Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Retrieved from
http://www.nursingcenter.com/pdf.asp?AI
D=828299
Holistic treatment
approach
Retrieved from
http://www.beechwoodneurorehab.org/_
1
Retrieved from
http://psychcentral.com/news/20
09/02/10/are-brain-exercisesmainly-hype/4009.html
Patient motivation
Memory problems and carryover
(often anterograde amnesia)
Patient insight regarding cognitive
and functional deficits (meta
functions controlled by frontal lobe)
Distraction
Pragmatic issues such as time &
money constraints for the therapist
Keeping up with recent EBP can be
challenging
Creating individualized, creative,
patient-centered interventions may
also be challenging
* Basic
Cognition
(orientation,
comprehension,
expression,
memory, basic
problemsolving)
* ADL
Processing
* IADL
Processing
* Community
Re-Entry
Work Re-Entry
BASIC
COGNITION
Trail-Making Test (oral version), COWAT (letters F/A/S), & CLOX 1 & 2
MMSE
MoCA
Primary use
How to acquire
Abilities addressed
Visuospatial/executive
skills, naming, memory,
attention, language,
abstraction, delayed recall,
and orientation
Total points
30 total points
30 total points
Time to administer
~10 minutes
~10 minutes
Learning effects
MMSE
MoCA
Sensitivity for
identifying MCI,
dementia, or AD
MCI: 17%
Mild dementia: 25%
Alzheimers: 78%
MCI: 83%
Mild dementia: 94%
Alzheimers: 100%
Internal consistency
Poor-to-adequate
Excellent
Test-retest reliability
Excellent if reExcellent
administered within 2
months (*however, this is
not suggested due to
significant learning effects)
Inter-rater reliability
Adequate
Excellent
Criterion validity
(predictive,
concurrent)
Poor
Excellent
BOTTOM LINE:
Inferior to MoCA
Superior to MMSE
SAMPLE:
MINIMENTAL
STATE
EXAMINATION
(MMSE)
SAMPLE:
MONTREAL
COGNITIVE
ASSESSMENT
(MOCA)
Trail-Making Test, oral version: Ask the patient to recite the alphabet
and count 1-25 before beginning to check for automatic sequencing
and/or aphasia; then ask the patient to associate letters with
numbers in the form of 1-A, 2-B, 3-C etc. (all the way through 13M). More than 2 errors indicates possible impairment.
Controlled Oral Word Association Test (COWAT): Ask the patient to
come up with as many words (with 3+ letters) as he/she can that start
with each of the following letters: F, A, and S. Give the patient 1
minute to come up with as many words as possible for each letter. Do
not score repeats, mistakes, or versions of the same word (i.e. plurals).
Correct words receive 1 point each. Individuals with a high school
education should score at least 30 points.
CLOX*:
CLOX 1: Have the patient draw a simple clock set to 1:45 (allow 1 minute)
CLOX 2: Have the patient copy a correctly-drawn clock (allow 1 minute)
*Please see article at http://www.nursingcenter.com/pdf.asp?AID=828299
for full scoring protocol
SAMPLE: FIMBASED
COMMUNICATION
& COGNITION
SCREENING
Created for patients with TBI; may also be appropriate for clients with
CVA
Assesses abilities, adjustment (including family/significant
relationships), participation, and pre-existing and associated conditions
(premorbid drug or alcohol abuse, psych conditions, or physical
conditions/disabilities)
Can be completed by patient, family member, or therapist
Should be scored using manual
Can be re-administered over time to show progress or improvements in
self-awareness
SAMPLE:
SELFAWARENESS
OF DEFICITS
INTERVIEW
(SADI)
SAMPLE:
MAYOPORTLAND
ADAPTABILITY
INVENTORY
(MPAI-4)
COGNITION IN
TERMS OF
ADL AND IADL
FUNCTIONALITY
SAMPLE:
COGNITIVE
SCREEN FOR
GROOMING
(CSG)
COMMUNITY
RE-ENTRY
Can be created for each unit/hospital setting (Jen has created a Sunrise
version)
Comprised of 6 specific errands, 4 facts to be written down, a time-sensitive
task, and a requirement to verbalize termination of the activity
Record errors as follows:
Inefficiencies: where a more effective strategy could have been applied
Rule breaks: where a specific rule (either social or explicitly mentioned
in the task) is broken
Interpretation failure: where requirements of a particular task are
misunderstood
Task failure: where a task is either not carried out or not completed
satisfactorily
SAMPLE:
REHAB
SCAVENGER
HUNT
SAMPLE:
MULTIPLE
ERRANDS
TEST (MET)
SAMPLE:
WALGREENS
TACO
SCAVENGER
HUNT
APPROACHES &
INTERVENTIONS
APPROACHES
Have patient predict how well they will do before completing a task; then
after completion, have them self-evaluate their performance
Error-free Learning
Goal, plan, do, check: patients are encouraged to create their own goals
for the session, create a plan for achievement, complete the activity, and
evaluate their performance (planning should be facilitated by therapist;
can use COPM-based format to set goals)
INTERVENTION IDEAS
Create a memory book or daily log to help patients keep up with therapy (schedule, goals,
interventions, and plans), visits from loved ones, or other specific events
Practice shopping online, paying bills; provide budgets and needed tools like balance
register or calculator (or encourage patient to use tools on his/her phone)
Acquire a bus schedule/route map and have the patient plan a trip using public transit
Help the patient use social media, email, or text messages appropriately to communicate
with family and friends (or find online peer support groups)
Write a note or post card, address, and send it in the mail (downstairs, outside)
Print out a menu online, give the patient a budget, and have the patient choose a meal
(including beverage, appetizer, and dessert); have patient total amount and calculate tip
(even better, take them on a TACO to Dennys and complete these steps)
Plan a meal, use the internet to search for a recipe, create a shopping list, then cook the
meal (have the patient do all steps except grocery shop)
Review home safety/emergency protocols (see following page)
Play memory or categorization games such as Simon, Scattergories, or The Game of Things
Use a map to plan a day trip or sequence outings (i.e. post office, grocery store, mall)
Learn how to use a navigation app on the phone or online for printed directions
Teach a novel sequence of exercises/steps to a task and have the person return demonstrate
Use newspaper or online resources to check weather, sports, or current events
Complete small fix-it tasks (install batteries and set a portable alarm clock for patients
room)
Unload dishwasher and sort utensils/put away dishes in the proper place
Help patient set up medication sorter before discharge
Walk to gift shop and purchase a small gift (book, magazine, snack, gift for a loved one); set
a budget beforehand and see if the patient can remember/follow limit
HOME SAFETY
DIGITAL APPS
DIGITAL APPS
http://www.brainline.org/content/2013/12/life-changingiphone-and-ipad-apps-for-people-with-brain.html
2.
3.
LUMOSITY
Cost: free basic program; free full program for clinicians who apply
through the CARE program and agree to share efficacy data;
otherwise, $11.95/month or $47.96/year for an individual (or $79.96
for up to 5 family members)
Available for Apple, Android, & PC
Pros: can individualize programs to target processing speed,
memory, problem-solving, divided attention, and cognitive
flexibility
Cons: most appropriate for high-level patients
Similar apps: NeuroNation (free), Elevate-Brain (free), Rosetta
Stone Fit Brains Trainer (free)
FLOW FREE
Cost: free
Available for Apple & Android
Pros: easy to learn, provides a colorful
and simple platform for visual learners;
can help patients strengthen problemsolving, visual-perceptual, and pathfinding abilities; provides levels from
easy (5x5 grids) all the way to hard (9x9
grids); grids can be refreshed or moves
can be undone if errors are made
Cons: frequent ads may confuse players;
there are no provided instructions, so
players may require orientation to the
app
Similar apps: Bubble Poke, Bejeweled,
Candy Crush
RESOURCES
RESOURCE LINKS
MoCA:
https://academiccommons.columbia.edu/download/fedora_content/
download/ac:157860/CONTENT/COG_SCREEN_GROOM_TEST_
MANUAL_OBSERVATION_SCHED_MORTERA_2011.pdf
EFPT:
http://tbims.org/combi/mpai/
CSG:
https://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%
2Fwww.me.umn.edu%2F~wkdurfee%2Fprojects%2Fdriving%2Fs
elf-aware%2FFINAL%2520SADI%2520form.doc
MPAI-4:
http://www.mocatest.org/
SADI:
http://www.heartinstitutehd.com/Misc/Forms/MMSE.1276128605
.pdf
http://www.ot.wustl.edu/about/resources/executive-functionperformance-test-efpt-308
http://strokengine.ca/assess/module_met_indepth-en.html
THANK YOU
FOR YOUR
TIME AND
SUPPORT!!
Please email me at
ot15.danielle.goddard@nv.touro.edu for a
digital copy of this presentation.