Cognitive and Emotional Function Linked To Successful Rehab Outcomes

Recently published research confirms what personal and professional caregivers have said for years: people’s ability to perform daily skills such as dressing, bathing, going to the bathroom, and getting into and out of bed (also known as Activities of Daily Living, or ADL) is as dependent on their cognitive skills as it is on their physical skills.

According to a study done by Wendy Coster, PhD, OTR/L, Stephen M. Haley, PhD, PT, Alan Jette, PhD, PT, Wei Tao, BA, and Hilary Siebens, MD, that studied 534 people receiving rehabilitation treatment in inpatient, outpatient, home, or skilled nursing facility settings, another set of criteria needs to be considered in addition to physical abilities. Called Instrumental Tasks of Daily Living (IADL), these tasks include financial planning, bill paying, shopping, meal preparation, and using the telephone among their among their assessment criteria, since some geriatric studies suggest these are more affected by cognitive impairment.

Using the IADL measurements, the study found that cognitive impairment did indeed affect people’s ability to perform ADLs and IADLs, even in patients with minimal cognitive deficits. Additionally, emotional distress, particularly anxiety and depression, was also associated with decreased ability to perform daily activities, through its indirect effect of creating cognitive impairment. Visual impairment was also indirectly associated with lower self-care scores, but again only through its association with cognitive impairment and not on its own.

Conclusion: both caregivers and therapists need to be alert to the impact that cognitive skill levels may have on daily living activities, and rehabilitation professionals, especially, should take cognitive and emotional factors into consideration when planning a patient’s functional rehabilitation program.

For further information: “Predictors of Basic and Instrumental Activities of Daily Living Performance in Persons Receiving Rehabilitation Services,” Wendy Coster, PhD, OTR/L, Stephen M. Haley, PhD, PT, Alan Jette, PhD, PT, Wei Tao, BA, and Hilary Siebens, MD, Archives of Physical Medicine and Rehabilitation, volume 88, July 2007