The first step in caring for a person living with a cognitive disability such as Alzheimer’s disease or dementia is to have a clear understanding of their cognitive level. When you identify a client’s cognitive level, you can help them feel valued and fulfilled with a higher quality of life. You can also ease stress and burnout for caregivers by reducing any difficult behaviors they may be dealing with.
 

“Once you understand someone’s cognitive level, you know how to care for them.”—Kim Warchol, OTR/L, President and Founder of Dementia Care Specialists


If you’re familiar with Claudia Allen’s Cognitive Disabilities Model, you likely know that there are a range of cognitive assessment tools available within the Allen Battery.

But which of the cognitive screening tools is the best for you or your practice?

Today we’re going to talk about one of the tools in the Allen Battery, the Allen Cognitive Level Screen (ACLS/LACLS).

What is the Allen Cognitive Level Screen (ACLS/LACLS)?

The most powerful (and simple!) assessment tool you’ll ever use.

The Allen Cognitive Level Screen (ACLS), also known as the leather lacing tool and the leather lacing test, gives you a quick measure of a person’s global cognitive processing capacities, learning potential, and performance and problem-solving abilities. You can also use this simple Allen Battery Assessment Tool to detect unrecognized or suspected problems related to functional cognition.

Who Is This Assessment Tool for?

Healthcare pros. Allen Model pros. People who care.

These types of cognitive assessments tools are designed for occupational therapists and other health care professionals who work with individuals with temporary or permanent cognitive impairments, such as persons with Alzheimer’s or dementia. You should be trained or mentored in the Allen Cognitive Model, as your education in the Allen theory helps you administer the test, and score and interpret the findings.

How do You Use the Tool?

One tool. Three stitches. Better quality of life.

Before you administer the test, start by establishing rapport with the person. Ask them to tell you about their day. Make sure you’re at their eye level. Speak to them calmly and ensure that your tone makes them feel your respect. Keep your sentences short.

Next, explain the leather lacing test. Show the person what you want them to do. Give them simple and clear directions.

To administer the leather lacing test, you’ll give the person three visual-motor tasks of increasing complexity. These tasks are three stitches for the person to do:

  1. The Running Stitch shows you what abilities someone has for doing activities of daily living (ADLs) such as dressing, grooming, and bathing. It also helps you discover how the person handles walking and swallowing. With this information, you can better develop a personalized treatment plan and coach caregivers on what supports to provide—and what to help the person continue to do for themselves. This can increase the person’s physical health and emotional well-being. It also reduces struggles between the person and the caregiver. And this relieves stress for everyone!
  2. The Whip Stitch helps you learn what problem-solving abilities the person has. This is important because it helps you know whether someone can prepare a meal, remember to take their medications, respond to emergency situations like a smoke detector going off, or know not to fall for credit card scams.
  3. The Cordovan Stitch shows you how the person processes information. It can help you determine whether they can hold a job, drive, or take care of others, like grandchildren.

As the person works on these three leather-lacing stitches, you’ll see how you can change their life by identifying their remaining abilities. Through your discovery of what they CAN still do, you’ll help them become more mobile, functional, and even independent. The ACLS-5 Manual provides details on administering and scoring the test, and we have many resources to support you. Here’s an overview of the cognitive assessment tool and its benefits.


This cognitive assessment tool works by engaging the person in attending to, understanding, and using:

  • Sensory and motor cues.
  • Your verbal and demonstrated instructions and cues.
  • And feedback from their motor actions.

When administering the test, apply your professional background and your understanding of the Cognitive Disabilities Model/Allen Cognitive Model to:

  • Observe the person’s remaining abilities.
  • Observe the deficits in their performance.
  • And look for a clear pattern of behavior between the two.

How do You Score the Leather Lacing Test?

Use the ACLS Manual or the Trifold Scoring Card.

One you’ve administered the ACLS, obtain the person’s leather lacing test score using the Allen Cognitive Scale of levels and modes of performance. You’ll find these in the Allen Cognitive Level Screen Manual, and in the Trifold Scoring Card. Keep in mind that it’s important to validate the score with further observations of the person and their performance in their environment.

How do You Purchase the Leather Lacing Assessment Test?

The Claudia Allen test is available for purchase from Dementia Care Specialists at Crisis Prevention Institute. You can choose the standard size (ACLS) or a larger size (LACLS) for persons with vision or hand-function challenges. Both sizes of the classic cognitive assessment tool come with one free Trifold Scoring Card, which is a pocket-sized reference of the scoring tables from the ACLS-5 Manual.

“Since we are better prepared to determine (and focus on) each person’s best ability to function, activities, programs, and approaches are more relevant and prevalent! Each resident’s quality of life is improved as dignity and ability are increased through these approaches.”—Alyssandra McKaye, Memory Care Director, Winchester House

Do you already use or teach the Allen Cognitive Level Screen (ACLS) and/or Allen Diagnostic Module (ADM) assessments?

You can order a wide range of cognitive assessment tools from Dementia Care Specialists at Crisis Prevention Institute. We provide total solutions to help care partners, therapists, and organizations deliver the very best memory care.