The relationship between cognition and functional outcomes in rehabilitation: FIMCog vs. MoCA.

AIM: To understand the relationship between scores on two standardized measures of cognition, the Montreal Cognitive Assessment (MoCA) and the cognitive subscale of the Functional Independence Measure (FIMCog), and whether these scores can predict functional outcomes in rehabilitation. METHODS: Retrospective data analysis was conducted on all inpatients admitted to a general rehabilitation unit within a 6-month period (N = 477). The average age of patients was 74 years. The Functional Independence Measure (FIM) was completed for all patients on admission and discharge. The MoCA was administered to patients on clinical suspicion of cognitive impairment. The MoCA was completed with 116 patients. Cognitive status was assessed using FIMCog and MoCA. The motor subscale of FIM was used to assess functional status in calculating the motor Rehabilitation Functional Gain (mRFG) and motor Rehabilitation Functional Efficiency (mRFE) scores. Discharge destination was also used as an outcome measure. RESULTS: There was a moderate correlation between FIMCog and MoCA scores on admission (r = 0.49, P < 0.001). Higher FIMCog and MoCA scores were associated with higher mRFG and mRFE scores. There was an indication that patients with higher MoCA scores were more likely to be discharged to a private residence (adjusted odds ratio 1.11; 95% confidence interval: 0.99, 1.25, P = 0.072). Cut-off points of <25 on the MoCA (sensitivity 88.9%, specificity 48.9%), and <29 on the FIMCog (sensitivity 77.8%, specificity 53.3%) predicted those patients who were less likely to discharge to a private residence. CONCLUSIONS: FIMCog and MoCA scores on admission were moderately correlated, and strongly correlated with functional rehabilitation outcomes. The FIMCog and MoCA had moderately high utility in predicting discharge destination. Geriatr Gerontol Int 2020; 20: 336-342.

Life without limbs: Technology to the rescue.

BACKGROUND: This article reports a rare and inspirational case of a four-limb amputee, the range of integrated technology solutions that enable him to be a productive member of his family and the process and pitfalls of seeking technology solutions. CASE DESCRIPTION AND METHODS: A complex case of bilateral transhumeral amputation and bilateral transfemoral amputation with residual upper limbs too short to oppose is presented. The multiple 'high-tech' and 'low-tech' devices used on a daily basis to move around his house and community, control his environment, communicate and feed himself without the use of limbs, prostheses or a second person are outlined. FINDINGS AND OUTCOMES: Recent advances in electronics, computing and telecommunications technologies provide him with capabilities not possible 10 years ago. CONCLUSION: The process and pitfalls in sourcing technology solutions and the innovative solutions to meet the unique functional needs of this individual provide guidance to those with similarly severe and profound limitations to independence. CLINICAL RELEVANCE: Descriptions of technology solutions to improve independent functioning of those with quadruple amputation without prostheses as well as those with high-level spinal cord injury are of value to occupational therapists, patients and families alike.

Clock drawing from the occupational therapy adult perceptual screening test: its correlation with demographic and clinical factors in the stroke population.

BACKGROUND/AIM: The aim of this study was to explore the relationships between clock drawing ability following stroke, and key clinical variables including cognition, functional independence, side and type of stroke, educational level and age. METHODS: One hundred and ninety-seven people with stroke were recruited from 12 hospital and rehabilitation facilities. The participants' scores from the Clock Drawing Test in the Occupational Therapy Adult Perceptual Screening Test were the dependent variables and were entered into logistic regression with Functional Independence Measure motor scores, side of stroke, Oxfordshire Classification System of Stroke, educational level and age as independent variables. Correlation with the Mini-Mental State Examination was analysed independently, due to its strong correlation with other variables. RESULTS: The Mini-Mental State Examination correlated significantly with the Clock Drawing Test ( Exp (B) = 0.826, P < 0.001). In the multivariate analysis, a significant relationship was found with age (Exp ( B) = 1.052, P < 0.001), Functional Independence Measure - motor (Exp (B) = 0.984, P = 0.030) and side of stroke (Exp (B) = 0.384, P = 0.003). Age demonstrated the strongest correlation with the Clock Drawing Test ability and the greatest decline was from approximately 70 years of age. CONCLUSIONS: The Clock Drawing Test may be a useful and quick screen of cognitive impairments following stroke. Age-related decline must be considered and it is essential that clinicians use this only as a strategy to determine whether a more comprehensive assessment is required.

Factors affecting the number and type of impairments of visual perception and praxis following stroke.

AIM: This study aimed to examine the effect of clinical factors including side of stroke, region of affected cerebral circulation, type of stroke and time since stroke, as well as age on the number and type of impairments of visual perception and praxis in patients following stroke. METHODS: Two hundred and eight participants with stroke were conveniently sampled from 12 hospitals in Brisbane and the Gold Coast. Background information was collected and each participant was assessed for impairments of visual perception and praxis using the Occupational Therapy Adult Perceptual Screening Test. RESULTS: Participants with left-hemisphere stroke were more likely to have impaired body scheme than participants with right-hemisphere stroke. Additionally, participants with right-hemisphere stroke were more likely to have unilateral neglect and impaired constructional skills than those with left-hemisphere stroke. There was a significant relationship between region of affected cerebral circulation and the occurrence of agnosia, unilateral neglect and constructional skill impairment. Moreover, the number of visual perceptual impairments experienced by participants was associated with the region of affected cerebral circulation. Increasing age was significantly related to the occurrence of constructional skill impairment and acalculia. CONCLUSIONS: Side of stroke, region of affected cerebral circulation and age affected the type of impairments of visual perception and praxis experienced by patients following stroke. Furthermore, region of affected cerebral circulation also influenced the number of impairments of visual perception and praxis in patients after stroke. The results have implications for more specific targeting of assessment and treatment practices following stroke.

Role of occupational therapy after stroke.

Internationally recognized best practice care in the early management and rehabilitation of individuals following stroke includes multidisciplinary assessment and treatment by a coordinated team of health care professionals that includes occupational therapists. Occupational therapists assess the impact of changes in motor function, sensation, coordination, visual perception, and cognition on a person's capacity to manage daily life tasks. Intervention improves participation in meaningful roles, tasks, and activities; remediates deficits; minimizes secondary complications; and provides education and support to the patient and caregivers. Occupational therapists' focus on independence and function, individual goal-setting, and their specialist skills in task adaptation and environmental modification underpin the profession's contribution to the multidisciplinary stroke rehabilitation team. The aim of this paper is to provide an overview of occupational therapy practice in stroke patients.

The incidence of visual perceptual impairment in patients with severe traumatic brain injury.

PRIMARY OBJECTIVES: To investigate the incidence of visual perceptual impairments in a sample of patients with traumatic brain injury (TBI) using the Occupational Therapy Adult Perceptual Screening Test (OT-APST), compare incidence rates to a normative sample and explore the relationship between the presence of visual perceptual impairment and the severity of cognitive and functional impairment following TBI. RESEARCH DESIGN: Cohort study using a convenience sample of patients with TBI and a normative sample. METHODS AND PROCEDURES: Thirty-one patients with severe TBI and 195 healthy people were compared on the OT-APST and measures of cognition and function. MAIN OUTCOMES AND RESULTS: The most common impairments in the TBI sample were unilateral neglect (45.2%) and impairments of body scheme (25.8%) and constructional skills (25.8%). Significantly higher incidences of agnosia, apraxia, unilateral neglect and impairments in body scheme and constructional skills were found in the TBI sample compared to the normative sample. No significant relationship was found between the presence of visual perceptual impairments and the level of cognitive and functional impairment after TBI. CONCLUSIONS: Visual perceptual changes are evident in patients with severe TBI when compared to a normative sample. Routine use of a screening tool such as the OT-APST may help identify visual perceptual impairments in these patients and the need for more detailed assessment.

Criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST).

This paper reports on the criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) including concurrent criterion validity and its sensitivity and specificity. The performance of 208 people following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA--Geriatric version (LOTCA-G)) was compared. The OT-APST subscale scores and performance outcome (intact or impaired) on related subscales of the reference tool was analyzed to evaluate the concurrent criterion validity of the OT-APST and its sensitivity and specificity at selected cut-off scores. Significant correlations were found between participants' performance (intact or impaired) on the reference tool and scores on the OT-APST. The sensitivity and specificity of the OT-APST were analyzed at selected cut-off scores to explore the validity of decisions based on OT-APST performance when compared with the reference tool. This study shows that the OT-APST is a tool with demonstrated concurrent criterion validity for the assessment of visual perception.

Construct and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST).

This paper reports on the construct validity (scale design and convergent validity) and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). The performance of 208 participants following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA-Geriatric version (LOTCA-G)) was compared. The OT-APST performance of the stroke sample was compared with a healthy normative sample (n = 356). The relationship between the OT-APST performance and the Functional Independence Measure (FIM) score of the participants following stroke was also examined. Factor analysis and internal consistency results supported the scale design of the OT-APST. Significant correlations between the performance of the participants following stroke on the OT-APST and the reference tool supported the convergent validity of the OT-APST. The ability of the OT-APST to separate the two participant groups provided further evidence of its construct validity. Significant correlations between OT-APST and FIM scores supported the ecological validity of this tool. This study shows that the OT-APST is an ecologically valid tool with demonstrated construct validity in the assessment of visual perception.

Development of a standardized occupational therapy screening tool for visual perception in adults.

Occupational therapy assessment and treatment of visual perceptual impairments are integral to the rehabilitation of clients following stroke and other acquired brain injuries. Occupational therapists need to identify the nature of visual perceptual performance impairments in order to choose rehabilitation intervention strategies appropriate for remediation of specific problems or to compensate for limitations in daily function. This paper describes the variations in visual perception terminology and occupational therapy approaches to visual perceptual assessment. Limitations of existing assessment tools for visual perception are highlighted in terms of reliability, validity, normative information, length of time to administer, and comprehensiveness in screening for visual perceptual impairment. In response to these limitations, a battery of items, called the Occupational Therapy Adult Perceptual Screening Test (OT-APST) was selected to screen adults comprehensively for impairments of agnosia, visuospatial skills including body scheme and neglect, constructional skills, apraxia, and acalculia. It also includes a subtest to evaluate functional skills directly observed during screening. This new battery has established reliability, validity and age-stratified normative data for adults 16 to 97 years of age. The OT-APST is recommended for use in conjunction with observational assessment of activities of daily living for clients with stroke and acquired brain injury.