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  2. Occupational Therapy Adult Perceptual Screening Test (OT-APST)

Occupational Therapy Adult Perceptual Screening Test (OT-APST)

Last Updated

Purpose

The OT-APST is a standardized tool used to screen for visual impairment and perception across the main constructs of visual perception. Specifically, the OT-APST is used to test individuals with acquired brain injury or post-stroke.

Link to Instrument

Link to Instrument

Acronym OT-APST

Area of Assessment

Bodily Functions
Cognition
Mental Functions

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$600.72

Cost Description

Cost ($955 AUS) is for cost of equipment. Ordering the OT-APST testing kit (including 25 assessment forms) from the Australian production website will cost approximately $600.72 USD. Alternatively, purchasing only the 25 assessment forms costs $66.04 USD. Note that costs may vary depending on the occupational therapist's country of practice.

CDE Status

Not a CDE--last searched 5/5/2025.

Populations

Neurologic Conditions
Stroke
Non-Patient

Key Descriptions

  • The OT-APST was developed as a way to quickly and accurately screen for visual impairments for people with acquired brain injuries. It has now been developed for use with people with dementia and stroke survivors.
  • The OT-APST is divided into 7 subscales:
    1) Agnosia: person is required to read a passage, name an object that is familiar, identify objects and colors, identify items that are presented as overlapping with one another, and identify specific types of shapes when presented in a variety of ways with other shapes.
    2) Body Scheme: requires person to identify body parts on either side of their body and differentiate between the right and left sides of their body.
    3) Unilateral neglect: assessed using five items including writing, telling time, drawing an image of a clock, copying an image of a house and reading a short passage.
    4) Constructional skills: person reconstructs two-dimensional and three-dimensional block designs, drawing a clock and copying a photo of a house.
    5) Functional skills: person completes tasks such as telling time, writing, reading, completing simple calculations, grabbing and use of a stapler
    6) Praxis: person copies movements of right and left upper body or copies facial expressions if unable to move their limbs. Also assessed through the person using a stapler and handwriting (used to assess graphic praxis).
    7) Acalculia: person will complete simple subtraction and addition problems.

  • Separate scores are given for each subscale. These scores are not combined to provide a “total score” for the client, instead, they are left as scores of subscales and together can be used to provide a general profile of the visual capabilities and deficiencies of the client.

Number of Items

25

Equipment Required

  • Administration manual, assessment booklet, assessment form, and toolbox with necessary supplies

Time to Administer

20-25 minutes

Required Training

No Training

Age Ranges

Adolescent

16 - 17

years

Adult

18 - 64

years

Elderly Adult

65 - 97

years

Instrument Reviewers

Reviewed in May 2025 by UIC OT students Katie Hetzel, Danielle Pullen, Sydney Swenhaugen, & Anna Kuechenberg under the direction of Sabrin Rizk, PhD, OTR/L, Department of Occupational Therapy, University of Illinois Chicago 

Body Structure

Head
Upper Extremity

ICF Domain

Body Function
Body Structure

Measurement Domain

Cognition
Motor
Sensory
Activities of Daily Living

Professional Association Recommendation

None found--last searched 5/5/2025.

Considerations

  • Although the screening tool is standardized, it is observation-based and introduces some level of subjectivity.
  • The test focuses on perceptual cognition and should be complemented with a functional assessment to ensure client-centered and meaningful care in real- life situations.
  • Given that the screening tool was last updated in 2001, it may not incorporate the most recent advancements in neuroscience and neurorehabilitation.
  • The screening tool was developed in Australia, and norms and population studies are primarily based on Australian populations. Clinicians should be aware of educational and cultural differences when using this tool that may affect test performance.
  • The screening tool is designed for adults with neurological conditions and has not been tested for usefulness in pediatric populations, psychiatric populations, etc. where neurological conditions may present differently.

 

Neurologic Conditions

back to Populations

Cut-Off Scores

Dementia: (Bialy et al., 2007; Dementia Sample: n = 25; mean age = 83.2 (5.1) years; age range = 71-91 years; female = 88.0%; mean MMSE score = 17.1 (4.3), range = 7-23; mean MBI score = 55.7 (22.5), range = 14-89); Normative Sample: n = 150; mean age = 81.5 (6.8); age range = 71-97; female = 54.7%; mean MMSE score = 28.2 (1.5), range = 24-30; mean MBI score = 98.4 (4.9), range = 68-100)

  • The OT-APST cut-off score for the indication of impairment for people 75 years or older by subscale: Agnosia ≤ 22, Body Scheme ≤ 20, Neglect ≤ 10, Constructional Skills ≤ 46, Apraxia ≤ 8, Acalculia ≤ 2, Functional Skills ≤ 9

 

Normative Data

Dementia: (Bialy et al., 2007)

Mean Scores on Subscales of OT-APST for the Dementia and Normative Samples

OT-APST Subscale (Subscale Total Score)

Mean (SD) for Dementia Sample (n = 25)

Mean (SD) for Healthy Sample (n = 151)

t-Value(p-Value)

Agnosia (26)

18.6 (5.5)

25.3 (1.0)

6.1 (≤ 0.001)

Neglect (13)

6.6 (3.2)

12.8 (0.5)

9.5 (≤ 0.001)

Apraxia (10)

8.2 (1.6)

10.0 (0.2)

5.5 (≤ 0.001)

Body Scheme (22)

20.4 (2.2)

21.9 (0.4)

3.5 (0.002)

Constructional Skills (53)

21.4 (17.1)

51.8 (1.7)

8.9 (≤ 0.001)

Acalculia (4)

2.1 (1.6)

3.9 (0.3)

5.7 (≤ 0.001)

Functional Skillsa (11)

6.6 (3.1)

10.8 (0.4)

6.9 (≤ 0.001)

aFunctional skills is not a construct of visual perception, but rather this subscale includes practical tasks that may be affected by visual perceptual impairment.

 

Frequencies of Visual Perceptual Impairment* for the Dementia and Normative Samples

OT-APST Subscale (Subscale Total Score)

Frequency (%) Impaired for Dementia Sample (n = 25)

Frequency (%) Impaired for Healthy Sample (n = 151)

x2 (p-Value)

Agnosia (26)

18 (72.0%)

6 (4.0%)

83.7 (≤ 0.001)

Neglect (13)

21 (84.0%)

3 (2.0%)

121.8 (≤ 0.001)

Apraxia (10)

11 (44.0%)

0 (0.0%)

70.4 (≤ 0.001)

Body Scheme (22)

10 (40.0%)

5 (3.3%)

36.8 (≤ 0.001)

Constructional Skills (53)

23 (92.0%)

3 (2.0%)

137.2 (≤ 0.001)

Acalculia (4)

21 (84.0%)

1 (0.7%)

69.8 (≤ 0.001)

Functional Skillsa (11)

20 (80.0%)

2 (1.3%)

120.7 (≤ 0.001)

aFunctional skills is not a construct of visual perception, but rather this subscale includes practical tasks that may be affected by visual perceptual impairment.

*OT-ASPST subscale cut-off scores for indication of impairment for people 75 years and older: Agnosia ≤ 22; Body Scheme ≤ 20; Neglect ≤ 10; Construction Skills ≤ 46; Apraxia ≤ 8; Acalculla ≤ 2; Functional Skills ≤ 9

 

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Dementia: (Bialy et al., 2007)

  • Adequate to Excellent correlations between performance on the OT-APST subscales, the Mini Mental Status Exam (MMSE), and the Modified Barthel Index (MBI)

Spearman’s rho Correlation Coefficients Between Performance on the OT-APST Subscales, the MMSE, and the MBI for Participants with Dementia (n = 25)

OT-APST Subscale

MMSE (r)

MBI (r)

Agnosia

0.64 (Excellent)

0.43 (Adequate)

Neglect

0.59 (Adequate)

0.42 (Adequate)

Apraxia

0.58 (Adequate)

0.48 (Adequate)

Body Scheme

0.49 (Adequate)

0.37 (Adequate)

Constructional Skills

0.46 (Adequate)

0.49 (Adequate)

Acalculia

0.54 (Adequate)

0.34 (Adequate)

Functional Skillsa

0.63 (Excellent)

0.55 (Adequate)

aFunctional skills is not a construct of visual perception, but rather this subscale includes practical tasks that may be affected by visual perceptual impairment.

 

Construct Validity

Discriminate validity:

Dementia: (Bialy et al., 2007)

  • Significant ability of OT-APST scores to discriminate between dementia and healthy groups for all OT-APST subscales (p ≤ 0.001 for all subscales except for Body Scheme, which was p = 0.002 – see table under “Normative Data” above)

 

Stroke

back to Populations

Cut-Off Scores

Stroke: (Cooke et al., 2006b; n = 208 (158 (76%) from public facilities and 50 (24%) from private facilities); mean age = 70.4 (14.1) years, range = 22 to 95 years; mean time since onset = 45.3 (66.4) days, range = 2 to 451 days; FIM cognitive score (available for 170 of the participants) = 27.3 (5.94), range = 11 to 35 (the maximum))

ROC analysis and cut-off scores for OT-APST and LOTCA-G Comparisons by subscale (5 out of 7 subscales)

  • Agnosia (22 out of 26) (sensitivity 71.1%; specificity 68%; accuracy 72.6%)
  • Body Scheme (20 out of 22) (sensitivity 34.3%; specificity 89.2%; accuracy 60%)Neglect (10 out of 13) (sensitivity 75.7%; specificity 73.8%;
  • Accuracy 72.6%)
  • Apraxia (8 out of 10) (sensitivity 64.9%; specificity 63.3%; accuracy 74.8%)
  • Constructional skills (50 out of 53) (sensitivity 90.4%; specificity 69.2%; accuracy 82.2%)

Cut-off scores for LOTCA subscales (maximum score)

  • Perception (16); < 15 = Impaired
  • Spatial perception (12); < 12 = Impaired
  • Motor praxis (8)*; < 8 = Impaired
  • Visuomotor organization (28); < 27 = Impaired
  • Neglect (8); < 8 = Impaired

Cut-off scores for LOTCA-G subscales (maximum score)

  • Perception (16); < 15 = Impaired
  • Spatial perception (12); < 12 = Impaired
  • Motor praxis (8*); < 8 = Impaired
  • Visuomotor organization (24); < 21 = Impaired
  • Neglect (8); < 6 = Impaired

*”motor imitation” item not included.

 

Test/Retest Reliability

Stroke: (Cooke et al., 2005; n = 15; mean age = 70.5 (17.6) years, range = 20-94 years; mean time since onset = 15 (13.5) days, range = 2-52 days)

  • Acceptable to Excellent test-retest reliability for OT-APST subscales (n = 10): (ICC = 0.76 to 0.95)

 

Interrater/Intrarater Reliability

Stroke: (Cooke et al., 2005; n = 15)

  • Adequate to Excellent interrater reliability OT-APST subscales (n = 15): (ICC = 0.66 to 1.0)
  • Adequate to Excellent intrarater reliability OT-APST subscales (n = 15): (ICC = 0.64 to 1.0)

 

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Stroke: (Cooke et al., 2006b)

Somers’s d Correlations between OT-APST & LOTCA subscales (n = 73):

  • Excellent correlation for Agnosia (Somers’s d = 0.64, p < 0.001)
  • Poor correlation for Body Scheme (Somers’s d = 0.27, p = 0.006)
  • Excellent correlation for Neglect (Somers’s d = 0.66, p < 0.001)
  • Poor correlation for Constructional skills (Somers’s d = 0.28, p = 0.025)
  • Adequate correlation for Apraxia (Somers’s d = 0.35, p = 0.007)

Somers’s d Correlations between the OT-APST & LOTCA-G subscales (n = 135):

  • Excellent correlation for Agnosia (Somers’s d = 0.47, p < 0.001)
  • Poor correlation for Body Scheme (Somers’s d = 0.25, p < 0.001)
  • Excellent correlation for Neglect (Somers’s d = 0.66, p < 0.001)
  • Excellent correlation for Constructional skills (Somers’s d = 0.80, p < 0.001)
  • Adequate correlation for Apraxia (Somers’s d = 0.36, p = 0.001)

Predictive validity:

Stroke: (Cooke et al., 2006b)

AUC values from ROC analysis of OT-APST and LOTCA/LOTCA-G subscale comparisons

OT-APST Subscale

OT-APST & LOTCA (n = 73)

OT-APST & LOTCA-G (n = 135)

Agnosia

0.82 (Adequate)

0.735 (Adequate)

Body scheme

0.63 (Poor)

0.626 (Poor)

Neglect

0.83 (Adequate)

0.83 (Adequate)

Constructional skills

0.64 (Poor)

0.68 (Poor)

Apraxia

0.68 (Poor)

0.897 (Adequate)

 

Content Validity

Stroke: (Cooke et al., 2006a; n = 13 experienced occupational therapists; mean time since graduation from OT school (SD) = 9.5 (8.5) years, range = 2-24 years)

"Expert panels comprising 13 experienced occupational therapists explored issues related to perceptual screening and assessment, and endorsed the clinical utility, content validity, and face validity of the OT-APST (p. 328)."

Face Validity

Stroke: (Cooke et al., 2006a)

"Expert panels comprising 13 experienced occupational therapists explored issues related to perceptual screening and assessment, and endorsed the clinical utility, content validity, and face validity of the OT-APST (p. 328)."

Floor/Ceiling Effects

Stroke: (Cooke et al., 2006b)

From comments on the Body Scheme Subscale:

“Interpretation…is difficult because participants' scores on this item fell within a very restricted range and a high number of scores approached the maximum score attainable. This ceiling effect...may also reflect a low incidence of body scheme impairment of participants with stroke in this study (p. 44)."

 

Non-Patient

back to Populations

Content Validity

Non-Patient: (Cooke et al., 2006a; n = 356 healthy adults; mean age = 63.7 (19.3), range = 16-97 years; Expert panel comprised of 13 experienced occupational therapists w/mean time since graduation from OT school = 9.5 (8.5) years, range = 2-24 years)

"Expert panels comprising 13 experienced occupational therapists explored issues related to perceptual screening and assessment, and endorsed the clinical utility, content validity, and face validity of the OT-APST (p. 328)."

Face Validity

Non-Patient: (Cooke et al., 2006a)

"Expert panels comprising 13 experienced occupational therapists explored issues related to perceptual screening and assessment, and endorsed the clinical utility, content validity, and face validity of the OT-APST (p. 328)."

Bibliography

Bialy, A., McKenna, K., & Cooke, D. M. (2007). Performance of People with Dementia on the Occupational Therapy Adult Perceptual Screening Test (OT- APST). Physical & Occupational Therapy In Geriatrics, 26(2), 1–21. https://doi.org/10.1080/J148v26n02_01

Cooke, D. M., Mckenna, K., Fleming J., Darnell, R. (2005). The reliability of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). British Journal of Occupational Therapy, 68(11), 509-517. https://doi.org/10.1177/030802260506801105

Cooke, D. M., McKenna, K., Fleming, J., & Darnell, R. (2006a). Australian normative data for the occupational therapy Adult perceptual screening test. Australian Occupational Therapy Journal, 53(4), 325–336. https://doi.org/10.1111/j.1440- 1630.2006.00597.x

Cooke, D. M., McKenna, K., Fleming, J., & Darnell, R. (2006b). Criterion validity of the occupational therapy adult perceptual screening test (OT-APST). Scandinavian Journal of Occupational Therapy, 13(1), 38–48. https://doi.org/10.1080/11038120500363006

Occupational therapy adult perceptual screening test (OT-APST). Function for Life. (n.d.). https://www.functionforlife.com.au/

Zeltzer, L. (2008, August 19). Occupational therapy adult perceptual screening test (OT-APST). Strokengine. https://strokengine.ca/en/assessments/occupational-therapy- adult-perceptual-screening-test-ot-apst/

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