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The PAL Instrument unlocks the secret to meaningful activity engagement


For those living with dementia, engagement in meaningful activity adds great value to their quality of life supporting cognitive, physical and mental health. Meaningful activities go deeper than simply tying in with the individual’s personal history of vocation, hobbies and interest. The truly meaningful activities are the ones that support the individual’s sense of self-identity that reflects their spirituality, sense of purpose and personal values.


When thoroughly engaged in the activity, an individual is in a state of ‘flow’, fully immersed physically, cognitively, emotionally. This immersion requires the activity to be at the ‘just right’ level of challenge for the person – too easy and it will be boring; too difficult and it will be frustrating. So, in order to support meaningful engagement there must be an in-depth understanding of the daily barriers that the individual is facing because of their symptoms of dementia and then for support to be given at the ‘just right’ level in the ‘just right’ activity.


Understanding those challenges is far from easy as they are nuanced and interlinked. Taking a craft activity as an example. A question that activity providers will probably ask is ‘how much can a person with more advanced dementia participate?’. But a better question is ‘what is getting in the way of that person participating?’. Understanding that, is key to then planning how to support the person to engage and to do so in a way that has personal significance for them. So, the craft activity can be broken down and presented to the individual in a way that enables them to engage in it and ensures that they are supported in expressing their individuality, values and beliefs while doing so.


This requires a deep and collective insight about the person and this is where the QCS PAL Instrument can help.

The QCS PAL Instrument

With this person-centred approach in mind, I developed the PAL Instrument in 1995. In 2008 the Instrument was validated by University College, London and it continues to provide a highly effective framework to assess people with cognitive impairments caused by conditions related to dementia, strokes and learning disabilities.


Not only does the PAL Instrument support the collection of life history and an understanding of what is meaningful to the individual, but it also contains an assessment tool for understanding the cognitive functional level of ability of an individual which then produces a bespoke guide as to how the person can be best supported at each specific level, of which there are four levels. This approach can make a real difference to the life of an individual and also to their carer, carers and activity providers.


The PAL Instrument is now available free of charge through Quality Compliance Systems (QCS) to health and social care providers