This learning scenario presents a fictional case designed to help students and practitioners apply occupational therapy concepts in cognitive assessment. Use the prompts below to reflect on key issues related to memory, orientation, and real-world function after stroke.
Case Profile
- Name: Ms. Eleanor Vance
- Age: 78
- Living situation: Lives alone in her own home
- Medical history: Mild stroke (right hemisphere)
- Background: Former librarian, highly independent, enjoys gardening, and managed her finances and appointments meticulously before stroke
- Referral: Outpatient OT for assessment of readiness to return to independent living
Presenting Concerns
Ms. Vance’s daughter reports:
- Missed several medication doses
- Difficulty remembering appointments
- Occasional confusion about the time of day
- Frequently misplaces items
Guided Learning Questions
1. What cognitive deficits may be present?
Based on the scenario, which specific cognitive domains might be impaired?
- Consider: Orientation, episodic memory, prospective memory, attention
2. How do these deficits affect occupational performance?
Reflect on how challenges in memory and orientation might influence Ms. Vance’s ability to:
- Manage medication safely
- Keep scheduled appointments
- Locate items needed for daily routines
3. What assessment methods/tools could be used?
Which tools from the OT cognitive assessment would help you evaluate Ms. Vance’s difficulties?
- Consider:
- Self-report measures
- Informal task observation
- Standardized tools (e.g., MoCA, Contextual Memory Test, RBMT)
4. How would you interpret the discrepancy between client and family reports?
Ms. Vance believes she is managing well, but her daughter sees major concerns. What might this say about her level of self-awareness? Which type (intellectual, emergent, anticipatory)?
5. How could informal observation help during a simulated medication task?
What specific behaviors would you watch for?
- Sequencing errors?
- Inattention?
- Use (or lack) of memory aids?
- Ability to recognize mistakes?
6. What performance-influencing factors should be considered?
Identify variables that could affect the validity of your cognitive assessment:
- Age-related changes
- Educational background
- Sensory function (vision, hearing)
- Emotional state or fatigue
How would you address these during the assessment?
Conclusion
Ms. Vance’s case highlights the importance of combining standardized tools, observational insights, and client/family perspectives when assessing cognition. Use the questions above to critically reflect on how to approach similar scenarios in clinical practice.
Note: This scenario is fictional and generated using AI (Notebook LM) for learning purposes based on evidence-based OT practice frameworks.