Workarounds for someone with arthritis

Question:

I have a client who may not be able to manipulate the LACLS. She has quite bad arthritis in her hands. Is the ribbon card a good work around for this and is using it still valid if you use it as the only tool? 

I see that there are two variations on your site. Is one better than the other? Any other workarounds for assessing functional cognition for someone with arthritis?

 Response:

The ribbon card comes with pattern A and pattern B in the one pack.

 If your client’s hand function is limited, it will impact all of the assessments in the ACL battery. I would think the LACLS would be the assessment of choice.

 The assessment is not timed which is good in this situation. The extra time that she will take to do the actions will not matter. I suggest the LACLS because it is easier to grasp and the Permalok needle is larger. You can assist her by stabilising the leather if necessary. If she can grasp the large Permalok needle you can go ahead with the assessment.

 Note any adjustments you make in your report. Be careful to note the process she uses to complete the stitches. You are looking for her ability to:

1.      Sequence through a short familiar (in and out the holes) sequence, a longer sequence (bring the lace over the edge of the leather and though the hole, pull tight), longer sequence (front to back through hole and loop, tighten back, then front)

2.      Need for demonstration vs problem solving to complete stitch

3.      Conservation (looks at the back to find errors)

4.      Recognition of errors and so on

5.      The cognitive ability to work in tight spaces

6.      You will be able to understand how she compensates for her disability.

 Don’t worry about the finished effect, provided she can recognise how hers differs from the sample. Loose tension is okay provided she does the 2-step tightening.

 Your aim is to determine if performance issues are focal (pain, hand deformity) or global cognition (learning, sequencing, problem solving).