Instructions

1. Observe this person while they are involved in a task such as getting dressed, eating, taking a bath or shower, resting, or visiting.

2. Ask YOURSELF the following questions. DO NOT ask the questions to the person you are observing.

3. The questions address your observations during the entire time of the task

4. The questions assume you are the care partner (that is, caregiver) assisting this person. (So you are observing while you assist.) If someone else is assisting instead, then the questions that refer to the role of a care partner should apply to whoever is providing the assistance while you observe.

5. Answer each question by selecting a response number from 1 - 4 (or a response of “Yes” or “No” in the Yes/No Response Format) that most closely matches your observations. Select “NA” (not applicable) when appropriate. If you don’t know the answer to a question, then try using the intervention strategies identified for that question in the “CAIS Cognitive Intervention Strategies” . They can help you better understand the question and the specific cognitive ability. These intervention strategies suggest ways you can help this person perform a particular cognitive ability more easily, even if they already perform it well.

A response number of “3” or “4” (or a response of “Yes” in the Yes/No Response Format) suggests this person has mild or no difficulty performing a particular cognitive ability as described by the question.

A response number of “1” or “2” (or a response of “No” in the Yes/No Response Format) suggests this person has at least moderate difficulty and directs you to the “CAIS Cognitive Intervention Strategies” where options of specific practical intervention strategies are identified for each question in this “CAIS Cognitive Abilities Questions to Ask-Four Point Response Format”(and in the Yes/No Response Format). These strategies suggest ways you can help this person perform a particular cognitive ability more easily, communicate, perform a task more successfully, and to feel more comfortable.

Please note: More detailed response options are available in the pdf version of the two response formats in the following Cognition questions: Sensory Questions I, J, K; Comprehension/Perception Question I, and Motor Questions B, C, D, E, G, H.

KEY: 1 = Rarely or Never 2 = Sometimes 3 = Often 4 = Usually or Always