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Dementia Tools

Reality Comprehension Clock Test
Dementia Populations gift of Purpose Programs

"Focus is on skills that remain, not on those that are lost."


Powerful RCCT & Fall Risk

The RCCT Asseses:

  • Comprehension of Task
  • Visual Spatial Awareness
  • Number Recognition
  • Visual Task Performance
  • Number Sequence
  • Orientation to Time
  • Shape/Line Recognition and Recall

Patients are directed to view a picture of a clock, then replicate it to the best of their ability.  The results are then scored and interpreted by a trained and certified health care professional.  RCCT data is used to establish appropriate care plans, goals and objectives.  The RCCT Manual contains step by step instructions, clock drawing examples, informative data and research tables.

The content validity of this test has been established by experts from the fields of nursing, occupational therapy, social work, recreational therapy.

About The RCCT Research Project

A clock test known as Reality Comprehension Clock Test (RCCT) may prevent falls and save lives of Alzheimer's and other dementia patients says a group of Northwest Ohio researchers whose research findings were published in the September 2005 issue of The Journal of Gerontological Nursing.

Alzheimer's is the most common form of dementia.  Currently 4 million individuals have Alzheimer's, and that number is expected to rise to anywhere betweeen 11.3 to 16 million by the year 2050 (Alzheimer's Association 2004).  Individuals who suffer from dementia are also at risk of falling.

Nursing home residents who suffer from dementia or other memory impairments are already in the high-risk column to experience a fall.  Residents who suffer from Alzheimer's or other types of dementia may experience one or more problems with their sensory processing abilities,  such as the lack of visual spatial awareness.  This may lead them to misjudge where the edge of a chair is or where the edge of their bed is located.

Almost one fourth of elderly persons who sustain a hip fracture die within six months of the injury.  Falls are very costly.  Billions of dollars are spent each year for older Americans who experience a fractured hip.

The majority of nursing homes are reporting upwards of 100-200 falls a year among their elderly residents.  This is an alarming number.  Many of the falls occur in health care facilities that have already spent millions of dollars to create an environment designed to prevent falls and keep their residents safe.  Yet, with researched fall assessments and with newly designed and more safety conscious environments in today's health care facilities, elderly residents continue to fall.  Sometimes they are referred to as the "fallers".  Reality dictates that a dramatic focus needs to be directed toward residents in this dangerous situation.

It is very difficult for health care professionals to identity residents that are at the highest risk of experiencing a fall.  The deficiency of objective, supportive data to identify causative factors in falls is a major part of the problem.  Another obstacle is the lack of an assessment tool that has the ability to identify visual spatial impairments in the elderly cognitive impaired.

For example:

  1. How do we know if the patient is able to understand the instructions we are giving to them?
  2. How can we tell if the patient has sensory processing deficits?
  3. Does the resident have visual spatial problems?

The ability to develop a falls intervention that is built around the resident's visual-spatial abilities would allow health care professionals an opportunity to prevent falls and save lives in this very vulnerable population.  To accomplish this an assessment tool is needed.

A completed research project by a group of Northwest Ohio researchers and health care educators in the field of aging has confirmed that a brief cognitive assessment known as the Reality Comprehension Clock Test (RCCT 1999 Brock, B., et al is capable of identifying visual spatial problems that lead to falls in elderly patients who suffer from Alzheimer's and other related dementia.  The research findings were published in an article in the September- 2005 issue of The Journal of Gerontological Nursing pages 45 - 51.  The article is entitled, "Visual Spatial Abilities and Fall Risk, An Assessment For Individuals With Dementia."

The RCCT assesses four functional categories:

  • Visual task performance
  • Visual spatial ability
  • Number awareness
  • Orientation / memory

Statistical analysis established the Visual Spatial Score (VSS) derived from the RCCT is capable of identifying dementia patients that have low or high visual spatial problems.  The degree of the visual spatial impairment may put residents at a serious or severe situation to experience a fall.  The maximum VSS score that can be achieved on the RCCT is 23.  When a resident scores 9 in the VSS category they have low visual spatial impairment and are revealed as having a serious risk of falling.  A VSS score of 5, high visual impairment, puts them in a  severe situation of falling.

The RCCT is a sensitive, valid and reliable tool.  The addition of the VSS data brings good news for elderly residents with dementia, their families, and the health care professionals who care for them.  The advent of the RCCT provides a welcomed insight into one aspect of resident behavior that is detrimental to their survival.

By utilizing the RCCT data and its VSS results,  health care professionals will be able to mitigate falls by:

  • Identifying residents' visual spatial abilities
  • Utilizing the data to determine the severity of residents' fall risk
  • Selecting interventions that address residents' visual spatial impairments
  • Recommending care plans to include a therapeutic social model that provides brain stimulating activities to enhance concentration, confidence, and well being

Eighty Ohio health care professionals representing 22 Ohio long term care health facilities and 364 Ohio long term care residents took part in the research study.  The research was funded by HCR Manor Care Foundation, Toledo, Ohio 2002/2003.

If you would like more information you may contact the researchers through the web site: .

Barbara Brock, RCCT Expert, Toledo, Ohio
Roy Olsson Jr. PhD, CTRS, The State University of New York at Cortland, NY
Diana Waugh, RN, BSN, Waugh Consulting, Waterville, Ohio
Suzanne Wambold, PhD, RN, RDCS, University of Toledo, Toledo, Ohio
Heather Sprague, MA, CTRS, Pawtucket, RI

To obtain a copy of the article, contact: The Journal of Gerontological Nursing, SLACK Incorporated.  Reprint orders and prices, John Kain 856.848.1000.
Some authors have moved from Northwest Ohio since the research project was conducted in 2002/2003.

Provider Magazine, February 2006

The recent study of the Reality Comprehension Clock Test (RCCT) and its ability to identify fall risk of patient's suffering fron Alzheimer's Disease was featured in the Provider Magazine's Focus on CAREGIVING section pages 31& 32.  The article is entitled, "Clocks Tell More Than Time".  To access the article go to Provider Magazine's website, .

The RCCT asks the individual to draw a picture of a clock while looking at a sample picture.  The RCCT contains a valid, reliable scoring process that measures four functional categories:

  • Number awareness
  • Visual- spatial functioning
  • Visual task performance
  • Orientation-memory

Visual-spatial deficits may cause patients to misjudge where objects are in their environment.  They may miss the edge of the chair when attempting to sit down or roll out of bed onto the floor because their visual-spatial impairment prevents them from knowing exactly where the edge of the bed is located.

Determining that the causative factor for falls is a visual-spatial deficit offers an opportunity for caregivers to focus on interventions that directly address the individual's.

Ohio Health Care Professionals:
80 Ohio Health Care Professionals representing 22 Ohio Long Term Care facilities took place in the study.

Ohio Authors & Researchers:
Barbara Brock, Artist and President of Communication Art, Inc.

  • Diana Waugh, RN, BSN of Waugh Consulting
  • Roy Olsson, Jr., PHD, CTRS University of Toledo
  • Suzanne Wambold., PHD, RN, RDCS of University of Toledo
  • Heather Sprague, MA, CTRS

The Reality Comprehension Clock Test was standardized in 1999, (RCCT1999, Brock., B. et al)

RCCT Education:
RCCT 4 hour Workshops for Health Care Professionals to learn how to administer, score, and interpret the RCCT are available.  Nine RCCT workshops were scheduled throughout Ohio in 2006. (Out of state classes available - call for information.)

For information call:
Barbara Brock, co-author at 419.865.6131 or Diana Waugh, RN at 419.351,7654.

Educational Classes.
In the classroom or On Line.
Call : 419-865-6131
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