Seniors need to stay active and mobile as long as possible.

By Susan Saldibar

Seniors need to stay active and mobile as long as possible. We’ve all read the studies indicating that prolonged sitting can lead to a more rapid decline of both physical and mental abilities.

The people at Aegis Therapies are on a mission to keep as many seniors on their feet as long as possible. The key, they tell us, is to take the whole person into consideration and to tailor fall management programs to each unique individual.

Getting the right match

The truth, however, is that, even with the best of intentions, many falls prevention programs fail. And, there is a good reason why, Angela Edney, Occupational Therapist and National Clinical Director for Aegis explains. “Assessing the cognitive level of an individual is absolutely essential. That is the best way to accurately match the resident’s ability to the therapy, the tools used, and changes to be made to the environment.”

There are plenty of strategies that can be used to improve residents’ balance and prevent falls. But when a strategy does not match a resident’s cognitive level, you may continue to see falls occur.  

In addition to standardized balance assessments, Aegis Therapies uses the Allen Cognitive Scale to assess the abilities of each resident and to properly match the level of ability to the method of therapy and necessary environmental adjustments.

How the Allen Scale works with Fall Management

The best way to illustrate the concept of using the Allen scale is to use examples. Below are two charts taken from the Aegis falls management guidelines, with suggested interventions for residents who are at Allen Levels 2.0 (moderate-to-severe dementia) and 3.0 (moderate dementia). Note the different approaches in each of the three key areas: Balance, Activities of Daily Living (ADLs), and Communication.

Allen Cognitive Level 2.0

  (Include all interventions from the previous level that are beneficial for the resident)

Balance Interventions:

  • Sitting balance activities to improve trunk control

  • Compensatory and anticipatory postural activities in sitting (catching a ball, batting a balloon with the hand, etc.)

  • Lower extremity weight bearing activities to improve/maintain pivot transfer ability

ADL Interventions:

  • Caregiver education for fall prevention, including support and cueing required (sensory cues) and facilitating the patient’s best ability to function

  • Determine optimal positioning for dressing, bathing and toileting to encourage patient participation and provide safest routine

  • Determine need for adaptive equipment such as raised toilet seat, tub bench with arms for support

Communication Interventions:

  • Train caregivers to use “1, 2, 3” counting technique to facilitate patient participation in transfers

  • Train caregivers to elicit “yes” and “no” to communicate wants and needs related to transfers and positioning

  • Train caregivers to allow extra time for change in position and to facilitate feeling of security in each position

Allen Cognitive Level 3.0

  (Include all interventions from the previous level that are beneficial for the resident)

Balance Interventions:

  • Gait training utilizing various sensory conditions including obstacle course, resistive walking and starting/stopping when cued

  • Reduce distractions by removing extraneous objects from view

  • Closed chain exercises (marching, knee bends, weight shifting)

  • Exercise program can include playing catch, reaching for objects in standing or sitting position, reciprocal pulleys, active range of motion (AROM) for the legs and hips, etc.

  • Several short treatment sessions (15 minutes) during the day, due to short attention span

  • Train caregivers to provide cues for stairs, sitting down and transferring

  • Environmental modifications to provide physical barriers to prevent getting lost and from walking on uneven surfaces

  • Environmental modifications to clear space (remove unnecessary furniture, decorations, etc., which may result in a fall)

ADL Interventions:

  • Train caregivers to allow extra time for response

  • Bed rails down to prevent attempts to climb over

  • Toilet schedule as patient is able to recognize need to void, assistance is needed for clothing management

  • Use of grab bars in bathroom and dressing area to prevent falls

  • Hold chair steady while patient transfers in and out, leave lights on in darkened hallways or rooms

  • Use of tub bench for safety

Communication Interventions:

  • Provide opportunities to name items and associated verbs (“push the cart,” “throw the ball” etc.)

  • Train caregivers to use simple, familiar commands

When the cognitive abilities are properly matched to the therapy and the approach, it removes the frustration of attempting to change the behavior of the residents to meet often unrealistic goals, Susan Almon-Matangos, Speech-Language Pathologist and National Clinical Director for Aegis, explains. “There is always that ‘aha’ moment when caregivers realize that what actually needs to change is their approach, not the resident.”

The goal, above all else, is enabling residents to remain comfortably mobile as long as possible.

“If you are going to contain anything, let it be the environment, not the individual,” says Angela. “When residents want to stand or walk, then stand and walk with them. And when they do sit, let it be because they need a rest from walking, not because you gave up.”

For more information about Aegis Therapies, visit

More information about the Allen Cognitive Disability Model is available through a 1995 book titled Understanding Cognitive Performance Modes by Claudia Allen, Tina Blue, and Catherine Earhart and a 2005 book, Allen’s Cognitive Levels:  Meeting the Challenges of Client-Focused Services (2nd edition) by DeLaun Pollard and Debbie Olin.

Allen, C. K. (2015). Allen Cognitive Disability Model (ACDM) and Allen Cognitive Level Screen, 6th Edition (ACLS-6). Retrieved from