22 Mar Assessing cognitive function
Medico-legal reports often state that the plaintiff has ‘reduced concentration’ or ‘poor memory’ which may impair their ability to work or undertake re-training. Such statements are difficult to quantify without a full neuropsychological assessment, which can be a costly exercise and is generally reserved for cases of acquired brain injury.
As an occupational therapist who has worked in the medico-legal field for many years, I am frequently advised by people I am assessing that they suffer from subtle deficits in their cognition in the absence of an acquired brain injury. I frequently hear, ‘I can’t focus’, ‘I’m not in the right head space to study’, ‘I forget everything’, ‘I tune out in conversations’, and ‘I used to be really sharp and organised and now I am hopeless’. I have been searching for a cost-effective, evidence-based tool to allow me to assess elements of cognition such as concentration and memory as a way of providing medical evidence of reduced cognitive performance.
I recently became aware of the Cambridge Brain Sciences assessment, which was developed by the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging, Dr Adrian Owen, over a 25-year period. Completed in 30 minutes, it is cost-effective and has been proven to be an efficient and sensitive measure of baseline cognitive capacity. It assesses aspects of cognition including reasoning, memory, attention and verbal ability.
Results can be extrapolated to provide specific information about how an injured worker may perform in the workplace. For example, a person who performs poorly on reasoning tasks may have difficulty processing information, making decisions, problem solving and reaching conclusions based on evidence. Working in a position which requires them to compare data and make rapid decisions will be difficult for these people.
Below average scores on memory tasks will affect a worker’s ability to retain information, learn new tasks and follow instructions. It could result in employers becoming frustrated that instructions need to be repeated and result in slowed productivity while workers check and re-check their work. It will mean that people may have difficulty studying because they cannot recall the content of lectures or retain information they have read.
If a person scores poorly on specific tasks relating to attention, this would mean they could be easily distracted by background noise or their pain levels. They may have difficulty concentrating and performing in environments where there is a lot of noise from machinery or other staff, such as call centres. They may have difficulty filtering out salient facts from general information.
Low scores on verbal ability mean the injured worker could have difficulty understanding verbal instructions and communicating effectively with others. They may be better working in a job which does not require with others and allows them to work in isolation.
I am now using the Cambridge Brain Sciences test in my medico-legal assessments on specific cases where I believe it would be beneficial in further exploring reported difficulties with concentration or memory. I have found it provides confidence in being able to comment on cognitive barriers to returning to work or study. It provides percentile scores with everyday examples of how below average scores may affect an individual’s performance. It can also clarify specific deficits or highlight over-reporting of symptoms.
I do not attempt to attribute deficits to physical or psychological factors such as fatigue, pain, medication or depression as this is outside my area of expertise. Rather I seek to comment on whether cognitive factors may or may not exist and how they may manifest in a work or study environment. This is particularly useful for Total and Permanent Disability assessments, where the person’s cognitive functioning may be overlooked.
Please note this assessment is not a replacement for a full neuropsychological assessment.
For further information please do not hesitate to contact ASSESS to arrange an appointment or speak with me further.
Nancy Stephenson is a respected Occupational Therapist, with 34 years of experience in the field, including many years in private practice consulting to industry, insurers, and government and private organisations. She has worked for 15 years in medicolegal assessments for personal injury, medical negligence and workplace and industrial accidents.