Improve OT Clinical Decision-Making, with Digital Cognitive Assessments

Over the last few decades, there have been incredible advancements in healthcare. While these advancements have resulted in people living longer and, presumably, staying in better physical health, our brains - the complex organ that effectively governs our quality of life - just aren't keeping up.

Deficits in cognition can arise from many physical and mental health challenges, as well as ageing and lifestyle factors. Despite this, cognition is not frequently measured as part of routine healthcare, or in acute treatment programs. When it is, occupational therapists (OTs) typically rely on rudimentary cognitive screening tools - for example, the Montreal Cognitive Assessment (MoCA) and mini mental state examination (MMSE) - or else infrequent (and often delayed) specialised reports from MRIs, or comprehensive neuropsychological examinations.

Like intelligence, cognition and executive function are complex. Without accurately and objectively capturing cognitive function, diagnosis and treatment decisions are too often reliant on subjective self-reporting.

Occupational therapists would be more effective in their clinical practice if they could regularly and objectively - with a great degree of accuracy - monitor their clients’ cognitive function.

The healthcare industry is evolving and, like many other aspects of medical care today, cognitive assessments and mental health scales are now available digitally. Telehealth is a familiar option for many people and digital solutions make it easier to deliver advanced care, both in the clinic and virtually. OTs can now use online cognitive assessment tools to accurately and objectively assess cognitive function on intake and throughout their clients’ treatment plans.

Keep reading to learn why you should consider making digital cognitive assessments part of your practice - and how today's technology makes that easy...

Making an initial diagnosis is the first and most critical part of the care journey - and often the most complex. Today, individualised care approaches (a client-centred care model, where the unique needs of individual patients are being assessed) are becoming more common, due to the many benefits they offer.

When seeing a client for the first time, an OT needs to have comprehensive information, to ensure a complete view of the factors influencing their client’s health. Cognition is a key piece of that picture. OTs frequently see patients who have concerns with cognition, due to conditions such as concussion, stroke, pain - and a range of others that affect a patient’s ability to get back to everyday life. Self-reported information is important, but it’s subjective; therefore clients can only provide insight into their own unique experience. They may be able to identify their general symptoms (such as “brain fog”) on a checklist, but many don’t have the means to compare their cognition to the population, in order to gauge how much brain fog is normal. Even using a standardised screener like the MoCA does not fully describe symptoms in a nuanced way.

Since the initial assessment is so pivotal in the client care journey, better diagnostic aids are needed, to support these potentially life-changing determinations. Supplementing self-report information with objective measures of cognitive function allows the OT to confirm or rule out cognitive consequences of an injury, illness or other factor - even in situations of comorbidity.

Leveraging objective measures of cognitive function can help OTs to understand precisely what may be going on with their new client.

Establishing an early baseline for a new client helps make future assessments more relevant, by measuring change; personalised results can be compared to previous scores. If a client's cognitive concerns are validated by an assessment demonstrating objective deficits, then recovery can be measured. Changes to cognition may demonstrate the effectiveness of treatments, help make decisions about returning to everyday activities, or justify a focus on strategies to compensate for severe deficits. Once an initial assessment is made, the path to recovery depends on the effectiveness of the treatment plan.

Cognitive function is complex. For example, someone may have a poor memory but simultaneously have above-average reasoning skills. Understanding the strengths and weaknesses of the specific client matters, in the context of creating a care plan that helps harness strengths in order to overcome weaknesses.

Once the care plan is in motion, how can an OT determine whether it is quickly and effectively supporting recovery? Information from the client’s point of view is some of the most valuable, but a sensitive and objective measure can provide greater confidence in how interventions are impacting cognitive function - and vice versa.

The importance of cognitive health is more widely accepted today than ever before - yet the topic continues to be difficult to discuss with clients.

When a person visits their healthcare provider, standard practice is to record their vital signs - the basic indicators of physical health - but the basic indicators of brain health are sometimes ignored. Often, this is because of the stigma or unease attached to questioning someone’s cognitive health.

It can be uncomfortable to broach this topic for a variety of reasons - whether clients don’t want to be judged, they simply don’t want to know, or they have some other reason for hesitation. However, avoiding the discussion can lead to missed opportunities for early and accurate diagnosis and treatment. Ultimately, this keeps clients from recovering their best cognitive functioning and gets in the way of providing outstanding healthcare.

Changing the way clients view cognitive health starts with removing the stigma, through intentional, meaningful conversations.

While many people are aware of the potential for head injuries and dementia-related conditions to affect brain health, there are many other conditions that are less known to be tied to cognition - such as pain, disrupted sleep, cardiovascular diseases, psychiatric disorders and more. Unfortunately, many patients are generally unaware of the day-to-day factors that influence cognition. Having a cognitive assessment tool as a standard part of the OT’s clinical toolkit helps normalise cognition as a key element of overall health and wellness.

It can be difficult to determine and interpret changes in cognitive performance from solely subjective information. This can make it challenging to demonstrate to clients small but positive, meaningful changes, as they progress through treatment.

Clients may be going through treatments for the first time and have only subjective feelings to indicate if the treatment has the desired effects. It’s important to communicate the benefits of the treatment, to keep clients engaged throughout their programs and highlight the improvements due to treatment. Keeping clients involved in treatment can be difficult without being able to provide objective evidence of progress through the program.

Alongside the usual conversations OTs have with their clients about cognition, building regular cognitive assessments into intake and care plans gives clients context for their healthcare journey, so they can be active participants.

It’s challenging to evaluate the current standard of care when it comes to cognition in occupational therapy, because there is often no expected standard.

Cognitive assessments are typically only performed when there is a suspected problem, which often means only considering cognition when the client's life is severely impacted. This leaves clients with milder concerns, or those who don’t even realise there is a problem, in a gap where they and their healthcare practitioners aren’t getting the full picture of that person's health.

Part of the reason for this gap is that, until recently, there have been no tools to easily and effectively perform regular, accurate cognitive assessments. While existing tools offer a good overall understanding of someone's cognitive function, they tend to lack sensitivity. Quick screening instruments - e.g. the MMSE, MoCA and The Saint Louis University Mental Status (SLUMS) - can help OTs come to the conclusion that a client is cognitively impaired, but it is typically in a binary manner; yes, they are severely impaired, or no, they are not impaired. However, cognition is much more nuanced than that, as there is a broad spectrum of outcomes and varying levels of impairment. Unfortunately, cognitive issues can go undiagnosed and unaddressed, when critical symptoms are self-reported or measured with crude screeners. These tools alone cannot provide a fully objective view of cognitive function.

More in-depth neuropsychological examinations are an option as well, but they are too costly and time-consuming to perform routinely - which means that they are only performed when rudimentary measures have already identified a severe deficit.

There is a clear need for more objective, reliable cognitive data, to address the gaps inherent in traditional measures.

OTs need a modern, comprehensive tool, that can detect subtle cognitive changes objectively and accurately - but quickly enough to administer routinely. This makes it possible to create an effective treatment plan, to recover or maintain cognitive function, while monitoring intervention effectiveness.

Today, there are digital cognitive assessment solutions that make it possible to quickly and easily measure cognition. They address the need for accurate and comprehensive assessments of initial status and change over time, yet are simple enough to support smooth conversations with patients and their families and keep them engaged in the care plan. They offer an improvement over traditional screening methods, but maintain scientific credibility, and are flexible enough to administer in-person or via telehealth.

Creyos (formerly Cambridge Brain Sciences) offers dynamic, user-friendly and scientifically-validated assessments - that provide objective, meaningful insights into patient brain health. The Creyos Health platform is easy to integrate into practice operations; the data generated can support established practices for diagnosing specific disorders, tracking changes in brain health and acting on the objective results. Ultimately, there are numerous benefits for patients and providers.

If you are an OT who would benefit from being able to regularly assess clients’ cognitive functioning - for example, in supporting stroke or concussion care, or assessing for complex neuropsychological conditions like autism or ADHD - check out Creyos Health here.