I’m frequently asked about performance-based assessments for cognition in practice. I love using them and they have shaped how I create and structure future interventions and they also improved my documentation. As Occupational Therapists, we are always looking to understand how an assessment translates to a functional task. Other cognitive assessments, may tell me the client has poor recall or challenges with executive function but not how it impacts the client’s function.
Functional Cognition is a hot topic and a health policy perspective article was just written in AJOT (Giles, Edwards, Morrison, Baum, & Wolf, 2017). It advocates for our profession and the performance-based assessments we have been doing for years demonstrate our value to our client and their healthcare outcomes.
Over the years, more assessments and screens have been created and refined to assess cognition in function. This post is not a comprehensive review of the assessments for functional cognition, nor does it discuss their psychometric properties, but reflects assessments I have used in practice. For me to use an assessment in practice, it typically needs to be public domain. This means I could download the assessment at any time for free, often I just contacted the author prior to downloading the assessment.
Cognitive Screen for Grooming: Developed as a screen, it is appropriate to use at bedside and in a hospital-based setting its easy to access the supplies required. It allows you to look at patterns within scoring to determine which cognitive and perceptual process your client finds the most challenging.
Executive Function Performance Test: I remember learning about this test at the AOTA Annual Conference in Indianapolis. As soon as I got back to work, my friend and OT colleague started to develop a drawer with some new assessments. This was the first place I created an EFPT kit and when I relocated, making this kit was one of the first projects I had for a Level II fieldwork student. It has four basic tasks: oatmeal preparation, using the telephone, taking medication, and paying bills. It has structured cueing provided in the manual. It’s an excellent resource and truly changed my practice. I became more aware of how I cued and this was further reflected in my documentation.
Kettle Test: This test is clinically mindful because you can fit all of the items in a small plastic box to carry to the client’s room, home, or for easy set up in an OT gym. This is one of the shorter tests which is excellent if you only have a thirty minute session. Additionally, it offers the client some choice in determining what type of drink they will prepare for themselves and then they also prepare a drink for the OT. Once the drinks are made, the client is asked to recall the instructions and discuss their performance. This provides insight into their self awareness of their deficits.
Multiple Errands Test: I recall reading Dawson et al.’s (2009) article demonstrating their ability to make a site specific MET. I went to work with my trusty OT colleague, to design a MET for our site. This was exciting because the location of the hospital was not in a great location to go off-site for community re-entry activities. However, we did have a gift shop and a cafeteria. We were able to create 6 tasks that require the client to purchase specific items, use a telephone, and send mail and the last 4 tasks requested the client to find information throughout the hospital. The article attached provides an example of the Baycrest MET version.
Mortera-Cognitive Screening Measure: Again, developed as a screen by the same author as the Cognitive Screen for Grooming. They complement each other well. This screen uses kitchen tasks to look at 7 cognitive processes: sustained attention, shifting attention, visual attention scanning, awareness of disability, judgment, recall, and planning.
I’m sure I’ve used other screens and assessments but these are some that top the list!
Reference
Gordon Muir Giles, Dorothy Farrar Edwards, M. Tracy Morrison, Carolyn Baum, Timothy J. Wolf; Screening for Functional Cognition in Postacute Care and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Am J Occup Ther 2017;71(5):7105090010p1-7105090010p6. doi: 10.5014/ajot.2017.715001.
Translating the Evidence 