Neuro Sim Report: SLUMS Exam

    As a part of the Neuro Aspects course I am taking this term, we participate in a "real-life" clinical simulation. This past Friday, we participated in our first simulation where we got to assess a cognitive screening of a client, played by an actor. The screening we assessed is known as the SLUMS Exam, also known as the Saint Louis University Mental Status Exam. In the SIM, we were given a scenario of assessing the exam on a client who had been newly moved from acute care to a rehab facility following a right-side cerebral vascular accident, also known as a CVA/ stroke, from being diagnosed with COVID-19 earlier. With the SLUMS exam, we want to assess a person's cognition, which is another word for processing information that goes through the brain such as thinking, memory, language, and much more. As occupational therapists, we always look at what is meaningful to the client as well as looking at them through a holistic point of view. When working with individuals with cognitive disorders, it is important to work on situations where memory comes into play. For example, if a client enjoys baking or cooking, it would be helpful to let the client recall ingredients they might need to cook their favorite meal or bake their favorite dessert and make it into a grocery list. To make it a bit more challenging, an OT could work on cooking/ baking with the client and let them recall the recipe on their own.

    When I finished assessing the SLUMS Exam, I calculated the score and got a 21 out of 30. Since the client had a level of education with a Bachelor's Degree, their score fell into the category of a Mild Cognitive Impairment (MCI). MCI is considered an early stage of memory loss and can affect other cognitive issues such as language, issues within a social setting, language impairment, and much more. Some challenges I think someone who would score in this area would be forgetting the day of the week, misplacing important items such as house keys or mail, repeating their stories, and so on. When it came to explaining what Occupational Therapy was to the client, I felt a bit nervous. Even though we have been taught how to execute an elevator speech since the day we started school, I always tend to glitch and overthink my explanation because I always try to highlight the main points of the career and what makes it different. I thought I did well enough to explain what the field was without using jargon that the client would not know and kept it sweet and simple. I personally think I could have been a bit more confident and executed it a bit more smoothly. I tried to adapt my elevator speech into making sure that the client understood that we treat all across the lifespan and reassure her that we look at what is meaningful to her and incorporate that with treatment. I made sure she understood what I said before moving on with the assessment just so she did not think I was being rude and did not care about what she thought. 

    I do believe I kept an inviting and welcoming tone to where the client felt comfortable being in my presence. I did notice that I was feeding off the vibe the client was giving as she was very kind, sweet, and welcoming herself. I think I had a good tone of voice as I spoke at a decent speed and a loud and clear tone to where she could still hear me clearly. I wouldn't say I was necessarily screaming at her and assuming she couldn't hear me because she was old, but I spoke in a clear tone in order for her to hear me clearly.  I would also find myself avoiding using words such as "Perfect!" or "Good Job!" when giving this assessment to avoid false hope for the client. Since the client had a right-side CVA, she also had left-side neglect. With one of the questions on SLUMS, she was asked to draw the hours of a clock and label it as ten minutes to 11 o'clock. I have attached what she drew below. I avoided using encouraging words because I did not want her to accept that what she drew out was correct. 

Nothing on the left side of the clock is a strong indicator of left-side neglect.

If I had a chance to re-do my SIM, I would work on strengthening my elevator speech to have a basis for what to say and then accommodate to the answer of the client. I would also work on asking questions at the end of the SIM that relate to what is meaningful to the client. I did hit on some questions and learned about her family and what she enjoys doing with her grandkids, but I feel like I could learn more about what she enjoys doing to help me come up with ideas on future interventions to work on. Before the SIM, I watched videos of someone assessing the SLUMS exam on a client and I even practiced on a family member to know what to expect and how to act when giving the exam. I wanted to be confident in assessing the exam because I wanted the client to be assured she was in good hands with someone who knows what they are doing. From having experience of being a PT Tech, I felt comfortable giving the assessment as I had done something similar prior in a clinic setting and adapting to the language of the client, making sure I wasn't using big words and giving time to answer questions and understand what was being asked. I always like to say things like "Let me know when you're ready" so the client knows that I am ready whenever they are. The debrief that followed after was really comforting knowing that my classmates were going through the same thing and even though we had the same scenario, we had different clients to accommodate with. It was interesting to hear about their experiences and I even learned tips and tricks they used when assessing SLUMS to their client.  As I was grateful for an experience like this during school and how it will help me one day as a future Occupational Therapist, I would take my weaknesses and turn them into my strengths for the next time I have a SIM or continue to practice on others so I can become more of a natural at it for when I'm in the real world of Occupational Therapy with, one day, my own clients.