Brief Cognitive Rating Scale
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Transcript Brief Cognitive Rating Scale
Utilizing Standardized Tools
for Recreational Therapy
Treatment With Geriatric
Clients
Jo Lewis, MS/CTRS
Megan Janke, Ph.D., LRT/CTRS
Upon successful completion of this session, the
participant will be able to:
Identify 3 standardized assessment tools that
may be utilized in Recreational Therapy
treatment with older adults.
Verbalize 2 benefits of utilizing standardized
assessments during Recreational Therapy
treatment
Utilize internet resources for standardized
assessment tools in Recreational Therapy
practice with older adults.
Validity
◦ Does it measure what it is intended to measure?
External
Internal
Reliability
◦ Does it consistently measure what is intended?
Internal Consistency
Inter-rater Reliability
Responsiveness
Can it detect real change when it happens?
Measure what you intend to measure
Justification of Services
Accepted across discipline boundaries
Brief Interview for Mental Status
Short Portable Mental Status Questionnaire
Blessed Orientation-Memory-Concentration Test
Global Deterioration Scale
Brief Cognitive Rating Scale
Clock Drawing Test
Montreal Cognitive
Assessment (MoCA)
Utilized for the MDS 3.0
Areas measured:
◦ attention
◦ orientation
◦ the ability to register and recall new information
Maximum Score: 15
◦ 13-15
◦ 8-12
◦ 0-7
Cognitively intact
Moderate impairment
Severe impairment
10 Items
Maximum Score: 10
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0-2 errors
3-4 errors
5-7 errors
8-10 errors
Intact
Mild impairment
Moderate impairment
Severe impairment
5-10 minutes to administer
Domains assessed
◦ Orientation
◦ Immediate and delayed episodic recall
◦ Working memory
6 Items
Maximum Score- 28
Higher score indicates greater impairment
3-6 minutes to administer
Rating scale
1:
2:
3:
4:
5:
6:
7:
No cognitive impairment
Very mild cognitive decline
Mild cognitive decline
Moderate cognitive decline
Moderately severe cognitive decline
Severe cognitive decline
Very severe cognitive decline
Used with Brief Cognitive Rating Scale
5 Axes
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Concentration
Recent Memory
Past Memory
Orientation
ADL & Functional Abilities
Each axis is measured on a scale of 1-7
◦ Scores from each axis added then divided by 5
Higher scores indicate higher level of
impairment
Correlates well with other cognitive
assessment instruments
Visuospatial Assessment of Cognitive
Functioning
6 point scoring system
The higher the score, the greater the degree
of impairment
Score of 3 or more indicative of cognitive loss
Completed in about 5 minutes
Screening tool for mild cognitive dysfunction
Cognitive Domains
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Attention and concentration
Executive functioning
Memory
Language
Visuoconstructional skills
Conceptual thinking
Calculations
Orientation
10 Minutes to Administer
Possible score of 30
◦ 26 or above is considered normal
Barthel Index
Berg Balance Scale
Katz Index of Independence in
Activities of Daily Living
Lawton Instrumental Activities of Daily Living
Tinetti Mobility Scale
◦ Performance-Oriented Assessment of Balance
◦ Performance-Oriented Assessment of Gait
Get-Up & Go Test
Self-report
◦ 2-3 minutes
Trained observation
◦ 10-15 minutes
3 point scale for each
item
Assesses:
Feeding
Grooming
Bowel & Bladder
Continence
Dressing
Toileting
Walking
Stairs
Bathing
Performance measure
◦ Self-report
◦ Trained observer
Scoring
◦ Letter score from A-G
A= Most independent
G= Most dependent
Bathing
Dressing
Toilet use
Transfer ability
Feed self
Maintenance of
bowel & bladder
continence
Self-report of
Performance
Scoring
◦ O= Low functioning
◦ 8= High functioning
Gender bias◦ transportation
Telephone usage
Housekeeping*
Food preparation*
Laundry*
Transportation
Medications
Money management
5 point scale
Higher score indicates more difficulty with
gait and balance
Scoring
1
2
3
4
5
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Normal
Very slightly abnormal
Mildly abnormal
Moderately abnormal
Severely abnormal
Score of greater than 3 at risk for falling
Can be performed as a timed assessment
14 item scale
5 point scale, ranging from 0-4
Completion time: 15-20 minutes
Equipment needed:
Ruler
Two standard chairs
Footstool or step
Stopwatch or wristwatch
Scoring
41-56: Low fall risk
21-40: Medium fall risk
0-20: High fall risk
3 point scale per item
Used in conjunction with Gait
Assessment
Assessment Process:
Nudge on sternum
Sitting in chair
Rising from chair
Immediate standing
balance
Standing balance
Balance with eyes closed
Turning balance
Neck turning
One leg standing
balance
Back extension
Reaching up
Bending down
Sitting down
8 Items
◦ 2 point scale
Assessment Process
Initiation of gait
Step height
Step length
Step symmetry
Step continuity
Path deviation
Trunk stability
Walk stance
Turning while walking
PHQ-9
Geriatric Depression
Scale
Zung Self-Rating
Depression Scale
Cornell Scale for
Depression in
Dementia
Zung Self-Rating
Anxiety Scale
WHOQOL-BREF
Part of the Patient Health Questionnaire
(PHQ)
◦ PHQ-9- Depression Module
Self-report
Multiple choice
Measures severity of depression
Implemented in the MDS3.0
30 Questions
◦ Short version available- 15 questions
Administration
◦ Self –administered
◦ Rater-administered
Questionable with older adults with severe
dementia
Scoring
◦ >5 indicates potential depressionShould have a comprehensive assessment
◦ => 10 almost always indicative of depression
Screening tool
Self-report
20 items
◦ 4 point scale
◦ Half of the items are positively worded; half
negatively
Respondents rate frequency of occurrence
Older adults score higher than other age
groups
Administration
◦ Observation
◦ Interview
Patient
Caregiver
3 Point Scale
◦ 0- Absent
◦ 1- Mild or intermittent
◦ 2- Severe
Assessment Areas
◦ Mood related signs
◦ Behavioral
disturbances
◦ Physical signs
◦ Cyclic functions
◦ Ideational disturbance
Self-report
20 items
◦ 5 affective
◦ 15 somatic
Score range: 20-80
Administration Time: 10-15 minutes
Used in psychiatric and medical patients and
with normal older adults
Measures the impact of disease
◦ Impact of disease and impairment of daily activities
and behavior
◦ Perceived health measures
◦ Disability/ functional status measures
26 Questions
Self-Administered
Interviewer assisted or administered
Manual is recommended to score the
assessment
Faces Pain Scale
Numeric Scale
Pain Thermometer
Brief Pain Inventory
Checklist of
Nonverbal Pain Indicators
Pain Assessment in Advanced Dementia Scale
Originally developed for pediatrics
No verbal component
◦ Language impairments
◦ Difficulty with expression
7 point scale
Self-rating
Scale of 0-20
◦ O= No pain
◦ 20= Pain as bad as it could be
Scores can be averaged over time
Widely used in clinical and research settings
Originally developed for used with cancer
patients
Currently used with individuals experiencing
chronic nonmalignant pain
16 items
◦ Measures pain and impact on daily function
Completion time: 5 minutes (short form)
Measures pain in older adults with cognitive
impairment
Observation during movement and at rest
Scoring: 0 or 1
6 items
Nonverbal, vocal complaints
Facial grimacing
Bracing
Restlessness
Rubbing
Verbal, vocal complaints
Observation
Score ranges from 0-10 points
1-3 Mild pain
4-6 Moderate pain
7-10 Severe pain
5 Areas Assessed
Breathing
Negative vocalization
Facial expression
Body language
Consolabilty
BANDI-RT
Utilizes information from MDS 3.0
Guides the therapist
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Identified problems
Care plan
Physician’s Orders
RT treatment
Flow sheet
Iowa Geriatric Education Center Geriatric
Assessment Tools
◦ http://www.healthcare.uiowa.edu/igec/tools/
Hartford Institue of Geriatric Nursing Try This
◦ http://hartfordign.org/practice/try_this/
Dementia Practice Guidelines for
Recreational Therapy
◦ Buettner & Fitzsimmons (2003) Available through
the ATRA Bookstore