Therapy Ed Chapter 15- Eval And Intervention For Occupation

Front 1

What is an occupational profile?

Back 1

It is an understanding of the client's occupational history and experiences, patterns of daily living interests, values and needs. Thereby establishing the individual's priorities for performance in areas of occupation.

Front 2

What occurs after an occupational profile is assembled?

Back 2

The person's client factors, performance skills, patterns, & contexts, and activity demands are assessed to ID specific strengths/limitations that impact on desired and needed occupational performance.

Front 3

Analysis of occupational performance entails...?

Back 3

Part of the OT evaluation where the person's client factors, performance skills, patterns, & contexts, and activity demands are assessed.

Must include obs. of person's actual performance of an activity in context or as close to natural context as possible.

Front 4

Levels of assist for NBCOT

Back 4

total=100%
max=75%
mod=50%
min=25%
SBA (stand by assist)
Indep

Front 5

Assessment of Motor and Process Skills (AMPS)

Back 5

-FOCUS: on effectiveness, efficiency, or safety of ADL performance, including personal ADL (PADL) and IADL.

-POPULATION: developmental age >2 and diagnoses w/ functional limitations in ADL

-interview pt to determine 3-5 challenging tasks, pt selects 2-3
-observe quality of ADL performance
-requires AMPS training course
-Test determines: pt's difficulty in task performance, level of task challenges pt can manage, quality of change in ADL performance post intervention

Front 6

Barthel Index

Back 6

FOCUS: measures independence in ADL and func mob before and after tx and level of personal care needed

POPULATION: adult/elderly w/ physical disabilities and/or chronic illness. (typically used in medical model settings)

-10 items: feeding, xfer, grooming, toileting, bowel control, bladder control, bathing, dressing, walking, stairs
-METHOD: direct observation of performance, interview, review medical records
-100=able to do all 10 indep
**does not indicate ability to live indep, self-care only! determines assist for basic ADL

Front 7

Cognitive Performance Test (CPT)

Back 7

FOCUS: assesses 6 functional ADL tasks that require cognitive processing: dressing, shopping, making toast, making a phone call, washing, traveling
-Based on Allen's cognitive level theory
-standardized for giving directions and demonstration
-level 1=lowest functioning, level 6=highest

-Used to determine a person's capabilities & needs in other ADL task & their ability to live indep.

POPULATION: adults and elders w/ psychiatric and/or cognitive dysfunction

Front 8

FIM and WeeFIM

Back 8

FOCUS: assessment of severity of disability as determined by assistance needed
-6 performance areas: self-care, bowel and bladder control, mobility(transfers), locomotion, communication, social cognition
-WeeFIM= 3-7 yrs old
WeeFIM for 0-3 yrs= 1-rare, 2-usually,3-always
-population-FIM=adults not indep, WeeFIM=birth-7yrs and above 7 w/ functional abilities less than a 7 yr old

Front 9

FIM Scores

Back 9

7-indep
6=mod I
5-supervision
4-Min A
3-Mod A
2- Max A
1-Total A

Front 10

Katz Index of ADL

Back 10

FOCUS: assess level of independence in 6 areas: bathing, dressing, toileting, transferring, continence, feeding
METHOD: observe or interview
-rated as indep, some assist, or dep
-Global letter scores used to evaluate intervention outcomes (A-G)
POPULATION: adults & elders w/ chronic disease

Front 11

Global letter scores for Katz Index

Back 11

A=indep in all 6 activities
B= indep in 5 activities
C= indep in all but bathing and one other
D= indep in all but bathing, dressing, and one other
E= indep in all but bathing, dressing, toileting, and 1 other
F= indep in all but bathing, dressing, toileting, transfers, & one other
G= dependent in all activities
Other= can't be classified in above categories

Front 12

Kitchen Task Assessment

Back 12

FOCUS: measures judgment, planning, and organizational skills for simple cooking tasks

*washing hands, evaluator can provide assist
-scores of 0 (ind)- 3(incapable) for 6 skills: initiation, organization, performing all steps, proper sequence, safety, completion

POPULATION: developed for Alzheimer's, can be used w/ any cognitive dysfunction

Front 13

Klein-Bell Activities of Daily Living Scale (K-B scale)

Back 13

FOCUS: assess indepence in ADL
-170 items 6 areas: dressing, elimination, mobility, bathing/hygiene, eating, emergency telephone use
-assistive devices are allowed
-each item scored "achieved" or "failed"
-Population= 6 mos and up w/ any diagnosis

Front 14

Kohlman Evaluation of Living Skills (KELS)

Back 14

-determines pt knowledge/performance of 17 basic living skills needed to live independently
-5 main areas: self-care, safety and health, money mgmt, transportation and telephone, work and leisure
-total score 5 1/2 or less= presence of skills for independent living; 6 or more=no indep living skills
-gives a baseline for further eval and intervention
-pop: originally for adolescents and adults in acute psychiatric hospitals, expanded to diversity of diagnoses

Front 15

Milwaukee Evaluation of Daily Living Skills (MEDLS)

Back 15

-assessment of actual or simulated performance of basic living skills for pt's EXPECTED environment:
basic communication, hygiene, medication mgmt, personal health care, time awareness, eating, dressing, safety in home, safety in community, phone use, transportation, clothing maintenance, money use
-only items relevant are administered
-pop: adults with ADL deficits

Front 16

Routine Task Inventory

Back 16

-measures level of impairment in ADLs according to Allen's model of cognitive levels
-6 physical scales and 8 instrumental scales
-observation, self-report or caregiver report
-each item rated 1-6 based on Allen's cognitive levels
-pop: adults and elders with cognitive impairment

Front 17

Scoreable Self-Care Evaluation

Back 17

-measurement of functional performance and identification of difficulties in 18 basic living tasks in 4 main areas: personal care, housekeeping, work and leisure, financial mgmt
-motivational questionnaire, then evaluate task
-pop: adolescent-elder w/ psychiatric illness in acute hospital settings or living in the community

Front 18

Sexual Expression/Activity Evaluation

Back 18

-assess during routine screenings and interviews

Front 19

Self-care abilites at C1-C3

Back 19

Total dependent
-instruct others on preferences
-can chew and swallow

Front 20

Self-care at C4

Back 20

total dependent in self-care
-can instruct others
-can drink from a glass with a long straw

Front 21

Self-care at C5

Back 21

-setup for feeding. May use: mobile arm support, dorsal wrist splint w/ universal cuff, dycem under plate, scoop dish, angled utensils
- UB dressing w/ min-mod A. Dep for LB dressing
-min-mod A for bathing
-setup and universal cuff for grooming

Front 22

Self-care at C6

Back 22

-mod I (indep according to NBCOT) for feeding using universal cuff, rocker knife, or cup with large handles
-LB dressing indep in bed w/ max a for shoes and socks. UB dressing indep w/ button hook and zipper pull
-min A for bathing using tub benching and SB xfer
-indep for grooming w/ tenodesis grip or splint

Front 23

Self-care at C7

Back 23

indep for feeding
-indep for dressing, may need button hook
-min assist using tub bench for bathing, may use depression xfers or SB
-indep for grooming using tenodesis grip or splint

Front 24

Self-care at C8-T1

Back 24

-indep for self-care
-can perform depression transfers. Can xfer from wc to floor and back w/ SBA

Front 25

Self-care at T6-L4

Back 25

indep in all self-care

Front 26

PLISSIT model for sexual intervention

Back 26

P=permission to raise concerns
LI=limited info, share facts, dispel myths
SS=specific suggestions
IT=intensive therapy. Indicated for long-standing problems, referral to sex therapist or counselor

Front 27

Family participation evaluation

Back 27

-there are no assessments
-assess during routine screenings and interviews

*Look at family dynamics, roles, responsibilities and expectations of members.

*Take into consideration ethnicity, religious values

Front 28

Activity Index

Back 28

-determination of pt's perception of leisure and extent pt participates in leisure activities
-Activity Index Questionnaire
-check level of interest for each activity on a 4 pt scale
-pop: developed for elders, can be used for other

*Results can be used to designed interventions using activities that are meaningful and preferred.

Front 29

Interest checklist

Back 29

-assesses level of interest in 80 leisure activities
-check level of interest
-pop: developed for adults, has been used with teens

Front 30

Leisure Diagnostic Battery (LDB)

Back 30

-measures leisure experience, and motivational and situational issues that influence leisure
-questionnaire w/ 1-3 rating scale
-pop: began as adults, has been modified for ages 9-14 with and without mental retardation

Front 31

Leisure Satisfaction Questionnaire

Back 31

-measurement of individual's perception that leisure pursuits are meeting personal needs
-6 categories: psychological, educational, social, relaxation, physiological, aesthetic
-answer questionnaire on a 5 pt scale
-pop: adults and elders

Front 32

Meaningfulness of Activity Scale

Back 32

-measures level of enjoyment, motivation, and perception of leisure
-questionnaire and likert scale for: level of enjoyment, reason for doing activity, and perception of activity competence
-get overall meaninffulness of activity score
-pop: adults and elders

Front 33

Minnesota Leisure Time Physical Activity Questionnaire

Back 33

-measures energy expended during leisure activity
-interview using list of 63 physical activities
-pt indicates level of participation in each
-daily calorie expenditure estimate
-used to compare activity levels w/ general health and increase activity as needed
-pop: adults

Front 34

Play History

Back 34

-assess child's developmental level and adequacy of play environments
-semi-structured interview with caregivers
-increases understanding of current play behaviors
-pop: children and adolescents

Front 35

Preschool Play Scale

Back 35

-observe child't play behavior within 4 play dimensions: space mgmt, material mgmt, imitation, participation
-observe free play for 15-30 min
-play age score by comparing observed to expected age behaviors

Front 36

General intervention guidelines for play/leisure intervention

Back 36

-assistive technology & adaptive tech to compensate
-thematic and topical groups to develop needed skills
-explore web-based opportunities for play and participation

-Valued activities should be adapted, modified, and/or simplified to continue engagement.

Front 37

Play/Leisure abilities at C1-C4

Back 37

-computer games and email using mouthstick, head pointer, or voice activation
-read, paint, watch tv w/ AE (mouthstick, head pointer, voice)

Front 38

Play/leisure abilities at C5

Back 38

indep w/ computer games, internet, speakerphone, reading, board games, and some crafts w/ splint, universal cuff, and typing splint

Front 39

Play/leisure abilities at C6/C7

Back 39

-can hold a phone, typing stick and pen w/ tenodesis grip. Tenodesis or universal cuff for typing.
-can play board games and some wheelchair sports
-some crafts

Front 40

Play/leisure abilities at C8-T1

Back 40

-same as C7 but performance is easier d/t good functional use of both UEs

Front 41

Functional Capacity Evaluation (FCE)

Back 41

-evaluates an individual's capacities in relation to one of several dimensions:
physical demands of a job, critical demands of a specific job, critical demands of an occupational group, demands of competitive employment

Front 42

Work capacity evaluation

Back 42

using real or simulated work activities to assess an individual's ability to return to work

Front 43

Job site anlaysis

Back 43

Used to evaluate a job's expectations, supports, ergonomics, essential functions o the job, marginal functions of the job, potential reasonable accommodations.

Front 44

Specific Work Assessments:

EPIC Functional Evaluation System

Back 44

-determines pt's capacity for lifting, carrying, climbing, pulling, ROM, dexterity, balance, standing
-6 standardized modules
-formal training and certification required
-pop: adults

Front 45

Specific Work Assessments:

Jacob's Prevocational Assessment (JPVA)

Back 45

-assessment of work related skills in 14 major areas
-pt completes 15 short tasks
-check off areas that appear difficult for pt
-pop; adolescents and pre-adolescents with learning disabilities

Front 46

McCarron-Dial System (MDS)

Back 46

-assesses prevocational, vocational, and educational abilities of individuals w/ disabilities and/or sociocultural disadvantages
-5 main areas: cognitive, sensory, motor, emotional, coping
-pre-screening interview, administer work samples for all 5 areas, observation at work or classroom
-3 day workshop to administer

-pop: 16 and over w/ neurophysiological and/or neuropsychological impairment

Front 47

Reading-Free Vocational Interest Inventory

Back 47

-identifies vocational areas of interest in a number of areas
-55 sets of pictures with unskilled, semi-skilled and skilled tasks
-no literacy required
-represents level of interest
-pop: adolescents and adults w/ learning or developmental disabilities

Front 48

Smith Physical Capacity Evaluation

Back 48

-individual's performance on 154 items
-performance of real or simulated work tasks based on pt's interest
-pop: adults

Front 49

Testing, Orientation, and Work Eval in Rehabilitation (TOWER)

Back 49

-assess pt's ability to complete specific work samples
-main focus on clerical, assembly, and manufacturing jobs
-progress from simple to complex
-performance compared to norms of persons with disabilities
-pop: adults w/ physical or psychiatric disorders

Front 50

Valpar Component Work Sample (VCWS)

Back 50

-assessment of groups of skills required for specific employment tasks and basic functional capabilities
-Methods-Time Measurement=quality of and time for task performance
-pop: adults with and without disabilities. Adapted version for visually impaired

Front 51

Vocational Interest Inventory-Revised (VII-R)

Back 51

-measures student interest in 8 employment areas
-pop: high school students who are unclear about their vocational interests
-questionnaire with 112 statements related to job activities

Front 52

Vocational Interest, Temperament, and Aptitude System (VITAS)

Back 52

-assessment of vocational interests, temperament, and aptitudes
-assists with career guidance and vocational placement
-22 work samples and vocational interest interview
-time and quality of performance based on observations and compared to norms
-pop: adolescents 14+ and adults

Front 53

Worker Role Interview (WRI)

Back 53

-determination of psychosocial and environmental factors related to past work experience and ability to return to work
-structured interview
-1-4 rating scale: 1=problems returning to work, 4=supports for return to work
-pop: adults involved in work hardening program

Front 54

Groups used for work intervention

Back 54

-thematic and topical groups to develop needed skills: task skills, social skills, work behaviors, pre-retirement planning

Front 55

Intervention for cumulative workplace trauma (carpal tunnel, low back pain)

Back 55

-avoid static positions, repetitions, awkward postures, forceful exertions, and vibration
-ergonomically correct workplace design

Front 56

Work hardening programs

Back 56

-interdisciplinary approach is used
-real or simulated work activities
-transition between acute care and return to work
-address productivity, safety, physical tolerance, and worker behaviors
-CARF accreditation required

Front 57

Work conditioning programs

Back 57

-services provided by one discipline
-real or simulated work activities
-transition between acute care and return to work
-flexibility, strength, movement and endurance addressed
-accreditation is not required

Front 58

Optimal work surface heights

Back 58

precision work= 31-37 inches
reading/writing= 28-31 inches
typing/light assembly= 21-28 inches

Front 59

Ergonomics

Back 59

book p. 323

Front 60

workbench height

Back 60

precision work=above elbow height/chest (37-43")
light work=just above elbow (34-37")
heavy work= 4-6" below elbow height (28-35")

Front 61

Reasonable Accommodations for personal self-efficacy in those w/ psychiatric disorders

Back 61

-reinforce or coach appropriate behaviors
-test for job skills on the job, avoid self report
-place in job where there is a model to follow or imitate
-teach self-advocacy skills
-provide successful job experiences
-begin with close supervision and cut back slowly
-maintain similarity or consistency in work tasks
-encourage positive self-talk

Front 62

Reasonable Accommodations for duration of concentration in those w/ psychiatric disorders

Back 62

-put each work request in writing and leave in "to do" box to avoid interruptions
-provide ongoing consultation, mediation, problem solving, and conflict resolution
-provide good working conditions (environmental)
-provide directive commands on a regular basis

Front 63

Reasonable Accommodations for screening out environmental workplace stimuli in those w/ psychiatric disorders

Back 63

-place person in a separate office
-room dividers between workstations
-allow person to work after hours when less people around
-ensure workstation facilitates work production and organization

Front 64

Reasonable Accommodations for maintaining stamina through the workday in those w/ psychiatric disorders

Back 64

-additional breaks or shortenend workday
-allow extended day for rest periods
-avoid work during lunch
-distribute tasks throughout the day according to energy level
-job-share with another employee
-work simplification techniques (wheeled cart, etc)
-liberal leave policy for health problems, flexible hours
-individualize work agreements
-verify employees' efficacy regarding their ability to sustain effort
-teach on-the-job relaxation and stress reduction

Front 65

Reasonable Accommodations for managing time/deadline pressure in those w/ psychiatric disorders

Back 65

-maintain structure through daily time schedule/hourly goals
-positive reinforcement for completed tasks
-separate work area to reduce noise and interruptions
-screen out unnecessary business

Front 66

Reasonable Accommodations for initiating interpersonal contact in those w/ psychiatric disorders

Back 66

-plan orientation to meet and work alongside coworkers
-allow sufficient time to make good, unhurried contacts
-make contacts during work, break and lunch. Adjust the conversation to the situation
-stand at a 90 deg angle instead of facing eachother
-allow person to work at home
-have an advocate to advise and support the person
-communicate honestly
-plan supervision times and maintain them
-develop tolerance for and helpful response to unusual behaviors
-provide awareness and advocacy training for all workers

Front 67

Reasonable Accommodations for muti-tasking in those w/ psychiatric disorders

Back 67

-eliminate number of simultaneous tasks
-redistribute tasks to give employees more of same type of task
-establish priorities for task completion
-arrange for all work tasks to be in writing with due dates

Front 68

Reasonable Accommodations for responding to negative feedback in those w/ psychiatric disorders

Back 68

-have employee prepare own work appraisal to compare with supervisors
-work together to establish methods employee can use to change negative behaviors
-positive feedback for desired behavioral change
-on-site crisis intervention to develop self-esteem, emotional support, and comfort
-establish guidelines for feedback

Front 69

Reasonable Accommodations for symptoms secondary to prescribed psychotropic medications in those w/ psychiatric disorders

Back 69

-provide release time to see psychiatrist
-encourage employee to work w/ dr to establish time schedule for meds conducive to work responsibilities
-provide release time or changes in job task that match condition

Front 70

Ergonomic program characteristics

Back 70

-prevention is the main focus
-Types of programs:
ergonomic survey, job site analysis, manager and employee training, educational seminars, exercise and stretching programs

Front 71

Rehabilitation (sheltered) workshops, supported employment programs, transitional employment programs (TEP)

Back 71

-multidisciplinary or interdisciplinary approach
-real work activities used (piece-work rate in rehab workshops) (paid at prevailing competitive wage in TEP and supported employment)
-participants considered employees
-job coaches used
-transition b/t program participation and competitive employment provided according to pt's functional level
-rehab workshops and supported employment may be final goal
-accreditation not required

Front 72

Discharge criteria from work programs

Back 72

-individual exhibits limited potential for improvement
-individual has declined services
-individual is non-compliant with the program
-individual has met program goals
-individual has returned to work

Front 73

Self-Care Intervention: Adaptive Equipment

Back 73

Toileting & toilet hygiene

- grab bars and/or toilet safety frame

- beside commode or raised toilet seat

Grooming/oral hygiene adaptive equipment

- universal cuff to hold toothbrush, razor etc.

- Built up, angled, or long handled brushes/razors

-Faucet turners

- electric toothbrush, floss holder, water pik

Front 74

Self-Care Intervention: Adaptive Equipment

Back 74

Bathing/showering

- grab bars & non-skid mats

- tub transfers bench/shower bench

-shower commode chair

-hand held shower

- anti-scald valves and/or faucets

- built up angled, or longhandled bath sponge

Front 75

Self-Care Intervention: Adaptive equipment

Back 75

Dressing

-Reaching aid, dressing sticks & pants dressing poles

- built up, angled, or long handled shoe horn

- pull on clothing, Velcro type closures and/or front opening closures for clothing

-elastic shoelaces, slip on shoes

-button hook, zipper pulls & zipper loop or ring

-sock/stocking aid

Front 76

What considerations need to be remembered for play intervention?

Back 76

Provide opportunities for culturally relevant solitary play & environmental mastery

- Facilitate active participation in ca use and effect learning

- Provide opportunities to play with peers/siblings

- Provide toys/activities that are visually & auditorally stimulating.