1. FOAM BUTTON BOOKMARK ACTIVITY ANALYSIS CHRIS CAREY JEFFREY ARNOLD

2. ALLEN COGNITIVE LEVEL (ACL) Uses 3 leather lacing stitches to assess the ability to process new information Quick estimate of how well a person is functioning at levels 3 to 5 Levels 1 to 2 are assessed by observing behavioral responses to stimuli Score is accurate 90% to 95% Usually used after the initial interview (Allen, p.2)

3. ALLEN DIAGNOSTIC MODULE (ADM) Designed to verify the ACLS score 35 different standardized craft projects designed to those who tend to deny functional limitations Projects should match the ACLS score, as well as have meaning Contains criteria for modes of performance Modes can be objectively monitored (Allen, p.3)

4. APPROPRIATE POPULATION FOR FOAM BUTTON BOOKMARKING Most suitable for persons with severe to moderate disability (3.6- 4.6 ADM) Portable (Home Health) and suitable for bedside use Recommended ages 8 and up (S&S p. 2)

5. PRECAUTIONS The needle is sharp!

6. FOAM BUTTON BOOKMARK Materials Pre-Punched foam bookmark (front and back) Waxed thread Assorted buttons Large eye metal needle (S&S p. 1)

7. ATTACHING BUTTON INSTRUCTIONS 1. Remove foam circles from pre-cut thread holes. 2. Tie knot at end of 12 inch thread and attach needle to other end. 3. Pick out buttons. To sew on buttons, push threaded needle from back to front through top hole in the center of bookmark front. Select a button with two to four holes and push needle through one hole from back to front of button. Slide button down thread to bookmark. Push needle through second hole in button and then through bookmark front toward the back of the bookmark. (S&S p. 1) 1 3 3 cont.

8. ATTACHING BUTTONS INSTRUCTIONS CONT. 4. Pull needle through until button is tight against bookmark front. 5. Repeat steps 3-4 with two more buttons. (2 or 4 holes) 6. Tie knot on back to secure thread. (S&S p. 1)

9. ASSEMBLING BOOKMARK PARTS INSTRUCTIONS 7. Place bookmark front on bookmark back, aligning holes. 8. Tie knot at end of 45 inch thread and attach needle. 9. Starting at lower edge of bookmark, push needle through both layers of bookmark from back to front; pull tight. Push needle through next hole to the left, from front to back. Continue to make this “running stitch” around the perimeter of bookmark. (S&S p. 1) 7 9

10. ASSEMBLING BOOKMARK PARTS INSTRUCTIONS CONT. 10. Upon reaching starting point (once around), reverse direction of stitching. Continue to make running stitches to fill the empty spaces between stitches. 11. Upon completion of second round of stitching, tie a knot on the back of the bookmark. Cut off thread and needle. (S&S p.1)

11. CRITICAL OBSERVATIONS Sewing Buttons  Comparing length of thread  Awareness of different size buttons  Learning short sequence of action  Tightening thread  Making knots Assembling Parts  Distinguishing front and back of parts  Adjusting alignment of holes Sewing Bookmark  Awareness of front and back of bookmark  Awareness of stitch errors and ability to correct them  Comparing single and double running stitches (S&S p.4)

12. OTHER IMPORTANT OBSERVATIONS Starting to work without directions Consulting sample (frequency/purpose) Moving on to next step/asking for next step Following suggested sequence of steps Requesting to deviate from sample (S&S p.4)

13. THERAPEUTIC BENEFITS Assesses working memory or allows retrieval of procedural memories (S&S p. 2) Stimulates creativity, visual discrimination, object orientation, awareness, eye-hand coordination, fine motor control, sustained attention, spatial relationships, and categorization

14. GRADING UP 1.(Motor) Use smaller buttons to fit the client with greater fine motor control requirements. 2.(Cognitive) Take away instructional example pictures and only provide a single completed sample at the beginning of the activity. This would increase the demand for working memory by requiring the client to use the instructions and convert them, as closely as possible, to the memory of the completed sample.

15. GRADING DOWN 1.Take each person to a different room in order to decrease noise, visual, and social stimuli for decreased environmental barriers and decreased cognitive requirements, like selective attention 2.Scaffolding – Helping the person complete a stage or stages that might be too physically or cognitively challenging Choosing materials (color, button size, etc.) for clients with arousal or creative deficiencies Completing the “attaching button” phase or the first part of the “front and back assembly” phase for clients with fine motor control deficiencies

16. SOURCE Thomas, H. (2012). Occupation-Based Activity Analysis. Thorofare, NJ: SLACK Incorporated. Allen, C. K., Anna Reyner (2008). How To Start Using The Allen Diagnostic Module (9th ed.). Retrieved from http://lsustudent.pbworks.com/f/Allen+Dg+Man.pdf. S&S Worldwide. Foam Button Bookmark. pdf. Retrieved from http://www.ssww.com/item/allen-diagnostic-module-foam-button-bookmark- CU253/cmc=SRCH/v=Zm9hbSBidXR0b24gYm9va21hcms%2C/p=1/