Cognitive Disabilities Model: Definition & Levels

Instructor: Lisa Millraney

Lisa has 27 years of experience treating speech, language, memory and swallowing disorders. She has a master's degree in speech pathology from Vanderbilt University.

In this lesson, you will learn how the cognitive disabilities model is used to assess people with dementia, and how the model helps caregivers predict patient's abilities and plan activities for them. Therapists use this model, outlined by the Allen Cognitive Levels, to help their patients succeed in their daily lives.

A Gradual Decline

Caregivers of people with dementia are constantly following the moving target of the disease, and often are not sure what they should be looking for in the behaviors of the person in their charge. People with dementia go through a sequence of declines in their cognition, or mental performance, including memory, communication, reasoning, and ability to solve problems.

The decline is predictable, but only in a general way. A person initially is able to do most ADLs (activities of daily living) like bathing and dressing, and IADLs (instrumental activities of daily living), like cleaning house or preparing a simple meal. ADLs involve moving the body for daily self-care; IADLs, as their name implies, require use of instruments like a broom or stove to support independent quality of life. Over time, people with dementia require more help, until ultimately they are no longer able to do anything independently.

Dressing is an activity of daily living that most older people need help with eventually.
a caregiver assisting an older man with dressing

Cognitive 'Disability' or Ability?

The cognitive disabilities model was designed to evaluate the limits of a person's functional cognition. It assesses the level of difficulty of a given task, and compares that to the person's current level of function. Even though the word 'disabilities' is part of the name, the idea is really more to pinpoint a person's abilities, and give them the best chance of success every day.

The model is often called the Allen model, after Claudia Allen, an occupational therapist (OT) who developed its first structured outline in the 1960s. Though the Allen tests are most often used by OTs, other health care professionals such as speech pathologists and psychologists are familiar with the test and use its results. OTs are known for their craft-based therapy, and the Allen tests use craft projects to assess each individual's skill set. For example, the Allen cognitive levels screening test (ACLS) uses a square of leather with punched holes and several progressively harder lacing tasks to estimate a person's functional cognition, so it's useful even for people who can no longer speak or use tools like a pencil and paper.

The Allen Levels

Here are the six levels of the cognitive disabilities model:

  • Level 1, automatic actions: This person needs total care and is usually bed-bound.
  • Level 2, postural actions: This person can sit, stand, and move around, with varying degrees of help.
  • Level 3, manual actions: This person can use objects in the environment and needs less assistance.
  • Level 4, goal-directed activity: This person can do more for themselves and may only need supervision. They can sequence the steps of a task, and may be able to learn new tasks.
  • Level 5, independent learning: This person can think beyond themselves and can understand the effects their actions have on others.
  • Level 6, planned activities: This person is basically independent.

What Does This Really Look Like?

To see how the levels translate into real life, let's follow Heather, an occupational therapist, through her day. Heather works for a home health care provider, so she travels to people's houses, evaluates them, and helps their families understand how best to care for and support them.

Heather's first stop is the Abels. Mr. Abel was recently diagnosed with early stage dementia. He is aware of his diagnosis, and is occasionally frustrated and angry. Using the ACLS, Heather finds he is performing right now at level 4.8. He can learn a simple new task with repetition, and needs reminding periodically. This information cheers him and is useful information for his wife and grown children.

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