Assessing and disclosing test results for ‘mild cognitive impairment’: the perspective of old age psychiatrists in Scotland

Background Mild cognitive impairment (MCI) is a condition that exists between normal healthy ageing and dementia with an uncertain aetiology and prognosis. This uncertainty creates a complex dynamic between the clinicians’ conception of MCI, what is communicated to the individual about their condition, and how the individual responds to the information conveyed to them. The aim of this study was to explore clinicians’ views around the assessment and communication of MCI in memory clinics. Method As part of a larger longitudinal study looking at patients’ adjustment to MCI disclosure, we interviewed Old Age Psychiatrists at the five participating sites across Scotland. The study obtained ethics approvals and the interviews (carried out between Nov 2020–Jan 2021) followed a semi-structured schedule focusing on [1] how likely clinicians are to use the term MCI with patients; [2] what tests clinicians rely on and how much utility they see in them; and [3] how clinicians communicate risk of progression to dementia. The interviews were voice recorded and were analysed using reflective thematic analysis. Results Initial results show that most clinicians interviewed (Total N = 19) considered MCI to have significant limitations as a diagnostic term. Nevertheless, most clinicians reported using the term MCI (n = 15/19). Clinical history was commonly described as the primary aid in the diagnostic process and also to rule out functional impairment (which was sometimes corroborated by Occupational Therapy assessment). All clinicians reported using the Addenbrooke’s Cognitive Examination-III as a primary assessment tool. Neuroimaging was frequently found to have minimal usefulness due to the neuroradiological reports being non-specific. Conclusion Our study revealed a mixture of approaches to assessing and disclosing test results for MCI. Some clinicians consider the condition as a separate entity among neurodegenerative disorders whereas others find the term unhelpful due to its uncertain prognosis. Clinicians report a lack of specific and sensitive assessment methods for identifying the aetiology of MCI in clinical practice. Our study demonstrates a broad range of views and therefore variability in MCI risk disclosure in memory assessment services which may impact the management of individuals with MCI.

Occupational Therapy Interventions for People With Parkinson’s Disease

Evidence Connection articles provide a clinical application of the evidence from the systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult recently diagnosed with Parkinson’s disease. The occupational therapy assessment and intervention process in the outpatient clinic is described. This Evidence Connection article is based on findings from an AOTA systematic review on interventions within the scope of occupational therapy practice to improve and maintain participation in education, work, volunteering, and leisure and social activities among adults with Parkinson’s disease. Each article in this series summarizes the evidence from the systematic reviews on a given topic and presents an application of the evidence as it relates to a clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can inform and guide professional reasoning.

Variables considered on art therapy assessments and rating instruments: a systematic review

Objectives: Art-based assessments are used by art therapists and sometimes researchers principally to: determine treatments, levels of cognition and functioning, evaluate progress of a client or to understand the client’s environment and problems that can be represented in a graphic level. These art-based assessments use determined evaluation instruments to measure parameters to understand their clients. The rating instruments have different variables and some studies even present their own adapted scales. For this systematic review, the tools examined in the analysis are: The Bird’s Nest Drawing (BND); the Bridge Drawing; the Diagnostic Drawing Series (DDS); the Person Picking an Apple from a Tree (PPAT); and Free Drawing Assessment. Rating instruments are also considered, including the Descriptive Assessment of Psychiatric Art (DAPA), the DDS Rating Guide and Drawing Analysis Form (DAF), the Formal Elements Art Therapy Scale (FEATS) and studies that include their own scale. There are different elements considered when assessing drawings and artwork approaches to make assessment test using art-based and art therapy tools. The principal objective of the present systematic review was to observe the different elements analysed. The specific objectives were; to describe characteristics of this assessments and to observe the elements considered to analyse drawings in order to observe their application and their validity. Methods: Studies available in English were accessed. The following databases were used: AMED, A&HCI, Arts and Humanities Citation Index, Medline, Psych INFO and Google Scholar. Searches covered the periods from database inception to July 2021 on art therapy and art-based assessment diagnose tools. Results: There were different variables used in art therapy and art based assessment diagnose tools. There were some variables that related or were named differently un some studies. However, there were other variables that were considered in some studies, while in other ones where not. To analyse the assessment the majority were using qualitative and observational technics, a few studies did not share their analysis, in this kind of studies only a thematic analysis or other type of analysis where developed studied. Descriptive results and synthesis outcomes reveal that art therapists are still in a nascent stage of understanding assessments and rating instruments, that flaws in the art therapy assessment and rating instrument literature research are numerous, and that much work has yet to be done. Conclusions: Descriptive results and synthesis revel that some studies have some limitations in some studies regarding to the content that is and how is analysed. Art therapy and art-based studies stills in a nascent stage of understanding the variables considered when using rating instruments. This systematic review also contributes as there are flaws in the art therapy and art-based rating instruments are numerous. There is a limited evidence on studies related with assessment diagnose tools and the reliability of some scales.

Occupational Therapy Assessment for Upper Limb Rehabilitation: A Multisensor-Based Approach

Most post-stroke patients experience varying degrees of impairment in upper limb function and fine motor skills. Occupational therapy (OT) with other rehabilitation trainings is beneficial in improving the strength and dexterity of the impaired upper limb. An accurate upper limb assessment should be conducted before prescribing upper limb OT programs. In this paper, we present a novel multisensor method for the assessment of upper limb movements that uses kinematics and physiological sensors to capture the movement of the limbs and the surface electromyogram (sEMG). These sensors are Kinect, inertial measurement unit (IMU), Xsens, and sEMG. The key assessment features of the proposed model are as follows: (1) classification of OT exercises into four classes, (2) evaluation of the quality and completion of the OT exercises, and (3) evaluation of the relationship between upper limb mobility and muscle strength in patients. According to experimental results, the overall accuracy for OT-based motion classification is 82.2%. In addition, the fusing of Kinect and Xsens data reveals that muscle strength is highly correlated with the data with a correlation coefficient (CC) of 0.88. As a result of this research, occupational therapy specialists will be able to provide early support discharge, which could alleviate the problem of the great stress that the healthcare system is experiencing today.

The Therapeutic Benefits of Children’s Literature: Responding Through Making Art and Writing Stories

This study explores the use of a children's book followed by the application of the Draw A Story (DAS) art therapy assessment tool by Rawley Silver (1988). The study takes place in three elementary school classrooms located in the greater Bay Area region. Previous literature addresses the historical uses of children’s books and their potential to offer therapeutic benefit to young readers. Through a quasi-experimental, one-group posttest only design, eighteen second to third grade level students were asked to reflect on a children’s book by writing a story of their own. Participants were between the ages of seven and nine, and all attended the same school. After choosing two DAS provided stimulus cards, participants drew images including the two cards and explained their images through a story with them in it as the main character. Quantitative data was collected and scored based on the three DAS scoring scales: Scale for Assessing Emotional Content, Scale for Assessing Self-Image, and Scale for Assessing Use of Humor. Results were categorized as expressing more positively themed, neutral themed or negatively themed content in the artwork and description of the story. Themes were compared to the themes presented in the children's book to assess for similarities. It was concluded that 64% of participants appeared to identify with a drawn subject who had a positive or aggressive self-image, with 28% presenting more negative or dark humor in emotional content. No significant findings were made in the similarities of the participants’ artwork and story to the themes in the children's book. Future research should inquire for direct examination of students’ art and stories made in response to a children's book without any additional stimulus card or assessment.

OP312 Developing A Tool-kit For Assessment Of Autism Spectrum Disorder

IntroductionBefore the coronavirus pandemic, children who were on the Early Years Neurodevelopment (EYND) assessment pathway and suspected to have possible Autism Spectrum Disorder (ASD), received clinic based appointments. This process included a parental interview by a doctor, a specialist speech and language therapy assessment, autism diagnostic observation schedule (ADOS), which were all carried out on hospital sites. These were postponed in March following national guidance. Our aim was to continue providing accurate evidence-based service for ASD diagnosis.MethodsWe utilised evidence-based telehealth methods to perform a specialist speech and language assessment in a child's home via video call. Parents were also invited to share videos of everyday activities via a secure portal. We could observe the child in a meaningful setting and witness functional impact of their needs. Each case is discussed by a multiagency panel based on DSM-V criteria.Online training was undertaken by professionals to deliver the Brief Observation of Autism Symptoms (BOSA) based on the ADOS for COVID times. Parents were coached by the therapist to enable them to become the administrator, rather than a professional.ResultsTelephonic feedback from the first ten parents whose children underwent a telehealth assessment has been positive; the home was deemed more natural and for some less distressing than clinic. Formal patient surveys have been devised for both the telehealth and BOSA clinic assessments. Analysis is expected by the end of March.To date we have been able to reach an outcome for thirty children, the diagnosis of ASD for twenty-four children and the other six received a diagnosis of global developmental delay or language disorder.ConclusionsWe expect that telehealth will reduce the number of assessments before an ASD diagnosis is made resulting in more prudent healthcare. The new methods have demonstrated clear increased parental participation.

SmartBathroom Data Visualization Tool to Inform OT Clinical Reasoning

Traditionally, Occupational Therapy assessment of an older adult’s toilet transfer performance has been based on qualitative observation and client self-report. The purpose of this study was to evaluate the effectiveness of supplementing traditional clinical reasoning with quantitative transfer performance data about body and foot position, balance, hand placement and grasping forces on grab bars. Specifically, we conducted an online survey of occupational therapy practitioners and educators to assess the usefulness and usability of 2D and 3D graphic visualizations representing foot and hand position and forces exerted on the floor, toilet seat and grab bars. These data were captured by sensors located throughout GA Tech’s SmartBathroom laboratory during a study of transfer performance. Findings are being used to identify the most useful sensor data and the most effective ways to convey that data to improve training of occupational therapy students.

A New Dynamic Response to Therapy Assessment in Postoperative Patients With Low-Risk Differentiated Thyroid Cancer Treated Without Radioactive Iodine

BackgroundTotal thyroidectomy (TT) or lobectomy without radioactive iodine (RAI) is becoming a common management for patients with low-risk differentiated thyroid cancer (DTC). However, the assessment of response to therapy for these patients remains controversial. The aim of this study was to propose and validate a new dynamic evaluation strategy to assess the response to therapy in patients with low-risk DTC treated with TT or lobectomy but without RAI.MethodsWe performed a retrospective analysis of 543 adult patients with low-risk DTC who underwent TT or lobectomy without RAI therapy. Follow-up consisted of trends of serum thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb) levels and neck ultrasonography (US) were conducted every 6–24 months. Response to therapy assessments were defined as excellent response, biochemical incomplete response, structural incomplete response, and indeterminate response according to the follow-up findings.ResultsAt a median follow-up of 51 months (range 33–66 months), 517 (95%) had excellent response, while the other 26 had either biochemical incomplete response (an increasing trend of suppressed serum Tg levels, n=9; an increasing trend of TgAb levels, n=3) or indeterminate response (a stable or decreasing trend of suppressed serum Tg levels, but a stable positive trend of TgAb levels, n=14). No patients had structural incomplete response or no deaths related to thyroid cancer. The risk of incomplete response was significantly higher in lobectomy than in TT (p<0.001).ConclusionOur study proposed and validated a new dynamic response to therapy assessment depending on trends of suppressed serum Tg, TgAb levels, and neck US findings which could be an appropriate tool for postoperative follow-up in low-risk DTC patients without RAI therapy. Our findings provided further evidence to support no routine recommendation of RAI after surgery in low-risk DTC.