Powerful RCCT & Fall
The RCCT Asseses:
- Comprehension of Task
- Visual Spatial Awareness
- Number Recognition
- Visual Task Performance
- Number Sequence
- Orientation to Time
- Shape/Line Recognition and
Patients are directed to view a picture of a
clock, then replicate it to the best of their
ability. The results are then scored
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
The content validity of this test has been
established by experts from the fields of
nursing, occupational therapy, social work,
About The RCCT Research
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
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
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.
- How do we know if the
patient is able to understand
the instructions we are giving
- How can we tell if the
patient has sensory processing
- 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.
RESEARCH FINDINGS OF A BRIEF COGNITIVE
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.
HEALTH CARE BREAKTHROUGH
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
- Recommending care plans to
include a therapeutic social
model that provides brain
stimulating activities to
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:
AUTHORS OF RESEARCH
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,
Suzanne Wambold, PhD, RN, RDCS, University of
Toledo, Toledo, Ohio
Heather Sprague, MA, CTRS, Pawtucket, RI
To obtain a copy of the article, contact:
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
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
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
- Number awareness
- Visual- spatial functioning
- Visual task performance
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
Ohio Health Care Professionals:
80 Ohio Health Care Professionals representing
22 Ohio Long Term Care facilities took place in
Ohio Authors & Researchers:
Barbara Brock, Artist and President of
Communication Art, Inc.
- Diana Waugh, RN, BSN of
- 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
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
For information call:
Barbara Brock, co-author at 419.865.6131 or
Diana Waugh, RN at 419.351,7654.