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Cognitive Performance Test

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grace powell

on 8 July 2016

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Transcript of Cognitive Performance Test

Cognitive Performance Test
Introduction
Standardized assessment tool used most commonly for older adults.
Began as a test for patients with Alzheimers, but has now been used with other populations: Stroke, Neuro, Dementia
Functional ADL based assessment with a "focus on the degree to which particular deficits in
information processing
compromise functional activities" (Burns, 1992, p.46).
Based heavily on the Allen Cognitive Disability Theory
6 Performance tasks measured:
Dressing
Shopping
Telephone
Toast preparation
Washing
Traveling
Theoretical Application
Theoretical Principle:
We are occupational beings and achieve health and wellness through engagement with a variety of desired occupations.
Adaptive Approach:
This test meets the individual at their current level of function. It brings about ideas about the type of adaptations that need to be made and the caregiver supports necessary for the highest level of functioning (Cole, 2012).
Allen Cognitive Disability Theory:
Highly informed by this disability theory. This theory focuses on adapting the context, task demand, and assistance level to provide a "just-right challenge" when engaging in activities (Cole, 2012). It meets the client at their level and maximizes function based on strengths to ensure success.
"Best applied when there is a need to measure and monitor a client's problem- solving ability and safety while performing daily activities in any of the areas of occupation" (Cole, 2012, p. 193)
Cognitive Performance Test
By: Grace Powell, Amanda Cutting, and Allie Adams
Cognitive Performance Test Data
Sampling:
Individuals with cognitive impairment
Normative Data:
High scores correlate with higher levels of independence (no cognitive impairment), while low scores correlate with lower levels of independence (high cognitive impairment) (Burns, 1992b).
Because the purpose of the test is to define a specific cognitive level, no normative scores are defined. Scores vary.
Standard and Criteria Scores:
Average score relates to Allen Cognitive Scale (Burns, 1992b)
Reliability:
Inter-rater: 0.91 (Burns, 1992b, p. 48)
Test-Retest: 0.89 (Burns, 1992b, p. 48)
Excellent Internal Consistency (Vancouver Coastal Health & Providence Health Care, 2012)
Validity:
High Predictive Validity for long-term risk of institutionalization (Burns, 1992b, p. 48)
Significantly correlated with MMSE (r=0.67), IADL Scale (r=0.64), and Physical Self-Maintenance Scale (r=0.49) (Burns, 1992b, p. 48).
Clinical Application
Administration Time: 45 minutes
"The specific tasks selected are less important than the manner in which the patient responds to demands of varying complexity" (Burns, 1992, p.46)
Focused more on
HOW
they go about completing the task
Information processing assessed
Deficits assessed in this test have implications for performance in a variety of ADL tasks (Burns, 1992).
Results give indications about necessary adaptations, level of assistance, and types of interventions that would be ideal for their cognitive level (Cole, 2012).
SET UP
of testing materials and maintaining consistency with
STANDARDIZED CUING
are very important for administration of this test
Procedures and Protocols to Administration
Interpretation of the Assessment
Each task in the CPT is scored on a scale of
1-6
or
1-5
.
Dressing:1-5
Shopping: 1-6
Toast: 1-5
Telephone: 1-6
Wash: 1-5
Travel: 1-6
Total Test Score = 6-33



Potential Bias
Culture
Ex: Concept of "gender specific"
Familiarity with the specific objects used in the assessment
Performance anxiety
Unfamiliar with testing environment compared to home environment
Motor skills
Inter-rater reliability
Ex: How much time would you wait as a therapist before you gave a cue?
Temporal or Generational
Ex: Phone books, maps
References
Burns, T. (1992a). Appendix C: Cognitive Performance Test. In C. K. Allen, C.A.
Earhart, & T. Blue (Eds.),
Occupational therapy treatment goals for the physically and cognitively disabled
(pp.69-84). Bethesda, MD: AOTA Press.
Burns, T. (1992b). Evaluation Instruments. In C. K. Allen, C.A.
Earhart, & T. Blue (Eds.),
Occupational therapy treatment goals for the physically and cognitively disabled
(pp.46-50). Bethesda, MD: AOTA Press.
Cole, M.B. (2012). Allen's Cognitive Disabilities Group. In Author (Ed.)
Group
dynamics in occupational therapy
(pp. 193-216)
.
Thorofar, NJ: SLACK
Vancouver Coastal Health & Providence Health Care. (2012).
Occupational
therapy practice: Occupational therapy cognitive assessment inventory & references
. Retrieved from: http://www.wrha.mb.ca/professionals/cognition/files/VancouverCoastal.pdf

6 Tasks to Administer
Task 1: Dress
Task 2: Shop
Wallet with specific features and specific amount of money
12 Belts with belt buckles
Small Table
Specifics of the materials are found in the CPT Manual
Task 3: Toast
Task 4: Telephone
Task 5: Wash
Task 6: Travel
Procedure
Equipment:
Clothes (Both men and women's items)
Heavy raincoat, lightweight raincoat, and bathrobe hung on hangers
Accessories
Straw hat, rain hat, scarf, umbrella
Wall mirror


(Burns, 1992)
Equipment is provided at the station and is set up like a closet
Specific guidelines MUST be followed when setting up each task so follow specific directions in the CPT Manual
General Guidelines for dressing task:
Client chooses appropriate clothing choices for going outside on a cold and rainy day.
Read the manual directions
exactly
as it appears to administer the task and prompt the client when needed with verbal cues.

Looking to see that the client chooses the appropriately sized belt, checks price tags, and determines the amount of money in the wallet.
Read the directions
exactly
as they appear in the manual when administering the task to the client
Equipment
Table
Toaster
Bread
Jam
Butter
Mustard
Small plate
Silverware
Set-up
Follow directions exactly as they appear in the manual
General Guidelines for Toast task:
Watch to see if they can locate an outlet, plug in the toaster, make toast, and add butter and jam to the toast.
State the directions
exactly
as they appear in the CPT Manual when administering the task.
Equipment:

Telephone
Yellow pages directory
Note pad and pen
Index cards with phone numbers
Magnifying glass or reading glasses
Set-up:
Patient sits at table with telephone in front of them
Other objects are placed on table according to directions in the manual
General Telephone Guidelines:

Client uses phone to find the cost of one gallon of white paint
Client must locate a number, call the number, and ask about the price.
State the directions and verbal cues
exactly
as they appear in the CPT manual
Equipment:
Sink
Table and chair
Box with:
Soap
Aftershave
Toothbrush
Dental floss
Hair comb
General Guidelines for Wash Task:
Client will be directed to use the materials in the box to clean their hands as if they were dirty.
State the directions
exactly
as they appear in the manual for administration.
Equipment:
Map
Concrete, written directions on separate sheet of paper
Clip board
Set-up:
Patient starts at starting point and faces the direction that they will go
General Guidelines for Travel Task:
Client will try to get from one place to another using a map.
Client will navigate hallways to find stairwell.
State the directions as they appear in the CPT manual.
Before you begin:

During the Administration:
Set the materials up according to the CPT manual
Read over the CPT manual for each task to become familiar with the directions
Become familiar with the parts of the task that are typically seen as challenging for clients so you are aware of what to expect
Follow the specific directions in the CPT manual for cognitive assistance and types of cues.
Four types of cues discussed by Claudia Allen:
Facilitative- Give sensory cues appropriate to their level of function (Cole, 2012, p.194)
Ex: Touch the client and guide them on the correct path to stairwell
Probe- Ask questions that encourage problem solving (Cole, 2012, p.194)
Ex: “Are you sure you have enough money to buy that belt?”
Observe- Allow client time to process cues and questions and try out new behaviors (Cole, 2012, p.194)
Rescue- When frustration arises, correct the error or do the step for the client and prompt them to complete the next one. (Cole, 2012, p.194)
Equipment:
Set-up:
Hang belts in sets of 2 at eye level
Table with wallet sitting on it
Price and size the belts according to manual
Specific set-up can be found in the CPT Manual
General Guidelines for Shopping Task:
Skills Assessed
Information processing
Awareness of environmental cues
Recognition of patterns
Filtering out irrelevant information or materials
Attention
Planning
Sequencing
Problem solving
Judgement
Reasoning
Goal formation
Organization
Speed of information processing
Memory

(Cole, 2012, p.197)
(Burns, 1992a)
(Burns, 1992a)
(Burns, 1992a)
(Burns, 1992a)
(Burns, 1992a)
(Burns, 1992a)
Scoring the Assessment (What?)
Interpretation of the Scores (So what?)
Interpretation of CPT scores uses the Allen Cognitive Levels (ACL), which ranges from
1 to 6

Multiply each Allen Cognitive Level by 6:
ACL 1 x 6 = 6
ACL 2 x 6 = 12
ACL 3 x 6 = 18
ACL 4 x 6 = 24
ACL 5 x 6 = 30
ACL 6 x 6 = 36
Compare these with the
CPT total test score
.

Example: A total test score of 25 would fall between an ACL of 4 and 5.
Application of the Scores (Now what?!)
ACL 1
Total assistance needed
Automatic actions
ACL 2
Maximum assistance needed
Postural actions
ACL 3
Moderate assistance
Manual actions
(Burns, 1992b)
(Cole, 2012)
ACL 4
Minimum assistance
Goal-directed actions
ACL 5
Standby assistance
Exploratory actions
ACL 6
No assistance
Planned actions
(Burns, 1992a)
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