ACLS-5/LACLS-5 Interpretation FAQs

1. Does the environment affect the validity of the assessment?

Yes. A well-lit space with few distractions is preferred. If, in the administrator’s judgment, the environmental factors may have influenced performance, this should be noted in interpreting the score.

2. How do you use a score on the ACLS when it is the only performance data that you were able to get prior to the person being discharged?

ACLS scores are estimates of a person’s ability to function and are not intended to be used in isolation. In situations where it is the only performance data available administrators must clearly indicate that the score is an estimate of present abilities only and requires verification. It should not be used as the sole basis for discharge recommendations.

3. If you are limited to only 20 minutes of time for evaluation, is it worth doing the ACLS (vs. an ADM or other observation?)

The ACLS should be part of a comprehensive evaluation process which minimally includes record review and interview to ascertain occupational history, present needs, and the person’s goals. While the ACLS can be administered in 20 minutes its purpose is to provide an estimate of abilities, and the scores obtained must be verified by further assessments. ADM assessments target a narrower range of abilities on the Allen scale and are selected based on ACLS scores or other skilled observation.

4. How can the OTR interpret the screen score when the COTA administers the test, if the OTR has not been trained in administering the test?

Administrators of the ACLS must consider all relevant factors when assigning a score to get reliable first estimate of abilities. A COTA with appropriate qualifications may administer the ACLS and assign scores. An OTR who works with a trained COTA should probably seek training in administration from the COTA. The OTR is responsible for interpreting the meaning of ACLS scores and scores from other related assessments to develop interventions that target identified goals in collaboration with the client and/or caregivers.

5. Is test-retest learning a problem with the ACLS? Is there an optimal amount of time that should elapse before re-testing with the ACLS?

As with any activity, it is possible to train a person to make a stitch they otherwise cannot imitate or discover on their own. The test ceases to be a test of new learning and problem solving when this occurs. Time lapse between administrations of the ACLS to minimize the impact of learning has not been studied but as with other activities, is influenced by the person’s cognitive level. Clinical observations of performance in ADM assessments with a similar range of task demands suggests that persons functioning in level 3 always require demonstrations and prompts to engage in actions that they have been trained to perform previously. Persons functioning in modes 4.0 – 4.4 who are trained to do a series of new actions similar to the single cordovan stitch (ADM Ribbon Card) are apt to forget the series after approximately two weeks. Persons functioning in modes 4.6 – 5.0 who are trained to do a new series of actions similar to the single cordovan stitch (ADM Needlepoint Key Ring) will likely remember it with some prompting several weeks later. Persons in modes 5.2 and above usually recall sequences similar to the single cordovan stitch they have learned without assistance several weeks later (ADM Needlepoint Key Ring.)

6. It seems the assumption is that the ACLS is administered early on. Is it OK to build rapport with the person prior to administration, as I do? I work in a long-term care facility.

Establishing rapport with a person is always advised as part of an assessment process. The ACLS assessment and related tools are used in long term care facilities not only for persons who are receiving Medicare Part A rehab therapy services but for long term residents to establish a baseline, assist with set up of maintenance programs and monitor for changes in functional cognition that may impact the resident’s safety and care needs.

7. Is there a Spanish language version of the manual or do you anticipate one?

Yes, a Spanish language version of the manual is available through our vendors as of May, 2010.

8. Are there plans to translate the manual into any other languages?

Yes, a Japanese language translation of the manual is scheduled to be completed summer, 2010. Other translations may follow as the need is recognized or as the Committee supports proposed research of the tool in those languages.