Allen Cognitive Levels: Scale & Description
When an individual has a cognitive deficit for any reason, how do you assess them? This lesson defines the Allen cognitive levels, explains the scale developed from the levels, and describes the screening process.
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.
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 one to six:
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 is 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’re 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.
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 person’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
The person’s cognition is 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 person’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.
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