A kitchen task and an apparently good score
A person returning home after stroke has improved isolated arm strength and a satisfactory short cognitive screen. The discharge goal is to prepare a simple breakfast. During a supervised kitchen task, the person does not notice ingredients on the left, leaves the kettle on and needs repeated prompts to complete the sequence. A family member says the good test scores prove that supervision is unnecessary. The therapist records the task conditions, actual prompts and safety concerns, and checks whether communication, vision, attention, fatigue or the unfamiliar room contributed. No single finding establishes the complete mechanism. The home has a different layout and support is available only during part of the morning. The team must agree on a safe, meaningful plan and how it will be reviewed.
1. Why do the scores not settle readiness for this task?
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Isolated strength and a brief screen do not reproduce all demands of meal preparation. Actual observed performance, context, cueing and risks provide information that a total score can miss.
2. What should the next plan include?
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Clarify priorities, assess relevant barriers, trial suitable task or environmental adaptations, agree support and document a realistic review in the home context. Do not record independent performance when repeated prompts are needed.