Medical terms relevant to disability assessment

Neurological deficit – an abnormal physical finding such as paralysis or loss of sensation

Hemiparesis – paralysis of one side of the body e.g. an arm and a leg on the same side, may be associated with drooping face on the same side, speech problems, swallowing problems. Dense hemiparesis means no movement at all - such a person would definitely not be able to walk unaided.

Dysarthria – a muscle weakness causing difficulty speaking/making themselves understood – slurred or slow speech

Dysphasia –complex disorder of language processing; both understanding and expression can be affected differently in the same person; language breakdown can be at any level; may include difficulties with reading, writing and numeracy.

Aphasia – unable to understand or to speak at all

Medical terms used to describe cognitive problems

Common difficulties include problems with:

Attention, allows information into the brain and underlies all other cognitive processes. The pre-requisites are alertness and arousal. The problems observed are that information is not properly processed by the brain resulting in reduced understanding or misuse of information. The person may be impulsive, show perseveration, lack of insight, denial or be too concrete or literal. They might have difficulty comprehending, be withdrawn, frustrated or aggressive.

Assessing for attention problems

The occupational therapist can use standardised assessments such as Test of Everyday Attention or Digit Span, a rating scale questionnaire and functional observations of every day activities such as making a hot drink, dressing self.

Executive functions allow us to accomplish goal directed behaviour, to co-ordinate and control our thinking and behaviour, to self-monitor, show initiation, ability to plan and to set goals and process information. The problems observed include difficulty planning and executing tasks, difficulty initiating appropriate behaviour, difficulty with problem-solving and inability to identify strengths / weaknesses.

Assessing Executive Functions

The occupational therapist can use any functional activity or may use a standardised test such as ‘Behavioural Assessment of dysexecutive Syndrome’ (BADS), to identify areas which are often difficult to pick up in everyday conversation.

Information Processing is the ability to make sense of the world by dealing effectively and efficiently with sensory and other information that constantly enters the system. It can occur at conscious or automatic level. Three components underlie conscious processing, these include speed ( the amount of information a person can attend to within a given time), capacity (the amount of information at any given time) and control (the ability to guide selective process by directing & organising whatever processing capacity he has.) Problems observed include difficulty following instructions, “delayed reaction” to instructions and overloading with information.

Assessing for Information Processing Problems

The occupational therapist can use standardised assessments including speed reading of word lists and questionnaires.

Memory includes the ability to keep things in the mind. It is a process involving attention (attending to information), encoding (registration of information), storage (stored in long term memory), consolidation (practising rehearsing information) and recall (retrieving information stored in long term memory). Two most functionally important aspects of memory are episodic memory (every day) and prospective memory (act in future).

Assessing for Memory Problems

The occupational therapist uses questionnaires, RBMT, MEAMS and digit span.

Visual Processing includes acquisition of visual information and appropriate use and manipulation of that information. It includes oculomotor skill (ability to move eyes). Visual fields (the area that the eye can see at any one time (160-180 degrees), visual acuity (sharpness of eyesight), visual attention (ability to attend to critical features visually or staring), scanning (ability to record all details of a scene in an organised way), pattern recognition (features of an object e.g. shape, colour, etc), visual memory (visually process information, store it and recall it) and visual cognition (mental manipulation of visual information).

Amended November 2009