Rehabilitation Assessment

1
Rehabilitation Assessment Clinical
ReasoningOccupational Therapy

• Jutta Hinrichs, BScOT
• CMSC Conference 2004
• Toronto, Ontario

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Occupational Therapy

• The art and science which utilizes the analysis
  and application of activities specifically
  related to occupational performance
• Is a client-centered practice
• Is described as promoting health by enabling
  occupation

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Occupation

• Occupation is used in the broadest sense
• Derived from the Latin word occupatio, meaning
  to occupy or to seize
• Occupations are activities or tasks which engage
  our resources of time and energy
• Self Care (looking after oneself and residence)
• Productivity (contributing to the social and
  economic fabric of the community)
• Leisure (enjoying life)

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Enabling Occupational Performance

• Enabling occupational performance means
  collaborating with people to choose, organize,
  and perform occupations which are meaningful or
  useful in a given environment
• Occupational performance is the result of a
  dynamic relationship between persons,
  environment, and occupation over a persons life
  span

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Model of Occupational Performance
Environment
Cultural
Institutional
Affective
Self Care
Productivity
Social
Spirituality
Physical
Physical
Cognitive
Leisure
Person
Occupation
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What do I screen for?

• Are there occupational performance issues for OT
  to address?
• Change in roles
• Ability to fulfill productivity roles
• Change in ability level
• Ability to perform self care routines
• Ability to engage in activities for enjoyment

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What do I screen for? (cont.)

• Are there performance components affecting
  function?
• Any underlying changes in impairments?
• Fatigue
• Cognition
• Physical status (tone, ROM, muscle strength,
  sensation, coordination primarily for U/E)
• Other symptoms affecting abilities?

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What do I screen for? (cont.)

• Are there environmental issues that need to be
  addressed?
• Physical environment barriers
• Social support systems available
• What are the patients/families concerns and
  goals?
• Level of comfort/discomfort with changes
• Their values/hopes
• Their readiness to make changes

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Other screening considerations

• Any previous rehabilitation?
• Involvement of other team members/need to refer
  to other team members?
• Practice setting?
• Potential time available?

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Screening Tools

• Review of medical record
• Interview (client and family reports)
• Questionnaires
• Observation

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Comprehensive Assessment

• Based on the screening, which areas require more
  indepth information/testing?
• Where do I need to target my interventions?

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Self Care Assessment

• Personal care (feeding, bathing, grooming,
  dressing, toileting)
• Community management (shopping, finances,
  transportation/driving)
• Functional mobility (transfers, current aids used
  - home and community, seating and positioning
  needs)
• Functional communication (writing or computer
  use, telephone use)

13
Productivity Assessment

• Paid or unpaid work (job, volunteer work, school,
  etc)
• Household management (cleaning, laundry, cooking,
  etc)
• Child Care/Parenting

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Leisure Assessment

• Activities enjoyed previously and currently
• Socialization (visiting, phone calls,
  correspondence, etc)
• Quiet recreation (hobbies, reading, crafts, etc)
• Active recreation (sports, outings, travel, etc)

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Assessment of Environment

• Physical environment possible barriers
• Consideration of social support systems available
• Consideration of cultural factors

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Fatigue Assessment

• MS fatigue
• Other factors contributing to fatigue
• Impact of fatigue
• Expectations for self

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Cognitive Screening

• Primarily assess functional cognition
• Attention
• Ability to follow directions
• Memory difficulties
• Executive function
• If more indepth assessment needed then refer on
  to Neuropsychology

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Assessment of Physical Status

• U/E tone
• U/E ROM
• U/E strength
• U/E sensation
• U/E coordination
• Functional balance (more of a screen)
• Pain (more of a screen)
• Often work together with PT on this area

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How do I use the assessment data?

• To decide on approach to treatment
  (restoration/remediation, adaptation,
  compensation)
• To determine at which level I intervene
  (impairments, occupational tasks/abilities,
  participation/roles)
• To make recommendations (eg, referrals, workplace
  accommodations, followup care)

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Functional assessment tools

• That I use
• Canadian Occupational Performance Measure (COPM)
• Functional Independence Measure (FIM)
• Multiple Sclerosis Self Efficacy Scale (MSSE)
• Doron Simulator
• Interview/observation

• That others use
• Functional Assessment Measure (FAM)
• Kohlman Evaluation of Living Skills (KELS)
• Self Reported Functional Measure (SRFM)
• Worker Role Inventory Checklist

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Environmental/Community assessment tools

• That I use
• Home assessment form developed by our Home
  Service OT

• That others use
• Reintegration to Normal Living Index
• SAFER

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Fatigue assessment tools

• That I use
• Daily activity diary
• Fatigue questionnaire
• Fatigue Impact Scale (FIS)

• That others use
• Modified FIS
• Fatigue Severity Scale (FSS)
• Fatigue Assessment Instrument (FAI)

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Cognitive assessment tools

• That I use
• Cognistat
• Rivermead Behavioural Memory Test (RBMT)
• Cognitive Competency Test (CCT)

• That others use
• Behavioral Assessment of Dysexecutive Syndrome
  (BADS)
• Pepper Visual Skills for Reading Test
• Test of Directed Attention

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U/E measurement tools

• That others use
• Jebson Hand Test
• U/E Performance Test for the Elderly (TEMPA)
• Arm Motor Ability Test (AMAT)
• Action Research Arm Test
• Purdue Pegboard
• Arthritis Hand Function Test
• Box and Block

• That I use
• Nine Hole Peg Test (9-HPT)
• Manual Muscle Test
• Dynamometer
• Pinch meter
• Sensation kit
• Handwriting sample