Download - Hinrichs_OTAssessments
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Rehabilitation Assessment & Clinical Reasoning:Occupational TherapyJutta Hinrichs, BScOTCMSC Conference 2004Toronto, Ontario
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Occupational TherapyThe art and science which utilizes the analysis and application of activities specifically related to occupational performanceIs a client-centered practiceIs described as promoting health by enabling occupation
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OccupationOccupation is used in the broadest senseDerived from the Latin word occupatio, meaning to occupy or to seizeOccupations are activities or tasks which engage our resources of time and energy:Self Care (looking after oneself and residence)Productivity (contributing to the social and economic fabric of the community)Leisure (enjoying life)
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Enabling Occupational PerformanceEnabling occupational performance means collaborating with people to choose, organize, and perform occupations which are meaningful or useful in a given environmentOccupational performance is the result of a dynamic relationship between persons, environment, and occupation over a persons life span
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Model of Occupational PerformanceSelf Care
LeisureSpiritualityProductivityAffectivePhysicalCognitivePhysicalInstitutionalCulturalSocialPersonOccupationEnvironment
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What do I screen for?Are there occupational performance issues for OT to address?Change in rolesAbility to fulfill productivity rolesChange in ability levelAbility to perform self care routinesAbility to engage in activities for enjoyment
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What do I screen for? (cont.)Are there performance components affecting function?Any underlying changes in impairments?FatigueCognitionPhysical status (tone, ROM, muscle strength, sensation, coordination; primarily for U/E)Other symptoms affecting abilities?
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What do I screen for? (cont.)Are there environmental issues that need to be addressed?Physical environment barriersSocial support systems available
What are the patients/families concerns and goals?Level of comfort/discomfort with changesTheir values/hopesTheir readiness to make changes
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Other screening considerationsAny previous rehabilitation?Involvement of other team members/need to refer to other team members?Practice setting?Potential time available?
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Screening ToolsReview of medical recordInterview (client and family reports)QuestionnairesObservation
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Comprehensive Assessment
Based on the screening, which areas require more indepth information/testing?Where do I need to target my interventions?
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Self Care AssessmentPersonal care (feeding, bathing, grooming, dressing, toileting)Community management (shopping, finances, transportation/driving)Functional mobility (transfers, current aids used - home and community, seating and positioning needs)Functional communication (writing or computer use, telephone use)
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Productivity AssessmentPaid or unpaid work (job, volunteer work, school, etc)Household management (cleaning, laundry, cooking, etc) Child Care/Parenting
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Leisure AssessmentActivities enjoyed previously and currentlySocialization (visiting, phone calls, correspondence, etc)Quiet recreation (hobbies, reading, crafts, etc)Active recreation (sports, outings, travel, etc)
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Assessment of EnvironmentPhysical environment; possible barriersConsideration of social support systems availableConsideration of cultural factors
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Fatigue AssessmentMS fatigueOther factors contributing to fatigueImpact of fatigueExpectations for self
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Cognitive ScreeningPrimarily assess functional cognitionAttentionAbility to follow directionsMemory difficultiesExecutive function
If more indepth assessment needed then refer on to Neuropsychology
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Assessment of Physical StatusU/E toneU/E ROMU/E strengthU/E sensationU/E coordinationFunctional balance (more of a screen)Pain (more of a screen)
* Often work together with PT on this area
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How do I use the assessment data?To decide on approach to treatment (restoration/remediation, adaptation, compensation)To determine at which level I intervene (impairments, occupational tasks/abilities, participation/roles)To make recommendations (eg, referrals, workplace accommodations, followup care)
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Functional assessment toolsThat I use:Canadian Occupational Performance Measure (COPM)Functional Independence Measure (FIM)Multiple Sclerosis Self Efficacy Scale (MSSE)Doron SimulatorInterview/observation
That others use:Functional Assessment Measure (FAM)Kohlman Evaluation of Living Skills (KELS)Self Reported Functional Measure (SRFM)Worker Role Inventory Checklist
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Environmental/Community assessment toolsThat I use:Home assessment form developed by our Home Service OT
That others use:Reintegration to Normal Living IndexSAFER
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Fatigue assessment toolsThat I use:Daily activity diaryFatigue questionnaireFatigue Impact Scale (FIS)
That others use:Modified FISFatigue Severity Scale (FSS)Fatigue Assessment Instrument (FAI)
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Cognitive assessment toolsThat I use:CognistatRivermead Behavioural Memory Test (RBMT)Cognitive Competency Test (CCT)
That others use:Behavioral Assessment of Dysexecutive Syndrome (BADS)Pepper Visual Skills for Reading TestTest of Directed Attention
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U/E measurement toolsThat I use:Nine Hole Peg Test (9-HPT)Manual Muscle TestDynamometerPinch meterSensation kitHandwriting sample
That others use:Jebson Hand TestU/E Performance Test for the Elderly (TEMPA)Arm Motor Ability Test (AMAT)Action Research Arm TestPurdue PegboardArthritis Hand Function TestBox and Block