ASSESSMENTS
The Montreal Cognitive Assessment (MOCA)
The Montreal Cognitive Assessment (MoCA) was designed as a quick screening instrument for the detection of mild cognitive impairment.
The MoCA assesses the following cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. The measure can be used with a client with a suspected cognitive impairment. On my Level 1 clinical placement, the MoCA was the most commonly used cognitive screening tool. I had the opportunity to administer this assessment on two clients. Typically, my preceptor used this tool to assess whether a client would be able to independently carry out their instrumental activities of daily living following discharge from the hospital. From the score, we could make clinical judgments on their memory capacities and how this may affect their ability to manage their IADLs, such as taking medications. We could also make judgments about their executive functioning and IADL tasks that they may experience difficulty with, such as cooking or managing finances. This assessment would help me set goals with clients related to their meaningful occupations that were being affected by their cognitive abilities.
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., ... & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699.
Mini-Mental State Examination (MMSE)
The Mini-Mental State Examination (MMSE) was originally developed as a brief screening tool to provide a quantitative evaluation of cognitive impairment and to record cognitive changes over time (Folstein, Folstein, & McHugh, 1975). Since that time it has become recognized that repeated use of the MMSE with the same client reduces its validity, so it is advised that this screening tool not be used repeatedly with the same individual if the time interval between testing is short. Rather than provide a diagnosis, the measure should be used to detect the presence of cognitive impairment (Folstein, Robins, & Helzer, 1983). The MMSE briefly measures orientation to time and place, immediate recall, short-term verbal memory, calculation, language, and construct ability. While the measure was originally used to detect dementia within a psychiatric setting, its use has become widespread. Since 1993, the MMSE has been available with an attached table that enables patient-specific norms to be identified on the basis of age and educational level (Crum, Anthony, Bassett, & Folstein, 1993).
Crum, R. M., Anthony, J. C., Bassett, S. S., & Folstein, M. F. (1993). Population-based norms for the Mini-Mental State Examination by age and educational level. Jama, 269(18), 2386-2391.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198.
Informal Observation for Cognition
Look at:
Task performance skills
Performance patterns
Activity demands
Environment as facilitator or barrier
Effects of fatigue and other impairments
Clock Draw Test (CDT)
The Clock Draw Test is used to quickly assess visuospatial and praxis abilities and may determine the presence of both attention and executive dysfunctions. In my OT 883 OSCE, I administered the CDT to measure spatial dysfunction and neglect in a client. The CDT may be used in addition to other quick screening tests such as the MMSE and the FIM.
Star Cancellation Test
The Star Cancellation Test is a screening tool that was developed to detect the presence of unilateral spatial neglect in the near extrapersonal space in patients with stroke.
Authors: Lisa Zeltzer, MSc OT; Anita Menon, MSc
The Assessment of Motor Process Skills (AMPS)
The Assessment of Motor and Process Skills (AMPS) measures a person’s performance capacity for activities of daily living (ADL) and/or independent living. The AMPS is a standardized observational assessment administered by an AMPS certified occupational therapist. The AMPS measures the quality of a person’s ADL performance by rating the effort, efficiency, safety, and independence while a person actually performs chosen, familiar, and life-relevant ADL tasks which include bathing, dressing, meal preparation, house cleaning tasks, outdoor maintenance tasks, and shopping.
An AMPS evaluation begins with an interview of the client so that the OT can determine which standardized AMPS tasks are familiar, relevant and of sufficient challenge to the client being evaluated. Following the interview, the client chooses and performs at least two ADL tasks that he or she has had prior experience performing. These tasks are performed in a familiar environment the way he or she usually performs them. After completion of the AMPS tasks, the OT scores the client on the 16 ADL motor and 20 ADL process skill items according to the criteria in the AMPS manual.
The benefits of the AMPS is that it establishes baseline performance and evaluates for change in performance. The results of the AMPS are used to determine a person’s need for support services and to write client goals that are occupation-based, and to plan interventions that meet an individual’s needs.
Motor-Free Visual Perception Test-4 (MVPT-4)
The MVPT-4 is a standardized assessment tool used to assess an individual's visual perception. It was originally developed in 1972 for use in children, but was later re-developed to be used with adults (Colarusso & Hammill, 2015; Brown, Rodger & Davis, 2003). The assessment tool does not require the individual to have advanced motor skills or be able to physically manipulate objects (Colarusso & Hammill, 2015). The MVPT-4 presents the client with 45 visual stimuli items measuring 5 domains: visual discrimination, visual figure-ground, memory, visual closure and spatial relationships (Colarusso & Hammill, 2015; Brown & Peres, 2018). These five domains do not represent separate subscales or subtests. The MVPT-4 provides a single score, representing an individual’s general visual perceptual ability (Colarusso & Hammill, 2015).
The MVPT-4 can be used on individuals aged 4-80+ (Colarusso & Hammill, 2015). The tool is untimed and is individually administered (Colarusso & Hammill, 2003). It can be used across a variety of diagnostic groups and requires minimal language requirements, making it easy to be administered and interpreted across cultural and ethnic groups (Canadian Partnership for Stroke Recovery, 2019). This tool is unable to detect change over time although there have been norms established related to the normal trajectory of visual perception skills that occur over an individual’s life span (Brown & Peres, 2018).
The MVPT-4 takes 20-30 minutes to administer with an additional 10 minutes to score the assessment (Colarusso & Hammill, 2015). All 45 items during the assessment use a multiple choice format where the individual selects their answers verbally or through gestures (Brown & Peres, 2018). Individuals are given a line of drawings or images and are requested to choose the drawing that matches the original drawing. The elimination of motor skills requirements allows assessment of visual perception rather than visual-motor impairments (Colarusso & Hammill, 2015).
The MVPT-4 can be used in multiple settings related to rehabilitation and research (Colarusso & Hammill, 2015). Specifically, it is used in hospitals, occupational therapy private practices, and in the client’s home. It also has application within schools and other education settings, and driving rehabilitation centres where perception is required (Colarusso & Hammill, 2015).
The MVPT-4 does not require the administrators to receive additional training. Occupational Therapists use this assessment tool to address performance issues due to a perceptual impairment often caused by learning disabilities, developmental coordination disorder, cerebral palsy, autism, spina bifida, attention deficit disorder, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and other neurological dementias (Brown & Peres, 2018). Issues can include risk of falls, problems with motor coordination, reading deficits, eating, grooming and dressing (Cooke, McKenna & Fleming, 2005). Using the MVPT-4 is useful for occupational therapy practice to guide intervention, create goals, and provide a baseline score to compare changes throughout treatment.
The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) Sixth Edition
The Beery-Buktenica Developmental Test of Visual-Motor Integration Sixth Edition (Beery VMI) is a standardized assessment designed to measure the extent to which individuals can integrate their visual and motor abilities (Beery & Beery, 2010). Visual motor integration (VMI) refers to the extent to which “visual perception and finger-hand movements are well coordinated” (Beery & Beery, 2010, p. 13). Across the lifespan, visual impairments that result in VMI difficulties can have an effect on one’s ability to perform their occupations (Cooke, McKenna, &Fleming, 2005).
This assessment consists of the main VMI task which includes a full and short format with 30 and 21 geometric shapes respectively that an individual must copy (McCrimmon, Altomare, Matchullis, & Jitlina, 2012). Administration of the full form takes 10-15 minutes, and the short form can be completed in less than 10 minutes. Due to the fact that the Beery VMI examines how motor coordination (MC) and visual perception (VP) interact, difficulties may stem from integrating these two factors, or from VP and MC separately. Thus, the Beery VMI has two supplemental tests that can be completed after administration of the VMI to determine MC and VP abilities separate from one another (Beery & Beery, 2010). The purpose of the Beery VMI and its supplemental tests are to (1) help identify significant difficulties in visual-motor integration, (2) obtain needed services for clients who exhibit these difficulties, (3) assess the effectiveness of educational and therapeutic interventions, and (4) serve as a research tool (Beery & Beery, 2010, pg.17). In order to be able to administer this assessment, a Master’s degree, membership in the Canadian Association of Occupational Therapists (CAOT), and a license to practice or formal training is required (Pearson, 2019). To score the Beery VMI one point is given for each correct item and one point is deducted for each incomplete item, up to three consecutive failures (Beery & Beery, 2010). If the assessor is unsure, they should follow the ‘when in doubt’ rule, and score the item as meeting the criteria (Beery & Beery, 2010). This is because inexperienced scorers tend to be too strict, which can greatly affect the norms. Greater familiarity with the manual and strong clinical reasoning will lead to greater reliability and validity. Age equivalents for Beery VMI raw test scores and standardized norms are additionally listed in the manual (Beery & Beery, 2010).
The Beery VMI was originally designed for a pediatric population; however, it is validated for individuals from 2-100 years of age. In these populations it has been shown to be an effective assessment tool used to understand VMI abilities amongst various demographics (Beery & Beery, 2010).In the pediatric population, the Beery VMI has been used to understand VMI deficits in children with Attention Deficit Hyperactivity Disorder, Traumatic Brain Injury (TBI), and Autism Spectrum Disorder (Green et al., 2016; Sutton et al., 2011). In the adult population, the Beery VMI can be used with individuals with cognitive impairments, TBI, and stroke clients who present with VMI skill deficits (Malloy, Belanger, Hall, Aloia, & Salloway, 2003; Willard, Crepeau, Cohn, OTR & Schell, 2009).
OTs use the Beery VMI in various practice settings. Specifically, it is commonly used in the school setting to work with youth to promote engagement in the student role. Furthermore, in understanding visual impairments in adults, OTs can use the Beery VMI “in order to choose rehabilitation intervention strategies appropriate forremediation of specific problems or to compensate for limitations in daily function” (Cooke et al., 2005, p.59).
Chedoke Arm & Hand Activity Inventory (CAHAI)
The Chedoke Arm and Hand Activity Inventory (CAHAI) is a validated, upper-limb measure that uses a 7-point quantitative scale in order to assess functional recovery of the arm and hand after a stroke. The purpose of this measure is to evaluate the functional ability of the paretic arm and hand to perform tasks that have been identified as important by individuals following a stroke.
The CAHAI is a performance test using functional items. It is NOT designed to measure the client’s ability to complete the task using only their unaffected hand, but rather to encourage bilateral function. There are 4 versions of the CAHAI, all having good psychometric properties. Administration times vary with the selected version (approximately 15-30 minutes).
The Chedoke-McMaster Stroke Assessment
The Chedoke-Mcmaster Stroke Assessment (CMSA) is a screening and assessment tool used to measure physical impairments of an individual following a stroke. The CMSA was initially developed and validated for the assessment of individuals older than 19 years of age that are one-week post-stroke, specifically in an inpatient and day-hospital setting. The CMSA consists of the Impairment Inventory and the Activity Inventory (Disability Inventory), which focus on severity of impairment and impact on function, respectively (Miller et al., 2008). The Impairment Inventory assesses six domains including the recovery stage of the arm, hand, leg, foot, postural control, and shoulder. Each domain is scored on a 7- point scale, where 1 represents the most impairment and 7 represents no impairment. For each category of the measure, clients start at a specific stage and aim to progress from their starting stage to stage 7. In order to progress, they must complete two of three tasks within each stage. If the client cannot do so, they must move back a stage. For example, the arm category starts the assessment at stage 3 where the client will either progress or regress from there. The stage of the client is dictated by where they successfully completed at least two of three tasks. The Activity Inventory assesses gross motor function (10 items evaluating rolling, sitting, transferring and standing) and walking (5 items). These 15 items are scored on a 7-point scale, where 1 represents complete dependence and 7 represents independence with the task.
According to Stroke Engine (2019), the CMSA is expected to take between 45 to 60 minutes to administer. It may not be feasible to complete the entire assessment in one session, however, evaluation should be completed within two days to minimize any physical changes in the client. While training is not required for use of the CMSA, users should read the manual prior to administration in order to be familiar with relevant administration instructions, scoring, and interpretation. Single-day workshops are available to teach healthcare professionals how to effectively administer the CMSA. While not mandatory, it is highly encouraged that professionals become trained because participation has been found to be more effective than self-directed learning in a study conducted with Canadian therapists (Miller et al., 2008).
Rivermead Behavioural Memory Test
RBMT-3 is designed to predict everyday memory problems in people with acquired, non-progressive brain injury and to monitor their change over time.
The RBMT comprises tasks analogous to everyday situations that appear to be troublesome for people with memory impairments.
RBMT-3 (Wilson et al., 2008) includes 14 subtests as follows:
First and Second Names - Delayed Recall: The examinee is showntwo photographic portraits and asked to remember the first and second names of both people in the photographs at a later point.
Belongings - Delayed Recall Two possessions belonging to the examinee are borrowed and hidden. The examinee is required to remember where these have been hidden at a later point.
Appointments - Delayed Recall An alarm is set. The examinee is required to ask some specified questions when the alarm sounds.
Story - Immediate Recall A story is read to the examinee and they have to recall it immediately
Picture Recognition - Delayed Recall The examinee is shown a set of pictures and then is asked to recognise them from a further set of pictures at a later time in the testing session
Face Recognition - Delayed Recall The examinee is shown a set of faces and then is asked to recognise them from a further set of faces at a later time in the testing session
Route - Immediate Recall The examiner shows the examinee a route to walk around the room and then asks the examinee to demonstrate it
Route - Delayed Recall The examinee is asked to demonstrate the route the examiner took around the room earlier, this time without it being demonstrated to them
Messages - Immediate Recall The examinee is required to take a message and book with them when they demonstrate the route and put them in the same place that the examiner did
Messages - Delayed Recall The examinee is required to take a message and book with them when they demonstrate the route again and put them in the same place that the examiner did
Orientation The examinee responds to a number of questions relating to person, time and place
Novel Task - Immediate Recall The examinee uses different coloured pieces to make a shape as demonstrated by the examiner
Novel Task - Delayed Recall The examinee uses different coloure pieces to make the same shape at a later time in the testing session, this time without demonstration from the examiner
