UNIT 10

activity limitations

Dysfunctions in ADLs and IADLs are termed

ADLs

are defined more narrowly as “activities that are oriented toward taking care of one’s own body”

IADLs

are defined as “activities that are oriented toward interacting with the environment and that are often com plex in nature”

AADL

also been used in different ways by various authors, for example, to capture activities that are more physically strenuous than IADLs

or to refer to activities that are “volitional” rather than essential

Evaluation

refers to the overall process of gathering and interpreting data needed to plan intervention, including developing an evaluation plan, implementing the data col lection, interpreting the data, and documenting the eval uation results

Assessment

refers to the specific method that is used to collect data, which is one component of the evaluation process (

Supported living

represents a continuum of options that includes in-home services, personal care assistants, assisted living centers, foster homes, group homes, independent living centers, supervised apartments, transitional apart ments, and long-term care facilities.

operational definition

; that is, the occupational therapy practitioner and client must be clear on the precise meaning of each term.

Barthel Index

to assess feeding, clients are rated “independent” if they can feed themselves, “needing assistance” if they can get food from the plate to the mouth but need help cutting food

Katz Index of ADLs

does not include preparation of food on the plate, clients are rated independent if they can get food from the plate to the mouth, even if they cannot cut food or butter bread

IADL Scale

generally considered to be the prototype assessment ins trument for IADLs, the highest level of competence is described as “plans, prepares, and serves adequate meals independently”

Nottingham Extended ADL Index

examine the ability to make a hot drink and hot snack alone and easily

independence, safety, and adequacy

Performance parameters are

Independence

is the performance parameter that is the focus of most assessment tools,

Arthritis Impact Measurement Scale

was developed for adults with rheumatic diseases and includes not only measures of ADL and IADL performance, but also symptoms that are commonly experienced by people with arthritis during or following activities, such as pain and fatigue

Nonstandardized assessments

lack testing of psychometric properties, such as reliability, validity, or sensitivity to change in a client’s status

norm-referenced testing

is to compare a client’s performance on a test to that of other people on the same test

criterion-based testing

compare a client’s performance to a performance standard

Criterion referenced tests

stress activity mastery and address ques tions such as “Can clients perform all activities, or procure the services, needed to live in the community on their own?”

often incorporate activ ity analyses, and the degree of structure that is imposed on testing is usually more flexible than those for norm referenced testing, allowing therapists to tailor tests appro priately.

descriptive approach

that is, the salient characteristics of clients’ activity perfor mance are observed or obtained through client or care giver descriptions.

Standardized quantitative measures

include instructions for the person who is complet ing the assessment, which makes the assessment more reliable when the tool is used for reassessment or when there are multiple therapists in a facility.

moderate assistance

could be interpreted in a number of ways, but if it is specifically described as “The patient requires more help than touching, or expends between 50 and 74% of the effort”

Quantitative methods

provide a more efficient way to document progress, although it might not provide the reader with adequate information.

Questioning

is also the data gathering method of choice when information is needed about daily living habits—that is, about what clients usually do on a daily basis—or to learn about clients’ ADL and IADL experience.

Assessment of Living Skills and Resources (ALSAR)

Interview with guiding questions; uses a three-point ordinal scale

Assessment of Motor and Process Skills (AMPS)

Interview to identify 2 or 3 tasks for performance testing; activities rated on 16 motor skills and 20 process skills; uses a four-point ordinal scale

Canadian Occupational Performance Measure (COPM)

Self-report using a semi structured interview; problems identified by client are rated for importance; the five most important problems are rated for both performance and satisfaction

Functional Independence Measure (FIM™)

Observation by a trained observer; uses a seven-point ordinal scale, grading amount of assistance needed by clients to complete activity

Independent Living Scale

Observation over the course of a week (needed for mea suring initiation and aberrant task behaviors). Data may be supple mented by other team members.

Kohlman Evaluation of Living Skills (KELS)

Combination of inter view and perfor mance; uses a three point ordinal scale.

Melville-Nelson Self-Care Assessment

Performance-based. Tasks are rated on two scales: how much the client does and how much/ what type of assistance is given. Client performance rat ings are made for subtasks and sub subtasks to help with planning intervention

Minimum Data Set

Performance, ascer tained from multiple health care profes sionals, over all shifts during past 7 days; activities rated for self-performance and support provided

Milwaukee Evaluation of Daily Living Skills (MEDLS)

Screening, based on information from clients, clients’ fami lies, health care team, and medical record to determine items to be exam ined; in examina tion, activities are performed, simu lated, or described

Outcome and Assessment Information Set (OASIS)

Data may be obtained through various methods (observa tion, client or proxy report); ratings are differentiated by task characteristics; scale varies from item to item

Pediatric Evaluation of Disability Inventory (PEDI)

Report of clinicians or educators who are familiar with the child or through parental interview. The PEDI is a normed test.

Performance Assessment of Self-Care Skills (PASS)

Performance-based observational tool that yields summary scores of activity independence, safety, and adequacy; uses a four point ordinal scale

Wee FIM IISM

Observation, interview, or both; uses same rating system as FIM™; scores range from 18 (total dependence) to 126 (complete independence)

Reliable assessments

enable practitioners to trust that differences in scores measured at different times represent true changes in ADL or IADL status and that reassessments done by another clinician can be reli ably compared to a client’s prior scores

COPM

gathers descriptive data, as an informal interview does, but also includes reliable and valid quantitative measures of clients’ self-reported performance ability and satisfac tion on client-selected occupational performance tasks

Performance of Self-Care Skills (PASS)

uses a standardized approach to assessing a number of ADLs and IADLs, often by structuring observations of key elements of a task, such as sweeping up cereal placed on the floor by the therapist rather then having to observe the client sweep the entire kitchen

Fatigue

the sensation of tiredness that is experienced during or following an activity, and dyspnea, difficult or labored breathing, can interfere with activity performance

degree of performance

how well or at what level the identified behavior will be done, sometimes referred to as the

initiation of a task, continuation of a task, and completion of a task.

Independence in activity performance may be divided into three phases:

ALTER THE TASK METHOD

task objects and contexts are unchanged, but the method of performing the task is altered to make the task feasible given the client’s impairments.

ADAPT THE TASK OBJECTS OR PRESCRIBE ASSISTIVE DEVICES

objects that are used for the task may be altered to facilitate performance.

family

, defined, as “a group of people living together or in close contact to take care of each other and provide guidance for their dependent members,” is the center of the ecological sys tem, supporting the growth of family members

“developmental niche,”

for understanding how cultural settings influence children’s lives, including their daily activities. In this framework, the cultural constructed envi ronment of the child is conceptualized as including three interrelated operational subsystems:

(1) the physical and social setting where the child lives,

(2) culturally regulated customs of child care and childrearing, and

(3) the psy chology of the caretakers.

Customs

refer to techniques of protecting, teaching, and socializing that are so commonly used by members of the community and are so thoroughly integrated into the larger culture that caretakers do not need to give them conscious consideration.

natural way to do things.

Nurturance or fostering of growth

refers to developing a child’s body and spirit.

Parenting Stress Index

Parent characteristics such as competence, isolation, attachment, health, role restriction; child characteristics such as distractibility/ hyperactivity, adaptability, demandingness; overall family stress

Parenting Sense of Competence Scale

Parenting self-esteem, parenting efficacy, and parenting satisfaction

Family Environment Scale

Dimensions of family environment, including quality of relationships within the family, opportunities for personal growth, and degree of organization/control within family

Family Support Scale

Perceived helpfulness of partner/spouse support, informal kinship support, formal kinship support, social organizations and professional services, total number of sources of support, and overall social support

Home Observation for Measurement of the Environment Inventory

Quality and quantity of psychological stimulation and cognitive support available in the home; four versions for children from ages 0–3, 3–6, 6–10, and 10–15 years are available

Beach Center Family Quality of Life Scale

Perceived importance of and satisfaction with family interaction, parenting, emotional well-being, physical/material well-being, and disability-related supports

Caregiver Strain Index

Perceived strain related to caregiving and impact on caregiver’s employment, finances, physical and social well-being, and time use

Caregiver Well-Being Scale

Caregiver well-being from a strengths-based perspective, assesses caregivers’ basic human needs and satisfaction with activities of daily living

Zarit Burden Interview

Perceived burden among family caregivers of older adults with dementia

Perceived Change Index

Brief, 13 items, perceived change in well-being in affect, somatic, and ability to manage

Caregiver Well-Being Scale

Extent to which caregiver’s basic human and activity of daily living needs are met

Bakas Caregiver Outcome Scale

Changes in caregiver’s social functioning, subjective well-being, and physical health as a result of caregiving

Task Management Strategy Index

Caregiver’s use of strategies to simplify everyday self-care tasks for people with Alzheimer’s disease and related disorders

Through the Looking Glass

, a community based nonprofit organization in Berkeley, California, that provides services to parents with disabilities, have developed resources and training materials on adaptive baby-care equipment for parents with physical disabilities

ParentingWell® Strengths and Goals form

which practitioners can use together with parents to help parents identify things that they do well, to determine the things that parents would like to do better, and to set priorities for change.

Home Environmental Skill-Building Program

, a skills training intervention to help families manage dementia care problems at home.

Section 504

supports reasonable accommodations for individuals with a disabil ity, a history of a disability, or a perceived disability if accommodations are needed to allow the individual to par ticipate in educational settings.

ADA

is a civil rights act and provides protection to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion.

supports the right of individuals with disabilities to have equal opportunities to live, work, and play within society

Education for All Handicapped Children Act (EHA) 1975

required states to provide special education and related services, including occupa tional therapy, to all eligible children ages 6 through 21.

EHA 1986

added services for preschoolers (ages 3 to 5 years), and provided incentives for states to develop statewide systems for pro viding early intervention services to infants, toddlers, and their families.

1990

what year EHA was renamed the Individ uals with Disabilities Education Act, or IDEA

response to intervention

increased the emphasis on pre referral intervention or early intervening services (com monly referred to as

Early intervening services:

Academic and behavior support to succeed in general education but is not part of special education.

Free Appropriate Public Education (FAPE)

Special education and related services provided at public expense that meets the standards of the state education agency (SEA).

General education

The environment, curriculum, and activities that are available to all students.

General education curriculum

The same curriculum as for nondisabled children.

Individualized Education Program (IEP)

A commit ment of services that ensures that an appropriate program is developed that meets the unique educa tional needs of children ages 3–21.

Individualized Family Services Plan (IFSP)

A commit ment of services that ensures that an appropriate program is developed that meets the unique devel opmental and preeducational needs of children 0–3 and their families.

Least Restrictive Environment (LRE)

The environment that provides maximum interaction with nondisabled peers and is consistent with the needs of the child/ student.

No Child Left Behind

P.L. 107-110, aimed at improv ing the educational performance of all students by increasing accountability for student achievement. Emphasizes standards-based education reform with the belief that high expectations will result in suc cess for all students.

Related services

transportation and such developmen tal, corrective and other supportive services (includ ing speech-language, audiology, psychological, and physical and occupational therapy services) needed to help the child benefit from special education.

Response To Intervention (REI)

An integrated approach to service delivery that includes both general and spe cial education and includes high-quality instruction, interventions matched to student need, frequent progress monitoring and data-based decision making.

Special education:

Specially designed instruction at no cost to parents to meet the unique needs of a child with a disability.

response to intervention (RtI)

defined as services that are provided for students, not in special education, who need “additional academic and behavioral support to succeed in a general education environment”

integrated approach to service deliv ery that includes both general and special education and includes high-quality instruction, interventions matched to student need, frequent progress monitoring, and data based decision making

the team defines the problem, analyzes what is hap pening, develops a plan, and evaluates the effectiveness of the plan.