The student researchers collaborated with Marcy Boschee, OTR/L, an occupational therapist practicing in the acute care unit at St. Joseph's Medical Center in Tacoma, WA to investigate two clinical questions: [1] “What evidence is there for the effectiveness of the Montreal Cognitive Assessment (MoCA) in predicting functional cognitive impairment of patients 18-years-old and older in acute care who have sustained an ABI?” and [2] “Which occupationally-based cognitive assessments, feasible to use in the acute care setting, are most effective at predicting functional impairment in patients 18-years-old and older with mild to severe ABI?” A systematic review was conducted and 29 articles were included. The AOTA levels and the Research Pyramid of categorization were used to determine rigor. The findings indicated that the MoCA is not sensitive enough, nor sufficient, in detecting no or mild cognitive impairment. It is therefore recommended that when the MoCA indicates no cognitive impairment, the OT practitioner should administer an occupationally-based cognitive assessment to fully assess the client’s executive functioning abilities.

The student researchers analyzed the findings and developed an occupationally-based assessment matrix, supplemented by a decision flowchart. These and the research itself were presented to Marcy and her colleagues in the acute rehabilitation unit at St. Joseph’s Medical Center. In order to best support the implementation of the new information into clinical practice, specific knowledge translation products and activities were offered.

The effectiveness of the knowledge translation process was measured through several methods. These included extensive revision processes, post in-service surveys and corresponding analysis, as well as a structured consultation (e.g. follow-up questions) for our collaborating clinician following the in-service itself. It is recommended that St. Joseph’s Medical Center purchase an occupationally-based assessment, as outlined in the assessment matrix, to improve their ability to adequately and effectively assess mild cognitive impairment.

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