Written by Simrin Pardal, OT Reg. (Ont.)
Traumatic Brain Injuries (TBIs) and Acquired Brain Injuries (ABIs) are conditions that are encountered in rehabilitation practice. They can result from motor vehicle accidents, falls, strokes, infections, and/or tumours.
These injuries can result in complex changes and impact and individual’s day-to-day functioning. Their presentation of symptoms can be unique for each individual.
TBIs and ABIs can cause cognitive, physical, emotional, and behavioural changes.
Cognitive changes in particular can be difficult to notice immediately after a brain injury, as their presentation is not visible. It often requires awareness from the injured individual or close friends and family to identify that there is a problem.
Common cognitive impairments observed following a brain injury include changes in attention, memory, executive functioning, problem-solving, visuo-spatial skills, orientation, decision-making, and self-awareness.
A change in one’s cognition can significantly limit their ability to engage in meaningful daily activities, such as participation in social roles or completing their work effectively.
Identifying a particular cognitive deficit is crucial for goal setting and determining a treatment plan that targets the specific areas of cognition which have been affected. This is where standardized cognitive assessments play a critical role.
Standardized cognitive assessments provide clinicians with structured and evidence-based methods to understand how a brain injury may be affecting an individual’s cognitive functioning and translate into real-word performance.
A wide variety of standardized assessments exist, including the Allen Cognitive Level Screen, Test of Everyday Attention, Montreal Cognitive Assessment (MoCA), Doors & People Memory Test, and many more.
The benefit of having a battery of assessments to choose from, is that they each offer a unique lens into cognitive functioning and can provide significant insight that is functionally relevant to an individual’s participation in their daily routine and activities.
For instance, if a clinician has reason to believe that a client’s ability to pay attention has been impacted, they may choose to administer the Test of Everyday Attention. On the other hand, if a broader lens was needed to identify the impaired cognitive domains on a lower functional level, a clinician may choose to administer the MoCA.
Moreover, standardized cognitive assessments are especially beneficial as they are designed to be administered and scored in a consistent manner. This allows for results to be interpreted against criterion-referenced levels and established norms.
Standardized testing in brain injury can help identify cognitive difficulties that may be missed by solely engaging in an interview with the client and their family and friends.
Understanding which specific cognitive domains are impacted using a standardized assessment also enhances communication between interdisciplinary teams. This is crucial when collaborating on goals and treatment plans.
Another benefit of standardized testing is that it allows for outcome measurement, which is important for tracking progress and determine efficacy of the proposed treatment or if modifications may be required. Ongoing evaluation is crucial, especially when it comes to injuries of the brain.
While standardized assessments are invaluable, they should be used alongside functional observation and client-reported experiences and behaviours to gain a holistic picture of the client’s cognitive performance.
At GLA Rehab, our Occupational Therapists (OTs) are trained to assess cognition, and collaborate with clients to determine meaningful goals in an individual’s recovery following an injury. The tests that are available for our OTs to use help them compare the person to their pre-accident abilities and level of function, in comparison to a neuropsychological assessment that compares a person to their peers.
Focusing on pre-accident abilities and level of function helps an OT in setting up meaningful and functional goals for rehabilitation.
At every stage of life, an individual’s effective cognitive functioning is crucial, so that they can engage in daily activities in a safe manner or receive the necessary support to remediate or compensate for their impairments.
Our OTs assess cognition with relationship to ability to work, to prepare/change a Will, to complete daily self care and homemaking tasks, to complete child care roles and to drive and be functional in the community.
Reach out to us at GLA Rehab to schedule an assessment if you have concerns about you or a loved one’s cognition.