Pool Activity Level

(PAL) Instrument for

Occupational Profiling
PREPARED BY JACQUELINE PHANG AND NAMRATA
Introduction
Developed by an Occupational Therapist Jackie Pool ( Bardford, UK)
Developed to engage persons with dementia in meaningful occupation
Persons with dementia may not be able to match abilities and skill levels to requirements of the
task/activity
Therefore, there is a need to adapt activities and facilitation techniques
to match the skill level of persons with dementia
For meaningful engagement
Aim is to improve the Quality of Life
Purpose of PAL
oEnable carers to engage people with dementia in meaningful activities
oTo be applicable in the home, day service or residential facility
oTo be integrated in to day-to-day care provision
oProvide information on individual’s strengths and abilities through a structured record of
observations. This process indicates an activity level at which the individual functions.
oEnsure activities are meaningful and appropriate
oTo facilitate persons with dementia in an appropriate manner for maximizing participation
oProvide guidance on how a carer should interact with the individual to promote maximum
benefits for both.
The PAL Consists of:
Life History Profile - Gathers information on the persons life history, likes, dislikes, routines etc.
from the resident, family/caregivers . Some questions if irrelevant can be ignored
PAL Checklist - Determines the persons current level of function in occupations
PAL Activity Profile - Provides information on persons likely abilities and limitations, the
caregivers role and suitable leisure activities
Individual Action Plan – A record of information regarding the individuals current needs,
preferences and routines in meaningful activities
Includes directions for facilitating the engagement of the person in ADLs.
Life History Work
It can be done with the person with dementia, relatives and care staff .
It gives information for selecting such an activity for the Pool Activity Profile
If the person cannot answer the questions, the family members can help fill the whole form
If certain questions not relevant, they can be omitted.
This will help the care staff know the person better
to plan activities that relate to the person’s interests and life experiences
To recognize the person a unique individual , not only to see the person’s disability
 PAL Checklist
Will be done by the Occupational Therapist
Consider how the person with cognitive impairment generally functions when carrying out
the activities described in the checklist.
Observe the person in the situations over a period of 2 weeks.
You might need to ask other caregivers for their observations.
Thinking of the last two weeks, tick the statement that represents the person’s ability in each
activity.
Make sure to tick only one statement for each of the activities.
If the number of ticks is almost evenly divided between two activity levels, assume that the
person is currently functioning at the lower level of activity. (This will provide an opportunity
for the person to move into the higher level of activity.)

6
 PAL Activity Profile

This is a general description of the environment in which the person is likely to best engage in activities.
The box at the end of the PAL activity profile should be completed by referring to the information
gathered and recorded in the Life History Profile.

7
Pool Activity Levels:
Planned Ability to engage in
activities:
Exploratory

Sensory

Reflex
Planned Activity Level P
Can work towards goal directed activities with a tangible outcome, but may not be able to solve
problems that arise in the process.

Caregiver’s Role:
To enable the person to take control of the activity and master the steps involved
To encourage the person to initiate social interactions
To solve problems as they arise
Planned Activity Level P
To facilitate participation:
Keep sentences short
Be present to help to solve problems that arise
Focus on activities that achieve a tangible result
 Planned Activity Level P
Using the Activity profile to support the person
Position of Objects Ensure that objects and material are in their usual, familiar places
Verbal Directions Explain activity using short sentences by avoiding using connecting
phrases, i.e. “and” “but”
Allow time for response. Repeat instructions if needed. Encourage
person to solve problems through gentle prompts
Demonstrated directions Show the person how to avoid possible errors. If unable to solve problem
(Visual demo) independently, demonstrate solution and encourage modelling
Working with others Person is able to make first contact and should be encouraged. Give
opportunity to initiate social contact
Activity characteristics There is a goal or end product, with a set process to achieve it
Planned Activity Level P
Suitable activities:
Activities meaning to the person, i.e. based on interest, career, home life
Ensure the task is simple
Introduce element of competition
◦ Memory games, newspapers, exercise activities, art and craft, board games, cooking, gardening, DIY,
word quizzes/crosswords
Exploratory Activity Level E
Can carry out familiar activities in familiar surroundings, but is more concerned with the
experience than the end result.

Caregiver’s Role:
To enable the person to experience the sensation of doing the activity rather than focusing on
the end result
To break the activity into manageable chunks
To keep directions simple and understandable
To approach and make first contact as it is rarely initiated by the person
Exploratory Activity Level E
To facilitate participation:
Make first contact
Use simple, understandable instructions
Use a creative and spontaneous approach
Break the activity into manageable chunks
 Exploratory Activity Level E
Using the Activity profile to support the person
Position of Objects Ensure that objects and materials are in the line of vision
Verbal Directions Explain activity using short sentences by avoiding using connecting
phrases, i.e. “and” “but”. Also avoid preposition words like “in”, “by”,
“for”.
Demonstrated directions Break the activity into 2-3 steps at a time
(Visual demo)
Working with others Others must approach the person and make the first contact
Activity characteristics There is no pressure to perform a set of rules, or to achieve an end
result. There is an element of creativity and spontaneity
Exploratory Activity Level E
Suitable activity:
Activities meaning to the person, i.e. based on interest, career, home life
Examples: Outings, newspaper discussion, exercise activity, art/craft, food tasting, board games,
computer games, reminiscence objects, conversation, cooking, gardening, DIY, flower arranging
Sensory Activity Level S
Primarily concerned with experiencing the sensation of the activity and moving their body in
response to those sensations.

Caregiver’s role:
To enable the person to experience the effect of the activity on his/her senses
To break the activity into one step at a time
To keep directions simple and understandable
To approach and make the first contact with the person
Sensory Activity Level S
To facilitate participation:
Guide to carry out single-step activities ( hand on hand guidance )
Ensure the person experiences a wide variety of sensations
Give simple directions and reinforce with demonstrations
Sensory Activity Level S
Using the Activity profile to support the person
Position of Objects Ensure that the person becomes aware of objects and materials by
making bodily contact
Verbal Directions Limit requests to carry out actions to the naming of the action and of
the object involved, e.g. “lift your arm”, “hold the brush”
Demonstrated directions Demonstrate to the person to the action on the object. Break the
(Visual demo) activity down into one step at a time
Working with others Others must approach the person and make the first contact. Use
touch and the person’s name to sustain the social contact
Activity characteristics The activity is used as an opportunity for sensory experience. This
may be multisensory. Repetitive actions are appropriate.
Sensory Activity Level S
Suitable activities:
Activities meaning to the person, i.e. based on interest, career, home life
Examples: Sensory box, smells, food tasting, hand massage, exercises, music and singing,
dancing, sweeping, polishing, wiping tables
 Sensory Activity Level R
Using the Activity profile to support the person
Position of Objects Direct stimuli to the area of body being targeted, e.g. stroke the person’s
arm before placing it in a sleeve. Use light across the person’s field of
vision to encourage eye movement
Verbal Directions Limit spoke directions to movement directions, i.e. verbs like “lift”
“open” “hold”. Use a warm, reassuring tone and adapt volume to
establish a connection with the person
Demonstrated directions Guide movements by touching the relevant body part
(Visual demo)
Working with others Maintain eye contact, make maximum use of facial expression, gestures
and body position for a non-verbal conversation. Use social actions
which can be imitated, e.g. smiling, waving, shaking hands
Activity characteristics The activity focuses on a single sensation: touch, smell, sound, sight,
taste
Reflex Activity Level R
Maybe unaware of surrounding environment or own body. Movement is generally a sub-
conscious, reflex response to direct sensory stimulation.

Caregiver’s role:
To enable the person to be more aware of him/herself
To arouse the person to be more aware of his/her surroundings
To engage with the person through direct sensory stimulation
To monitor the environment and reduce multiple stimuli, loud noises and background sounds
Reflex Activity Level R
To facilitate participation:
Use direct sensory stimulation to raise self awareness
Don’t over-stimulate
Use single-word commands
Use facial expressions and tone of voice
Reflex Activity Level R
Suitable activities:
Activities meaning to the person, i.e. based on interest, career, home life
Examples: Smells, food tasting, hand massage, music , lights, textured objects, chimes, sensory
mobiles
Individual Action Plan
Will be done by the OT as Individual Action
Plan Guidance Notesd of facilitation
Will instruct on the abilities of the person
Method of facilitation in ADL and other
meaningful activities
Example: Dining
Planned:
◦ Encourage person to select when and what to eat
◦ Encourage the person to prepare the dining table, select crockery and cutlery from cupboards and
drawers
◦ Encourage the person to clear away afterwards

Exploratory:
◦ Store cutlery and crockery in view and encourage the person to select own tools for dining
◦ Offer food using simple choices
◦ Create a social atmosphere using table decorations and music
◦ Promote conversation
Example: Dining
Sensory
◦ Serve food so that it presents a variety of colours, tastes and textures
◦ Offer the person finger foods, encourage him/her to feel the food
◦ Offer the person a spoon, place it in his/her hand and direct him/her to “scoop the rice”, “lift your arm”,
“open your mouth”

Reflex:
◦ Use touch on the person’s forearm to make contact, maintain eye contact, and smile to indicate the
pleasure of the activity
◦ Place a spoon in the person’s hand. Close your hand over the person’s and raise the spoon with food on
it to his/her mouth (hand over hand assistance)
◦ As the food reaches the person’s mouth, say “open” and open your own mouth to demonstrate. Touch
the person’s lips gently with the spoon
Example: Dressing
Planned:
◦ Encourage the person to select/plan what to wear
◦ Encourage the person to dress him/herself, provide assistance if necessary
◦ Point out labels on clothing to help orientate back from front
◦ Encourage the person to participate in grooming activities

Exploratory:
◦ Encourage discussion about the clothing to be worn for the days: is it suitable for the occasion? Is it a
favourite item?
◦ Spend time colour-matching items of clothing and select accessories
◦ Break down the activity into manageable chunks: help lay the clothes out in order of donning. If the
person wishes to be helped, give cues for sequencing
◦ Encourage the person to check his/her appearance in the mirror
Example: Dressing
Sensory:
◦ Offer simple choice of clothing to be worn
◦ Spend a few moments enjoying the sensations of the clothing, i.e. feeling the fabric, smelling the laundry
◦ Break down the task into one step at a time

Reflex:
◦ Prepare the clothing for the person. Ensure the dressing area is private and that a chair or bed at the right
height is available for sitting
◦ Talk through each stage of the activity as you put the clothing onto the person. Use a calm tone, speak
slowly and smile to indicate that you are non-threatening
◦ Stimulate a response in the limb being dressing by using firm but gentle stroking. Use single word
instructions to get him/her to assist you
◦ At the end, spend time brushing the person’s hair using firm massaging brush strokes
Example: Preparing a Fruit Salad
Planned: Able to use a recipe card for directions to prepare the fruit juice base of the salad
Exploratory: Uses ready fruit juice, opens the tin, empties it , chops peeled fruit
Can carry out 2-3 step parts of the process
Sensory: Can carry out single step activities. May require demonstration , encourage person to
handle the fruit, he/she separates the segments of a peeled orange , picks grapes from the stem
Encourage the person to smell and to lick his/her fingers , enjoy the aroma and look of the fruit
salad
Reflex: Keep a piece of soft fruit and guide the person’s hand to hold it and smell or taste it.Use
body language to reinforce that it is a pleasant experience
Can smell, taste and feel the individual ingredients and end product.
Table-top Games Activity Samples
Board Games
Large-piece jigsaw
Large-size playing cards
Large-piece dominoes
Large print playing cards

31
 Social Games Samples

Parachute
Ring Toss Set
Sing-along CD and Song Books
Bean-bag target
Bowling Set

32
 Creative Activities Sample
Art and Craft Materials
Paint Brushes
Poster Paints
Colored Pencils
Collage Assortment Pack
Glue/Paste
Modelling set

33
Sensory Activities Sample
Relaxation music CD
Rainmaker
Doll
Foot spa
Vibrating pillow
Sensory Room

34
Q&A