A Practical Resource for Carers of People with Cognitive Impairment. The Pool Activity Level PAL Instrument has become generally used as the framework for activity-based care systems in a variety of health and social care settings for people with cognitive impairments. The Instrument is recommended for daily living skills training and activity planning in the National Institute for Health and Clinical Excellence Clinical Guideline for Dementia NICE, 2006. This updated fourth edition has been substantially revised to contain all the latest research in the field and the statistical evidence from research studies which