Date Presented 04/22/21 OTs are trained to identify cognitive impairments in individuals diagnosed with specific diseases or who have sustained injuries or experienced a neurological event such as stroke. However, the presenters’ research demonstrates that OTs are underutilizing formal cognitive assessments and more often relying on observations and screening tools. Presenters discuss survey findings, setting influences, and potential solutions for OTs to increase the use of cognitive assessments in practice. Primary Author and Speaker: Amanda J. Blattman Contributing Authors: Jacqueline Schechter, Anne Spence, Susan S. Hayashi, Kara Sauerburger, Molly Houdeshell, Jennifer Henry, Judith Lieu, Robert Hayashi, and Allison King

Date Presented 04/19/21 The Social Cognition Screening Questionnaire–Taiwan version (SCSQT) was designed to assess multiple domains of social cognition in people with schizophrenia in Taiwan. The SCSQT contains five subscales and provides estimates of the core domains of mentalizing and social perception and an overall social cognition score. Our validation of SCSQT indicated that the SCSQT had good test–retest reliability, acceptable random measurement error, and negligible practice effects. Primary Author and Speaker: Shu-Chun Lee Additional Authors and Speakers: Trudy Mallinson Contributing Authors: Alison M. Cogan, Ann Guernon, Katherine O'Brien, and Piper Hansen

Date Presented 04/200/21 Older adults in the United States are at high risk for polypharmacy, which is related to increased falls, confusion, constipation, weakness, and tiredness. OTs are uniquely prepared to notice function-related impairments due to polypharmacy but do not routinely screen for or address it. This study found that an infographic increased OTs' knowledge of and willingness to intervene regarding polypharmacy and may be cost effective and time efficient in encouraging OTs to attend to polypharmacy side effects. Primary Author and Speaker: Anna M. Quigg Contributing Authors: Jennifer Gordon, Allison Bigg, Kathleen Graser, and Victoria Fichter

Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings. What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.

Importance: Engaging and pulling up a zipper is a functional skill needed by young children. Objective: To compare the efficacy of a standard zippering teaching vest presented with general verbal prompts to a modified zippering teaching vest presented with a related story and vocabulary among typically developing preschoolers. Design: An experimental, two-group, pre–post design. Setting: A local preschool. Participants: Fifty preschoolers ages 3 yr, 6 mo to 4 yr, 11 mo were recruited. Intervention: Eligible children received three zippering practice sessions from occupational therapy and speech-language pathology graduate students supervised by faculty; either a standard (control group) or modified (comparison group) zippering teaching vest was used. Outcomes and Measures: Individual sessions were video recorded. We coded data using a score of 2, 1, or 0, indicating degree of success through seven zippering steps. Using IBM SPSS Statistics (Version 26) for analysis, we conducted independent t tests to compare measures between the two groups. Results: Each cohort consisted of 14 preschoolers (N = 28); 252 separate zippering trials were analyzed. Pretrial zippering ability demonstrated no initial differences. Results indicate that both groups advanced their skills with added practice; however, the comparison group performed statistically significantly better than the control group, beginning with the second set of interventions. Conclusions and Relevance: Beginning with a second exposure to a novel instructional method, preschoolers increased their success by completing more of the seven identified steps of zippering than those receiving traditional input. This study demonstrates the ability of occupational therapy–speech-language pathology partnerships to create innovative treatments that facilitate occupationally based skill acquisition. What This Article Adds: This article adds evidence supporting the use of a modified practice zippering vest with added visual and language cues to teach zippering skills to occupational therapy clients.

Importance: Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person’s ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. Objective: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Design: Retrospective chart reviews were conducted over a 6-mo period. Setting: Four Canadian driver rehabilitation programs. Participants: Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. Outcomes and Measures: Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. Results: The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. Conclusions and Relevance: Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. What This Article Adds: Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.

Importance: A psychometrically sound measure of social knowledge (SK) is necessary to assess people with schizophrenia because they tend to have moderate to severe deficits in SK. Objective: To develop a computerized adaptive test (CAT) for assessing SK in people with schizophrenia. Design: Two phases, consisting of (1) development and validation of an SK item bank and (2) determination of the best stopping rules for the CAT. Setting: Two psychiatric hospitals. Participants: Two hundred thirty-six people diagnosed with schizophrenia through convenience sampling. Measure: Computerized Adaptive Test–Social Knowledge (CAT–SK). Results: The SK items were examined using Rasch analysis. A CAT simulation was performed to determine the best set of stopping rules for achieving high reliability and efficiency. After unsuitable items were removed, 71 items remained with acceptable model fit (infit and outfit mean square <1.4) and no gender bias. Two suboptimal alternative sets of rules were identified. The most efficient set used 21 items to achieve acceptable Rasch reliability (.81). The most reliable set used 40 items to achieve satisfactory Rasch reliability (.88). High correlations (r > .93) between CAT–SK scores and scores on the SK item bank support the concurrent validity of the CAT–SK. Conclusions and Relevance: The CAT–SK appears to be a valid assessment that can provide reliable or efficient measures of SK. If high reliability is needed, examiners can adopt the most reliable set of 40 items. If efficiency is the primary concern, they can adopt the most efficient set of 21 items. What This Article Adds: The CAT–SK is a valid measure of SK with flexibility to meet examiners’ needs.

Functional cognition is a critical domain of concern for occupational therapy practice. As the health care system moves to assessing value through achievement of quality outcomes, the field of occupational therapy must address the inclusion of functional cognition in evaluation and treatment. Evidence indicates that impaired cognition contributes to risk of hospital readmission and poor overall health outcomes across diagnostic groups. Moreover, expenditure on occupational therapy services that address functional cognition has been shown to lower hospital readmission rates. To improve client outcomes, occupational therapists must consistently screen for and, when appropriate, evaluate and treat functional cognition impairments and consider functional cognition in the discharge planning process. Occupational therapy professionals must make a proactive, coordinated effort to establish the profession’s role in evaluating and treating clients’ limitations in functional cognition as a means to achieving improved quality care and client outcomes.

Importance: The Centers for Medicare & Medicaid Services (CMS) has identified the need to assess functional cognition as part of the postacute care planning process. Objective: We examined the reliability, validity, and clinical utility of the Menu Task (MT) as a screening measure of functional cognition to assess the need for occupational therapy services. Design: Cross-sectional study testing a convenience sample of community-dwelling older adults (n = 130) and adults hospitalized for elective orthopedic surgery (n = 60). The MT and four neuropsychological screening tests—the Brief Interview of Mental Status, the Montreal Cognitive Assessment, Trail Making Tests A and B, and an instrumental activities of daily living (IADL) scale—were administered. Setting: Community-dwelling participants were tested at the University of Wisconsin occupational therapy program and in community settings. Hospitalized participants were tested at the University of Missouri Orthopedic Institute. Participants: We recruited healthy community-dwelling adults in Madison, WI (community sample; n = 130) and patients hospitalized for elective orthopedic surgery in Columbia, MO (hospital sample; n = 60). Inclusion criteria were age 55 yr or older, living in the community, and willingness to be tested in English; for the hospital sample, participants had to be referred for elective orthopedic surgery requiring a hospital stay and be independent in activities of daily living before being admitted for surgery. Results: We found significant differences between groups classified as impaired or not impaired on the basis of MT scores. Participants classified as impaired on the MT performed significantly less well than those classified as not impaired on the neurocognitive and IADL measures. Conclusion: The reliability and validity of the MT were supported. What This Article Adds: The American Occupational Therapy Association and the occupational therapy experts advising CMS have stressed the importance of a brief performance-based screening tool to identify people who need more comprehensive occupational therapy evaluation. The implementation of a functional cognition screening tool as part of the required CMS assessment protocol should greatly increase the number of patients referred for occupational therapy evaluation and treatment. The MT has the capacity to address the gap in the proposed CMS assessment of Medicare recipients across postacute care settings.

Occupational therapists have a long history of assessing functional cognition, defined as the ability to use and integrate thinking and performance skills to accomplish complex everyday activities. In response to passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113–185), the American Occupational Therapy Association has been advocating that the Centers for Medicare and Medicaid Services consider functional cognition for inclusion in routine patient assessment in postacute care settings, with important implications for occupational therapy. These efforts have the potential to increase referrals to occupational therapy, emphasize the importance of addressing functional cognition in occupational therapy practice, and support the value of occupational therapy in achieving optimal postacute care outcomes.

PURPOSE. To examine the visual status of a cohort of older adults on an orthopedic unit to determine their level of available vision to complete everyday activities in the hospital setting. METHOD. A convenience sample of 50 people was recruited. A visual history was obtained, and participants’ glasses were inspected. Distance acuity, reading acuity, and contrast sensitivity were assessed using standardized screening charts. RESULTS. Of participants, 26% did not have their glasses with them until prompted, and 85% had glasses in poor condition. When tested wearing their habitual correction, 6% had low vision, 2% were blind, 41% had reading acuities worse than 20/25, and 28% had contrast sensitivity deficits. CONCLUSION. Visual impairment is prevalent in older adults, yet visual function is not routinely screened in hospitals. Occupational therapists should routinely inquire about patients’ visual status, inspect their glasses, and encourage regular eye examinations. Failure to address vision could lead to inaccurate evaluation results.

OBJECTIVE. This article describes the use of assessment tools by North American driver rehabilitation specialists (DRSs). PARTICIPANTS. Participants were 227 self-identified DRSs from the combined databases of two national associations. MEASURES. Information was solicited through a self-administered survey about the driving evaluation process, assessment tools, and process for making fitness-to-drive recommendations. RESULTS. More than 80% of the DRSs reported testing visual acuity, range of motion, muscle strength, and fine motor coordination. The most consistently used cognitive–perceptual tests were the Trail Making Tests, Motor-Free Visual Perception Test–Revised, and short cognitive screening tests. A client’s behind-the-wheel performance was the main factor in making a fitness-to-drive recommendation. Few specialists are using computer-based tests or interactive driving simulators. CONCLUSION. Although use of the Useful Field of View^® has increased, there continues to be no consistency in cognitive assessments or guidelines for behind-the-wheel assessment. Implications for practice are discussed.

The Health Enhancement Lifestyle Profile–Screener (HELP–Screener) is a 15-item self-report questionnaire conceptually excerpted from the original 56-item HELP. This article describes the development and validation of the HELP–Screener with a sample of 483 community-dwelling older adults. Data derived from the sample were first analyzed using the Rasch dichotomous model. Unidimensionality and data–model fit of the HELP–Screener were largely supported by the analyses of principal components of residuals, fit statistics, local dependency, differential item functioning, and item hierarchy. To delineate the clinical significance of the test results, the cutoff score for the HELP–Screener was established through the mean and standard deviation generated from the study sample. The HELP–Screener can serve as a time-efficient screening for identifying older adults who may require a comprehensive evaluation through HELP and, as a result, who may benefit from a lifestyle intervention. Of note, more studies are planned to further corroborate psychometric properties of this new instrument.

OBJECTIVES. We sought to determine the criterion validity of the Useful Field of View (UFOV) assessment and Stroke Drivers’ Screening Assessment (SDSA) through comparison to the results of on-road assessment. METHOD. This was a prospective study with people with stroke. Outcome measures used were UFOV, SDSA, and the results of on-road assessment. RESULTS. Both the results on UFOV (Divided Attention subtest, p < .01; Selective Attention subtest, p < .05) and SDSA (p < .05) were significantly related to the recommendation from on-road assessment. The Divided Attention subtest of the UFOV had the highest sensitivity value (88.9%). CONCLUSIONS. UFOV and SDSA are valid assessments of driving ability for stroke. The Divided Attention subtest of the UFOV can guide decision making of occupational therapists in stroke driver rehabilitation and in determining those who require further assessment on road because they pose a safety risk. Screening assists people with stroke to decide whether they are ready to have an on-road assessment.

OBJECTIVE. This study was used to (1) develop an occupational therapy screening questionnaire (the Handwriting Proficiency Screening Questionnaire [HPSQ]) to identify handwriting difficulties among school-aged children and (2) examine its reliability and validity. METHOD. The questionnaire’s content validity was established. Internal consistency, interrater and test–retest reliability, and concurrent and construct validity were initiated. Participants included 7-to 14-year-old (N = 230) typically developing school-aged children. RESULTS. The tool demonstrated good internal consistency (α = .90). Test–retest reliability for the score revealed an intraclass correlation coefficient (ICC) of .84 and interrater reliability of ICC =.92 for the total questionnaire score. Construct and concurrent validity were also confirmed. CONCLUSION. The HPSQ is suitable for use by occupational therapists for identification of handwriting deficiency among school-aged children and is appropriate for varied academic and clinical uses. More studies with larger samples of varied age groups are required to further support the questionnaire’s reliability and validity.

OBJECTIVE. The purpose of this study was to validate a laboratory-based driving simulator as an off-road screening tool for older adult drivers by measuring their visual attention skill, and to determine how the visual attention skill changes across time in a 45-minute simulated driving test. METHOD. One hundred and twenty-nine community-dwelling older drivers volunteered to take part in the study. A range of driving scenarios was devised and implemented in a simulator setting to assess the driving skills of the participants. Visual attention skill, an important contributing factor to motor vehicle crashes, was assessed by the participant's reaction times to a sequence of 14 visual stimuli during the primary task of sustained driving. Repeated measures of analysis of variance (ANOVA) were undertaken to determine the effects of age and gender on the visual attention skill. Trend analysis was performed to investigate how repeated exposures to the visual stimulus affected the reaction time. RESULTS. The visual attention skill of older drivers was found to decline with age (F_(1,126) = 42.52, p value = 0.002), whereas the effect of gender was not significant. Participants increased their speed of reaction times for the first half of the testing then slowed down during the second half. CONCLUSION. That visual attention skill declined with age was consistent with the literature, and validated the driving simulator as an effective screening tool for older adult drivers. With rapid advancements in computer technology, the driving simulator will likely play an important role in assisting occupational therapists with off-road assessment of older drivers.

Objective. In this correlational study of adults receiving occupational therapy who sustained a cerebrovascular accident (CVA), the relationship between basic visual functions (including acuity, visual field deficits, oculomotor skills, and visual attention or scanning) and higher level visual-perceptual processing skills (e.g., visual closure and figure–ground discrimination) was investigated. Method. Thirty adults who sustained CVA and 20 adults without a history of CVA were given a basic visual function screening and the Motor-Free Visual Perception Test (MVPT). Scores on the vision screening and the MVPT were correlated statistically. Results. A Pearson product-moment correlation analysis produced a correlation of r = .75 between vision screening scores and scores from the MVPT. Conclusion. These results suggest that a positive relation exists between basic visual functions and visual-perceptual processing skills. Further, the results suggest that evaluation of visual-perceptual processing skills must begin with assessment of basic visual functions so that the influence of these basic visual functions on performance in more complex tests can be taken into consideration.