Consideration of time frames between retesting

Question:

I had a question about the timing in between utilising the LACL’s tool. Are there particular time frames that we need to wait for before retesting?

Are there any guidelines or recommendations you would provide if a person has done the LACL’s tool before using it again?

Currently I am working in a setting where we complete baseline assessments - MoCA and ACL within the first 6 weeks. An ACL was completed for one of the residents in the community in November 2023 and I repeated the assessment in August 2024. His ACL went from 5.4 to 5.6 but when documented, I noted that some of the improvement in ACL score could have been due to his previous knowledge of assessment; there could have been improvement in mental state, and from treatment and therapy. Would that be an appropriate consideration? 

Response:

It’s a question that comes up frequently. Decisions to repeat an ACL are always clinical. If there is a clinical indication to repeat the screen, then it is okay to do it. The capacity to learn a stitch may influence the performance but if you administer the screen to the person according to the manual, the person is not taught to do the stitch. You give a maximum of two demonstrations and if the client has not been able to complete the stitch correctly you stop. If you complete the screen later and the person is able to do the stitch after 1 or 2 demonstrations, this suggests an improvement in their functional cognitive abilities.

The only concern I have are with people functioning at 5.4 and above, who may show some learning from doing the screen that they may use if you re-screen the person frequently (multiple times over a few weeks). I cannot think of a reason anyone would do this.

 I rarely find that previous leather work experience influences a person’s performance on the ACL. Very few people do a single cordovan stitch. Most leather lacers do double or triple cordovans. Their approach to the task will be different to what you are used to as they try to use their procedural memory to do the task. You will see the person default to their memory of the double/triple cordovan.

The people I have seen whose procedural memory influences the task are people who have had jobs that rely heavily on visuo-spatial skills.  People with exceptional visuo-spatial skills can do this task but their performance of unfamiliar tasks reflects abilities predicted at a lower Level.Mode of function. When this is the case, you give a validated screen score that reflects general task performance and comment on the person’s visual-motor skills and the tasks they may be able to do better than predicted.  

The ACL screen score is usually only a mode or two out. The screen is considered highly accurate within 1 mode. This is why we are required to validate our scores and only report a validated ACL. We should never rely solely on the screening tool to assign an ACL and every screen requires validation.

You need to consider your client’s functional performance or performance on an ADM to determine his ACL. The screen score suggests an improvement in functional cognitive abilities but your reasoning that it might be due to “learning” the stitch suggests you have not observed changes in his functional cognitive abilities.

If you are reporting an unvalidated screen score (not recommended) you need to state it is unvalidated and then the clinical reasoning you have given is accurate.

The 2nd (current) edition of the manual addresses the issue of re-screening.