SSU MOT 6691 & 6692

This study looks at backward chaining as a technique used with adults who have suffered a brain injury.

This is an article written about a parent's experience with backward chaining. It is helpful to use when teach self-care routines. It also is beneficial to kiddos who are lower functioning because it provided instant success.

This is another self-regulation system used in schools. Some prefer this method as compared to the Zones of Regulation; however, this one only addresses having more energy.

Great resource on dysgraphia. Many of my recent OT referrals were for fine motor deficits, when in reality, the symptoms were more in line with dysgraphia. The school psychologist was contacted to evaluate further, as OTs cannot diagnose.

This article gives insight into rehab protocols for amputation, which I was able to be exposed to during this second fieldwork rotation. I was able to evaluate a client with a traumatic digit amputation one week post injury.

The BCAT's utility for identifying dementia versus mild cognitive impairment was excellent, with a sensitivity of .99, a specificity of .77, and an area under the receiver-operatingcharacteristic (ROC) curve of .95. Executive control, contextual memory, and attentional capacity items were the best predictors of diagnostic category and of instrumental activities of daily living. From a clinical standpoint, it is recommended a BCAT cut score of 37/38 for differentiating between persons with dementia and those with MCI. This means that patients who have scores of 37 and below are likely to have dementia. This research utilized a population residing in assisted living facilities. Future studies should address a cut off for mild cognitive impairment and non-impaired and community dwelling adults.

The article describes the development and validation of a short form for the Brief Cognitive Assessment tool, BCAT-SF. The article compares the psychometric properties with the short form versus the original. The items represented in the short form represent cognitive domains such as contextual memory, executive functioning, and attention. As a result the BCAT-SF differentiated between mild cognitive impairment and dementia with a sensitivity of .9 and specificity of .8. It was also able to predict IADL and ADL. While the study determined subjects with a score of 16 or below are likely to have dementia it did not establish a cut off score to distinguish MCI from non impaired participants. This is the next step for the researchers in validating the BCAT-SF for a quick, 5 minute or less cognitive screen with functional measures.

Cognitive impairment is under-recognized and misdiagnosed among community-dwelling older adults. At present, there is no consensus about which cognitive screening tool represents the 'gold standard.' However, one tool that shows promise is the Brief Cognitive Assessment Tool (BCAT), which was originally validated in an assisted living sample and contains a multi-level memory component (e.g. word lists and story recall items) and complex executive functions features (e.g. judgment, set-shifting, and problem-solving). 75 community dwelling adults took the assessment and the MoCA with a cut off score of <26. A cut off score for the BCAT was 45 after utilizing the results of the study to balance sensitivity and specificity at .81 and .8 respectively. In addition scores can be separated to interpret BCAT memory and executive dysfunction component scores.

The MoCA is a valid screening test for Mild Cognitive impairement. This study aims to establish 90% reliable change indices for the MoCA together with MMSE in cognitive healthy adults. The study demonstrated RCI for the MoCA and MMSE in a 3 year time period that can be used for the estimation of cognitive decline or improvement in clinical settings.

The aim of this study was to explore the relationship among cognitive reserve, Executive function, and health and safety judgment among a sample of older adult inpatients of an extended medical care unit at a Veterans Health Administration (VHA) hospital. Independent Living Scales (ILS): Health and Safety subtest were used to assess judgement and safety. Executive function was measured by the Trial making test. Global function was measured by the MMSE. After controlling for global cognitive functioning, the results revealed that people with high estimated IQ performed similarly on a measure of health and safety judgment, regardless of their EF abilities. However, among individuals with low estimated IQ it appears that intact EF is critical in making appropriate health and safety decisions. Therefore, the results suggest executive functioning is critical for making appropriate health and safety decisions for patients with lower measured intellectual abilities and provide further support for the cognitive reserve model.

The aim of this study is to identify and evaluate the psychometric properties of cognitive assessments for older adults. Assessments were categorized based on length of time to assess, less than or more than 30 minutes and body function versus activity or participation. The authors reviewed evidence to determine the strength of each assessment (validity, reliability, sensitivity, specificity) and the amount of literature supporting the use of these cognitive assessments for older adults. The following assessments demonstrated the best rigor for psychometric properties for cognitive assessment with older adults: for body function(under 30 minutes): the MMSE and 3MS, for body function (over 30 minutes): the Cognistat and CASE/Pecpa, and for the activity and participation level: the AMPS.

In every scientific profession, practice is constantly evolving in response to new knowledge. However, new knowledge presents challenges for all practitioners, not only in terms of how to stay up-to-date but also in terms of how to deliver the best quality practice. Another issue with the use of brief cognitive assessments is the use of specialized assessments based on the diagnosis typically presents. All presentations are different and therefore this reduces the effectiveness of a screen and attempts to act as a tool to diagnose. There is call in Australia for brief cognitive assessment with supported validity, reliability, sensitivity and specificity to better screen and address deficits. This same call has been made by AOTA.

The article addressed LACLS' ability to predict medication management through the use of MARS (Medication adherence Rating Scale. All participants reported that did not use medication aids despite evidence of impaired cognition. A strong, positive correlation was found between medication adherence and LACLS for participants that access mental health services in the community. This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. However, the findings are preliminary and should continue to be assessed by future studies to determine the specificity, sensitivity and cut off score for medication adherence.

The study examined two assessments, one an occupation based assessment (AMPS) and body function assessment (LACL). 30 clients who recently experienced a stroke took both assessments at home. Two groups of participants were formed, one group took the AMPS first and the other group took the LACLS first. Subjects were allowed to choose tasks that were known to them from the AMPS. Data was analyzed to assess the ability for the AMPS and LACLS to predict independence with ADLs and subsequently IADLs. The results confirmed the hypothesis of this study: a moderate positive correlation was found between the LACL and both the motor and the process scales of the AMPS, suggesting that although correlations between the tests were found, they do not fully examine the same concepts. The results also indicated moderate positive correlation between the LACL and the AMPS, yet there were discrepancies between the two tools in the determination of independence in instrumental activities of daily living (IADL). Clients who were found to be independent by one assessment were found to be dependent by the other. The authors suggest the use of these tools in conjuction with observation of ADLs and IADLs to predict independence levels. The authors also identified areas of each tool that was assessed in conjunction with predicting levels of independence with focus directed at judgement and comprehension to predict functional performance as supported by previous literature (Fong, Chan, and Au, 2001).

The MoCA screen is commonly used for individuals with Parkinson's Disease. The current study is a follow up from an original study. Thus, the aim of this pilot study was to develop an initial version of a new scoring procedure for the MoCA which considers the subtests' power to detect cognitive symptoms in PD, and to test whether it improves the ability to discriminate PD patients without cognitive impairment from patients with MCI and PD dementia. Screening procedures have high value as a time-economic, easy to use tool for a first step in detecting cognitive impairment in clinical practice, but will unlikely outweigh the reliability and validity of a neuropsychological test battery. The sensitivity of the MoCA increased from 68.8% to 81.3% while maintaining a specificity of 75% when using the weighted measurements. This means that more cognitively impaired subjects were detected in both patient groups. Since the sensitiviy increased it greater serves the purpose of a screen, to identify patients with cognitive impairments. The authors suggest this algorithm of weighting subtests may be applicable to patients with PD and other populations as historically some subtests of the MoCA have been too simple for non-demented patients.

Performance on MoCA subtests was compared at these MMSE cutoffs to determine profiles of early cognitive difficulties. The MoCA detected cognitive impairment not detected by the MMSE in a high proportion of participants, and this impairment was evident across various subtests. The MoCA appears to be a sensitive screening test for detection of early cognitive impairment.

The MoCA also measures a wider range of abilities including executive functions, a higher level cognitive ability required for the implementation of goal-directed behavior and the process of creating and fulfilling a plan. For these reasons, the MoCA was chosen as the comparator assessment of cognition in this study. The cut off score for the MoCA has widely been research and inconclusive. The original cut off score was 26/30 for normal cognition, however many argue the score is too low. This study suggests a computerized battery (CBS- Cambridge Brain Sciences Battery) for patients scoring 23-26, that have a borderline cognitive impairment in order to classify them as impaired or unimpaired. Five tasks from the original 12 of the CBS were chosen to assess aspects of short-term memory, attention, reasoning, and planning. Results: Only two of the tasks were able to distinguish between impaired and unimpaired. Utilizing these tasks in conjunction with the MoCA provides more information regarding testers that fall in the "borderline" category 23-26. The older adults were accepting of the electronic technology.

Abstract in English only, continued investigation for full article in English. Summary: Results MCI is best detected with a MOCA cut off point of 24/25 (80-81% specificity and sensitivity) MCI is best detected with a MMSE cut off 27/28 (66% sensitivity and 73% specificity ) MoCA test better meets the criteria for screening tests for the detection of MCI among patients over 60 years of age than MMSE.

In the ED and some acute care settings therapy services are based off of self-report measures in interviews with physicians. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability. Patients reported higher functional ability than observed by using the performance-based measures. This indicates that the two methods provide different information about functional ability. Previous research demonstrates a discrepancy between self-report measures and functional measures of functional tasks ADLs, functional mobility and IADLs. It is suggested both measures are utilized to appropriate a plan of care

Here is an overview of OT's role in Telehealth. This is more of a pros versus cons perspective to the topic. Something to consider as the world of OT is changing and continuing to develop.