This test could be used in acute care. This assessment offers a hospital version (MET_HV) that would be appropriate in the VA setting. This test was developed for use with a wider range of participants than the original version; it has more concrete rules, simplification of task demands and space provided on the instruction sheet for the patient to record the information they were to collect. There are 12 separate subtasks within four sets of simple tasks. These four task sets are as follows: 1. The patient must complete six specific errands (purchase 3 items, use the phone, collect and envelope from reception and send a letter to an external address), 2. The patient must obtain and write down four items of designated information (e.g. the opening time of a shop on Saturday), 3. The patient must meet the assessor outside of the hospital reception in 20 minutes after the test had begun and state the time, 4. The client must inform the assessor when he/she finishes the test. The test cannot be administered to patients confined to bed due to the nature of the questions. The test would be difficult to complete on patients instructed to only get up with help as they would have to have a nurse available at the time they need to meet some of the task requirements. Both validity and reliability have been established for this test for various populations (see citation for specifics).

This assessment is based on observation of a patient in a more natural environment/setting and looks at if they initiate expected activities such as, turning off appliances, closing doors when they leave, doing dishes, prepping dinner.. etc within 15 min of expected time. This is looked at and recorded each day of the week. In acute care this is just not very applicable, as we don't watch patients all day, every day of the week and the Vets are in an unfamiliar setting where they likely won't initiate such activities even if cognition is unimpaired. Even the activities that do occur in the hospital setting, such as eating lunch, don't apply very well because the score is acquired by adding up how they did each day of the week and it is not very practical to see a patient every day for the entirety of their lunch for a week straight. This may be a nice assessment for the nursing home to use in some instances.

This article used 6 other articles to review effects of exercise on ADL performance of those with Alzheimer's Disease. Occupational therapy intervention that includes aerobic and strengthening exercises may help improve independence in ADLs and improve physical performance in people with Alzheimer's. More research needs to done to identify specific components of intervention and optimal dosage to develop clinical guidelines. At my SNF placement, I have worked with many residents with Alzheimer's. We do use strength training with most patients is they are able to do it, and we also work to increase endurance as well. It is good to see evidence to back up treatment

I chose this article because I treat many CVA patients in my setting. I was curious to see how the typical VA treatments related to other hospitals with their treatments. The results were very similar. Mainly we work on functional activities and we add in some exercising to strengthen and further enhance the functional abilities.

I chose this article because we use the Allen Cognitive level often in my setting and I continue to question the outcome at times yet everyone experienced that I work with fully believes that it is a great assessment. I like the idea in this article that there is more to be learned than the ACL can give you.