Evaluation and Treatment Flashcards
Explain what makes an assessment effective
-Standardized, easy to use, has validity, has a baseline to refer to, reliable, can pick up on limitations, ecological validity intact
What is ecological validity?
How the assessment is compared to real-life environments, and situations
What are the two evaluation approaches?
Top-down (Functional) uses ADL’s or purposeful activities to evaluate why a task cannot be completed (performance components)
Bottom-up (Skill based) uses enabling activities to evaluate specific impairments
What are the advantages/disadvantages of using a top-down approach?
Advantages: related to a goal (ADL), High ecologic validity, provides pre/post-treatment data, demonstrated impact of impairment, context taken into account, Root of OT practice
Disadvantages: Requires training, observational/analytical skills, validity, and reliability may be poor if training is limited, test environment still not the real world
What are the advantages/disadvantages to using a bottom-up approach?
Advantages: easy to administer, easy to grade, can see pre/post results easily, focuses on diagnosing the impairment
Disadvantages: Poor ecological validity, can be costly, isolation for one skill in an attempt to diagnose but skills are not used in isolation, does not address context.
Name some limitations to Functional evaluations.
Environments are typically set up to optimize performance which can help the client but it is not really the same as them doing it at home. it is typically distraction-free, cues may be provided, time demands are minimized, and clients can receive clear repeated instructions.
What are common functional assessments?
- Activity analysis, helps to breakdown where performance is limited and what performance components are needed.
- Kitchen Task: Assesses level of cognitive support needed to complete cooking task
What is the OTA role in Cognitive Activity Analysis?
To use activity analysis to determine where barriers to independence are, what performance components are affected to direct treatment
Also can be used to determine a client’s progress
What are the common skill-based evaluations and what do they assess?
MMSE (Mini-Mental Status Exam)- orientation (3 p’s), registration, attention and calculation, recall, language.
MoCA (Montreal Cognitive Assessment)- Visuospatial and executive functioning, naming, memory (immediate and delayed), attention, language, abstraction, orientation
What does the delivery of cog-perceptual treatment require?
-Strong ability to grade up or down
-Sharp observation skills to monitor where challenges exist
-Understanding of the impact of context/environment
-Employing a client-centered approach
When is a remedial approach used?
When cognitive/perceptual recovery is anticipated
What are table top activities?
Typically enabling activities that focus on skills. they are repetitive, graded and scored to monitor progress
What are functional activities?
Functional activities focus on ADLs and is more meaningful to a client. They are repeated, graded and observed to monitor success. Emphasis is on the just right challenge for a client.
Bottom-up vs Top-down remedial treatment
Bottom-up treatment focuses on cognitive and perceptual performance skills using enabling activities.
Top-down treatment focuses on purposeful/functional activities to engage the client in ADL which are context-driven and will help improve performance with ADLs and skills
What Cog-perceptual skills are required to perform almost all ADLs?
-Short-term memory
-Problem-solving
-Sustained Attention
-Divided Attention
-Sequencing
