Chapter 15 Evaluation and Intervention for Performance in areas of occupation

Question 1

Definitions of ADL

1. BADL
2. IADL

Answer 1

1. BADL - includes self-care tasks such as grooming, oral hygiene, bathing/showering, toilet hygiene, dressing and eating
2. IADL - home management tasks, shopping, money management, meal prep, and community mobility.

Question 2

focus of OT eval for occupational performance

Answer 2

must focus on the individual’s ability to perform meaningful occupations that are NEEDED and DESIRED by the INDIVIDUAL

Question 3

Should assessments follow a “top down” progression or a “bottom up” progression.

General process of evaluating Occupational performance

Answer 3

• Use top down approach to address areas of occupation rather than focusing on performance skills.
• create an occupational profile, understand occupational history, experiences, patterns of daily living, interests, values
• Next examine client factors, performance skills, patterns and contexts, and activity demands
• Followed by observation of the person’s actual performance of an activity in context or simulation of activity

Question 4

Scales to measure functional performance

1. Total assistance
2. Maximum assistance
3. Moderate assistane
4. Minimum assistance
5. Standby Assistance
6. Independent

Answer 4

1. Total - need for 100% assistance by one or more persons to perform all physical activities and/or cog assitance to elicit a functional response to an external stimulation
2. Max - need for 75% physcial, cog assitance to perform gross motor function in response to direction
3. Mod - need 50% assistance
4. Min - need 25% assistance
5. SBA - need for supervision, safety precautions are not always anticipated by the patient.
6. Independent - no physical or cog assistance required.

Question 5

General progression of Intervention for Occupational performance

Answer 5

• first understand person’s prefered occpational history
• eval performance skills preventing full particilatioin in prefered occupational performance.
• specific interventions to remediate, alleviate, or compensate for effects of performance skill deficits and client factors on occupational performance
• for skills that cannot be remediated, recommend adaptive strategies or adaptive equipment that compensate for deficits.
• Training in adavitive strategies to enhance performance must consider the person’s privacy and dignity.

Question 6

Factors to consider when recommending adaptive strategies

Answer 6

• What is important to the individual wabout the task?
• Is the strategy viewed as compatible with the particual social context?
• Does the strategy enhance the individual’s sense of personal control?
• Does the strategy minimize the effort?
• Does the strategy interfere with social opportunities or diminish the presentation of self?
• Is the recommended strategy temporally realistic given the context
• Does the strategy provide for safety?

Question 7

Assessment of Motor and process skills (AMPS)

Answer 7

• Focus - assessment of effectiveness, efficiency, safety of person’s ADL task performance, including personal activities of daily living and IADL.
• Population - anyone with developmental age older than 2 with any diagnosis that causes functional limitation in ADL
• Interpretations - score interpretation enables the therapist to determine the following: nature of individual’s difficulty in task performance, level of task challenges a person can manage, the quality of change in ADL performance after intervention

Question 8

Barthel Index

Answer 8

• Focus - measurement of a person’s ind in basic ADL and functional mobility before and after intervention and the levle of personal care needed by the individual. 10 Areas covered: feeding, transfering, hyginee and personal grooming, toileting, control of bowel and bladder, bathing, dressing, walking, negotiating stairs.
• Population - adults and elders with PHYSICAL disabilities and/or chronic illnesses, typically used in the medical model
• Interpretations - max score is 100, indicating complete independence for all 10 areas. Scores can inform decisions for need for personal assistance.

Question 9

Cognitive Performance Test

Answer 9

• Focus - assessment of 6 functional ADL tasks that require cognitive processing skills based on allen’s cognitive level theory. dressing, shopping, meal prep (making toast), making a phone call, washing, traveling
• Population - adults and elders with PSYCIATRIC and/or cognitive dysfunction
• Interpretations - Level 1 represents the lowest functional level and 6, the highest. Possible range of scores 6-36. Scores used to determine a person’s capabilities an dnees in other ADL taks and ability to live independently.

Question 10

Kohlman Evaluation of Living Skills (KELS)

Answer 10

• Focus - Determination of an individual’s knowledge and/or performance of 17 basic living skills needes to live independently in 5 main areas: self-care, safety and health, money management, transportation and telephone, work and leisure
• Population - Originally designed fo radolescents and adults in acute psychiatric hospitals but has since expanded to elders and those with diverse diagnoses.
• Interpretation - for each of 17 items a sore of “ind” or “needs assistance” given. N/A is given if test item does not apply to client (ie not doing bills). a score of 5 1/2 or less indicates presence of skills for independent living. 6 or more indicates absence of skill. Score results can provide general overview of functional levle and give baseline for further eval and intervention.

Question 11

ADL intervention

• Determining factors for modification of activity -
• Determining factors for elimination of activity -

Answer 11

• Modification of activity - activities are valued, meaningful, enjoyable and are related to desired role performance. Modification for individual performance should also provide appropriate supports as needed (adaptive equipment)
• Elimination of actiivty - activities that are difficult to perform and are not enjoyable can be eliminated or provided assistance from others.

Question 12

Self care intervention for ADLs

• Adaptive strategies for
  
  • toileting/toilet hygiene
  • grooming/oral hygiene
  • bathing/showering
  • Dressing
  • feeding/eating
  • medication management

Answer 12

• toileting/toilet hygiene - Grab bar, toilet frame, 3:1 commode, bowel training device, skin inspection mirror, toilet paper holder
• grooming/oral hygiene - Universal cuff to hold grooming tools, built up handels, angled or long-handled brushes, faucet turners, electric toothbrush,
• bathing/showering - grab bars, non skid mand, tub transfer bench/shower bench, anti-scald valves and faucets. built-up, angled and long handeled bath sponge.
• dressing - reachers, dressing sticks, pants. built-up handles. pull on clothing, velcro closures, front opening closures. elastic shoelaces, button hood, sock/stocking aid.
• feeding/eating - adapted nipples and bottles for infants, scoop dish, plate guards, built or long handled up angled, rocker knife, adaptive cups or angled straws.
• medication management - pill organizers, medication minders, easy open non child proof medication bottles.

Question 13

Naming of Spinal chord injuries

Answer 13

• In Rehab, Spinal cord injuries are defined as the lowest spinal segment with normal function. ie a C6 spinal cord injury will retain the motor functions that C6 is responsible such as wrist extension and elbow flexion.

Question 14

SCI levels and Self-Care abilities

• C1-C3
• C4
• C5
• C6
• C7
• C8-T1
• T6-L4

Answer 14

• C1-C3 - totally dependent in self-care abut can instruct others in preferences for care. can chew and swallow
• C4 - Total dependent in self -care can drink from a glass with a long straw and instruct other in preference for care
• C5 - Feeding requires assistance. adaptive equipment used: mobile arm support, dorsal wrist splint, with universal cuff, sycem for antislip, angled utensils. dressing: dep for LBD and min/mod A for UBD.
• C6 - Feeding - ind with adaptive equipment such as rocker knife, large handled cups, utensils, tenodesis splint, universal cuff. Dressing - ind in LBD when performed in bed. max assist with socks and shoes, ind with UBD using button hook and zipper pull. Min assist bathing with tub bench and sliding board transfer. Ind with grooming with tenodesis grasp or splint
• C7 - ind feeding, ind dressing, may need button hook, bathing min assist with tub bench and sliding board and depression transfers. ind with grooming with tenodesis grasp or splint
• C8-T1 - Ind self care, performs depression transfers, can transfer from wheelchair to floor and back with standby assist.
• T6 - L4 - ind in all self care

Question 15

ADL Intervention Self-Care

Method of practice to attain proficiency in activity performance

Answer 15

• Train in use of adaptive equipment.
• provide verbal prompts, nonverbal gestures, written directions, physical prompts, hand-over-hand,
• educate and train caregivers, teach organization strategies,
• have patient direct/train caregiver on personal care

Question 16

Sexual Expression/Activity Intervention

PLISSIT model

Answer 16

• P - Permission. the therapist creates an atmosphere which gives the individual permission to raise concerns about sexualitiy/sexual activity. incorporating sexuality in a matter-of-fact manner. refer pt to a team memeber who is comfortable with addressing the individual’s concerns
• LI - limited information is provided by therapist to ensure that individual has accurate knowledge about sexual abilities. dispell myths about sexual expression. share facts
• SS - Specific suggestions are provided by therapist to facilitate the individual’s pursuit of sarisfying sexual expression either alone or with partner. making suggestions specific to client’s abilities, positioning alternatives and adaptive equipment, energy conservation methods, catheter care, hygiene concerns, skin integrity
• IT - Intensive therapy required for intervention for long-standing relationship problems, need to refer to a marriage counselor or sex therapist.

Question 17

Misconceptions about sexual expression/activity

Answer 17

• Myths:
  
  • eldery and disabled individuals are asexual and have less interest in sexual expression
  • are physically unattractive and not desirable as a sexual partner
  • inherently have poor judgement and cannot make appropriate decisons
  • cuddling, oral sex, caressing are not adequate sexual activities.
  • individuals who live in shared residential settings(group homes, nursing homes, assisted living facilites) are asexual
  • elder and disabled individuals who desire or engage in sex are inappropriate and oversexed.

Question 18

Performance In areas of occupation

Parenting ability eval

Answer 18

• Determine ability to care for child’s
  
  • physical needs
  • emotional needs
• Determine knowledge of child’s developmental level and its corresponding play and communication level.

Question 19

Parenting Ability Intervention for person with disability

Answer 19

• Educate parent about normal develpmentla roles
• educate/practice use of adaptive equipment as it pertains to roles of parenting (ie adapted adjustable height crib, pillow to support breast feeding, light weight/angled bottles, velcro fasteners, baby furniture that matches parent’s capabilites)
• Arrange tasks that are accessible to the child. teach child self-reliance (ie move clothes from laudry to dryer)
• modify environment to maximize parentign task performance and ensure safety of parent and child.

Question 20

Play/Leisure intervention

Developmental considerations for play interventions

Answer 20

• Provide opportunitis for culturally relevant solitary play and environmental play.
• facilitate active participation in cause and effect learning
• provide opportunites for play with siblings and/or peers.
• provide toys that are stimulating

Question 21

SCI levels and play/leisrue abilities

• C1-4
• C5
• C6-7
• C8-T1

Answer 21

• C1-4 - Can play computer games and access the internet usign a moithstick, head pointer or voice activation. can use mouthstick, headpointer, electronic page turning to control art tools, electronics, ECU
• C5 - Can independently play computer games, access internet, use speakerphone, ECU. use universal cuff for typing or crafts
• C6 -7 - Can hold a phone, typing stick, pen with tenodesis grasp. can play board games and some wheelchair sports.
• C8-T1 - Can do the save activies as C& but easier performance due to good functional use of UE.

Question 22

Work evaluation assessments

Answer 22

• Evlauate deficts in Occupational performance areas/ performance components that could impact work abilites and potential.
• Gather relevant work, education, social and med history
• Identify prevocational interest through use of interest inventories or structured interviews.
• Determin if individual can return to past employment, identify supports, limitations, barriers, and reasonable accommodations

Question 23

Work Intervention Guidelines

• Adaptation
• Practice
• educate
• follow up

Answer 23

• Adaptation - eval site and adapt environment and job task to enable individual to perform tasks for job function. Provide assistive devices, strategies (adaptive computers, typing aids, universal cuff, etc)
• Practice/modify work activities.
• Educate about work safety, injury prevention, educate employer about reasonable accomodations to enable performance of essential job functions. Educate family about capabilities. Explore alternative sot competitive work if it is not an attainable goal.
• follow up - provide counseling, work support group, psychosocial clubhouse as needed

Question 24

Work intervnetions for cumulative trauma such as carpal tunnel syndrom and low back pain

Answer 24

• avoid static position, repetition, awkward postures, forceful exertions, and vibrations
• design workplace and work station to be ergonomically correct to prevent trauma

Question 25

Work intervnetions for psychosocal and cognitive deficits

Answer 25

• Engage person in program suitable to functional vocational abilities

Question 26

Seated ergonomics

Answer 26

Question 27

Standing work Ergonomics

Answer 27

Question 28

Specific work Programs

• Work Hardening Program
• Work conditioning
• Ergonomic program

Answer 28

• Work Hardening Probram - interdisciplinary approach, real or simulated work activities used, transitions patient from acute care to return to work, issues of productivity and safety, physical tolerance and worker behaviors
• Work Conditioning program - one discipline is provider of services, real or simulated work activities are used, address flexibility, strength, movement, and endurance.
• Ergonomic - prevention is main focus of program, specific job site analysis, manager, employee training, educational seminars, exercise and stretching programs

Question 29

Dishcharge criteria from work program

Answer 29

• 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.