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Chapter Objectives

Upon completion of this chapter, the learner should be able to:

  1. Describe the rationale for screening attention, cognition, perception, and communication in all patients, including those with neurological dysfunction.

  2. Compare and contrast the signs and symptoms of cognitive dysfunction across common neurological disorders.

  3. Differentiate valid and reliable tests and measures that can be used to assess attention, cognition, depression, perception, and communication.

  4. Describe the procedures used to administer and document cognitive tests and measures.

  5. Discuss the therapeutic implications of impairments in attention, cognition, depression, perception, and communication, including the selection of motor-learning strategies, modification of patient/client-related instruction, and referral to other health-care practitioners.

  6. Given a case study, be able to (a) identify what type of screening is needed, (b) select appropriate screening tools, (c) perform the screening, (d) interpret the results, and (e) modify the plan of care based on this interpretation.

  7. Describe multidisciplinary and developmental screening tools used to assess attention and cognition in pediatric populations.

  8. Discuss the therapeutic implications of impaired cognition and attention in the pediatric population.


Mr. J is a 68 year-old male with Parkinson disease who has been referred to outpatient physical therapy for examination and treatment after falling three times in the last month. He has been to this clinic on previous occasions. During the initial examination, it is noted that Mr. J is awake and alert but seems somewhat disheveled and distracted. For example, he opens and closes his wallet several times during the history portion of the examination as if searching for something he lost, and he is wearing his sweatshirt inside out. Mr. J knows his name and date of birth, the correct time, and that he is in the physical therapy clinic at University Hospital. He sheepishly admits however that he got lost trying to get there.

As a physical therapist or future physical therapist, what concerns do you have given this description of Mr. J? Is it normal to appear disheveled and distracted or to get lost? Should you assume if he drove to the hospital himself he has normal cognition? What tests or measures can you use to objectively determine whether Mr. J has attention, cognition, perception, or communication deficits? Would the statement “the patient was alert and oriented times 3” be accurate given this scenario? Would it be thorough? Does it give you enough information on how to best work with Mr. J?

The previous questions can help guide your clinical reasoning regarding cognition when working with patients who have neurological conditions. The Guide to Physical Therapist Practice (APTA, 2015) identifies “arousal, attention, and cognition” as one of 24 categories of tests and measures used by physical therapists. Testing arousal, attention, and cognition is especially important when working with patients who have neurological disorders as evidenced by the special issue of the Journal of Neurological Physical Therapy (JNPT, ...

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