ASSESSMENT OF
OCCUPATIONAL
FUNCTION
CAMS
Majmaah University
LEARNING OBJECTIVES
O Understand the nature and importance of
Assessment in Occupational Therapy.
O Evaluate roles, competence and
occupational functioning, beginning with
clients perception of their occupational
performance issues.
O Understand the measurement criteria
necessary for reliable and valid
assessments for Occupational therapy
practice.
Assessing Roles & Competence
O INTRODUCTION:
O Occupational therapists provide services to
optimize the Occupational performance of
persons who have or at risk for developing
Occupational dysfunction.
O AOTA-2002 states , occupational
performance is the ability to carry out Basic
ADL and Instrumental ADL.
\
O The evaluation of occupational performance
often begins with a semi- structured
interview to assess the client’s need ,
problems, and concern regarding role
participation and competence in daily living
task & activities.
O Gather informations from client and family
O After identifying the clients areas of difficulty
in occupational performance appropriate
intervention is selected.
Measurement concepts
O Several Measurement concepts are used to
assess the role and competence in OT, but
these concepts should include standardized
measures with established reliability and
validity.
O Reliability- The ability of an assessment to
consistently measure performance and to
differentiate among clients under various
conditions.
O Validity- The extent to which an instrument
measures what it is intended to measure.
Semi- structured Interview
Assessments
O The therapists are advised to select the
standardized Semi- structured Interview
Assessments to identify occupational need
areas and , as well as direct measures of
abilities and skill during observation of task
performance.
O Widely used assessment-------Canadian
Occupational performance measure COPM.
Canadian Occupational performance
measure- COPM
O The COPM is administered in 4 steps
O 1. Problem definition
O 2. priority setting
O 3.Scoring
O 4.Reassessment.
O
Example of scores given:( scored on 1-10 scale)
Activity
problem
Importance
Performance
satisfaction
Preparing
sandwich
5
1
4
Assessing roles & Community
integration
O Community integration refers to ability of a person to
O
O
O
O
O
live, work and enjoy his free time within the
community setting.
The community Integration measure –CIM uses 10
item to gather qualitative information
Examples of items :
1. I move around my living quarters as I feel
necessary.
2. I feel that I can deal with life events as they
happen.
(each item is scored with 10 cm visual analogue)
Assessing Tasks and Activities
O The basic ADL , Instrumental ADL , work and
O
O
O
O
Leisure are assessed.
ADL- assessment:
1. BARTHEL INDEX- evaluates 10 activities ,
total score ranges from 0 to 100.
Score 100 denotes- total independence
Score 60 seems to be the transitional from
dependency to assisted independence.
O 2. Functional independence Measure (FIM):
O uses a 7 –point ordinal scale to evaluate
occupational performance for 18 items.
O It measures the severity of disability and not
the impairment.
O 3.Katez Index: evaluates six ADL
O 4. Assessment of Motor & process skills
(AMPS) :uses 4 point scale to assess,16
motor and 20 process skill items.
Assessing abilities and capacities
O 1. Range of Motion
O 2. Strength
O 3. Endurance
Range of Motion
O Assessed by Goniometry- using Universal
Goniometer.
O AROM & PROM should be measured.
O The therapist must place the axis and arm
appropriately to ensure accuracy and
reliability.
O Each measurement is accurately recorded
on ROM form with therapist signature and
date , as the medical record is a legal
document.
Universal Goniometer
Measuring edema
O Methods:
O 1. Circumferential measurement:
A millimeter tape is used, it is essential to measure at
exactly the same place from test to test. Figure of 8
technique is used for hand edema
O 2. Volumetric measurements:
When the hand is placed in a vessel, water is displaced
and spills out in a graduated beaker. An edematous
hand displaces more water. A micropipette was used to
measure the volume of water.
O Compare the values with the normal side.
Volumetric / Figure of 8 - measurement
Muscle Strength
O A maximum voluntary contraction (MVC) is
used.
O Break Test:
O The muscle to be tested is positioned at its
greatest mechanical advantage. Once the
extremity is positioned the patient is asked
to hold the position as the tester imparts an
external force to overcome the contractile
force of the muscle using his hand.
MUSCLE GRADING CHART
Grading Scale Range: 0 to 5
0
None
No visible or palpable contraction
1
Trace
Visible or palpable contraction with
no motion ( a 1 )
2
Poor
Full ROM gravity eliminated
3
Fair
Full ROM against gravity
4
Good
Full ROM against gravity, moderate
resistance
5
Normal
Full ROM against gravity, maximul
resistance
Measurement of Grasp & Pinch
strength
O Dynamometer is used
O Grasp – is measured by hand held
dynamometer.
O Pinch strength- PINCH METER.
Hand held Dynmometer
Measurement of Endurance
O Endurance is the ability to sustain effort and to
O
O
O
O
O
O
resist fatigue.
It is related to Cardiopulmonary and Muscular
Function.
Endurance can be measured dynamically and
statically
Dynamic assessments include:
1.No.or repetitions per unit of time
2.percentage of maximal heart rate generated
by an aerobic activity
3.MET metabolic equivalent
Assessing Motor behavior
O Evaluation s used by Neuro physiological
O
O
O
O
O
O
O
approaches,
1.Muscle Tone
2.Abnormal reflexes
3.Movement patterns
4.Postural control
5.Sensation
6.Perception
7.cognition
Muscle Tone Evaluation
O
Modified Ashworth scale : a qualitative scale to assess the degree of
spasticity
.
Score
0 (0)
1 (1)
1+ (2)
2 (3)
3 (4)
4 (5)
Ashworth Scale Modified Ashworth Scale Bohannon &
(1964)
Smith (1987)
No increase in toneNo increase in muscle tone
Slight increase in Slight increase in muscle tone,
tone giving a catch manifested by a catch and release or by
when the limb was minimal resistance at the end of the
moved in flexion or range of motion when the affected part(s)
extension
is moved in flexion or extension
Slight increase in muscle tone,
manifested by a catch, followed by
minimal resistance throughout the
reminder (less than half) of the ROM
(range of movement)
More marked
More marked increase in muscle tone
increase in tone
through most of the ROM, but affected
but limb easily
part(s) easily moved
flexed
Considerable
increase in tone - Considerable increase in muscle tone
passive movement passive, movement difficult
difficult
Limb rigid in flexion Affected part(s) rigid in flexion or
or extension
extension
Evaluation using Task -oriented
Approach
O 1.Role performance:
Identify past roles and whether hey can be maintained or
must be changed.
Determine how future role will be changed Eg. student,
volunteer.
2.Occupational Performance task: areas of occupation
BADL,IADL, Work, leisure
3. Task selection and analysis:
Performance components that limit occupation
O 4. Person: performance components
Cognitive, psychosocial, sensorimotor
O 5. Environmental – performance context
Physical, socioeconomic, cultural.
Sensation assessment
O Purpose of sensory evaluation in OT:
O
O
O
O
O
O
O
Assess type & extend of sensory loss
Evaluate and document sensory recovery
Determine impairment and functional limitation
Provide direction for OT INTERVENTION such as
1.Determine time to begin sensory reeducation
2.Determine the need for education to prevent injury during
occupation
3. Determine need for sensitization
Sensory Testing techniques
O 1. Touch Threshold :
Assessed using Semmes –Weinstein
monofilaments
O 2. Static two- point discrimination:
Assessed using AESTHESIOMETER
O 3. Vibration threshold:
Assessed using Vibrometer
Semmes –Weinstein
monofilaments
Sensory assessment tools
Aesthesiometer
vibrometer
Assessing visual Perception
O A basic eye history, including premorbid
visual conditions eg. Congenital strabismus,
trauma
O Interview with clients for symptoms
O Observation of clients during functional
activities
O Screening of foundation skills
Assessing Apraxia
O Apraxia is the inability to carry out skilled
movement in the presence of intact
sensation, movement and coordination.
O The widely used tool is FLORIDA APRAXIA
SCREENING TEST.
Assessing Cognition & function
O 1. Arnadottir OT-ADL Neurobehavioral
evaluation: examines ADL&
Neurobehavioral dysfunction.
O 2. Rabideau Kitchen Evaluation: evaluation
in context with meal preparation.
O 3. Kitchen task assessment: measures the
cognitive support necessary for the patient
to prepare cooked pudding.
O 4. Work simulations
Assessing context : Personal , social
and cultural
O PERSONAL: Age, gender identity, values &
preferences, spirituality ,coping style,
cultural identity, Fatigue, Pain, mood
O Social: social class, social network, social
role expectations
O CULTURAL: values, behavior of broader
community
Pain Assessment
O Two subjective measures of pain
O 1. McGill Pain questionnaire- short form
measures pain and response to pain
interventions.
There are 15 descriptors, rated on 0 to 3
intensity scale
O 2. Visual Analogue scale: It’s a 10 cm line
Assessing Home, Community &Work
place access
O To identify and evaluate barriers that challenge the
O
O
O
O
O
O
O
competency and ability of individual to carry out their chosen
occupation and roles.
To identify and evaluate resources that will support
occupational performance & functioning
To develop strategies to eliminate or ameliorate barriers.
ASSESSMENT & REFERENCE:
1. ADA: Americans with disability act------ provides information
and technical assistance for accessible designs.
2. Adaptive environment Human- centered design:
provides access to universal design
3. FAIR Housing FIRST: GUIDES TO IMPLEMENT fair housing
act amendments.
Work site Assessment
O
O
O
O
O
O
O
O
O
O
Preparing For a site visit:
1. Description of Job Eg.duties & responsibilities
2. Description of Work site/ work station
3. Consent of employer
4. Understanding worker and employer perspectives
eg.expectations,issues
5. Arrangements of visit
6. Presence of a contact person during visit eg. Supervisor
7. Activities & safety concern
8.Assesment forms / charts for recording
9. Consideration of contribution from second personPhysiotherapist
Conclusion
O The use of well- validated standardized
instruments help us to obtain the reliable
and valid data. Efficient assessment
procedures are the key for efficient
treatment skills.