----- Original Message -----
Sent: Thursday, October 09, 2003 9:01
AM
Subject: Re: [OTlist] Regarding the
websites for Cognitive assessement!!!
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
