Hello to all of our Readers,
In this edition of the newsletter, we have chosen to compare the assessment tools used in our GLA OT Attendant Care Assessment for clients with head trauma.
The OSOT publication, released in 2011 Assessment of Attendant Care Needs, Form 1: A Resource for Reflective Practice states that,
“Clearly it is within the occupational therapist’s scope of practice to assess a client’s capacity to perform self-care and daily living skills and to identify needs for attendant care. The OT’s education prepares them to assess and analyze a client’s physical, mental and/or cognitive impairment(s) that impact function in order to provide recommendations that will reduce the impact of the client’s disability on his/her daily life”.
It states that when assessing attendant care needs, one must consider the predictability and consistency of a client’s performance (physical, cognitive, and behavioural).
Components of a comprehensive assessment include both subjective and objective information gathered from the client and other relevant or collateral sources.
Under the Basic Supervisory Care section of the forms, OTs are encouraged to consider the client’s general supervisory needs. According to the OSOT publication, “The care outlined in this section does not include the time for the physical hands on care”. The OT must consider if the client is not able to be physically, cognitively, behaviourally and/or emotionally self-sufficient in an emergency situation.
For those clients with cognitive limitations, the OSOT publication states, “...consideration of the need for attendant care services to provide ongoing cueing and prompts in order to complete the task is important”. This cueing can be provided through indirect methods such as phone calls, text messaging, or FaceTime.
When a client has sustained a head injury, it is important to choose proper assessment tools in order to support recommendations on the Form 1 for cueing, prompting, reminders, encouragement or safety. These may be due to a lack of judgment or cognitive-perceptual impairments, including impaired memory, attention, visual-perception, organization, and others.
One of the tools our therapists are using is The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which is a screening battery used to measure neuropsychological sequelae in adults. It is standardized and passed content and construct validity tests. It measures immediate memory, visuospatial/constructional abilities, language, attention and delayed memory.
In addition, one of the RBANS' uses is to track recovery during rehabilitation. Alternate forms are available for evaluating progression or improvement of neuropsychological symptoms. This is important in order to eliminate content practice effects. These alternate forms allow the therapist and client to objectively measure the changes in cognition over time.
Other tools our therapists use include the Doors and People memory test, the TEA for attention, and the Independent Living Scale for competency in activities of daily living related to independent living.
A test often used by hospital therapists is The Montreal Cognitive Assessment (MoCA). It is a short 30 item cognitive screen that was developed in 1996 for the setting of mild cognitive impairment and early Alzheimer’s disease. It was not developed for population of cognitive impairments post trauma.
We avoid using the MoCA as a single cognitive assessment tool for determining attendant care needs due to cognitive impairments. This is because it lacks the depth of symptoms provided by the tools we use, and does not have alternative forms, but only one form, which limits the clinician’s ability to track progress. As well, MoCA is limited in its ability to detect cognitive impairments and is not sensitive enough for our clientele.
To read more about the advantages of the RBANS visit our blog.
In addition, our second blog post this month is in regards to the Minor Injury Guidelines (MIG). The MIG is probably one of the most critical of the amendments that were made to the SABS in 2010. The changes in the MIG policies have resulted in many injured claimants not getting the care they require.
To read more about the Minor Injury Guideline, please visit this comprehensive article which was written by Niraj Joshi.
We are excited to be a Silver Sponsor at the BIST/OBIA Mix and Mingle event on June 10, 2015 to raise awareness of brain injury, as well as raising funds to support ongoing programs and services. We hope to see you there.
Galit Liffshiz, MA OT Reg. (Ont.)
President of GLA
Expertise and Experience in Life Care Planning
Designated Capacity Assessor