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Cognitive Disability Model: Levels & Care

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.

The cognitive disabilities model was developed to help caregivers assess the functional cognitive abilities of people they serve. In this lesson, we will learn about the levels of the model and how a person's stage informs the care they need.

Claudia Allen's Big Idea

Claudia Allen, an occupational therapist, worked at a mental health facility in Pennsylvania in the late 1960s. She and her colleagues observed their patients and began trying to develop a way to assess their functional cognition. That is to say, the therapists were looking at how mental function determined what people were able to do for themselves on a daily basis.

Influenced by the sequence of cognitive development originated by Jean Piaget, Allen formulated a sequence of six levels of functional cognitive performance, from normal to maximally impaired. She saw these levels in association with persons with mental illness, dementia, and other conditions that negatively impact the workings of the brain.

With a set of levels in place, Allen then set about creating a reliable and valid test to determine a person's level. She eventually put together a group of tasks involving lacing leather pieces, which was able to pinpoint learning and problem-solving skills and deficits.

Throughout the 1970s and 1980s, and on to the present time, Allen and her colleagues have continued to refine the levels and test procedures. Guides for caregivers have also been developed which lay out how much care in what specific areas a person at a given level needs.

The Levels of Cognitive Disability and Appropriate Care for Each

The cognitive disabilities model is numbered in descending order, with the highest number, level 6, being the highest functioning level. It is often called the Allen model, after Claudia Allen, or the levels are termed Allen levels.

A person with level 6 cognition is basically normal. They can understand and follow directions, learn new tasks, plan for the future, and anticipate problems and make contingency plans. The level 6 individual does not require outside help in their daily life. Judy, an home health occupational therapist, is obviously a level 6. Let's follow her on her rounds.

Peter, one of Judy's patients, suffered a head injury. He tests at level 5 (5.0-5.8) and has mild cognitive impairment. He can learn, but his judgement is often poor, and he frequently makes hasty decisions without taking all factors into account. Peter lives alone, but since his injury, his parents supervise him in areas like money, medication management, cooking, daily planning, and time management. Judy recommends external aids like weekly pill boxes, daily task checklists, calendars, and kitchen appliances with automatic shut-off to help him be independent and safe.

Judy sees several patients with dementia, like Susie, who tests at level 4. She is a widow, and for a while was safe living alone, but as she has declined from level 4.8 to 4.2, her niece has moved in to help care for her. Susie isn't as aware of her poor balance and safety risks as she once was, so Judy helps set up her house with adaptive equipment like grab bars in the bathroom. She was an immaculate housekeeper, and though she is slower now, she still tries to help, with verbal and visual cues from her caregiver.

Ed's dementia has progressed to Allen level 3. His primary caregiver is his wife, Stacey, and she has to do a lot of things for him now that he formerly did for himself. She cuts his food up, helps him with bathing and dressing, and takes him to the bathroom regularly. He wants to be with her all the time, so Judy suggests Stacey put him to work folding laundry or dusting the bookshelves at home. It works well, but she has to remind him periodically to keep going. Where Susie, at level 4, can stay home alone for an hour while her niece runs to the grocery store, Stacey has to have someone sit with Ed, or else take him with her: he needs constant supervision.

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