What to do when the whipstitch is started next to the single cordovan stitches

Although this is a rare scenario, clinical observations remain central to understanding the person’s occupational performance and verifying the final Level.Mode. The series of questions below outlines the procedure to follow.

Q1: What should I do if a client starts the whipstitch next to the single cordovan stitches (e.g., picks up the wrong needle/turns the tool and stitches in the wrong location)?

A:  Do not redirect the client to the correct location. Instead, provide a second demonstration of the whipstitch.  Many clients will repeat the same error even after a second demonstration.

Q2: The client completed the whipstitch correctly (including correcting the inserted errors) but scored 4.2 based on the single cordovan. How should this be interpreted?

A:  Mixed performances across stitches are occasionally seen. If the client can identify and correct the twist error in situ during the whipstitch, it is correct to assign a score of 4.4 for that task, because ACLS scoring directs clinicians to record the highest ability demonstrated. Proceeding to the single cordovan and assigning 4.2 for that portion is appropriate.

Q3: Should I repeat the whipstitch with a second demonstration to prompt stitching in the correct location?

A:  Yes, you should offer a second demonstration. However, you should not physically redirect them to the correct location. Document whether the person repeats the error after the second demonstration, as this contributes to your clinical reasoning and verification.

Q4: What score should I record when performance differs across stitches (e.g., 4.4 on whipstitch criteria and 4.2 on single cordovan)?

A:  Per ACLS guidelines, you record the highest ability observed (e.g., 4.4). Then, use your verification process to determine the final verified Level.Mode, integrating observations from both stitches and functional performance.

Q5: How should I handle verification when the two stitches suggest different modes?

A:  The ACLS is typically accurate within one mode. When performance differs between the whipstitch and single cordovan, expand your verification to consider the range of abilities predicted between 4.0 and 4.4 (i.e., one mode above and below the on‑screen score). Look for functional performance indicators that support where, within that range, the person is most likely operating.

Q6: What should my documentation include in this scenario?

A:  A clear, detailed report supports your verification and helps future clinicians:

• Describe how the client approached each stitch.

• Note which criteria were met (e.g., corrected twist in situ).

• Explain the verification process and rationale for the final verified Level.Mode.

• If relevant, acknowledge fluctuations (e.g., fatigue in dementia) and, when clinically appropriate, report a range of modes with your reasoning.

Q7: I didn't give a second demonstration of the whip stitch. Do I need to repeat the assessment?

A: No. Proceed with the information you have. The ACLS screen helps get you “in the ballpark,” but your clinical observations are central to understanding the person’s occupational performance and verifying the final Level.Mode.

Quick Takeaways

• Don’t redirect to the “correct spot”; do offer a second demonstration.

• Recognise highest ability demonstrated (e.g., 4.4 for in situ twist correction) while also scoring single cordovan performance (e.g., 4.2).

• Verify across 4.0–4.4 when stitches differ, then report a final verified Level.Mode (or a range, if appropriate).

• Prioritise detailed documentation to support clinical reasoning and continuity of care.