P
rofessionals studying and trearing persons with de-
Cognitive Performance
in Senile Dementia of
the Alzheimer's Type:
The Kitchen Task
Assessment
Carolyn Baum, Dorothy F. Edwards
Key Words: activities of daily living.
Alzheimer's disease
The Kitchen Task Assessment (KTA) is a jimctional
measure that records the level 0/ cognitiue support re-
quired hv a person with Senile Dementia 0/ the Alz-
heimer's Tvpe (SDAT) to complete a cooking task suc-
ces_~/ullv. The results allow the clinician to help
caregivers understand the ler'el o/support the im-
paired person needs to perform dai/]' living tasks This
paper presents the validit) , and internal consistenc)' 0/
the KTA Data were collected from 106 persons diag-
nosed with 5DAT Construct /jalidity was establisbed by
examining the relationship het/(xen subjects' pel/orm-
ance on tiJe KTA and standard nellropsl'cholo[;ical
measures.
Camlyn I3aum, ,\IA. OlR I FAOl.\. is Elias Michael Director and
Assislanr Professor of Occupalional Therapy and Neurology,
and Direcrol' of the Program in Occupational Therapy at
Washingron Universiry School of Medicine. Box 8066. 4567
Scot I Avenue, Sf. Louis, MiSSOUl'i 63110.
[)orolhv F. Edwards, Phil. is As~islanr Profe~sor of Occupalion-
al Thel';PY and Neurolug:', Washinglon Universil:' School of
Medicine, 51. Louis, Missouri.
Tbis ar/ide /.('(/S accepted/or puh/iuilio)l JaJ1ua r r 15. /993
The> AmeriClA1/
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menria need to know the capabilities of the person
with Senile Oemenria of rhe Alzheimer's Type
(SOAT) to help rhe caregiver develop strategies for man-
aging his or her family member. It is often difficult to
determine rhe residual capahility from self or family re-
ports. Traditionally, neuropsychological tcsts (specifical-
ly, measmes of brain function) are used to predict behav-
ioral pattcrns. These tests are important in diagnostics as
rhey can he used to gUiue clinical and hehavioral manage-
ment programs and to prOVide information about defi-
ciencies of language, memory, perceprion, reasoning,
planning, emotion. and self-control (Wilson, 1987). How-
ever, critics have caurioned againsr roral reliance on spe-
cific neuropsychological tesrs ~lS predicrors of funcrionaJ
srafUS because a person's poor performance could be due
to an inabilirv to integrate visual, moror, anu cognirive
skills (Elithorn, 196-'); Hearon & Pendleron, 1981). Lirrle is
known abour rhe relarionship bcr\veen :1 [lcrson's per-
formance on ncuropsvcho!ogical tests and his or her per-
formance of cveryday activiries (\X!ilson, 1987). Neuropsy-
chological resring does nor prcwide information abour rhe
abilitv of the per-son wirh SOAT to pCt'form a rask or the
level of assisrance necess3l'y ro supporr him or her in rhe
performance of rhe rask.
The occuparional therapisr evaluates cognirion ro
derel-minc wherher a person can use rhinking and mem-
or\' skilLs fCl fZlciliwre performance of daily life rasks (Reed,
1984). Ir is imrorranr ro understand a person's strengths
in order ro bvpass the weaknesses resulting from the
demenria (Wilson, 1987). Ir is also imporrant to have an
assessmenr rhm records change in the pel'fot'l11anCe over
rime because the person's performance changes as rhe
disease progresses. The Kirchen Task Asscssmenr (KIA)
was developed to provide a performance-based standard-
i/ed assessment.
In 1983, when the KTA was developed, no standard-
ized perforrr18nce-based cognitive measures exisreu: two
assessmenrs were developed suhsequently for occupa-
rional rheraliists' use The Allen Cognitive LeveJ (ACL) resr
is a screening rool thZlr iclenrifies a person 's por~nrial for
rehabilitation (Allen, 1991). 1t measul'es "a quality of
problem solVing used while doing a perceptual moror
task" (1991, p. 2). Ol"iginally designed for psychiarric pa-
tients, rhe ACL is now used [0 test persons wirh Other
diJgnoses. The scoring uiteria desuibc rhe motor beh:1v-
ior of a person performing a learher lacing task. Though
similar to rhe ACL. as it involves the perfol'lllance of a
task, rhe KTA diffCt's in thar rhe examiner elicits and rc-
cOl'ds rhe highesr level of performance with cues and
as.,;isrance.
The orher instrumenr dcveloped since 1983 is rhe
Assessment of Morm and Process Skills (AJ\tlPS) (Fisher,
1991) The !\ivlPS measures skills such as posture, mobil-
ity, coordin:1fion, and strengrh, as well as attenrional, ide-
ational. organizational, and adaptive capabiliries. The
431
 KTA differs from the AMPS in that it measures onlv the
actions associated with the processing skills of initiation,
organization, inclusion of all steps, sequencing, safety and
judgement, and comrletion and was designed only to
measure the cognitive aspects of performance.
The KTA (a) evaluates the cognitive rrocesses that
affect task rerformance and records the level of cognitive
surport necessary for successful task completion; (b) can
be performed either in a clinic or in the person's horne in
a short reriud uf time; (c) alluws the clinician to observe
and translate the person's performance into strategies
the caregiver may use to manage the cognitively impaired
person un other activities of daily living and instrumental
tasks; and (d) generates a score to measure changes in
performance over time (either progression or improve-
ment). It can be used with a companion instrument, the
Functional Behavior Profile (Baum, Edwards, & Morrow-
Howell, in rress), to record the caregiver's rerceptiun's
of the impaired person's capahilities. This paper presents
a study exam ining the content validity and construct valid-
ity, interrater reliability, and the internal consistency of
the KTA
Method
Subjects
The subjects in this study came from the Memory and
Aging Project at Washington University, a longitudinal
study of healthy aging and SDAT The subjects were re-
cruited through public annuuncements, the Alzheimer's
Disease and Related Disorders Association, and referrals
from community physicians and uther health profession-
als. Before enrollment in the Memory and Aging Project,
rotential subjects were tested for hypothyroidism, vita-
min B-12 deficiency, and uther potentially reversible
causes of dementia. Thuse with severe h)'pertension,
strokes, severe medical problems, or psychiatric illness
were excluded from partiCipation. This study included
106 suhjects, 56 women and 50 men with a mean age of
71.75 years (range 53.8-85.4). Ninety-three rersons were
married; 13 were widowed or single. All were living in the
community with a caregiver.
Diagnosis and staging were performed hy a team of
neurologists and psychiatrists using the Clinical Demen-
tia Rating [CDRj (Berg, 1988; Burke et aL, 1988). This
alluws the analysis of data across the progressive stages of
the disease. A CDR is derived from the subjeCts' perform-
ance in the areas of memory, orientation, judgment and
prohlem solVing, community affairs, home and hohbies,
and personal care. Clinical Dementia Ratings of 0.5,1,2,
and 3 indicate questionable, mild, moderate, and severe
dementia.
Instruments
The KTA tests the cognitively impaired person's ability to
complete the task of making cooked pudding from a
432
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commercial package. The test addresses the follOWing
questions regarding the person's performance:
1 Can the person begin the task?
2. Can the person gather the items necessary to
perform the task?
3. Can the person rerform all the steps necessal)' to
complete the task)
4. Can the person sequence the activiti<:s that make
it rossihle to complete the task?
5. Is the person safe in performing the task)
6. Does the person know when he or she is finished
with the task?
The person administering the test provides the nec-
essary assistance to make it a successful exrerience for
the subject (see Appendix A) Performance is scored on
the follOWing components: (a) initiation, (b) organiza-
tion, (c) rerformance of all steps, (d) sequencing, (e)
judgment and safety, and (f) cumpletion. The level uf
surport required from the tester fur each component is
scored: 0 (independently competent), 1 (reqUired verbal
cue), 2 (reqUired physical assistance), 3 (totally incapa-
ble). The higher the score, the more impaired the per-
furmance (total scores range from 0 tu 18) (see Appendix
B).
Procedure
The KTA (see Figure 1) was administered in the occura-
tional therapy department kitchen as a part of a Function-
al Test Battery by an occupational therapist or research
assistant trained in its administratiun. The caregiver was
not present, and the testers were blind to the CDR rating.
Testers recurded observations regarding the assistance
the)' provided during the assessment but the scming was
recorded only after the task was finished. Verbal assis-
tance and physical assistance were marked regardless of
the numher of cues given. The subject may have needed
several verbal cues and only one physical assistance, but if
physical assistance was required, it was recorded.
Five analyses were used in this study: (a) Kendall's
tau B to determine the interrater reliability of the KTA; (b)
correlation analysis to examine the relationship among
the six variables in the measure; (c) factor analysis to
identify common relationships among the variahles; (d)
correlation analysis with other valid instruments to deter-
mine the construct validity of the KTA; and (e) analysis of
variance to examine the KTA across stages of SDAT and
between men and women.
Results
For the Kendall's tau B analysis, Videotapes of three sub-
jeCts, each at a different stage of impairment, were scored
by 12 persons. The testers were given an orientation to
the KTA and a descriptiun of the scoring criteria. They
,11(/1' 1993, vutume 47. Number 5
 '.JAME _ DATE _

EXAMINEI~ _

Circle the number that corresponds to the level of support the individual required_
REQUIRED
REQIIIRED PI IYSICAL NOT
COMPONENT INDEPENDENT VERl3AI. CUES ASSISTANCE CAPAI3LE
INITiATION:

DID HE OR SHE I3EGf I TilE

TASK WHEN ASKED TO I3EGIN' a 2 .J
ORGANIZATION:
Oil) HE OR SHE GATHER THE
~ECF.SSARYITEMS. TOOLS,
INGRP:OIENTS, ETC.
TO DO TIlE .10m o 2 .3
PERFORM:S ALL STEPS:
DID III' OR SHE DO
EVERTIIING TIIAT WAS
NECESSARY TO COMPI.ETE
THE TASK' a 2 .3
SEQUENCING:
DlD HE OR SIIE DO EVERYHING
IN TilE ORDER THAT MADE
SENSE, GIVE THAT TASK' o 2

JUDGMENT AND SAFETY:

WAS HE OR SI IE SAFE AND
AWARE OF POTENTIAL
DANGERS' o 2 .3
COMPLETION:
DID HE OR SHE RECOGNII.E
THAT THE TASK
WAS f'INISHED' o 2 .3

Figure 1. The Kitchen Task Assessment.

were then shown the videotapes and asked to score 3 these subjects required only verbal assistance on the KTA.
subjects. There was no discussion until all three subjects For the correlation analysis, correlation coefficients
had been scored. The interrater reliahility for the total were computed among the six KTA variables and the total
score was .853. The range was .632 for safety to 1.0 for score (see Tahle 2). The strong correlation coefficients of
initiation. .72-.84 suggested that only one dimension might exist
As a preliminary step to the correlation and factor (Nunnally, 1978) and that the sample of cognitive do-
analyses, the univariatcs were reviewed for the total sub- mains selected for the KTA all contrihute to the measure-
ject group (n = 106) and the four CDR groups. Scores on ment of the cognitive performance of the task.
the KIA increased with the severity of dementia (see
Table 1). The CDR 3 group were the most impaired. The
Table 1
tremendous variahility within each CDH group should be
Mean, Standard Deviation and Range of Scores on the
carefully noted. The importance of staging SDAT persons Kitchen Task Assessment by Stage of Dementia
when conducting research is demonstrated by the per-
formance of the group as a whole. The mean score of8.71
CDR O.S (QUte'li()(1;lbk) 55 /.7S 0-07
suggests that a1l106 suhjects would require physical assis- CDH I (Mild) -i2 -1.6S O-IK
tance with the task. When subjects are grouped by CDR CDI{ 2 (Modcralte) 21 9~1 4-1~

stage, the mean scores of th<:: ljuestionahle and mild Cf)I( .~ (Sc\,terte) 10 I:~.~H 7-IH
('1'< H;11 SUbjl'lIS) 10(, ~.71 a-It-:
grou ps (1.75 and 4.65 respectively) clearly indicate that

7be American journal oj' Occupational Tberapl' 433

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 Table 2 ation and sequenCing, The subject is required to draw
Pearson Correlation Coefficients Among Test Items vertical lines through a series of horizontal lines, The test
(n = 106) is scored so that the higher the score, the better the
Se- rel'formance
Inilia- O'gan- All qucnc- Com-
lion il.<Hion Sleps ing SaFcl)' pk:!ion Total
Initialion 10 Functional Tests
Organ il,al il)n ,K2 10
Include All Clinical Dementia Rating [CDR). This test (Hughes
Stcps 7K .K2 ID et aI., 1982; Berg et aI., 1982) is a measure of a person's
Sequencing ,77 K6 K9 ID
Safc!)'/1 udg- performance in daily living tasks in the areas of memory,
meJ)( ,72 ,77 .HI Hl ID orientation, judgment and problem solVing, community
Completion ,7) 79 H,3 ,H2 H) ID affairs, home and hobbies, and personal care as given by
TOldl KTA .HH 92 9·j 94 90 9.3 10
caregiver report, The test indicates severity of dementia
Nule, None oFllle correlali'"1 c()(:mcicflls was helo'" .72 (P = <.00(1)
and rrovides a picture of the overall performance of the
subject. The test is scored so that the higher the score,
the poorer the performance.
Factor analysis was used to explore the component Blessed Dementia Scale. Developed by Blessed,
structure of the variables, A principal component analysis Tomlinson, and Roth (1968), this is a behavioral check list
was computed to determine the internal structure of the derived exclusively from questions asked of the caregiver;
variables and to establish the KTA as a unidimensional it rates the subject on performance of everyday activities,
instrument, A varimax rotation was chosen to reveal the changes in personal care, and changes in personality,
relationship among the variables. The orthogonal rota- interests, and drive, This test was included to see how the
tion resulted in the identification of only one factor ac- subjects' actual performance as reported by the KTA relat-
counting for 84% of the variance. All the factor loadings ed to the performance reponed by the caregiver. The test
exceeded ,88, is scored so that the higher the score, the poorer the
In the fourth analysis, construct validity, the KTA was performance, The cognitive section of the Blessed De-
correlated with established valid and reliable neuropsy- mentia Scale was analyzed separately.
chological and functional tests, The correlation coefficients of the neuropsychologi-
cal and functional tests are shown in Table 3, The more
complex integrative tasks (Token test 2, 3, 4, 5, and 6)
Neuropsychological Tests were more highly correlated than the Crossing-Off and
Token Test Short Version This tcst (De Renzi & Vig- Token Test 1. The CDR and the Blessed were Significant
nolo, 1968) consists of six parts. It measures verbal pro·
cessing and is sensitive to disru pted linguistic processing, Table 3
The subject must comprehend the token names and the Correlation Coefficients of Neuropsychological
instructions and be able to pick the correct response and Measures with the Kitchen Task Assessment (n = 106)
take (a motor response) the token from the table, Parts 1 lnila- Organ- Se- COin· Towl
Te'l lion SICP, i/,atioll 1I1i ence Safely pbion SC()[\!
through 4 are progressively more difficult because of the
number of tasks that must be performed in sequence, Token Tesl
Pan J - :I·V - ,:\F - ,36" - .2H - ,.')2'" - ,:\4':' - .,')6"
The process reqUires the subject to follow a series of
Tokcn '1'<:"
commands. Perseveration (inability to move to another Pan 2 - AW"" - .4~;:".: - ,SO':":, - ,SO':,:' - AT':' - ,)D': - .)3":'
task) is often seen as the instructions become more com- Tokcn '1'<:,'1
Pan :\ .- AS':'" - AS':'" - ) I'''''' - AW':' - .44':':' - AT':' - ,)F'"
plex, If the person fails to respond in 5 seconds, the
Tokcn Te.'t
instructions are repeated; a half score is recorded for the P:1rI .j - .'j~F'" - .)9':"" - ,67':'" - .S9':"·' - ,62':':' - ,e,j"":' - .6W'·'
second try, Thus, the test contains aspects of initiation Token Test
and sequencing. The test is scored so that the higher the Pan ') - ,)-1':'" - ,60"'" - ,61""" - ,))':--:' - .64':--:' - ,64 - .66':""
Token TeSI
score, the better the performance. Pan 6 - .'jD':':' - ,')6';'" - .S~F'" - .)6''':' - AW':' - ,S)"" - .6J':'"
Trail Making Test-Part A (Armitage, 1946) is a T'i:d Making
A (sc-c) .:\9':' A 2"';' ,)1';'" ,:\9' ,:\S';' 23 AW""
timed test of visual conceptual and visuomotor tracking
CDr< .6:>':'" .6l""·' 66"'" .04':":' .))':':' ,)W';' .6T'"
and involves motor and attention skills. The subject must Cn >s,'ing-OFF - .-1:\""" - .-10""" - ,46':":' - A2: - .4 I ...... - ,,34""" - .-16':'"
connect numbered circles on a page, a task that involves J3k"ed
Delllcnli;, .:;7:'::": .S"/':'·' .S5':"" .50'" AT':' ,SO':," .59':'"
initiation and sequenCing, The test is scored so that the
Bksscd Dc-
higher the score, the poorer the performance, 1l1CI11ia
Crossing Off Developed by Botwinick and Storandt Cognitive .62""" .)W";' .)11''''" ,59':':' .5)""" .)~F" ,64''':'
(1973), this is a timed test of psychomotor speed func- ':p> 00]
tions, without a verbal component, that measures initi- ';':-P> ,0001

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Downloaded from ",fa)! 1993, Volume 47, Number 5
 at the p >0001 level hut wel-e not rerfeetly correlated.
One possible explanation for the less than perFect correla-
tion with the Functional measures may he that the care-
giver reporting on the person with SDA1"s perFormance
may not be capahle of cueing the suhJect to achieve the
level of performance obtained hy the trained examiner
The highly significant correlations with the rsychometric
measures served to establish construct vaJiclity of the
KTA The KTA, as a test of practical cognitive skills, is
related to the cognitive skills measured by neuropsycho-
logical tests.
The coefficient alrh8 sets an urper limit to the inter-
nal consistency of a test and provides a good estimate of
reliability (Nunnally, 1978) The Cronhach Alpha For stan-
dardized variables was 961. The coefficient :Jlrha of the
KTA by CDR group was .1175 for CDR 05,909 for CDR 1,
944 fm CDR 2, and 963 for CDR 5 The high reliability
coefficients suPPOrt the structure of the test.
The fifth analysis, analysis of variance, examineel the
differences on the KTA across the stage.s of SDAT ancl
yielded a significant Fratio of 3723 (df = 4.102; P <
.000l). This demonstrates that performance on the KTA
\,vas afFected by the progression of the disease. POSt hoc
Scheffe tests (see Table 4) on the means demonstrated
significalll differences for all stages of the disease Be-
cause [here could he a question of gender bias in the
selected task, Table 4 also reports the perFormance of
subjects in CDR grours hy gendel·. There is a difference
between the scores of male and female suhJects in the
questionahle (CDR = o =i) and moderate (CDR = 2)
stages of the disease.
Perhars men in the question3ble stage of the disease
(CDR = 0 ')) rerformed berter beca use they read and
followed the dil-ections, whereas women in this gmur,
who may h3ve been more familiar' with the task of cook-
ing, were less likely to refer to instruerions. ]n the moder-
ate stage (CDR = 2) INomen may have rerformed berter
because they relied on over-learned skills Regardless of
gender, [he KTA differentiates performance across all
stages of [he disease.
Discussion
The Kitchen Task Nisessmelll was designed to gUicie the
occupation31 therapisl in treatment planning It allows
Table 4
Means of KTA Scores across the stages of SOAT for
Females, Males, and All Subjects
(:I)!{ () ~
(li Lll"lillll' (1)1' 1 CJ)R
1/ ,,11k) (Illild)
f-l'lll;t1C ~c()rc ~(, ~.{)ll" l. -15"
;\-lale ,u>re 'iO Ir '196··
TIll:l! :-'Cllre W(, I '(,. -J.6~~·
.:'p = <{)'i
The American Journal or Occupational Therapy
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the clinician to administer a .stand3rdil.ed measure with-
out employing an anificial task. The KTA is a valid and
reliahle measul-e that C8n be used as a clinical as well as a
research [001 because it c1isCi"iminates the performance of
persons across all stages of the disease; therefore, it can
record ch3nge.s in the rerson"s rerFormance
The inform3tion obtained from the admlllistration of
the KTA will be helpFul in obtaining objective information
that the clinician can use in training the caregiver to assist
the person with SDAT in daily living tasks. The mean
score oFthose in the mild stage of the disease (CDR = 1)
indicates that verbal cueing is necessary to surr0rt per-
formance; those in the moderate and severe stages oFthe
disease (CDR = 2 and CDR = 3) require rhysical assis-
tance However, the variation demonstrated by the sub-
jeers in the t3sk indiccltes that knowledge of the diagnosis
and the stage oFthe disease does not rerFectly prediCt the
I)erson"s carabilities. Individual assessment is necessary
to cletermine the aCtual functional capabilities of the per-
son with SDAT Some ofrhe variahility in the performance
of subjects in the questionahle and mild SDAT groups
may be attrihuted to their unfamiliarity with the testing
environment. A sludy to test the instrument's ecological
validity in the home and cliniC setting is needed
The health care team will henefit from knowing
whether or not a person with SDAT can perform a com-
plex basic living t,lsk independently and the level of cogni-
tive support necessary for successful t3sk comrletion.
The infomlation fmm the KTA can assist the te3m in
disch8rge planning and counseling a family on the level of
interaerion necessary to support a cognitively impaired
person in the community This standardization of [he
KTA was on a selected sumple of persons with SDAT For
u~e with other' [)opubtioI1s, the validity of the test with
that l)opulation must be established fir'st. A
Acknowledgments
We thank Lconard Berg, .'111. Director of rhe AJzhellYler's Disease
RcscJrch Ccntcr, Jnfl David Cillesrie, PhD George Warren
Brown School of Social Work;ll Washingron llnlversiry, for rheir
rhoughrful r-evielVs of this pJper
This wmk \\8S supponccl in p,lr( hy rhe National Insli-
lure on Aging. Granr #A6()399 1 ami The Norman J SlUpp
Foundation
Appendix A
Administration Procedure
PIT-resr Ser-up
Place to Ihe lefr on the ["()UIHer
201· :3 fLiI'lll·S of I)ullding mix ([he kind Ihar require, couk-
~ CJ)R"
(ll11ld.) (",('\erc)
ing. nor insral1r)
a 1-11., lju:nr saucel,an wirh a heal-rc.sislanr handle
HH5' 15 He-,· :1 11()(lden .'iI)(1Lln
II 11';· '\ ,A
a ru hhe r sera pc r
<) I >it. I,-I.HW·
a 2 Clip glass mC~lsuring cup
.j sm:lll dishes (paper CLIpS will do)
435
 2. Have a quarr of milk in [he ,·efrigeraror
:3. PI·int rhe instructions in large letters on a riece of papn and
mount the instructions where the person can read [hem. Use
the same instruerions that are on the box, except add "pour
inro curs."
4. Have hand soap and raper towels near Ihe sink.
Before you begin the assessment:
Determine the individual with SDATs ability to rTspond to
verbal or rhysical assistance or- both by instruering him or her to
wash his or her hands. If the person can not do this, eithn with
or without assistance, the tesr should not be adminisrered, as
the rerson will not be able to follow cues and will be unsuccess-
ful.
Instructions
Tell the person
• ro mix a box of pudding and rour the mixrure into four
dishes
• that the milk is in rhe refrigeraror-
how the srove works and whar burner ro use
• that the instruerions are on the box and on the wall
• to begin when readv
• You will cue only after you have determined he or she
cannot perform without heir (wait five seulIlds) UN·
LESS safety is an issue.
Appendix B
Scoring Guide
Initiation: Did he or she begin the task after being told to
begin~ If not, did he or she begin when remind-
ed (verbal) or did you have to oren the box and
hand it to him or her (rhysical)'
Organization: Was he or she able to get the milk from the refrig-
erator and use the tools arrrorriatelv~ Some
may use the rools or equirlllent incorreerly; for
examrle, some t1y to cook in the measuring cur.
Did the rerson resrond to verhal help or did he
or she requir-e rhysical assistance~
Perfor-mance Did he or she rel·for-m all the major steps - mea-
of all steps: suring, stirring, pouring - a/()ne~ Diel you have
to assist him or her, for examrle, light the stove?
Was it verhal or rhysical assistance?
Sequencing: Was he or she able to do the tasks in a funerional
sequence? During sequencing, it is essential not
to overcue. Some reor1e stir the mixture initially
in the cur. This is permissihle if he or she has
the right amount of milk and all of the mix from
the hox. Some peorle pour the hot mixture into
the measuring cur before filling the serving
dishes. This, too, is rermissible. A problem
arises when the person does not perform the
tasks necessary to rroceed with the activity, i.e.,
rour milk or powder into the dishes, or turn on
the stove hefore starring.
Judgment Evaluation is hased on how the rerson manages
and Safety: the stove and the hot pudding. Because of the
possihility of injury, tbe examiner must he alen
436
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to rhe subjecr< needs CJive phvsical assistance if
the person is in danger.
Conlpletion. Evaluarion h ha.'ied on whether the person knows
he or she is finished Some will continue rhe
proccss and do chores such as scraping the pan
after it is empty or moving the dishes around on
the counter. Jic or she may put the dishes in the
sink, hut is nO[ required to clean ur. Saying that
vou will wash the dishes is nO[ consiclel-cd a
~erhal cue; howevcr, you must wait until he or
she puts the rudding in the dishes before you
offer to clean ur·
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iVlav 1993, Volume 47, Number 5