Therapy Adult Perceptual Screening Test Research Articles

Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study

Purpose We document current clinical practice and needs in screening for visual perception problems after stroke to inform development of new screening tools. Materials and methods We interviewed 12 occupational therapists and 13 orthoptists. Interviews were thematically analysed using the Value Proposition Canvas, a model which establishes challenges and facilitators in what people want to achieve. Results Participants’ understanding of visual perception varied and often included sensory and cognitive deficits. Occupational therapists commonly screened for visual field deficits and hemispatial neglect, while other aspects of visual cognition were rarely assessed. A positive screening result triggered an orthoptic referral. Screening generally occurred during functional assessments and/or with in-house developed tools. Challenges to practice were: lack of time, lack of training, environmental and stroke survivor factors (e.g., aphasia), insufficient continuation of care, and test characteristics (e.g., not evidence-based). Facilitators were: quick and practical tools, experienced staff or tools with minimal training requirements, a streamlined care pathway. Conclusions Screening employs non-standardised assessments and rarely covers higher visual perceptual deficits. We demonstrates the need for an evidence-based visual perception screen, which should ideally be 15 min or less, be portable, and require minimal equipment. The screen should be suitable for bedside testing and aphasia-friendly. Implications for rehabilitation There is a high demand for training on what visual perception deficits are and how to screen for them. Building local relationships between orthoptists and occupational therapists is perceived as highly beneficial for providing good vision and visual perception care for stroke survivors. Occupational therapists should be alert for visual perceptual deficits in their patients preferably through systematic screening with standardised assessments such as the shortened version of the Rivermead Perceptual Assessment Battery or Occupational Therapy Adult Perceptual Screening Test.

Convergent validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) with two other cognitive-perceptual tools in a South African context

Background and aim: Occupational therapists working in the field of neuro-rehabilitation need to use screening tools which demonstrate validity and reliability to correctly identify patients with cognitive-perceptual impairments. The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is a screening tool which was developed to identify patients with visual perceptual problems and apraxia following a stroke or other forms of acquired brain injury. Other instruments available are the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the Rivermead Perceptual Assessment Battery (RPAB). These tools evaluate similar constructs such as visual agnosia, body scheme, unilateral neglect and constructional skills but are too lengthy to use as screening tools. The aim of the study was to determine the convergent validity of the OT-APST with two other cognitive-perceptual tools commonly used in South Africa, namely the Dynamic Occupational Therapy Cognitive Assessment (DLOTCA) and the RPAB when administered to patients with a primary diagnosis of stroke. Method: A quantitative cross-sectional study was conducted on a sample of 32 participants with a primary diagnosis of stroke. Participants completed the three tools and subscales were compared with the Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA) cognitive areas and the RPAB items. Results: Five subscales of the OT-APST had significant correlations with similar DLOTCA and/or the RPAB subscales. Only the Apraxia subscale did not correlate with the referencing tools. Conclusion: This study provides further evidence of the convergent validity of the OT-APST when compared to the DLOTCA and RPAB. Although the OT-APST was standardised on an Australian population, it proved to be another option of a visual perceptual screening tool to identifying visual perceptual problems in patients with stroke in South Africa. Key words: Cognitive-perceptual, Stroke, convergent validity, Occupational therapy Adult Perceptual Screening Test (OT-APST), Dynamic Occupational Therapy Cognitive Assessment (DLOTCA), Rivermead Perceptual Assessment Battery (RPAB).

Convergent validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) with two other cognitive-perceptual tools in a South African context

BACKGROUND AND AIM: Occupational therapists working in the field of neuro-rehabilitation need to use screening tools which demonstrate validity and reliability to correctly identify patients with cognitive-perceptual impairments. The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is a screening tool which was developed to identify patients with visual perceptual problems and apraxia following a stroke or other forms of acquired brain injury. Other instruments commonly used in South Africa are the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the Rivermead Perceptual Assessment Battery (RPAB). These tools evaluate similar constructs such as visual agnosia, body scheme, unilateral neglect and constructional skills but are too lengthy to use as screening tools. The aim of the study was to determine the convergent validity of the OT-APST with two other cognitive-perceptual tools, namely the Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA) and the RPAB when administered to patients with a primary diagnosis of stroke. METHOD: A quantitative cross-sectional study was conducted on a sample of 32 participants with a primary diagnosis of stroke. Participants completed the three tools and subscales were compared with the DLOTCA cognitive areas and the RPAB items. RESULTS: Five subscales of the OT-APST had significant correlations with similar DLOTCA and/or the RPAB subscales. Only the Apraxia subscale did not correlate with the referencing tools. CONCLUSION: This study provides further evidence of the convergent validity of the OT-APST when compared to the DLOTCA and RPAB. Although the OT-APST was standardised on an Australian population, it proved to be another option of a visual perceptual screening tool to identifying visual perceptual problems in patients with stroke in South Africa. Key words: Cognitive-perceptual, stroke, convergent validity, Occupational Therapy Adult Perceptual Screening Test (OT-APST), Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), Rivermead Perceptual Assessment Battery (RPAB)

Can Cognitive and Perceptual Standardized Test Scores Predict Functional Performance in Adults Diagnosed with Stroke?: A Pilot Study

ABSTRACTStroke is a major cause of disability worldwide, and typically leaves people with impaired cognitive and perceptual faculties. This pilot study assessed three standardized cognitive and visual perceptual assessments for their ability to predict functional performance in adults who have had a stroke—the Neurobehavioural Status Examination (Cognistat), Occupational Therapy Adult Perceptual Screening Test, and the Developmental Test of Visual Perception-Adolescent and Adult. The participants were 27 adults diagnosed as having had a stroke, who were admitted to an inpatient rehabilitation center over a nine-month period. The Functional Independence Measure (FIM) was used to measure their functional performance at discharge from rehabilitation. The results indicate that the “comprehension” and “similarities” subscales of the Cognistat were the best predictors of functional performance as measured by the FIM. A large amount of variance in functional performance remained unexplained by the standardized tests; however, overall and despite their limitations, the tests were able to predict functional performance skills of stroke patients.

Convergent Validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) with Two other Cognitive-Perceptual Tests

Background: It is common for individuals with a neurological impairment, such as a stroke, to present with cognitive-perceptual impairments. The early identification of such problems can assist with rehabilitation efforts. Standardised cognitive and perception tests are often used by practitioners to make such identifications; therefore, it is important to examine the measurement properties of these tests. Objective: This study investigated the convergent validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) with two other cognitive-perceptual tests: the Neurobehavioural Cognitive Status Examination (Cognistat) and the Developmental Test of Visual Perception — Adolescent and Adult (DTVP-A). The Cognistat is primarily a test of cognition but has some subscales that evaluate perceptual skills. The convergent validity between the Cognistat and the DTVP-A was also investigated. It is imperative that tests used by therapists have documented validity to ensure that the results obtained actually measure the skills and abilities that the tests claim they measure. Method: Thirty-two adult patients, ranging in age between 46 and 91 years (mean = 73, SD = 4.6) with a primary diagnosis of stroke, completed the OT-APST, the Cognistat and the DTVP-A. Spearman's rho was used to analyse the correlations between the tests' subscales. Results: Three of the Cognistat subscales were significantly correlated with OT-APST subscales: Cognistat Constructional Ability and OT-APST Body Scheme; Cognistat Memory and OT-APST Functional Skills; and Cognistat Calculations and OT-APST Body Scheme. Only one of the OT-APST subscales, Body Scheme, had statistically significant correlations with the DTVP-A's Figure-Ground, Visual-Motor Search and Visual Closure subscales. There were significant correlations between the Cognistat's Constructional Ability and Judgment subscales and five of the six DTVP-A's subscales. Conclusion: Given that only a few of the subscales from the Cognistat and DTVP-A were significantly correlated with those of the OT-APST, this indicates that many of the constructs assessed by the three tests are not associated; hence, limited convergent validity evidence for the OT-APST was present. Further inquiry is required because it is important that such instruments are assessing what they purport to test, particularly when they are used to determine clients' strengths and weaknesses in clinical practice.

Clock drawing from the occupational therapy adult perceptual screening test: Its correlation with demographic and clinical factors in the stroke population

The aim of this study was to explore the relationships between clock drawing ability following stroke, and key clinical variables including cognition, functional independence, side and type of stroke, educational level and age. One hundred and ninety-seven people with stroke were recruited from 12 hospital and rehabilitation facilities. The participants' scores from the Clock Drawing Test in the Occupational Therapy Adult Perceptual Screening Test were the dependent variables and were entered into logistic regression with Functional Independence Measure motor scores, side of stroke, Oxfordshire Classification System of Stroke, educational level and age as independent variables. Correlation with the Mini-Mental State Examination was analysed independently, due to its strong correlation with other variables. The Mini-Mental State Examination correlated significantly with the Clock Drawing Test ( Exp (B) = 0.826, P < 0.001). In the multivariate analysis, a significant relationship was found with age (Exp ( B) = 1.052, P < 0.001), Functional Independence Measure - motor (Exp (B) = 0.984, P = 0.030) and side of stroke (Exp (B) = 0.384, P = 0.003). Age demonstrated the strongest correlation with the Clock Drawing Test ability and the greatest decline was from approximately 70 years of age. The Clock Drawing Test may be a useful and quick screen of cognitive impairments following stroke. Age-related decline must be considered and it is essential that clinicians use this only as a strategy to determine whether a more comprehensive assessment is required.

Interrater Reliability of the Clock Drawing Task in the Occupational Therapy Adult Perceptual Screening Test

The clock drawing item in the Occupational Therapy Adult Perceptual Screening Test (OT-APST) screens for unilateral neglect and impairments in constructional skills. The purpose of this study was to re-evaluate the interrater reliability of the clock drawing item in the OT-APST following the addition of example clock drawings to the manual. This study also compared the interrater reliability for occupational therapy clinicians with that for final year occupational therapy students and examined clocks with poor interrater reliability for the individual scoring criteria. Sixteen occupational therapy students and 15 practising occupational therapists scored 50 clocks drawn by people with stroke, using the OT-APST clock drawing criteria. Interrater reliability was determined for each rater in comparison to the gold standard, using intraclass correlation (ICC) and kappa statistics. Student and clinician interrater reliability were compared using t-tests. The scoring of clocks with poor agreement was examined further in order to identify disparities. The student and clinician groups demonstrated excellent reliability for ICC (0.83 and 0.84 respectively) and moderate reliability for kappa statistics (0.58 and 0.59). The differences between the groups were not significant (p &gt; 0.05). Scoring disparities were seen in the formation of the circle or in the placement of the numbers. The results support reliable scoring for the clock drawing item in the OT-APST.

Performance of People with Dementia on the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

The aim of this study was to investigate the use of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) as a screening tool of visual perception among people with dementia. The study compared the performance of twenty-five people with dementia with a normative sample of 150 people on the OT-APST. The dementia sample was found to perform significantly worse than the normative sample on all subscales of the OT-APST. Fair to moderate correlations were found between performance on each of the OT-APST subscales and dementia severity. The OT-APST may be useful in determining areas of difficulty and strength, allowing for more effective, individualised care for people with dementia. Results should be interpreted cautiously however given the demonstrated impact of declining cognitive skills on OT-APST performance in people with dementia.

Performance of People with Dementia on the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

The aim of this study was to investigate the use of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) as a screening tool of visual perception among people with dementia. The study compared the performance of twenty-five people with dementia with a normative sample of 150 people on the OT-APST. The dementia sample was found to perform significantly worse than the normative sample on all subscales of the OT-APST. Fair to moderate correlations were found between performance on each of the OT-APST subscales and dementia severity. The OT-APST may be useful in determining areas of difficulty and strength, allowing for more effective, individualised care for people with dementia. Results should be interpreted cautiously however given the demonstrated impact of declining cognitive skills on OT-APST performance in people with dementia.

Australian normative data for the Occupational Therapy Adult Perceptual Screening Test

Objectives: The purpose of this study was to examine variables impacting on the performance of healthy adults on the Occupational Therapy Adult Perceptual Screening Test (OT‐APST), and present the Australian normative data for this standardised assessment tool. Method: The OT‐APST was administered to a sample of healthy adults aged 16–97 (n = 356).Results: Neither gender nor highest level of education significantly impacted on OT‐APST performance in the healthy normative group. Increasing age significantly correlated with reduced performance on all OT‐APST subscales except for body scheme. Australian normative data for the OT‐APST are presented in two age intervals: 16–74 years (n = 232) and 75–97 years (n = 124).Conclusion: Presentation of a large, age‐stratified Australian normative data set including cut‐off scores for intact/impaired perceptual performance for each of the OT‐APST subscales will enable occupational therapists to make a norm‐referenced interpretation of scores for individual clients when using this screening tool.

Construct and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

This paper reports on the construct validity (scale design and convergent validity) and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). The performance of 208 participants following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA-Geriatric version (LOTCA-G)) was compared. The OT-APST performance of the stroke sample was compared with a healthy normative sample (n=356). The relationship between the OT-APST performance and the Functional Independence Measure (FIM™) score of the participants following stroke was also examined. Factor analysis and internal consistency results supported the scale design of the OT-APST. Significant correlations between the performance of the participants following stroke on the OT-APST and the reference tool supported the convergent validity of the OT-APST. The ability of the OT-APST to separate the two participant groups provided further evidence of its construct validity. Significant correlations between OT-APST and FIM™ scores supported the ecological validity of this tool. This study shows that the OT-APST is an ecologically valid tool with demonstrated construct validity in the assessment of visual perception.

Criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

This paper reports on the criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) including concurrent criterion validity and its sensitivity and specificity. The performance of 208 people following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA – Geriatric version (LOTCA-G)) was compared. The OT-APST subscale scores and performance outcome (intact or impaired) on related subscales of the reference tool was analyzed to evaluate the concurrent criterion validity of the OT-APST and its sensitivity and specificity at selected cut-off scores. Significant correlations were found between participants’ performance (intact or impaired) on the reference tool and scores on the OT-APST. The sensitivity and specificity of the OT-APST were analyzed at selected cut-off scores to explore the validity of decisions based on OT-APST performance when compared with the reference tool. This study shows that the OT-APST is a tool with demonstrated concurrent criterion validity for the assessment of visual perception.

The Reliability of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is designed to screen for impairments in visual perception and apraxia in adults following stroke. The OT-APST is a comprehensive battery that contains 25 items in the following seven subscale areas: agnosia (5 items); visuospatial relations covering elements of body scheme (4 items) and unilateral neglect (5 items); constructional skills (3 items); apraxia (6 items); acalculia (1 item); and functional skills (5 items). Several OT-APST items contribute to more than one subscale, hence there is a difference in the number of items in each subscale and the overall number of items. This study reports three aspects of the reliability of the OT-APST: interrater, intrarater and test-retest reliability. The participants in the interrater and intrarater reliability study were 15 people following stroke. Videotaped OT-APST performance was scored by nine occupational therapists and the results compared with the scores of the first author as the gold-standard rater. The participants in the test-retest reliability study were 10 people who were neurologically stable one year after stroke and were assessed 2 weeks apart on the OT-APST. The results obtained for each of the 25 OT-APST items included intraclass correlation coefficients (Type 3,1) for interrater reliability ranging from 0.66 to 1.0, for intrarater reliability ranging from 0.64 to 1.0, and for test-retest reliability ranging from 0.76 to 0.95. These results indicate that the OT-APST has good interrater, intrarater and test-retest reliability and offers a reliable screening tool for use by occupational therapists working in the area of stroke.

Development of a standardized occupational therapy screening tool for visual perception in adults

Occupational therapy assessment and treatment of visual perceptual impairments are integral to the rehabilitation of clients following stroke and other acquired brain injuries. Occupational therapists need to identify the nature of visual perceptual performance impairments in order to choose rehabilitation intervention strategies appropriate for remediation of specific problems or to compensate for limitations in daily function. This paper describes the variations in visual perception terminology and occupational therapy approaches to visual perceptual assessment. Limitations of existing assessment tools for visual perception are highlighted in terms of reliability, validity, normative information, length of time to administer, and comprehensiveness in screening for visual perceptual impairment. In response to these limitations, a battery of items, called the Occupational Therapy Adult Perceptual Screening Test (OT-APST) was selected to screen adults comprehensively for impairments of agnosia, visuospatial skills including body scheme and neglect, constructional skills, apraxia, and acalculia. It also includes a subtest to evaluate functional skills directly observed during screening. This new battery has established reliability, validity and age-stratified normative data for adults 16 to 97 years of age. The OT-APST is recommended for use in conjunction with observational assessment of activities of daily living for clients with stroke and acquired brain injury.