More about scoring a client who does not want a second demonstration

Question:

When scoring, is it correct to say that if someone does not accept 2x demonstrations, they can only be scored on their last highest performance/level e.g., the Whipstitch along with the errors?

Response:

Yes, that is generally correct. If the person is unable or unwilling to imitate after the maximum number of demonstrations permitted within the ACLS administration guidelines, scoring is based on the highest level of performance they successfully demonstrated, together with the type and number of errors observed at subsequent stitch levels. In the example you provided, if the individual completed the Whipstitch but did not accept or benefit from the demonstrations for the next stitch, the score would typically reflect the Whipstitch performance and the errors observed when attempting the higher-level task (single cordovan).

 The refusal of a second demonstration is part of the evaluation. It does not occur consistently enough to be part of the primary scoring. At 4.6 people accept a second demonstration of the single cordovan but this makes little difference to the way they form the stitch. We begin to see refusal of a second demonstration at 4.4 (not inevitable) and this becomes much more likely at 4.2. Below 4.2, the person is likely to have already withdrawn from the assessment at some point before or during the single cordovan section.

The clinical questions that arise are:

• Is the person not understanding or unable to imitate the demonstration (cognitive performance issue), OR

• Is the person declining or refusing participation despite appearing able to understand the task (behavioural/motivational factor).

When you note the refusal of the second demonstration in the report narrative, document your clinical reasoning. Generally, when I verify the score I find it is accurate within the expected mode and I can confidently assign a Level.Mode that reflects the person's typical occupational performance.