The cognitive disabilities model had its beginnings at the eastern pennsylvania psychiatric institute in the late 1960 ’ s when claudia K. Allen, MA, OTR, FAOTA and her colleagues first observed patterns of performance difficulties in adult patients with mental disorders.Cognitive based learning in seeking to better understand and thereby serve the needs of these individuals, allen and other therapists began a systematic and careful collection of observations of these difficulties.Cognitive based learning the focus of inquiry at that time was the “sensorimotor actions originating in the physical or chemical structures of the brain and producing observable and assessable limitations in routine task behavior” (allen, 1985).Cognitive based learning the construct of “functional cognition” has since become a useful term for describing the focus of concern of the cognitive disabilities model.Cognitive based learning functional cognition encompasses the complex and dynamic interactions between an individual ’ s cognitive abilities and the activity context that produces observable performance.Cognitive based learning

Allen and her colleagues first observed and described a sequence of six levels of abilities, called the cognitive levels, in the 1960 ’ s and early 1970 ’ s.Cognitive based learning the cognitive levels were conceptualized as a hierarchical sequence of sensorimotor abilities similar to the developmental levels of cognition described by jean piaget.Cognitive based learning these underlying global cognitive abilities produced clinically observable, qualitative differences in abilities to perform functional activities.Cognitive based learning based on her observations of functional performance, allen hypothesized that this sequence could be observed in the progression and remission of mental illness, dementia, and fatigue in adult individuals.Cognitive based learning

Work on the levels continued by allen and others at johns hopkins hospital in baltimore and after 1974, at LAC+USC medical center in los angeles.Cognitive based learning A test of learning three increasingly complex sewing stitches on a piece of leather, now known as the allen cognitive level screen (ACLS), was developed to provide a quick measure of learning and problem solving abilities.Cognitive based learning A standardized procedure for administering the ACLS was developed in 1978 (moore, 1978). Several studies followed, establishing inter-rater reliability and correlations between the ACLS and other psychological tests including the block design of the WAIS, the brief psychiatric rating scale, shipley institute of living scales, and the symbol digit modalities test.Cognitive based learning other studies examined the relationship of cognitive level, as measured by the ACLS, to different psychiatric disorders, and between normal and psychiatric populations.Cognitive based learning the standardized directions for the ACLS were first published in the text occupational therapy for psychiatric diseases: measurement and management of cognitive disabilities (allen, 1985) and revisions in ratings were made in 1988, 1990, 1996, and in 2000.Cognitive based learning

In 2007 the fifth version of the allen cognitive level screen (ACLS-5) was published. The six contributing authors relied on feedback from various stakeholder groups in academic and practice settings and were guided by the standards for educational and psychological testing (AERA, et al., 1999).Cognitive based learning this process continued the tradition begun by allen of relying on the skilled experiences and opinions of many expert clinicians to develop the tools used in the cognitive disabilities model.Cognitive based learning the fifth version defined the construct of “functional cognition” as encompassing “both functional performance and the global cognitive processing capacities of the brain” (allen, et al., 2007).Cognitive based learning the structure of the test and its links to theory were described, as was the intended use of the assessment as a screen to guide further interventions.Cognitive based learning

During the 1980 ’ s, allen and therapists at the LAC+USC medical center became increasingly aware that they were unable to adequately account for clinically significant improvements observed in functional activities with the existing 6 point cognitive level scale.Cognitive based learning as a result, an effort to identify the elements of an expanded scale began in 1990. The modes of performance, a 26 point expansion of the original 6 cognitive levels, were published in occupational therapy treatment goals for the physically and cognitively disabled in 1992 (allen, earhart, & blue, 1992).Cognitive based learning in this text, allen also articulated the framework for a clinical practice theory. Assessment tools described included the ACLS-90; the routine task inventory-2, an analysis of fourteen activities of daily living by cognitive level; and the cognitive performance test, six standardized tasks of daily living analyzed by cognitive level.Cognitive based learning the routine task inventory-expanded (RTI-E) has since been developed by katz (2006) and the CPT has been used to assess function in persons with dementia (burns, 1994).Cognitive based learning

In 1993, catherine earhart, allen, and other experienced therapists at LAC+USC medical center combined their extensive clinical experience to develop the first edition of the allen diagnostic module, a collection of 26 craft based performance assessments that engage new learning and problem solving abilities.Cognitive based learning the materials and procedures used in each assessment were standardized to introduce predictable problems to solve while engaging the individual ’ s energies in making a useful and attractive object such as a greeting card or a key chain.Cognitive based learning an extensive manual provided protocols describing the dynamic administration and scoring of each assessment. The ADM administration manual was updated in 2006 with expanded guidelines for use and a format guided by the standards for educational and psychological testing (AERA, et al., 1999).Cognitive based learning the ADM-2 nd edition contains 35 assessments with task demands ranging from modes 3.0 through 5.8 on the allen scale of modes of performance.Cognitive based learning the photo above illustrates the set up of the recessed tile box, one of the ADM performance assessments.

Currently, the cognitive disability model and related tools are used by therapists practicing in the areas of mental health, forensic psychiatry, rehabilitation medicine, and geriatric care.Cognitive based learning interventions vary by setting and the clinical problems to be solved. In acute care settings, changing functional capacities are assessed and monitored for anticipated improvements.Cognitive based learning the photo on the left illustrates the set up for the leather key fob, another ADM performance assessment. In post-acute or stable conditions, the allen scale of levels and modes provides a specific activity analysis that identifies the cognitive and motor requirements of meaningful activities that the individual wants to do.Cognitive based learning this assists therapists to identify realistic goals that match current abilities. In deteriorating conditions, therapists may recommend meaningful activities that help maintain abilities, protect the person ’ s safety, and reduce the burden of care.Cognitive based learning in all settings, understanding remaining abilities fosters a realistic optimism for success in participation in community life.