may become confused by changes in routine.
4.2 Differentiates features of objects
4.4 Completes familiar goal
4.6 Personalizes features of objects
4.8 Learns by rote memorization

Standby Assistance/Supervision 

Exploratory Actions

New learning can occur and can generalize skills
Can learn independently through exploratory actions and trial and error
• Participates well in concrete tasks 
• Able to alter actions through trial and error
Poor organization, planning and socialization

5.0 Comparing and changing variations in actions and objects 7    Automatic, Appropriate

Minimal Assistance for Daily Living Skills

Patient performs daily routines automatically, and shows carry-over for new learning. Will be able to follow a schedule. Will demonstrate impaired safety awareness and judgment. May express interest in completing an activity, but may require assistance actually completing it. 
– Minimal assistance to complete familiar tasks, including self-care and household tasks. Requires minimal supervision for new learning and able to carry over new learning. May have problems planning, initiating, and completing activities.
5.2 Discriminates parts of activity
5.4 Self-directed learning 8    Purposeful, Appropriate

Stand-By Assistance

Patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels. Able to independently complete new tasks once learned. Independently attends to and completes tasks in spite of distractions.
5.6 Considers social standards 9    Purposeful, Appropriate

Stand-By Assistance- on request

Patient able to shift between tasks. Aware of limitations. Able to acknowledge the needs of others and self-monitor social interaction with stand-by assistance. Will consider the point of view of others during conversation.
5.8 Consulting with others

Modified- Complete independence

Planned Actions

No global cognitive impairment
Independent with all activities
• New motor learning can be done safely and consistently.
• Hazardous situations are anticipated and avoided, or help is sought when needed.
• Mobility, communications, and maintenance of adaptive equipment is self-monitored.
• Able to think of hypothetical situations and plan ahead to prevent mistakes
• Able to consider the consequences of actions
• Able to follow multi step verbal or written cues

6.0 Typically functioning adult brain and functional cognitive capacities 10   Purposeful, Appropriate

Modified Independent

Patient independently carries out daily routine, may need extra time/adaptive strategies. Will compensate for memory loss by using adaptive aids or methods. Able to obtain or create own memory aids. Able to multi-task, may need periodic breaks

Comparing the Allen Scale of Cognitive Levels and Modes with Other Global Measures of Function
Catherine A. Earhart BA, OT Cert., OTR/L and Claudia K. Allen, MA, FAOTA, OT