Allen Cognitive Levels: Scale & Description

Instructor: Gaines Arnold
When an individual has a cognitive deficit for any reason, how do you assess them? This lesson discusses the Allen Cognitive levels as to what they are, what the scale developed from the levels are, and how people are screened.

Patient Assessment

The new patient in the rehabilitation hospital had been placed in a room to await assessment. He had been thrown from a horse and struck his head when he fell. Georgia was tasked with assessing how profound his deficits were and she was also to recommend a beginning course of treatment. The patient responded to a change of light in the room by moving his head when the light dimmed or increased in brightness. He was able to respond to the prick of a pin and he could raise his arm when directed. He seemed unable to get up from the bed, so Georgia understood the limits of his present abilities. She presented her findings to the care team and together they used the Allen's Cognitive Levels to determine how they should proceed in treatment.

What are Allen's Cognitive Levels?

Claudia K. Allen is an occupational therapist and theorist who developed a six level test of cognitive functioning. Her work is used any time an individual has a disease or disability resulting in diminished cognitive capacity and the professional needs to understand a person's level of cognitive functioning. According to the Allen cognitive levels website, understanding a few set ideas is necessary prior to using the Allen Cognitive Levels.

  • There are six levels of performance numbered from 1-6: awareness, gross body movements, manual actions, familiar activity, learning new activity, planning new activity.
  • Within each level there are three components: attention, motor control and verbal performance.
  • To characterize more specifically the cognitive functioning of individuals, Allen delineated modes within each of the six levels (i.e., 3.2, 6.8, etc.).
  • The modes are: .0 - information from the whole level, .2 - characteristics of time and place, .4 - description of the level, .6 - shifting of thought orientation to the next level, .8 - information from two levels understood, but how the two fit together is unrecognized. These will be explained in greater detail later.
  • Functioning has three parts. What a person: can do, will do, and may do.
  • As the therapist is using the cognitive levels to assess the individual, they are also treating the person.

The cognitive level screen is used to determine at what level an individual is at, at the beginning of treatment and at all points during treatment. It is a guideline that occupational therapists, and other healthcare professionals, use to determine if treatment is effective or if another mode of treatment is needed.

The Allen Cognitive Levels Scale

The Allen Cognitive Levels Scale was developed from the research of Allen and her colleagues. It is a guideline that can be used to determine initial and subsequent levels of cognitive functioning. The scale has the following elements:

  • Level One: Awareness - the individual's cognition is severely compromised. For example, at level 1.4 an individual is only able to locate stimuli (such as a sound or flashing light).
  • Level Two: Gross body movements - individual's cognition still severely compromised, but he or she has the ability to move. However, this movement is not accompanied by an understanding of how that movement effects other people or objects. For example, at level 2.2 an individual can only overcome gravity (meaning they can only move limbs up or down).
  • Level Three: Manual actions - the individual's cognition remains significantly impaired, but now the patient can react to a situation and use tools. The individual requires supervision to complete daily activities, such as hygiene.
  • Level Four: Familiar activity - this individual has moderate cognitive impairment and can direct their own actions given cues. For example, an individual at level 4.6 can live alone and care for themselves, but the individual still requires daily visits.
  • Level Five: Learning new activity - at this level, the patient is only mildly impaired and can learn new activities through a trial-and-error process. For example, at level 5.2 the individual is able to curb impulsive actions when directed and may be able to maintain employment with a coach.
  • Level Six: Planning new activity - there is no cognitive impairment. The individual is able to make plans that best fit their goals.

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