In your typical skilled nursing setting, the typical process of evaluations basically looks like you as the therapist asking the patient to perform a series of tests and tasks, with the expectation that they will follow your direction and attempt each task/test to the best of their abilities.
Dementia does not always allow for that.
So how do we effectively evaluate these individuals to get a clear and clinical picture for appropriate recommendations? Keep it as functional as possible and use your activity analysis skills.
Friendly reminder that activity analysis is a skill that we learn in OT school and develop throughout our careers.
It refers to the process of assessing all the areas of function and occupation that can be addressed within a given functional task. So to look at this practically, I’m going to share some examples of what I do within my evaluations.
Let’s start with range of motion (ROM).
Sometimes individuals can imitate the motions that I do with my arms, hands, and legs and I always attempt a typical ROM assessment to determine if the individual does have the ability to imitate action. If they don’t have this ability, then I’ll use a gross motor task that they might enjoy, such as dancing or playing catch. We might work on unpacking some of their items into cabinets to assess functional reach above shoulder-height (with a bonus ability to assess dynamic balance).
Another great way to assess balance and mobility is by taking a tour of the facility. The goal here is not to learn our way around the building but rather to identify how the individual ambulates as well as any assistive mobility devices they might need.
Self care assessments are easy if the person asks to use the bathroom during your evaluation.
If they don’t and they can’t or won’t complete some other form of dressing or toileting assessment, I will simply denote this in my evaluation, creating a short term goal such as “Therapist will determine individual’s current self care status to better address long-term goals”.
Fine motor coordination and eating can be combined into one assessment.
I’ll offer a snack in a pre-packaged wrapper or a cup of coffee and simply present the items before complete preparation. In other words, I’ll hand them a wrapped granola bar. Or I’ll bring them a black cup of coffee with the cream and sugar packets and assess their ability to open small items.
Now of course, these assessments are not going to be standardized, and that’s okay.
We’ll talk more about standardized assessments moving forward. But for today, use functional tasks, incorporating measurable components (such as time it takes to complete or assist level required) to make goals that are client-specific.
Bottom line: it is not up to your patient or resident to modify themselves to fit your evaluation template. It is up to you as their therapist to modify how you ask questions in order to get the information you need.
The Memory Unit OT 
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