Re: [OTlist] Regarding the websites for Cognitive assessement!!!

[Incandescent]

Hello there: The Assessment of Motor and Process Skills (AMPS) is an excellent assessment, but requires certification before it can be used.  I am certified in administering the AMPS and it took me about 5-6 months to research, participate in the intensive 5-day workshop, then do the 10 assessments required for *evaluation* (in 3 months if I recall correctly) before certification is granted.  And if one does not meet the evaluation criteria, then one has to submit another set of assessments. In the meanwhile I would strongly suggest you check out the "Cognitive Disabilities Model" (CDM) by Claudia K. Allen. I recommend it highly and have been consistently impressed by it.   I find it critical in my work with clients.  It is one of a number of functional performance measures developed by occupational therapists that emphasizes cognitive issues. It looks at both the functional and behavioral consequences of cognitive impairment. The model emphasizes six hierarchical levels of functioning based upon three aspects: 1) attention to sensory cues 2) sensorimotor associations 3) motor actions. The six cognitive functioning levels from least to most functional are: 1. automatic actions 2. postural actions 3. manual actions 4. goal-directed activity 5. exploratory actions 6. planned actions Assessment is conducted using various tests i.e. the Allen Cognitive Level (ACL) test, a leather lacing test (screen actually) which I use consistently and am most familiar with;  the Routine Task Inventory (RTI) etc. I use the ACL regularly and based on my discussions with other OTs find they constantly underrate its clinical utility.  In my opinion they are missing out on an excellent assessment tool.  It is a seemingly simple leather and lacing task which takes about 20 minutes to administer but generates meaningful findings. Its comprehensive manual gives an indepth analysis of virtually every ADL/functional task.  Which in and of itself is invaluable to any OT since one does not have to go about re-inventing the wheel or trying to be comprehensive in scope as it is all laid out in the text.  It is extremely helpful in focusing on level of support/supervision required, type of housing support required, focusing on "just-right challenges", and safety.  In fact I also find it useful to check my findings from more performance oriented assessment e.g. a kitchen task against the findings of the ACL. In this connection if you like you may want to check out the following resources/links: For a good review of the Cognitive Disabilities Model there is: Allen, C.D. & Blue, T (1998). Cognitive Disabilities Model: How to Make Clinical Judgments.  In Katz, N. Cognition and Occupation in Rehabilitation.  Rockville, MD: AOTA. As well you might wish to check out the following CDM manual/text, it is very critical to my work as an OT: Allen, C.K., Earhart, C.A., & Blue, T. (1992) Occupational Therapy Treatment Goals for Physically and Cognitively Disabled. Rockville. MD: American Occupational Therapy Association. As well as the following weblink: http://store.aota.org/aotastore/product.asp?pf_id=1173 This may be premature (and perhaps presumptuous of me) but if you decide to look into and use the Cognitive Disabilities Model (CDM), I would like to share my perspective on using the CDM and would strongly suggest that in any reports / documenation written that cognitive functional levels NOT be stated numerically.  As this often leads to a tendency (by anyone reading the notes or the OT report) to rate a client according to the level.  And gradually clinicians start referring to clients by the number of the cognitive level e.g. (s)he is a level 3 or 4 and so on.  This shifts emphasis to static labelling rather than focusing on understanding the cognitive issue which warrants attention and developing a treatment strategy or recommendation to address it.  Besides it is not client-centred to view clients as a level.  I prefer to be descriptive in describing the client's cognitive level in terms of her or his functioning along with recommendations.  The manual provides abundant examples of such descriptions in its comprehensive ADL tables (if needed). Hope this is helpful. Good luck, Biraj Khosla OT - Reg. (Ont.) Canada   OT Department wrote: Dear friends,                   I am working as a Senior Occupational Therapist in the Incorporated Orthopaedic Hospital, Dublin, Ireland. I have been working here with patients with THRs, Hemiarthroplasty, DHS, etc. It is a specialty Orthopaedic Rehab hospital and get referrals from the other major hospitals in Dublin. The problem that I am encountering here is that few of the patients (most of whom are elderly), being referred from the other hospitals, have marked cognitive impairments other than their orthopaedic problems. And our hospital doesn't have adequate services for this purpose.So there is a lot of stress on the team with regards to integration of the patient at home for relieving the pressure of bed availability here. But the problem is that they can't be discharged before adequate steps are taken for their cognitive impairments.We do cognitive assessments specifically to chart out a course for referrals to the other hospitals. The cognitive assessments that we do here are MMSE, MEAMS, etc. But I believe that they are not that effective in listing out the impairments in the different cognitive areas and the results/scores are too vague to come to any conclusion.So can anybody help/guide me on how to get about it and which is the most suitable and reliable tool for this purpose. Can you also guide me regarding any Occupational Therapy websites with details regarding the assessment tools, implementation, etc so that I can give a more detailed report to my team so that we can chart out suitable rehabilitation goals and refer it forward to the other agencies with adequate proof and relaible backing. Thanks.With RegardsMalhotra