And Dementia Specific Tools

Presented by

Barbara BROCK, Published

Research Author, President Communication Art,
Inc. Toledo, Ohio

and

Mary Beth LAVEY COTA/L

Woodland Adult Services. Bowling Green, Ohio

Reality Comprehension
Clock Test (RCCT)
and the
A standardized assessment .

Ideal for Alzheimers and other

types of dementia.

Communication Art Programs

A Social Model for dementia populations that
contains a brain stimulating curriculum.

OHIO OCCUPATIOANL THEARPY CONFERENCE 2008

Reality Comprehension
Clock Test (RCCT)
Reality Comprehension Clock Test
Identifies cognitive skills and abilities
of Alzheimer and other dementia
residents/clients.

Communication Art Programs

Social Model contains Brain
Stimulating Curriculum for
Alzheimer s and other types of
dementia.

To become certified to administer the RCCT

you are required to complete the 4 hr RCCT
educational workshop.

Focus is on skills that remain, not those that are lost.

Reality Comprehension
Clock Test
RCCT does not
diagnose dementia.

Assesses:
Cognition
Memory
Fall Risk
Continence Status
1999 RCCT Brock,B. et al

The Reality Comprehension Clock Test was developed to pick

up where the Folstein Mini Mental Status Exam leaves off.

What makes the RCCT different from other

clock drawing tests?

If resident scores 23 or lower on the Folstein Mini

Mental Status Exam administer the RCCT

While viewing a sample drawing of a clock,

resident is asked to replicate it.

Test contains a specific scoring method .

Evaluates Four Functional Categories

And actual clock drawing by the resident helps

caregivers and family members reduce the
difference of opinions as to.

Functional Age
(FA = remaining brain power)

Global Deterioration Stage

(GDS = stage of the dementia)

How much their loved one

understands..

Risk of Falling
(visual spatial score on RCCT)

Continence Status
And how capable they are of
taking care of themselves.

Appropriate Level of Cognitive

Activities
Potential Memory Deficits

RCCT
-Administrator of RCCT is required to be certified by
completing the RCCT 4 hr. educational workshop.
12 month certification.
-Annual re-certification is required.

Reality Comprehension Clock Test

FA

Functional Age

GDS

Global Deterioration Stage

VSS

Visual Spatial Score Fall Risk

Must administer the RCCT one with one.

Person who gives RCCT must score RCCT

Reality Comprehension Clock Test

Cost Effective
Quick Screening
Tool

Geriatrics

Non-Threatening

Pre-school and

Portable
Easy to Administer

School aged children

Easy to Score

Cognitive impaired groups

RCCT currently being used in:

Can be administered:

Physician s offices
Long Term Care Facilities
Assisted Living Facilities

*Pre-Admission

Adult Day Cares

*Admission

Mental Health Clinics

MR/DD Workshops

*Quarterly

Home Health Care Agencies

*Annually

Adult Protective Services

Upon Significant Change

Non Medical Home Care

*Score on Mini Mental is 23 or below

OT Private Practice
Geriatric Care Managers Private Practice

R eality
C omprehension
Administered by

O Ts, Speech Therapists, R Ns, L P Ns, Licensed Social Workers,

Kinesio Therapist Registered, Recreational Therapists, Art Therapists,
Activity Professionals, Health Care Professionals who have completed
the 4 hour RCCT Workshop

C lock
T est

RCCT copyright 1999.

Permission to duplicate denied.

Copyright fines apply

An original RCCT must be kept
with individuals private medical information.

Lets look at the RCCT scoring pages

of

RCCT
nicknamed the
PINK
clock test.

How does the RCCT identify Fall Risk ?

Matts RCCT
Lets find out what the
RCCT tells us about Matt.

Journal of Gerontological Nursing

Visual Spatial Abilities and Fall Risk.An
Assessment for Individuals With Dementia
Published Sept. 2005

Research funded by a grant from

HCRManorCare Foundation

Reality Comprehension Clock Test

Validity
Reliability

Reveals

Drives appropriate interventions

on care plans for dementia
Residents or Clients

Matt completed the RCCT.

We have valuable information to care for Matt on his level of
understanding but he is still sitting there looking at us.

He needs brain stimulation.

RCCT score (43) revealed Matt is a good candidate

Designed specifically for

Stages 3,4,5, and 6 dementia

Each Communication Art
Program contains 18 brain
stimulating exercises
Popular, nostalgic themes.

for Level II Communication Programs

All the WORK is done for You!

Clients/Residents participation in
each brain exercise is monitored by a
trained Communication Art
Program staff member.

Ideal for use with Occupational and Speech Therapy!

Copyright 2008 Communication Art, Inc.

Give ME a PURPOSE!

The most IMPORTANT part for the

Resident or Client
Brain Exercises

WOOD COUNTY BD. OF

MR/DD
Adult Services (22 yrs and older)
Shelter Employment (WLI)
Community Employment

Each task is designed on resident/clients level of understanding.

Non Vocational Services

Day Services / Day Hab. / Older Adult

Down Syndrome &

Alzheimers

1997 Study

In 1997 a study of 307 patients with

Down Syndrome revealed the following:

66% between the ages of 50 59.

11% of individuals with Down Syndrome

developed Alzheimers between the ages
of 40 49

77% between the ages of 60 69

-100% had Alzheimers by the time they
were over 70.

1997 Study

Prospective Study of the Variance

of Alzheimer's/Dementia in Instructional
Individuals with Downs Syndrome
American Journal Mental Retardation
Vol. 101 pages 400 412 Visser, F
AldenKapa, A, Huffelen

Down Syndrome &

Alzheimers
Down Syndrome have
higher risk of
developing AD.
Symptoms begin at
earlier age.
Decline is quicker.

Two diseases share a

neuropathology.
Leading hypothesis is
based on chromosome
21.
Sally Albrecht AID workshop

Assessment of DS in AD
Difficult due to presence of mental
retardation.
An approx. 1 2 year elapse exist before
diagnosis is confirmed.
Sally Albrecht AID workshop

Statistics
First symptoms observed ages 36 and 62, with
mean the mean age of 50.
Diagnosis is confirmed between 37 and 62, with
mean age of 52.6.
Death occurs between ages of 46.7 and 69.8
with mean age of 60.11.
Duration from 1 st symptom to death 9 years
(range 6 to 11)
Sally Albrecht AID workshop

Early Stage of AD in DS

Middle Stage of AD in DS

Confusion, disorientation and wandering

usually not recognized and commonly
misdiagnosed.

Marked deterioration of ADL

Behavioral Changes

Behavioral problems are exaggerated,

and psychotic behavior may be displayed.

Visual Deficits

Communication skills decline.

Sally Albrecht AID workshop

Sally Albrecht AID workshop

Advanced Stage of AD in DS

Special Considerations for DS

Diagnosis is complicated by the MR.

Patients are almost at a vegetative level.

Common neurocognitive test not useful.
They totally depend on others and
interact minimally with environment.

Depression may be mimicking AD

Sally Albrecht AID workshop

Hypothyroidism (30% of DS) may

simulate dementia.
Sally Albrecht AID workshop

INTERVENTIONS

SOCIAL MODEL
Communication Art Programs

SOCIAL MODEL AND RCCT

Reminiscing
LOW IMPACT WATER AEROBICS

Choices
Which One?

SWEAT N TO THE OLDIES

Drawing

Reminiscing
Questions on the topic of the day.
Different levels of questions.

Choices
Which type of bird would you prefer to
watch?

Sharing of memories.
Turn taking skills.

A Robin
A Red Cardinal

Listening skills.

Which One?

WHICH ONE? Level 1

Circle the picture that does not belong.

Leve1 has 5 pictures

5 PICTURES

Level 2 4 pictures

HARDER

Level 3 3 pictures

MOST CAN CIRCLE THE ONE

THAT IS NOT THE SAME.

WHICH ONE? Level 2

4 PICTURES EASIER
THEY CIRCLE THE
PICTURES THAT ARE
THE SAME.

DRAWING
EYE HAND
COORDINATION.
SPATIAL PLACEMENT
CREATIVITY

CIRCLING THE
PICTURE THAT IS NOT
THE SAME IS A
HARDER CONCEPT.

RISK TAKING

Socialization- PUZZLE
Drawing maybe overwhelming for
some.
Putting a puzzle together can be
less threatening.

COLORING
Choosing the correct colors
Staying within the lines.
Writing name

Problem solving.

Writing date
Spatial placement.

WATER EXERCISE
PROGRAM
Taking risks
Learning new skills
Forming
friendships

WARM UP EXERCISES
Leg exercises
Hand walking
Cardio activity

Recall of routine

Competitive Drive
Races
Teamwork

DEEP WATER EXERCISE

Pool now at 3 foot deep.
Go in one direction, once we get a
good current going we stop turn and
go the other way resistive exercise.

Turn taking

RESISTANCE
Strength
Endurance
Increases balance

COGINTIVE SKILLS
Leading the group through a counting
exercise.
The swimmer who counts then has to
pick the next person to count by calling
out their name.

Cardio Workout

Walk walking 5 ft deep water

holding on to the wall.

Data Objective
Information
Rating swim sessions on participation,
following directions, verbal prompting.

Work down the wall until

they get to the steps.

Monthly Weights
Body Fat and Body Mass Measurements

SWEAT N TO THE OLDIES

ROUTINE
MUSIC
BODY IN SPACE
PROPRICEPTIVE INPUT
COUNTING
RECALL

Moving with Music

Following directions.
Dancing like movements.

Feedback

Sweat n to the Oldies

Body in Space.

Music makes you want to move!

Proprioception

Accomplishment.

Movement
Stomping
Shaking
Clapping

How Have the Interventions

Impacted Their Lives
Increase in
communication
skills.
Increase in social
skills.
Increase personal
appearance.

Increase in self
esteem.
Increase in social
connectedness

Focus for the the job!

Reality Comprehension
Clock Test
NUMBER AWARENESS
VISUAL/SPACIAL
MEMORY

Sensory Integration

Case Study #1
Age: 46
Wt. Jan. 2001 275 / Aug. 2008 195 (80 lbs)

EYE HAND COORDINATIOON

Case Study # 2
Age: 48
Gender: Female

Diagnosis: Down Syndrome

Wt.: Jan. 2001 144 / Aug. 2008 160 (16 lbs)

Diagnosis: Downs Syndrome, Mod. MR

Medical issues: pre-diabetic, obesity, poor

circulation, poor breathing, poor eating habits.

Medical Issues: Headaches

General Comments: Very low muscle tone, and
low motivation. Moves very slowly in all
activities.

General Comments: Harder worker, supportive

family.

Case Study 4

Case Study # 3
Age: 48
Gender: Male
Wt:Jan. 2001 203 / Sept. 2008 174 (29 lbs)
Diagnosis: Down Syndrome, Obese
General Comments: Has an extended
stomach due to hernia surgery, enjoys the
water & playing basketball.

Case Study # 5

Age: 57
Gender: Male
Diagnosis: Downs Syndrome
Comments: Not involved with the water
exercise program

The RCCT provides us with a standardize tool

for monitoring cognitive skills.

Age: 50
Gender: Female
Diagnosis: Down Syndrome, Mild MR
General Comments:

Case Study # 6
Age: 53
Gender: Female
Diagnosis: C.P, Parkinson like symptoms medications
Comments:

WOOD COUNTY BD. OF

MR/DD

The RCCT gives us feedback on how our

water exercise program, cognitive groups and
sweat n to the oldies group is impacting the
participant's life.
The RCCT gives validation to subtle changes
noted by staff of a consumers decline.

11160 East Gypsy Lane Rd. Bowling Green, Ohio

Mary Beth Lavey, COTA/L & Stacy Schumacher, COTA/L

For attending this presentation

Barbara BROCK, Published

Research Author, President Communication Art,
Inc. Toledo, Ohio

and

Mary Beth LAVEY COTA/L

Woodland Adult Services. Bowling Green, Ohio

OHIO OCCUPATIOANL THEARPY CONFERENCE 2008