Occupational Therapy Adult Perceptual Screening Test (OT-APST)

Purpose of the measure

The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is a standardized screening measure that enables occupational therapists to test for the presence of impairment in visual perception across each of the major constructs of visual perception and praxis, including the problems most frequently occurring after stroke.

Available versions

The OT-APST was developed by Deidre M. Cooke in 1992 and was first published in 1993 (Cooke, 1993). The OT-APST was revised in 2001.

Features of the measure

Items:
The OT-APST has 25 items in 7 subtest areas (Agnosia; Visuospatial Relations – Unilateral neglect and Body scheme -; Constructional skills; Apraxia; Acalculia; Functional Skills). Several of the items contribute to assessment of more than one area and are only performed once. The subtests and their respective items are organized as follows:

Agnosias (5 items)

  • Colour agnosia: The client is requested to name/identify six colors in an array to evaluate color recognition skills.
  • Object agnosia: The client is presented with a stapler that he/she must name and describe in terms of its use to demonstrate object recognition and naming.
  • Figure-ground: The client must recognize five items in an overlapping array to demonstrate figure-ground/perceptual closure skills.
  • Shape constancy: The client is presented with a mixed array of 10 shapes of varying sizes and positioned at different angles. The client must name/point on command to four common shapes to demonstrate shape recognition ability.
  • Reading-alexia: The client is asked to read a passage of text that has indentations of random lengths on both sides of the page to be sensitive to attention/neglect changes to both the left and right side of space.

Visuospatial relations – Unilateral neglect and Body scheme:

Unilateral neglect (5 items)

  • Clock drawing
  • Copying a house diagram
  • Writing: The client is asked to provide a handwriting sample that consists of writing their name and address.
  • Reading a paragraph: The client is asked to read a passage of 12 lines to assess reading and visual scanning accuracy, to detect for the presence of neglect or the impact of visual field loss on reading, and to screen for alexia.
  • Telling time

Body scheme (4 items)

  • Body parts self: The client is asked to identify his/her own body parts.
  • Body parts therapist: The client is asked to identify the examiner’s body parts.
  • Left/right discrimination: The client is requested to differentiate sides (left and right).
  • Directions/position in space: The client is asked to move colored blocks to different positions in relation to each other (e.g. ‘on top of’ or ‘behind’), or to describe the color or point to the block that is ‘furthest away’ from and ‘nearest’ to him/her on the tabletop.

Constructional skills (3 items):

  • Graphic constructional skills: The client is asked to draw a clock and place its hands at a designated time. They must also copy a house.
  • Two-dimensional construction: The client is asked to reproduce colored block patterns in two-dimensional planes by copying a model provided.
  • Three-dimensional construction: Three-dimensional models rather than pictures of these models are copied.

Apraxia (6 items):

  • Smile command and copy
  • Wave right hand-command and copy
  • Wave left hand-command and copy
  • Stapler hold command and copy
  • Pen use for writing
  • Writing

Acalculia (1 item):

  • The client is asked to perform simple one- and two-digit addition and subtraction calculations that are set at a grade two level.

Functional skills (5 items):

  • Reading
  • Writing
  • Calculations: The client must complete simple mathematical calculations.
  • Telling time
  • Use of stapler

Futher observations of the client’s performance of other activities of daily living such as dressing and grooming, in addition to performing a kitchen task are recommended but are not formally included in the OT-APST.

Other:
The length of time taken to complete the OT-APST in its entirety is recorded as a general indicator of the information-processing speed of the client and to reflect the client’s perceptual processing ability.

Scoring:
Scores for items in each construct or subtest area are summed to allow interpretation of patterns of impairments and to compare with normative data, but not to produce a total score for the OT-APST.

The table below outlines the subtest total scores and individual item scores of the OT-APST:

(Cooke, McKenna, Fleming, & Darnell, 2005a)

OT-APST subtests (subtest total score) OT-APST items (item scores)

Agnosias (26)

Colour agnosia (6)
Object agnosia (1)
Figure-ground (5)
Shape constancy (10)
Reading-alexia (4)

Visuospatial relations:
Unilateral neglect (13)

 

 

Body scheme (22)

Clock (3)
House (4)
Writing (1)
Reading (4)
Telling time (1)

Body parts self (8)
Body parts therapist (4)
Left/right discrimination (4)
Directions/position in space (6)

Constructional skills (53)

Graphic construction
Clock (3)
House (4)
Two-dimensional construction (26)
Three-dimensional construction (20)

Apraxia (10)

Smile command and copy (2)
Wave right hand-command and copy (2)
Wave left hand-command and copy (2)
Stapler hold command and copy (2)
Pen use for writing (1)
Writing (1)

Acalculia (4)

Calculations-addition and subtraction (4)

Functional skills (11)

Reading (4)
Writing (1)
Calculations (4)
Telling time (1)
Use of stapler (1)

Cooke, McKenna, Fleming, and Darnell (2006c) examined the impact of age, education, and gender on OT-APST scoring based on the performance of 356 healthy Australian adults aged 16-97 years. When mean scores were compared for each subscale, the most significant differences were observed with age. Gender and level of education did not significantly impact on OT-APST performance of the healthy participants. Increasing age was significantly associated with reduced performance on all subscales but the Acalculia and Body scheme subscales. The age at which the most significant differences in OT-APST performance occurred was at age 75 years and above.

The tables below provides the cutoff scores indicating impairment for each of the subscales of the OT-APST, stratified by age group:

(Cooke, McKenna, Fleming, & Darnell, 2006c)

Age 16-74 years cut-off scores indicative of impairment

Agnosia

Body scheme

Neglect

Constructional skills

Apraxia

Acalculia

Functional skills

≤  24

≤  21

≤  12

≤  51

≤  9

≤  2

≤ 9

Age 75-97 years cut-off scores indicative of impairment

Agnosia

Body scheme

Neglect

Constructional skills

Apraxia

Acalculia

Functional skills

≤ 22

≤ 20

≤ 10

≤ 46

≤ 8

≤ 2

≤ 9

Time:
The OT-APST can be administered within 20 to 25 minutes (Cooke, McKenna, & Fleming, 2005a).

Subscales:
The OT-APST has 7 subscales: Agnosia; Visuospatial Relations – Unilateral neglect and Body scheme -; Constructional skills; Apraxia; Acalculia; Functional Skills.

Equipment:
All of the equipment required for completion of the OT-APST is provided in the assessment kit that can be purchased online at: http://www.functionforlife.com.au/images/OT-APSTorderformA4.pdf

Training:
No formal training is required for the OT-APST. The manual provides standard directions for the administration and scoring of the measure.

Alternative forms of the OT-APST

None.

Client suitability

Can be used with:

Patients with stroke.

Should not be used with:

  • Completion of the OT-APST requires adequate comprehension of simple verbal instructions.
  • It is not suitable for individuals with severe auditory comprehension problems.
  • It is not suitable for individuals who are unable to use either hand for task completion.
  • The OT-APST is not suitable for individuals whose level of arousal or attentional capacity precludes participation for the necessary time required for task completion.
  • The OT-APST is not suitable for individuals with receptive language problems, however, alternative methods of test administration are included for clients with expressive language problems.
In what languages is the measure available?

To our knowledge based on a review of the scientific literature, the OT-APST has not been formally translated and validated in other languages.