Hi Ron My version of the scoring which is the 2000 revision says "When there is a discrepancy between the whipstitch and single cordovan stitch, score the highest score." This is the last sentence in the administration section headed Whipstitch not in the scoring guidelines. How do your clinical observations of this client fit with the profile of the screening score you got? You must validate it somehow by observing actual voluntary motor behaviour, or having behaviour described to you by someone other than the client, which fits the profile before you report conclusions. One way to validate is to continue interventions such as the lymphodema wrapping instruction and see if the 4.4 prediction holds. Then you have a good case for the client's continuing need for assistance. 4.2/4.4 is such a neat score to start with. It gives you a crack at all three stitches but the inability is clear to see. At the beginning it is easy to doubt yourself at 4.6 and above when clients can put up a verbal screen. My version also explains the pouch versus no pouch as item 6 in the set up instructions. Generally to my initial amazement people do do all the things in the scoring guidelines. Sometimes they do completely different things. This is our cue to look for focal deficits and perceptual problems. It also gives you confidence to push for further investigation. Two of our 'nonstandard' clients had brain tumors and a third had a previously undetected abdominal mass - go figure. We kept insisting that there had to be something until the docs ordered more investigation. Yes, we use the ADM. Often in a craft group to follow our long term care residents who have a base line score so we have a pretty good idea where to start, or with people who refuse the leather (often former nurses or school teachers). We use it also if we are checking for improvement because learning may be retained from the original administration. If you are following a decline you can continue to use the leather. It's an expensive proposition for someone working alone in private practice like you. What "book" do you have? Kathy Earhart who has developed most of the ADM was the main speaker at last year's symposium and she put us all through our paces. I'll never forget my red face when I looked at my own sun hanger and said "There is a mistake in the sample." -looked again and saw why the piece in question was positioned as it was. We all learned a lot about ourselves. Again - have fun. Joan Riches
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Wednesday, May 11, 2005 2:38 PM To: [email protected] Subject: [OTlist] Calling all Allen Cogn Screen People!!! A Question OK all you allen people, I need help!! The scoring guidelines are confusing. The whipstich guidelines indicate a score of 4.4 is possible,if the client corrects mistakes. However, the more complicated cordovan stitch results in a score of 4.2 if the client "follows the whip stitch...and does not benefit from [repeated] demonstration". So, what is the score if the client complete the whipstich and corrects mistakes (4.4) but then is unable to do the cordovan stitch (4.2)? Thanks Ron P.S. I am open and willing to hear any and all suggestions about the ACLS. p.s.s. Does anyone use the Allen Diag. Module (ADM)? -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
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