The COPM with Cognitive Impairments

Melodie is a 26 year old woman who was injured in a car accident about six months ago. Although she experiences a small amount of ataxia, she is physically well-recovered. However, she is left with a number of cognitive deficits, which prevent her from living alone. Melodie's memory impairment, judgement lapses and volatile temper have resulted in some problems at home, and Melodie has been referred for the development of community living skills.

In addition to the problems outlined for William, a client like Melodie may also have difficulties dealing with abstract scoring procedures, and may require the therapist to be more creative in how he or she derives baseline and progress values for the performance and satisfaction with occupation.

A further challenge with cognitive impairment arises out of attention and memory problems. It may be doubly important to conduct the COPM in an area that is free from distractions and minimally stimulating, in order to obtain useful information from the interview. Further, it may be necessary to complete the interview in multiple sittings if fatigue or distractibility become apparent.

6 thoughts on “The COPM with Cognitive Impairments

    1. Hi Manish,

      Thank you for your question about the use of the COPM with older patients. We have a number of links on the COPM website that may be useful for you. There is an Advanced Application titled “Using the COPM with an Alternate Respondent” (http://www.thecopm.ca/advanced/the-copm-with-an-alternate-respondent). The section titled “The COPM in Use” also has a case study on using the COPM in “Interventions for Musculoskeletal Conditions” (http://www.thecopm.ca/casestudy/intervention-for-musculoskeletal-conditions/) and for “Kickstarting Dialogue Between Client and Therapist” (http://www.thecopm.ca/casestudy/kickstarting-dialogue-between-client-and-therapist/). We hope this is helpful. Please feel free to contact with further questions.

    1. Nicole – thanks for your question. The COPM can be used with a person having problems with expressive language as long as they are able to understand the questions asked by the therapist and have an way to express their needs regarding the occupations that are important and with which they are having difficulty. Therapists may seek help from a speech pathologist to understand the person’s capabilities with expressive language. In some situations, a person may be able to respond yes or no when asked about problems with typical occupations. Some therapists have suggested using alternate communication methods such as pictures to identify important occupations. Others have involved the person’s family in the assessment process. When scoring, the use of the scoring cards can help as the person can point to the numbers. It may be important to conduct the COPM in an area that is free from distractions and minimally stimulating, in order to obtain useful information from the interview. Further, it may be useful to complete the interview in more than one sittings if fatigue becomes apparent.

  1. Hi there, I work in an neuro rehab unit and many of our clients have significant language and/or cognitive impairment. My colleagues and I have formed a working party to attempt to address this, we all feel the COPM is an invaluable tool in our work place. One of the suggestions we had in conjunction with our Speech and Language therapist was to use something akin to ‘talking mats’ whereby we would use pictures to describe issues clients may be experiencing with performance areas. My question is, how does this effect the efficacy of the assessment? Does this raise any issues as it is a ‘client centred’ tool rather that a therapist administered assessment. I am guessing that you will have had more than one similar enquiry to this in the past.

    Many thanks for your time
    Jo

    1. Thanks Jo for your comment and questions. We have heard from a few other therapists who have raised this same issue. The COPM can be used with a person having problems with language and cognition as long as they are able to understand the questions asked by the therapist and have an way to express their needs regarding the occupations that are important and with which they are having difficulty. Working together with speech pathologists is a really good idea. In some situations, a person may be able to respond yes or no when asked about problems with typical occupations. Using alternate communication methods such as ‘talking mats’ is worth trying to help clients to identify important occupations. This approach can still be client-centred if a full range of potential occupational performance issues is used and available to the client to select. This process may change the effectiveness of the COPM for specific clients but that will have to be determined through trying it and evaluating its use. Others have involved the person’s family in the assessment process. When scoring, the use of the scoring cards can help as the person can point to the numbers. It may be important to conduct the COPM in an area that is free from distractions and minimally stimulating, in order to obtain useful information from the interview. Further, it may be useful to complete the interview in more than one sittings if fatigue becomes apparent.

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