2012

Emily King, OTR/Clinical consultant

HTS/Proactive Medical Review

3/22/2012

Occupational Therapy Formal Testing

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Occupational Therapy Formal Tests Preview: Why use formal tests? …………………………………………………………………………………………………………. 2

I. Activities of Daily Living A. BarthelIndex………………………………………………………………………………………………………… 4 B. Rivermead……………………………………………………………………………………………………………… 6 C. Kohlman Evaluation of Living Skills (KELS)…………………………………………………………….. 10 D. Canadian Occupational Performance Measure……………………………………………………. 12

II. Functional Occupations-Activity of Interest A. Interest Checklist…………………………………………………………………………………………………16

III. Depression A. Geriatric Depression Scale (GDS)…………………………………………………………………………. 18

IV. Cognition A. Allen Cognitive Level Screen (ACLS)……………………………………………………………………….20 B. Allen Diagnostic Modules……………………………………………………………………………………… 21 C. Routine Task Inventory (RTI)………………………………………………………………………………… 22 D. Cognitive Performance Test (CPT)………………………………………………………………………… 24 E. Montreal Cognitive Assessment…………………………………………………………………………… 25

V. Biomechanical A. 10 Repetitions Sit to Stand…………………………………………………………………………………….32 B. 5 Times Sit to Stand……………………………………………………………………………………………….33 C. Test of Reaction Time…………………………………………………………………………………………….34 D. Modified Functional Reach Test (mFRT)…………………………………………………………………35 E. Chair Stand Test……………………………………………………………………………………………………..36 F. Reedco…………………………………………………………………………………………………………………..37 G. Borg……………………………………………………………………………………………………………………….41 H. Dyspnea Scale………………………………………………………………………………………………………..45 I. Braden Risk Scale…………………………………………………………………………………………………..46 J. Advanced Balance Confidence Scale (ABC)……………………………………………………………47 K. 9 Hole Peg Test……………………………………………………………………………………………………..49

VI. Pain A. Wong-Baker FACES Pain Rating Scale……………………………………………………………………50 B. Pain Assessment in Advanced Dementia………………………………………………………………52 C. Severity of Tremor ………………………………………………………………………………………………..53 D. Diabetic Foot Screen……………………………………………………………………………………………..56

VII. Vision A. Motor-Free Visual Perception Test (MVPT)…………………………………………………………..57 B. Amsler Grid……………………………………………………………………………………………………………61 C. Line Bisection Test…………………………………………………………………………………………………63 D. Snellen Chart …………………………………………………………………………………………………………65 E. Geriatric Pattern Card……………………………………………………………………………………………67 F. Letter Cancelation Test………………………………………………………………………………………….68

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Why use formal tests?

1. To obtain objective, factual, and verifiable information 2. To assist in treatment planning 3. To measure progress and the effectiveness of treatment

CMS Manual (Transmittal 88) states: “Objective evidence consists of standardized patient assessment instruments, outcome measurements tools or measurable assessments of functional outcome. Use of objective measures at the beginning of treatment, during and/or after treatment is recommended to quantify progress and support justifications for continued treatment. The use of these tools will enhance the justification for needed therapy.” Choosing the appropriate test may depend on several factors:

1. Medical history 2. Diagnosis 3. Problems presented 4. Abilities 5. Interview 6. Observation 7. Prescription

Therapists must select the test that best validates the situation at hand. They need to know what the test is measuring and score it correctly.

Transmittal 63 requires practitioners to include in their documentation of evaluations either the results of a specified performance measure tool or documentation required to indicate objective, measurable beneficiary function.

” Objective, measurable beneficiary physical function may be documented by including one of the following three options: 1. Functional assessment individual item and summary scores (and comparisons to prior assessment scores) from commercially available therapy outcomes instruments other than those listed above; or 2. Functional assessment scores (and comparisons to prior assessment scores) from tests and measurements validated in the professional literature that are appropriate for the condition/function being measured; or 3. Other measurable progress towards identifiable goals for functioning in the home environment at the conclusion of this therapy episode of care. This means that the documentation must include either (1) the functional assessment from a therapy outcomes instrument available on the market, or (2) functional assessment scores from a test or measurement that has been published in the peer-reviewed literature that is appropriate for the patient’s condition/function, or (3) other information that defines functional status which can be used to identify objective measurable goals and progress toward goals for functioning in the environment to which the patient will be dischargedat the conclusion of this therapy episode of care. This third option of documenting the patient’s progress towards

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functional goals must relate to the patient functioning in the place where the patient will live at the conclusion of the course of treatment. Documenting objective, measurable beneficiary physical function is to spell out how the patient information gathered shows the patient’s function limitations and relates to the patient’s functional goals (occupational performance). This documentation should contain the following elements: 1. List all standardized/non-standardized assessments administered during evaluation and the results; 2. Document how the assessments selected measure performance deficits and functional problems identified in the evaluation; 3. Document results of assessments and how they relate/what they mean in terms of performance deficits; 4. Document client performance observed (skilled observation) by therapist; and 5. Summarize and interpret the results of assessments and observations as they relate to the person’s occupational performance (ADL, IADL, social participation) and as they form a foundation for the plan of care and goals. These components should support the presumption that the occupational therapy services are reasonable and necessary. This means that the services are considered under accepted standards of medical practice to be safe and effective treatment for the client’s condition and that there is an expectation that the client’s condition will improve materially in a reasonable (and generally predictable) period of time based on the assessment of the client’s restoration potential and unique medical condition. (See 42 C.F.R. § 409.44). References American Occupational Therapy Association. (2002). Occupational Therapy Practice Framework: Domain and Process. America

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Barthel Index Authors: Florence I. Mahoney, MD, and Dorothea W. Barthel, BA, PT Format: Performance index based on observation, interview, or records. Method: The index consists of 10 common ADL’s, 8 of which represent activities related to personal care while 2 are related to mobility. Each item is scored in intervals of 5 based on the amount of time and assistance required to perform the activity. The BI can be completed through either direct observation or self-report. Purpose: This tool is useful in evaluating a patient’s state of independence before treatment, his progress as he undergoes treatment, and his status when he reaches maximum benefit. A patient scoring 100 on the Barthel Index is continent, feeds himself, dresses himself, and gets up out of bed and chairs. He can bathe himself, walk at least a block and can ascend and descend stairs. Guidelines: 1. The index should be used as a record of what a patient does, not as a record of what a patient could do. 2. The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason. 3. The need for supervision renders the patient not independent. 4. A patient's performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources, but direct observation and common sense are also important. However, direct testing is not needed. 5. Usually the patient's performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant. 6. Middle categories imply that the patient supplies over 50 per cent of the effort. 7. Use of aids to be independent is allowed.

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THE Patient Name: ___________________________ BARTHEL Rater Name: ___________________________ INDEX Date: ___________________________

FEEDING Activity Score

0 = unable 5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent ______ BATHING 0 = dependent 5 = independent (or in shower) ______ GROOMING 0 = needs to help with personal care 5 = independent face/hair/teeth/shaving (implements provided) ______ DRESSING 0 = dependent 5 = needs help but can do about half unaided 10 = independent (including buttons, zips, laces, etc.) ______ BOWELS 0 = incontinent (or needs to be given enemas) 5 = occasional accident 10 = continent ______ BLADDER 0 = incontinent, or catheterized and unable to manage alone 5 = occasional accident 10 = continent ______ TOILET USE 0 = dependent 5 = needs some help, but can do something alone 10 = independent (on and off, dressing, wiping) ______ TRANSFERS (BED TO CHAIR AND BACK) 0 = unable, no sitting balance 5 = major help (one or two people, physical), can sit 10 = minor help (verbal or physical) 15 = independent ______ MOBILITY (ON LEVEL SURFACES) 0 = immobile or < 50 yards 5 = wheelchair independent, including corners, > 50 yards 10 = walks with help of one person (verbal or physical) > 50 yards 15 = independent (but may use any aid; for example, stick) > 50 yards ______ STAIRS 0 = unable _______ 5 = needs help (verbal, physical, carrying aid) 10 = independent TOTAL (0-100):________

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Rivermead Activities of Daily Living (ADL) Scales Reference: Whiting and Lincoln (1980); Lincoln and Edmans (1990) Format: Task performance exam Method: This scale includes self-care tasks and household 1 & 2 tasks. Each task is scored as independent, verbal assistance required, or dependent. The scores are added to achieve a total score. The higher the score the more independent the patient is. It was developed for patients post CVA. Purpose: Good test to establish baseline status before therapy and status post therapy.

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Instructions Rivermead Activities of Daily Living (ADL) Scales

1. Decide where to start. If the patient can do that item, go back three to make sure that the patient can do these as well, and forward until three consecutive failures – then stop. This applies to each section.

2. All aids supplied or recommended to be stated on form. 3. Guidelines are given on next page. Scoring 1= Independent with/without aid 0v = Verbal assistance only 0= Dependent (i.e. if unfit, unassessable, unsafe or time is taken beyond practical bounds) Self care Score Equipment Drinking Clean teeth Comb hair Wash face/hands Make up or shave Eating Undress Indoor mobility Bed to chair Lavatory Outdoor mobility Dressing Wash in bath In/out of bath Overall wash Floor to chair

Household 1 Score Equipment Preparation of hot drink Preparation of snack Cope with money Get in/out of car Prepare meal Carry shopping Crossing roads Transport self to shop Public transportation

Household 2 Score Equipment Washing Ironing Light cleaning Hang out washing Bed-making Heavy cleaning

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Self-care • Drinking A full cup of hot liquid, not spilling more than 1/8 of its contents. • Clean teeth Unscrewing toothpaste, putting toothpaste on brush, managing tap (faucet). • Comb hair To be presentable on completion. • Wash face and hands At basin (not with bowl), including putting in plug and managing taps and patient drying him/herself. (All materials to hand.) • Make up or shave Shaving to be done by patient’s preferred method • Eating A slice of cheese on toast eaten with a knife and fork. • Undress Dressing gown, pajamas, socks and shoes to be taken off. • Indoor mobility Moving from one room to another. Turns must be to the left. Distance of 10 m. • Bed to chair From lying covered, to chair with arm, within reach. • Lavatory Mobility to WC (less than 10m). To include managing pants and trousers, cleaning self and transferring. • Outdoor mobility To cover a distance of 50 m, and to include going up a ramp and through a door. • Dressing Does not involve fetching clothes. Clothes to be within reach in a pile, but not in any specific order. All essential fastenings to be done up by patient. • Wash in bath Showing movements i.e. ability to wash all over. Ability to manage taps (faucets) and plugs. • In and out of bath A dry bath. • Overall wash Not in bath – at basin (not with bowl). Patient must be able to wash good arm, stand up and touch toes from sitting in order to be able to wash all over. • Floor to chair - From lying to upholstered chair without arms, seat 45 cm (15 in) high.

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Household 1 • Preparation of hot drink Fill electric kettle, everything to be ready on working surface • Preparation of snack Cheese on toast – materials to be easily reached. Washing and cleaning work surface to be done easily. • Cope with money Match coins to packet of sugar, cornflakes and margarine. Ask for change of 34p from 50p; 72p from £1.00 ; £3.21 from £5.00 • Get in and out of car Front seat of any car except sports model. • Preparation of meal Peel one potato, fry sausage. Frozen vegetables from freezer. Open tin. • Carry shopping Half-pound of butter (250g), 14 oz tin (500g) and money. • Crossing road Cross at traffic lights with curbs – no pedestrian crossing. • Transport self to shop and back Distance of ½ mile (1 Km) • Public transport Travel on bus ( not Park and Ride). Distance of at least 1 mile (2 Km) with minimum three stops before destination. Household 2 • Washing Handwash underwear at sink. • Ironing Not with steam iron. Organize surface (board or table). • Light cleaning Cleaning and tidying surface – height 13-37 in (30-90 cm). • Hang out washing On rail indoors, away from sink, no pegs. • Bed making Putting on sheet and blanket, straightening and tucking in. Bed 21 in (50 cm) high. • Heavy cleaning Hoover (vacuum), sweep and dustpan/brush 11 ft (3 m) square room, moving dining room chairs only.

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The Kohlman Evaluation of Lving Skills (KELS) Authors: Linda Kohlman Thomson, MOT, OTR, OT(C), FAOTA Format: Interview and task performance test Method: 17 living skills are tested under 5 areas:

1. Self-care 2. Safety and Health 3. Money Management 4. Transportation and Telephone 5. Work and Leisure

Scoring: Each item marked as “Needs Assistance” is scored as 1 point, excluding the two items under Work and Leisure as these are counted as only a half point. “Independent,” “See note,” and “Not applicable” are counted as zero (0). A score of 5 ½ or less indicates the client is capable of living independently. A total score of 6 or more indicates the client needs assistance to live in the community. When a client has a score in the range of 5-5 ½ the client has borderline skills for living independently in the community. Purpose: A tool to determine an individual’s ability to perform basic living skills and to help determine appropriate discharge setting Equipment: notebook, local phone book, telephone, $2 & change, and photocopied KELS forms This test can be ordered through Brenda Joniec from the HTS corporate office

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Canadian Occupational Performance Measure (COPM)

Authors: Mary Law, PhD, OT, Sue Baptiste, MHSc, OT, Anne Carswell, PhD, OT, Mary Ann McColl PhD, OT, Helene Polatajko, PhD, OT, and Nancy Pollock, MSc, OT

Format: Interview-based rating scale

Method: An interview to identify 5 important performance problems in three areas of life: self-care, productivity, and leisure and are rated on performance and satisfaction based on a scale of 1 to 10. Summing the performance and satisfaction scores for all activities and then divide by five to get a score.

Difficult to complete with patients who have cognitive impairments

Benefits: Good way to start the partnership dialogue between patient and therapist. It lets patients know that you hear them and consider them to be experts in the occupational performance areas.

Purpose: To identifyproblem areas, provide a rating of patients priorities, evaluate performance and satisfaction in the problem areas, measure changes in a patient’s perception of his/her occupational performance

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Allen Cognitive Level Screen (ACLS) –leather lacing/Use the large leather lacing (ACLS)

Author: Claudia Kay Allen, MA, OTR, FAOTA

Format: Task analysis with standard demonstration instruction

Method: contains 3 different stitches, each stitch is more complex than the previous one. Stitches are demonstrated one at a time and the patient is asked to reproduce stitching. Errors in stitching are also introduced to the patient to determine problem identification and problem solving abilities. Patient is allowed 2 demonstrations (if needed) and scored based upon the results.

For use with ACL’s 3.0 and higher –they have to use their hands purposefully

Purpose: To determine patient’s cognitive level in accordance with the author’s theoretical hierarchy of cognitive levels of function and to provide appropriate treatment interventions.

When you purchase the ACLS it comes with a test manual. Can be ordered from S&S Worldwide, PO Box 513, Colchester, CT 06415-0513. Tel: 800-243-9232

Can order through Brenda Joniec at the HTS corporate office

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Allen Diagnositc Module (ADM)

Authors: Tina Blue, OT, Catherine Earhart, OT and Claudia Allen, MA, OT,FAOTA -26 craft projects. 2004 updated to include 34 craft projects

Format: Rating scale based on task performance

Method: To observe the patient completing one of the craft projects and then score them using the recommended guidelines to obtain a cognitive level according to the Allen cognitive performance modes.

Ex: Placemat (3.0-4.6) Tile Trivet (3.0-5.8) Ribbon Cards (4.0-5.0) Purpose: To determine the appropriate cognitive level

There is an Allen Diagnostic Module Instuction Manual (located at the HTS office) which contains instructions for all 34 craft activities. Individual activities are sold through S&S Crafts and include directions for set-up of the sample, required supplies, set-up of the environment for testing, and scoring guidelines.

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Routine Task Inventory-Expanded (RTI-E)

Author: Claudia Allen, MA, OT, FAOTA and Naomi Kootz, PhD, OT

Format: three sources of information can be used to complete the functional assessment 1. Patient self-report 2. Caregiver’s report 3. Observations

Method: Consists of 4 behavior disabilities

1. Physical scale – ADL’s (1-5) 2. Community Scale – IADL’s (2-6) 3. Communication Scale (1-6) 4. Work Readiness Scale (3-6)

If using observations, the therapist must observe at least 4 of the tasks within the area being scored then add all four tasks together and divide by 4 to get the ACL score. Scoring: Scores are determined by identifying a pattern of behaviors for each task of the RTI-E which is being scored. The therapist matches the data gathered in the process of administering the assessment with the scoring criteria. Therapists then score the highest level at which there is a clear pattern of performance. The scores which result from averaging often include decimals; however, this scoring system should not be confused with the modes of performance. The RTI-E manual is available from Brenda at the HTS corporate office

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Cognitive Performance Test (CPT)

Author: Theressa Burns, OT

Format: Standardized, performance-based assessment to determine patient’s cognitive level.

Method: 7 tasks comprise the test

1. Dress 2. Shop 3. Toast 4. Phone 5. Wash 6. Travel 7. Medbox

Scoring: A gross level score is determined for each task, these scores are then added for a total score and averaged (divided by # of tasks administered) to determine the cognitive level and mode.

It is recommended, that if the therapist does not administer all 7 subtasks that 4 are used to obtain an average performance score.

Verbal cueing, verbal directives and demonstration are types of assistance that are used in progression depending on the needs of the patient.

• Verbal cueing: non-specific verbal assistance, i.e. “What do you do first?, Do what you think is best.”

• Verbal directives: specific verbal assistance actually telling the patient what to do, i.e. “Put the bread in the toaster.”

• Demonstration: physically demonstrating what you want the patient to do.

Test can be ordered through Brenda Joniec at the corporate HTS office.

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Montreal Cognitive Assessment Authors: Nasreddine, ZS, Phillips NA, Bedrian V, Whitehead V, Collin I, Cummings JL, Chertkow H Format: Paper pencil test Method: Patient completes tasks such as picture naming, clock drawing, and recall to assess the following domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. The total score is out of 30 with scores of 26 or lower indicating the presence of cognitive impairment.

Purpose: to identify patients with a mild cognitive impairment

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Montreal Cognitive Assessment (MoCA) Administration and Scoring Instructions The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points; a score of 26 or above is considered normal. 1. Alternating Trail Making:

Administration: The examiner instructs the subject: "Please draw a line, going from a number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A then to 2 and so on. End here [point to (E)]."

Scoring1 −A - 2- B- 3- C- 4- D- 5- E, without drawing any lines that cross. Any error that is not immediately self-corrected earns a score of 0.

: Allocate one point if the subject successfully draws the following pattern:

2. Visuoconstructional Skills (Cube): Administration

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: The examiner gives the following instructions, pointing to the cube: “Copy this drawing as accurately as you can, in the space below”.

coring• Drawing must be three-dimensional

: One point is allocated for a correctly executed drawing.

• All lines are drawn • No line is added • Lines are relatively parallel and their length is similar (rectangular prisms are

accepted) A point is not assigned if any of the above-criteria are not met. 3. Visuoconstructional Skills (Clock):

Administration

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: Indicate the right third of the space and give the following instructions: “Draw a clock. Put in all the numbers and set the time to 10 after 11”.

coringContour (1 pt.): the clock face must be a circle with only minor distortion

acceptable (e.g., slight imperfection on closing the circle);

: One point is allocated for each of the following three criteria:

Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face; Roman numerals are acceptable; numbers can be placed outside the circle contour;

Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand; hands must be centered within the clock face with their junction close to the clock center.

A point is not assigned for a given element if any of the above-criteria are not met. 4. Naming: Administrationthis animal”.

: Beginning on the left, point to each figure and say: “Tell me the name of

Scoringlion, (3) rhinoceros or rhino.

: One point each is given for the following responses: (1) camel or dromedary, (2)

5. Memory: Administration: The examiner reads a list of 5 words at a rate of one per second, giving the following instructions: “This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn’t matter in what order you say them”. Mark a check in the allocated space for each word the subject produces on this first trial. When the subject indicates that (s)he has finished (has recalled all words), or can recall no more words, read the list

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a second time with the following instructions: “I am going to read the same list for a second time. Try to remember and tell me as many words as you can, including words you said the first time.” Put a check in the allocated space for each word the subject recalls after the second trial. At the end of the second trial, inform the subject that (s)he will be asked to recall these words again by saying, “I will ask you to recall those words again at the end of the test.”

Scoring

: No points are given for Trials One and Two.

6. Attention: Forward Digit Span: Administration: Give the following instruction: “I am going to say some numbers and when I am through, repeat them to me exactly as I said them”. Read the five number sequence at a rate of one digit per second. Backward Digit Span: Administration: Give the following instruction: “Now I am going to say some more numbers, but when I am through you must repeat them to me in the backwards order.” Read the three number sequence at a rate of one digit per second. Scoring: Allocate one point for each sequence correctly repeated, (N.B.: the correct response for the backwards trial is 2-4-7).

Vigilance: Administration: The examiner reads the list of letters at a rate of one per second, after giving the following instruction: “I am going to read a sequence of letters. Every time I say the letter A, tap your hand once. If I say a different letter, do not tap your hand”.

Scoring: Give one point if there is zero to one error (an error is a tap on a wrong letter or a failure to tap on letter A). MoCA Version November 12, 2004 © Z. Nasreddine MD www.mocatest.org 3

Scoring

: This item is scored out of 3 points. Give no (0) points for no correct subtractions, 1 point for one correction subtraction, 2 points for two-to-three correct subtractions, and 3 points if the participant successfully makes four or five correct subtractions. Count each correct subtraction of 7 beginning at 100. Each subtraction is evaluated independently; that is, if the participant responds with an incorrect number but continues to correctly subtract 7 from it, give a point for each correct subtraction. For example, a participant may respond “92 – 85 – 78 – 71 – 64” where the “92” is incorrect, but all subsequent numbers are subtracted correctly. This is one error and the item would be given a score of 3.

7. Sentence repetition: Administration: The examiner gives the following instructions: “I am going to read you a sentence. Repeat it after me, exactly as I say it [pause]: I only know that John is the one to help today.” Following the response, say: “Now I am going to read you another sentence. Repeat it after me, exactly as I say it [pause]: The cat always hid under the couch when dogs were in the room.” Scoring

: Allocate 1 point for each sentence correctly repeated. Repetition must be exact. Be alert for errors that are omissions (e.g., omitting "only", "always") and substitutions/additions (e.g., "John is the one who helped today;" substituting "hides" for "hid", altering plurals, etc.).

8. Verbal fluency: Administration: The examiner gives the following instruction: “Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you in a moment. You can say any kind of word you want, except for proper nouns (like Bob or Boston), numbers, or words that begin with the same sound but have a different suffix, for example, love, lover, loving. I will tell you to stop after one minute. Are you ready? [Pause] Now, tell me as many words as you can think of that begin with the letter F. [time for 60 sec]. Stop.”

Scoring

: Allocate one point if the subject generates 11 words or more in 60 sec. Record the subject’s response in the bottom or side margins.

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9. Abstraction: Administration

After the practice trial, say: “Now, tell me how a train and a bicycle are alike”. Following the response, administer the second trial, saying: “Now tell me how a ruler and a watch are alike”. Do not give any additional instructions or prompts. MoCA Version November 12, 2004 © Z. Nasreddine MD www.mocatest.org 4

: The examiner asks the subject to explain what each pair of words has in common, starting with the example: “Tell me how an orange and a banana are alike”. If the subject answers in a concrete manner, then say only one additional time: “Tell me another way in which those items are alike”. If the subject does not give the appropriate response (fruit), say, “Yes, and they are also both fruit.” Do not give any additional instructions or clarification.

10. Delayed recall: Administration: The examiner gives the following instruction: “I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember. Make a check mark () for each of the words correctly recalled spontaneously without any cues, in the allocated space. Scoring: Allocate 1 point for each word recalled freely without any cues.

Following the delayed free recall trial, prompt the subject with the semantic category cue provided below for any word not recalled. Make a check mark () in the allocated space if the subject remembered the word with the help of a category or multiple-choice cue. Prompt all non-recalled words in this manner. If the subject does not recall the word after the category cue, give him/her a multiple choice trial, using the following example instruction, “Which of the following words do you think it was, NOSE, FACE, or HAND?”

Optional:

Use the following category and/or multiple-choice cues for each word, when appropriate: FACE: category cue: part of the body multiple choiceVELVET:

: nose, face, hand category cue: type of fabric multiple choice

CHURCH: : denim, cotton, velvet

category cue: type of building multiple choiceDAISY:

: church, school, hospital category cue: type of flower multiple choice

RED: : rose, daisy, tulip

category cue: a colormultiple choice: red, blue, green Scoring

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: No points are allocated for words recalled with a cue. A cue is used for clinical information purposes only and can give the test interpreter additional information about the type of memory disorder. For memory deficits due to retrieval failures, performance can be improved with a cue. For memory deficits due to encoding failures, performance does not improve with a cue.

Orientation: Administration: The examiner gives the following instructions: “Tell me the date today”. If the subject does not give a complete answer, then prompt accordingly by saying: “Tell me the [year, month, exact date, and day of the week].” Then say: “Now, tell me the name of this place, and which city it is in.”

Scoring: Give one point for each item correctly answered. The subject must tell the exact date and the exact place (name of hospital, clinic, office). No points are allocated if subject makes an error of one day for the day and date.

TOTAL SCORE

: Sum all subscores listed on the right-hand side. Add one point for an individual who has 12 years or fewer of formal education, for a possible maximum of 30 points. A final total score of 26 and above is considered normal.

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Chair Sit and Reach Test

This test measures lower body flexibility

Equipment: ruler, straight back chair

Procedure: The subject sits on the edge of the chair (placed against a wall for safety). One foot must remain flat on the floor. The other leg is extended forward with the knee straight, heel on the floor, and ankle bent at 90 degrees. Place one hand on top of the other with tips of the middle fingers even. Instruct the subject to inhale, and then as they exhale, reach forward toward the toes by bending at the hip. Keep the back straight and head up. The distance is measured between the tip of the fingertips and the toes. If the fingertips touch the toes then the score is zero. If they do not touch, measure the distance between the fingers and the toes (a negative score), if they overlap, measure by how much (a positive score). Perform two trials.

Scoring: The score is recorded to the nearest ½ inch or 1 cm as the distance reached, either a negative or positive score. Record which leg was used for measurement. The table below shows the recommended ranges (in inches) for this test based on age groups

Jones C.J., Rikli R.E., Measuring functional fitness of older adults, The Journal on Active Aging, March April 2002, pp. 24-30.

Men’s Results

Age Below average Average (inches) Above average 60-64 < -2.5 -2.5 to 4.0 > 4.0 65-69 < -3.0 -3.0 to 3.0 > 3.0 70-74 <-3.5 -3.5 to 2.5 > 2.5 75-79 < -4.0 -4.0 to 2.0 > 2.0 80-84 < -5.5 -5.5 to 1.5 > 1.5 85-89 < -5.5 -5.5 to 0.5 > 1.0 90-94 < -6.5 -6.5 to -0.5 > -0.5

Women’s Results

Age Below average Average (inches) Above average 60-64 < -0.5 -0.5 to 5.0 > 5.0 65-69 < -0.5 -0.5 to 4.5 > 4.5 70-74 < -1.0 -1.0 to 4.0 > 4.0 75-79 < -1.5 -1.5 to 3.5 > 3.5 80-84 < -2.0 -2.0 to 3.0 > 3.0 85-89 < -2.5 -2.5 to 2.5 > 2.5 90-94 < -4.5 -4.5 to 1.0 > 1.0

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Chair Stand Test

To assess leg strength and activity tolerance

Equipment: straight back chair without arm rests

Modified chair stand test – chair with arm rests

Procedure: Place the chair against a wall. The subject sits in the middle of the seat, with their feet shoulder width apart, flat on the floor. The arms are to be crossed at the wrists and held close to the chest. From the sitting position, the subject stands completely up, then completely back down, and this is repeated for 30 seconds. Count the total number of complete chair stands (up and down equal’s one stand). If the subject has completed a full stand from the sitting position when the time elapsed, the final stand is counted in the total.

Scoring: The table below shows the recommended ranges for this test based on age groups

Jones C.J., Rikli R.E., Measuring functional fitness of older adults, The Journal on Active Aging, March April 2002, pp. 24-30.

Men’s Results

Age Below average Average Above average 60-64 < 14 14 to 19 > 19 65-69 < 12 12 to 18 > 18 70-74 < 12 12 to 17 > 17 75-79 < 11 11 to 17 > 17 80-84 < 10 10 to 15 > 15 85-89 < 8 8 to 14 > 14 90-94 < 7 7 to 12 > 12

Women’s Results

Age Below average Average Above average 60-64 < 12 12 to 17 > 17 65-69 < 11 11 to 16 > 16 70-74 < 10 10 to 15 > 15 75-79 < 10 10 to 15 > 15 80-84 < 9 9 to 14 > 14 85-89 < 8 8 to 13 > 13 90-94 < 4 4 to 11 > 11

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Modified 0-10 Borg scale in assessing the degree of dyspnea

Figure 1. Modified Borg scale.

SCALE SEVERITY 0 No Breathlessness* At All 0.5 Very Very Slight (Just Noticeable) 1 Very Slight 2 Slight

Breathlessness 3 Moderate 4 Some What Severe 5 Severe

Breathlessness 6 7 Very Severe

Breathlessness 8 9 Very Very Severe (Almost

Maximum) 10 Maximum

Figure 1. Modified Borg Scale. (Note: The word "breathlessness" was added in our version of the scale for clarification.) (From Burdon JGW, Juniper EF, Killian KJ, Hargrave FE, Campbell EJM.The perception of breathlessness in asthma. Am Rev Respir Dis 1982;126:825-8. Official Journal of the American Thoracic Society.© by the American Lung Association.)

The symptom of shortness of breath or dyspnea is one of the most common and significant complaints of patients with respiratory disease. The sensation of dyspnea is a sensory experience that is perceived, interpreted, and rated by the individual.

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Dyspnea – labored or difficult breathing

Dyspnea Intensity – Method 1

1. = mild, noticeable to patient but not to observer 2. = some difficulty, noticeable to observer 3. = moderate difficulty, but can continue 4. = severe, patient cannot continue

Dyspnea Intensity – Method 2

0. = able to count to 15 easily 1. = able to count to 15 but must take one breath 2. = must take 2 additional breaths 3. = must take 3 additional breaths 4. = unable to count

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The Activities-specific Balance Confidence (ABC) Scale*

Instructions to Participants: For each of the following, please indicate your level of confidence in doing the activity without losing your balance or becoming unsteady from choosing one of the percentage points on the scale form 0% to 100%. If you do not currently do the activity in question, try and imagine how confident you would be if you had to do the activity. If you normally use a walking aid to do the activity or hold onto someone, rate your confidence as it you were using these supports. If you have any questions about answering any of these items, please ask the administrator. The Activities-specific Balance Confidence (ABC) Scale* For each of the following activities, please indicate your level of self-confidence by choosing a corresponding number from the following rating scale: 0% 10 20 30 40 50 60 70 80 90 100% no confidence to completely confident “How confident are you that you will not lose your balance or become unsteady when you… 1. …walk around the house? ____% 2. …walk up or down stairs? ____% 3. …bend over and pick up a slipper from the front of a closet floor ____% 4. …reach for a small can off a shelf at eye level? ____% 5. …stand on your tiptoes and reach for something above your head? ____% 6. …stand on a chair and reach for something? ____% 7. …sweep the floor? ____% 8. …walk outside the house to a car parked in the driveway? ____% 9. …get into or out of a car? ____% 10. …walk across a parking lot to the mall? ____% 11. …walk up or down a ramp? ____% 12. …walk in a crowded mall where people rapidly walk past you? ____% 13. …are bumped into by people as you walk through the mall?____% 14. … step onto or off an escalator while you are holding onto a railing? ____% 15. … step onto or off an escalator while holding onto parcels such that you cannot hold onto the railing? ____% 16. …walk outside on icy sidewalks? ____%

Powell, LE & Myers AM. The Activities-specific Balance Confidence (ABC) Scale.J Gerontol Med Sci1995; 50(1): M28-34

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9-Hole Peg Test

Method: The patient is timed while taking 9 pegs out of the container one at a time and places them into the empty holes in the block as quickly as possible. Once all holes are filled, the patient is required to remove each of the pegs, one at a time, and place them back into the container as quickly as possible. Total time required to complete the task is recorded. The test is run twice consecutively for the dominant hand and then twice for the nondominant hand. The two trials for each are averaged and then converted to the reciprocals of the mean times. These two recipricals are then averaged. Lower scores indicate better fine manual dexterity.

Purpose: to measure arm and hand function (manual dexterity), how fast one can put all of the pegs in and take them out again.

Norms: Age: 30 40 50 60 70 80 Male Right 17.5 sec. 19 20.5 22 23 24.5 Left 19 21 22.5 24.5 26 28 Female Right 17.5 19.5 21.5 23.5 25.5 27.5 Left 18.5 21 23 25.5 27.5 29.5

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Motor-Free Visual Perception Test (MVPT)

Authors: Ronald P. Colarusso, EdD, Donald D. Hammill, EdD

Format: paper pencil test

Method: it assesses visual perception independent of motor ability in 5 areas: spatial relations, visual discrimination, figure-ground discrimination, visual closure and visual memory. The test consists of 36 items involving 2 dimensional configurations presented on separate cards or plates. Each plate consists of an example and a multiple choice response set of four alternatives. One point is given for each correct response and scores range from 0 to 36. MVPT norms are available.

You can obtain a copy of the MVP from Brenda Joniec at the HTS corporate office

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Line Bisection Test

Format: Paper and pencil test

Method: The test consists of 18 horizontal lines drawn on a single piece of paper. Patients are required to place a mark on each line that bisects it into two equal parts. The test is scored by measuring the distance from the bisection mark to the actual center of the line. A deviation of 6mm or more is indicative of unilateral spatial neglect. USN may also be suggested if the patient omits two or more lines on one half of the page.

Purpose: To detect the presence of unilateral spatial neglect.

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Instructions for testing/scoring Acuity:

Snellen

Post the Snelleneye chart and measure a distance of 20 feet. Mark a line on the floor with tape at 20 ft. and ask the patient to stand there. Use a disposable (non-opaque) cup to cover one eye at a time. Acuity is represented as:

Last row read legibly

Distance standing

Example: at 20 feet, you can read the letters on the row marked "40", this means you have visual acuity of 20/40 or better: 1/2 normal. From 10 feet, if the smallest letters you could read were on the "40" line, this would give you acuity of 10/40: 1/4 normal. (referral for < 20/40 or disparity > 1 lineon eye chart

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