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Content: ADL apartment on a rehabilitation unit to simulate the person's home)
-In the OT Practice Framework, this part of the evaluation process is called an analysis of occupational performance
Occupational performance assessment tools
-Include interview,s, checklists, task performance, rating scales, and standardized instruments
-Interpretation of occupational performance assessments that are used to determine a person's ability to live independently must be made cautiously due to the self-report and/or simulated nature of certain items and the limited number of items tested in many evaluation tools
-Many assessments used to measure occupational performance provide a determination of the person's level of functional performance along a level of assistance continuum
Scales to measure functional performance
-Total Assistance: the need for 100% assistance by one or more persons to perform all physical activities and/or cognitive assistance to elicit a functional response
-Maximum Assistance: the need for 75% assistance by one person to physically perform any part of a functional activity and/or cognitive assistance to perform gross motor actions in response to direction
-Moderate Assistance: the need for 50% assistance by one person to physical activities or provide cognitive assistance to sustain/complete simple, repetitive activities safely
-Minimum Assistance: the need for 25% assistance by one person for physical activities and/or periodic, cognitive assistance to perform functional activities safely
-Standby Assistance: the need for supervision by one person for the patient to perform new activity procedures that were adapted by the therapist for safe and effective performance. A patient requires standby assistance when errors and the need for safety precautions are not always anticipated by the patient
-Independent Status: no physical or cognitive assistance is required to perform functional activities. Patients at this level are able to implement the selected course of action, consider potential errors, and anticipate safety hazards in familiar and new situations
General intervention guidelines for performance in areas of occupation
-Intervention should follow a "top-down" progression of considering the person's areas of occupation first rather than a "bottom-up" approach which focuses initially and/or solely on performance skills and client factors
-The impact of performance skill deficits and client factors on occupational performance is considered after the establishment of individual's desired occupational outcome
-Specific interventions to remediate, alleviate, and/or compensate for the effects of performance skill deficits and client factors on occupational performance are often required
-The focus of remediation interventions for performance skill deficits and client factors must be related to the individual's ability to perform meaningful occupations that are needed and desired by the individual
-Intervention for deficits that cannot be remediated should include recommendations for adaptive strategies and/or adaptive equipment that compensate for the deficits and ease performance in areas of occupation
-Strategies that can be generalized to different situations are particularly helpful (eg. principles of energy conservation)
-Multiple factors should be considered when recommending adaptive strategies (these factors are also relevant to consider when selecting adaptive equipment)
-Training in adaptive strategies and/or equipment used to enhance performance must consider the person's privacy and dignity (this is especially critical in interventions for the performance of PADL)
Factors to consider when recommending adaptive strategies
-What is important to the individual about the task?