I am an Occupational Therapist with a specialism in dementia and in 1999, I developed the Pool Activity Level (PAL) Instrument with the encouragement and mentorship of Professor Tom Kitwood. I was convinced that a more helpful view of dementia is to identify the ability level of each individual. With that viewpoint, we are likely to enable rather than disable the person as we understand the physical and social environment required to sustain those abilities. If we only recognise the difficulties an individual is having, we will always disable them as we will only provide care and support to address their difficulties. So, the PAL Instrument uses a strengths based approach, underpinned by cognitive developmental theory.
The PAL Instrument has a Checklist of statements that identifies how the person can perform in nine every day activities. There are four statements for each of the activities and each statement describes a slightly different level of ability. By completing the PAL Checklist, it is possible to identify the overall level of cognitive and functional ability. From that knowledge, we can select the appropriate PAL Profile which describes how to support the person at that level of ability.
I began developing the PAL Instrument by building on the work of Claudia K Allen. She had developed an Occupational Therapy model for understanding cognitive disability, based on developmental theory. Allen’s model has a robust assessment for OTs and then relies on their professional knowledge to interpret the outcomes of the assessment. I wanted a tool that would self-interpret and provide a guide to those without the clinical skills so that they could enable individuals with cognitive difficulties to be less disabled in every-day activities.
The first draft of the PAL Instrument was tested out in a local Hospital ward for people living with severe dementia and also in care homes where people were living with early to moderate dementia. Following feedback, I refined the PAL Checklist and Profiles and, with the support of Professor Tom Kitwood, published the first edition of the PAL book. This was published by Jessica Kingsley publishers as part of the Bradford Dementia Group Good Practice Guide series.
In 2008, the PAL Instrument Checklist was validated by Jennifer Wenborn and team at the Department of Mental Health Sciences, University College London.
The book is now in its 4th edition, with additions to the case studies and guidance on the use of the PAL Instrument. The PAL is now translated into several languages and is used within research programmes and also in health and social care settings to support care and activity planning. I regularly receive wonderful messages from care professionals telling me of the difference that using the PAL Instrument has made to their service. Their feedback describes the positive impact it has had on enabling people with dementia and other forms of cognitive impairment, including acquired brain injury, stroke and, learning disability to live meaningful and fulfilling lives.
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