OT 504 Week 3 Small Group: Assessing and Treating Cognition in Older Adulthood.

Why are there many different cognitive assessments?

Cognition is multifaceted, so different assessments measure different aspects of cognitive function

What types of assessment methods can OTs use to evaluate cognition?

Skilled observation, semi-structured interviews, formal assessments, and informal assessments.

What is one important recommendation when administering cognitive assessments?

Avoid making the person feel like they are being tested.

Should cognitive testing be completed in one session?

Not necessarily; it can be completed across multiple visits if needed.

What should you do if a client becomes upset or uncomfortable during testing?

Do not force them to complete testing.

Why should OTs be cautious about diagnosing based on assessment results?

The results may reflect factors other than cognitive impairment.

What is white coat syndrome?

Anxiety or testing pressure that may negatively affect performance.

What sensory factors may influence cognitive assessment performance?

Hearing and vision impairments.

How can the environment affect assessment performance?

Familiar vs. unfamiliar settings may impact results.

What environmental factors can interfere with cognitive testing?

Ambient noise and distractions

What physical factors can influence cognitive assessment performance?

Pain, discomfort, poor sleep, medications, and substances.

How can emotional regulation affect cognitive assessment results?

Dysregulation may make performance appear worse than actual cognitive ability.

What questions should an OT ask before selecting a cognitive assessment?

What assessments are available, competency level, assessment format, concerns, time available, client abilities, and why testing is being done.

What is the most important question when selecting a cognitive assessment?

"Why am I testing?"

Name four common paper-and-pencil cognitive assessments.

SLUMS, MoCA, MMSE, and BIMS.

Name two functional cognition assessments discussed in class.

Kettle Test and E-ADL.

What is functional cognition?

How a person uses thinking and processing skills to perform everyday activities in clinical and community environments

According to AOTA, how should cognition be adequately assessed?

Through evaluation of function

How does functional cognition assessment differ from paper-and-pencil testing?

It evaluates cognition through real-life task performance.

What is the purpose of the Kettle Test?

To predict a person's ability to perform ADLs and IADLs through task performance.

What age group is the Kettle Test normed for?

Ages 13 and older.

How long does the Kettle Test typically take?

10–30 minutes

What task is completed during the Kettle Test?

Making two hot beverages with different ingredients

When should cueing begin during the Kettle Test?

When performance is unsafe, the task stops for at least a minute, repeated failures occur, or assistance is requested

What is an example of a general cue in the Kettle Test?

“What is the next step?"

What is an example of a specific cue in the Kettle Test?

"The spoons are in the utensil holder."

What is an example of physical assistance in the Kettle Test?

Plugging in the kettle for the patient.

What does a score of 0 indicate on a Kettle Test item?

Intact performance.

What does a score of 1 indicate on a Kettle Test item?

Slow performance and/or trial-and-error performance.

What does a score of 2 indicate on a Kettle Test item?

General cueing required.

What does a score of 3a indicate on a Kettle Test item?

Specific cueing required.

What does a score of 3b indicate on a Kettle Test item?

Incomplete or deficient performance.

What does a score of 4 indicate on a Kettle Test item?

Physical demonstration or assistance required

What is the maximum Kettle Test score?

52.

What do higher Kettle Test scores indicate?

More severe performance problems

How many performance indicators are scored in the Kettle Test?

13.

What does E-ADL stand for?

Erlangen Test of Activities of Daily Living

Who is the E-ADL designed for?

Individuals living with dementia

What severity level of dementia is the E-ADL normed for?

Moderate to severe dementia.

How long can the E-ADL take to complete

As little as 8 minutes

What five tasks are included in the E-ADL?

Pouring a drink, cutting bread, opening a cupboard, washing hands, and tying a bow

What is the scoring range for the E-ADL?

0–30.

what does a score of 30 on the E-ADL mean?

A score of 30 on the E-ADL indicates that the individual is completely independent in all assessed activities of daily living.

what does a score of 4 on the E-ADL mean?

A score of 4 on the E-ADL indicates that the individual requires assistance with most assessed activities of daily living, showing significant impairment in independence.

what does a score of 15 on the E-ADL mean?

A score of 15 on the E-ADL indicates that the individual requires assistance with some assessed activities of daily living, reflecting moderate impairment in independence.

what does a score of 0 on the E-ADL mean?

A score of 0 on the E-ADL indicates that the individual is completely dependent on others for all assessed activities of daily living.

What do higher E-ADL scores indicate?

Better ADL performance and better prediction of functional ability.

What type of cues are allowed before providing specific assistance in the E-ADL?

General cues such as "Please carry on as I have told you" or "Please try to do it yourself."

What does "no cues required" mean?

The participant independently completes the task without assistance.

What is indirect verbal guidance?

Open-ended verbal prompting that encourages problem-solving without telling the person what to do.

Give an example of indirect verbal guidance.

"What do you need to do next?"

What is gestural guidance?

Nonverbal visual cueing through gestures or pointing.

Can you talk while providing gestural guidance?

No. Point or gesture without words.

What is direct verbal assistance?

Giving a command that tells the person exactly what to do.

Give an example of direct verbal assistance

"Pick up the toothbrush."

What is direct physical assistance?

Physically helping with part of the task while the person still participates.

Give an example of direct physical assistance.

Hand-over-hand assistance or unscrewing a toothpaste cap.

What does "cannot do" mean?

The person cannot perform the task and the therapist must do it for them.

What are the four steps of treatment planning?

WHAT, WHY, WHICH intervention, and WRITE the goal/treatment plan.

What does the "WHAT" refer to in treatment planning?

The occupational performance problem

What does the "WHY" refer to in treatment planning?

The underlying cause of the problem.

Why is identifying the "WHY" important?

It guides selection of the most appropriate interventions.

What factors should influence intervention selection?

Evidence, client preferences, environmental context, insurance/practice requirements, and therapist competence

What should goals include?

Objective, measurable outcomes and a timeframe

What is habilitation?

Developing a new skill or a skill that previously did not exist.

What is health promotion?

Encouraging wellness and independence.

What is prevention?

Reducing risk of injury or development of disease/disorder.

What is compensation/adaptation?

Modifying the task or environment to work around limitations.

What is maintenance?

Preserving the current level of performance.

What is rehabilitation?

Regaining a lost or diminished skill.

Name common OT intervention types used for cognition.

Cognitive training, ADL retraining, IADL retraining, daily routine management, disease self-management, adaptive equipment training, and care partner training.

What intervention type teaches clients to use memory aids?

Adaptive equipment training and IADL retraining

What intervention type focuses on modifying routines?

Daily routine management.

What intervention type teaches clients to communicate with healthcare providers regarding medication issues?

Disease self-management.

What are the four activity categories in the Snow Approach?

Productive, Leisure, Self-Care, and Rest & Restoration activities.

What are productive activities?

Paid or unpaid activities that help a person feel they are making a difference.

What are leisure activities?

Pleasurable activities that can be active or passive.

what is an active leisure activity vs a passive leisure activity?

Active leisure activities involve physical engagement and participation, such as sports or exercise, while passive leisure activities include more relaxed pursuits like reading or watching movies.

What are self-care activities?

Activities that care for the body, brain, or environment

What are rest and restoration activities?

Activities that recharge energy and restore functioning.

What is the goal when grading activities?

To achieve the "just right challenge."

What is grading up?

Making an activity more challenging.

What is grading down?

Making an activity less challenging.

Why do OTs grade activities?

to prevent boredom from tasks that are too easy and frustration from tasks that are too difficult.