The authors of this research project collaborated with Sarah Bicker, OTR/L, an acute care therapist working at Harborview Medical Center in Seattle, WA to investigate two clinical questions: [1] “What is the correlation between high-level (C1-C7) spinal cord injury (SCI) and cognitive impairment?” [2] “Which assessments are most effective for evaluating cognition in adult clients who have very limited motor and/or verbal abilities and could potentially be used with clients who have acute high-level spinal cord injuries?” A review of the research revealed that common comorbidities, including orthostatic hypotension, sleep apnea, and traumatic brain injury, often affect cognition in clients with high-level SCI. Unfortunately, no specific cognitive assessments have been developed for individuals in this population that can accommodate for limited motor and/or verbal abilities. Some assessments are more accommodating of limited motor and/or verbal ability and have potential for application for individuals with high-level SCI but there is a need for research applying these assessments to this specific population.

This research and its implications were presented at in an in-service at Harborview Medical Center to promote knowledge translation from research to practice. To monitor the impact of this presentation, the authors administered a survey at the end of the in-service to determine the usefulness of this research and whether it could affect established procedures of care. Future recommendations following this research include advocating for proper evaluation of cognition in clients with acute high-level SCI early in the rehabilitation process, promoting greater awareness of comorbidities that may impact cognitive function, and conducting further research on the application of certain verbal and motor-free cognitive assessments to this population.

Publication Place

Tacoma, Washington


University of Puget Sound

Faculty Advisor

Tatiana Kaminsky, PhD, OTR/L

Project Chairperson

Publication Date



Capstone Project





Degree Program

Occupational Therapy

Degree Level

Master of Science


Occupational Therapy


University of Puget Sound

T5_Allen-page1.pdf (199 kB)
Capstone Approval