ADAPTATIONS FEATURE
The occupational therapist must weigh up the benefits of adaptations against potential safety risks contributed to by cognitive challenges .
Individuals presenting with cognitive impairment may have difficulty in learning to use new devices , and stairlifts present with significant safety risks in these situations . The application of valid and reliable standardised assessments can alleviate these risks and support decision-making processes .
The standardised assessment flame was reignited when a group of social care occupational therapists attended an executive function workshop delivered by Dr Charlie Chung , an NHS Fife occupational therapist . The workshop explored how identifying cognitive strengths can promote occupational performance .
A cognitive assessment working group within Fife Health and Social Care Partnership was formed , comprising occupational therapists from Fife Council , NHS Fife Stroke and NHS Fife Older Adult Mental Health Services .
The group ’ s key goal was to better inform clinical decision making and risk management when considering new equipment or adaptation provision for those with cognitive impairment , starting with stairlifts but applicable to other powered / mechanised equipment .
Cognitive domains for stairlift use The cognitive domains for stairlift use are : Attention : sustaining attention on instructions , moving attention between operating procedure and the environmental situation / distractions . Visual spatial awareness : locating the stairlift seat , armrests , footplate , safety belt and controls . Perception of body position high over the stairs during travel . Memory ( procedural and episodic ): knowing the sequence of operation and controls and remembering the reason for using the stairlift ; repeat practice to develop procedural memory . Executive function : understanding use , planning the steps , starting and recognising when to stop , moving to the next task ,
© freemixer via Getty Images and responding to unexpected problems or issues , for example the stairlift bleeping or not charging .
Cognitive screening assessment tool implementation Standardised cognitive assessments are routinely used by our NHS colleagues , and we have utilised their experience of which assessments work well and could be practically adopted within social care .
On project commencement , a literature review of cognitive screening tools and research on cognitive assessment and stairlift use was completed . Although no articles on cognition and stairlift assessment were found , several tools were identified with practical application within the home environment .
We also contacted other local authorities and occupational therapy networks , making this project feel potentially groundbreaking .
The most suitable tools included the Montreal Cognitive Assessment ( MoCA ) and the Large Allen Cognitive Level Screen ( LACLS-5 ). The tools complemented each other in providing information on cognitive domains , executive function levels and relationship to occupational performance with acceptable validity , sensitivity and specificity .
The MoCA has since been replaced with the Mini-ACE . A comprehensive activity analysis of stairlift operation was completed . We mapped the cognitive assessments to identify how the person ’ s cognitive profile matched to the skills required for stairlift use .
To date , embedding the tools into practice was facilitated by joint NHS and social care assessment visits . The tools have been effective for validating occupational therapists ’ clinical reasoning when sharing the findings with the person and carer / family .
An algorithm was designed to guide decision-making regarding when to assess , how to complete the risk management plan , and when to review . An added benefit is the detection of early cognitive changes and , with consent , share the results with the person ’ s GP for further investigation and therapy .
Dissemination , training and milestones A facilitated poster presentation was delivered at the RCOT 2018 Annual Conference in Belfast , and the Alzheimer Scotland conference in Edinburgh . We also delivered a workshop at the RCOT Specialist Section – Housing conference in Newcastle in 2019 .
Workshops were delivered to familiarise Fife ’ s social care occupational therapists with the tools and their application . Assessment packs were provided for each locality team , and followup refresher sessions and ongoing peer support was implemented .
The project was highlighted by Alison Keir , RCOT professional practice lead for Scotland , at the dementia cross-party group for Scottish Government .
In February 2021 , over 1,000 people registered for an Alzheimer Scotland webinar presented by occupational therapists Ailsa Dow ( local authority ), Gail Hogg ( mental health ), and Charlie Chung ( stroke
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