Rehabilitation Assessment & Clinical Reasoning:Occupational TherapyJutta Hinrichs, BScOTCMSC Conference 2004Toronto, Ontario

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

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)

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

Model of Occupational PerformanceSelf Care

LeisureSpiritualityProductivityAffectivePhysicalCognitivePhysicalInstitutionalCulturalSocialPersonOccupationEnvironment

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

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?

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

Other screening considerationsAny previous rehabilitation?Involvement of other team members/need to refer to other team members?Practice setting?Potential time available?

Screening ToolsReview of medical recordInterview (client and family reports)QuestionnairesObservation

Comprehensive Assessment

Based on the screening, which areas require more indepth information/testing?Where do I need to target my interventions?

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)

Productivity AssessmentPaid or unpaid work (job, volunteer work, school, etc)Household management (cleaning, laundry, cooking, etc) Child Care/Parenting

Leisure AssessmentActivities enjoyed previously and currentlySocialization (visiting, phone calls, correspondence, etc)Quiet recreation (hobbies, reading, crafts, etc)Active recreation (sports, outings, travel, etc)

Assessment of EnvironmentPhysical environment; possible barriersConsideration of social support systems availableConsideration of cultural factors

Fatigue AssessmentMS fatigueOther factors contributing to fatigueImpact of fatigueExpectations for self

Cognitive ScreeningPrimarily assess functional cognitionAttentionAbility to follow directionsMemory difficultiesExecutive function

If more indepth assessment needed then refer on to Neuropsychology

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

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)

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

Environmental/Community assessment toolsThat I use:Home assessment form developed by our Home Service OT

That others use:Reintegration to Normal Living IndexSAFER

Fatigue assessment toolsThat I use:Daily activity diaryFatigue questionnaireFatigue Impact Scale (FIS)

That others use:Modified FISFatigue Severity Scale (FSS)Fatigue Assessment Instrument (FAI)

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

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