“For many living with a person who has dementia can be an unforgettable challenge that evokes guilt, resentment and despair.” Michael Sefton 2018
This is a clock recently submitted by by a Whittier Speech Language Pathologist who was working with a 90-year old male who was recently admitted to our hospital. He is very sick with a complex medical history. He was admitted to a hospice service – essentially receiving comfort measures only. The conceptual errors in this drawing made me ask about his hearing. Did he understand the task? The clock was dawn using his dominant hand. Clearly there are other elements in the drawing. Some staffers though it looked like a shoe. It seemed to me as I looked at this unscoreable clock that the patient has lost a conceptual awareness of what clock means. Next, I would be interested in knowing whether he could be prompted into copying a clock such as the one on the wall in each patient room. Finally, as a patient entering hospice one is reminded that life expectancy can be quite short and the changes in cognition are common.
What do you think about this clock drawing. It looks pretty good from the execution of the circle but you see the number placement is slightly off. Hmm? What do you expect perfection? Well truthfully yes the clock drawing is a task that should be quite routine – even when you are 70, 80, or even 90 years of age. Now the time it takes to complete the task varies from person to person and co-occurring illnesses, etc. As you watch this video what do you think about the hand placement? Does the clock read 10 minutes past 11? Or is it off?
“Patients with ICU delirium are less likely to survive and more likely to suffer long-term cognitive damage if they do.” STAT Boston Globe (2016)
Marcantonio, E. Delirium in Hospitalized Older Adults. (2018) NEJM 337; 15.
Sefton, M. (2016) What is encephalopathy? Blog post: https://concussionassessment.wordpress.com/2016/10/06/what-is-encephalopathy/ Taken 11-10-2018
In 2016 the majority college ice hockey player spend one to two years in junior hockey (ages 17-21) allowing them to continue their physical development prior to entering college hockey. This includes not only Division I scholarship programs but Division II and Division III programs as well. Very few natural freshmen play college hockey at 18 years of age unless they are highly gifted athletes. Even these players are coached and managed by trainers with ongoing development programs, weight training, and nutritional support to enhance upper body size and strength. Michael Sefton, 2016