Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Cheung KY (1), Brian Choy PC (1), Fan MK (1), Kenny IP WM (1), Miranda Lau (1), Alex Yu SY (1), Hilda Ho HH (1), William Yip CH (1), Queenie Tse KY (1)
Affiliation :
(1) Occupational Department, Shatin Hospital
Introduction :
Cognitive impairment is prevalent among the geriatric population and patients with neurological disorders (Mitchell et al., 2010). Deficits in cognition can impact daily functioning. Cognitive rehabilitation, which is defined as an individualized approach to enhance daily functioning, has been one of the main focuses in occupational therapy. Abundant studies have suggested its effects on improving the domain-specific and functional performance of patients (Griffin et al., 2022). However, the types of intervention varied among different therapists.
Objectives :
This study aims to explore the feasibility of developing a standardized cognitive assessment and intervention protocol in our clinical setting.
Methodology :
A cognitive rehabilitation protocol was formulated based on the Cognitive Functional Evaluation (CFE) process, which is a six-staging procedure that gathers information on patients’ cognitive profile and occupational performance. Hong Kong Montreal Cognitive Assessment (HK-MoCA) was used as a screening test for cognitive impairment. Based on the total scores, patients were classified and triaged into three different levels. With reference to their domain sub-scores (i.e. attention and delayed recall), specific treatment packages involving different modalities were designed, which include computerized cognitive components training (5 times per week), compensatory strategies education, prescription of home program cognitive exercises, carer training, memory aids suggestion and home modification, supplemented with a self-developed cognitive pamphlet (basic or advanced level). Cue cards were provided to therapists to facilitate their practice in treatment implementation in daily routine.
Result & Outcome :
Clinical trials were conducted from July to November 2023 to review on the suitability of content in the treatment package targeted on attention and memory domains. A total of 50 patients aged between 31 and 94, who were diagnosed with neurological disorders, were recruited from the Neurological and Neurosurgical wards of Shatin Hospital. Patients with varying degrees of cognitive deficits were screened and given with the designated intervention program. Clinical improvement was observed. 92% of the patients had an improved total HK-MoCA score. 58% and 24% of them showed an increase in attention and memory sub-scores respectively. 100% of the therapists complied with the application of protocol and reported an increase in efficiency during the initial phase of treatment planning. Both caregivers and patients showed positive feedback on the information pamphlet given.
This study provides a preliminary understanding on the potential use of a standardized protocol in enhancing the quality service in cognitive rehabilitation. It is suggested that the use of a uniformized treatment package could promote consistent and evidence-based care across different therapists. In order to enhance the cognitive functions of patients, an intervention approach involving a wide spectrum would be required. Further study on the effectiveness of the revised practice on cognitive and functional performance would be recommended.
