1. General Assessments KNR 279

2. General Assessment Typically CTRS do not administer general assessments but need to be familiar and understand implications of their results for TR services  Sylvester, Voelkl, & Ellis, 2001, p. 304 Lists variety of general assessments (p. 304-308) Physical Psychological Social Quality of life Stumbo, N. J. (1994/95). Assessment of social skills for therapeutic recreation intervention. Annual in Therapeutic Recreation, 5, 68-82.

3. General Assessments NCTRC/ATRA Global Assessment Functioning (GAF) American Spinal Injury Association Scale (ASIA) Rancho Los Amigos Scale Glasgow Coma Scale Children’s Coma Scale Global Deterioration Scale (GDS)

4. GAF Global Assessment of Functioning Scale Behavioral health (psy./substance) Looks at overall functioning Continuum from psychiatric illness to health Looks at highest functioning in last year

5. GAF (cont.) Scale 1 (sickest) to 100 (healthiest) 81-90/91-100 = positive mental health 31-70 most outpatients 1-40 most inpatients Areas Psychological impairment Social skills Dangerousness Occupational skills Substance abuse

6. GAF (cont.) Sources: Activity Therapy interview Observation Reliable informant Medical record Outcome measure Beck Depression Scale, improve from 35 to 18 http://www.bsu.edu/csh/ssrc/media/pdf/gafpa ge.pdf http://www.bsu.edu/csh/ssrc/media/pdf/gafpa ge.pdf

7. American Spinal Injury Association Scale (ASIA) Used with spinal cord injury Impairment Scale Complete: No motor or sensory function Incomplete: Sensory but not motor function preserved Incomplete: Motor function is preserved & more than half of key muscles have muscle grade less than 3 Incomplete: Motor function preserved, grade 4 or more Normal: Motor and sensory function are normal http://www.sci-info-pages.com/levels.html

8. Ranchos Los Amigos Cognitive Scale Helpful in assessing patient in first weeks or months of brain injury Does not require cooperation of patient Based on observations of response to external stimuli 10 levels (8 levels on original) Scale: http://www.waiting.com/rancholosamigos.htmlhttp://www.waiting.com/rancholosamigos.html http://www.braininjury.com/recovery.html Family guide: http://www.rancho.org/patient_education/bi_cognitio n.pdf http://www.rancho.org/patient_education/bi_cognitio n.pdf

9. Glasgow Coma Scale Assesses degree of brain impairment & identifies seriousness of injury in relation to outcome 3 determinants Eye opening Verbal responses Motor response (movement) http://www.northeastcenter.com/glasgow_co ma_scale.htm http://www.northeastcenter.com/glasgow_co ma_scale.htm

10. Children’s Coma Scale Used with children Eye opening Best verbal or nonverbal response Best motor response http://www.medal.org/visitor/www%5CActive %5Cch17%5Cch17.01%5Cch17.01.02.aspx http://www.medal.org/visitor/www%5CActive %5Cch17%5Cch17.01%5Cch17.01.02.aspx

11. Global Deterioration Scale (GDS) Stages of cognitive function for patients with primary degenerative dementia like Alzheimer’s disease 7 stages 1-3 = pre-dementia 4-7 = dementia stages Beginning in stage 5 an individual can no longer survive without assistance http://www.seniors- resource.com/frames/dem9.htm http://www.seniors- resource.com/frames/dem9.htm

12. Global Deterioration Scale (GDS) 1: No cognitive decline 2: Very mild cognitive decline  Age associated memory impairment 3: Mild cognitive decline 4: Moderate cognitive decline  Mild dementia 5: Moderately severe cognitive decline  Moderate dementia 6: Severe cognitive decline  Moderately severe dementia 7: Very severe cognitive decline  Severe dementia

13. Global Deterioration Scale (GDS) Brief Cognitive Rating Scale (BCRS) Often used with GDS Concentration Recent memory Past memory Orientation Functioning & self-care www.geriatric-resources.com/html/bcrs.html

14. Assessing Pain JCAHO requirement January 2001 Importance of pain management

18. Pain Assessment Variety of pain assessments http://www.partnersagainstpain.com/professio nal-tools/pain-assessment-scales.aspx?id=3 http://www.partnersagainstpain.com/professio nal-tools/pain-assessment-scales.aspx?id=3

19. Other Assessment Issues Language