Reflections Week 2 OTR 615 Chapter 3-5

Occupational therapist engage with people as patients, clients, students, workers, and family members, in a range of environments such as hospitals, day centers, schools, the workplace and the home. Hence, occupational assessment becomes paramount to investigate the full impact of cognitive deficits upon the life of the affected individual, and also upon the people he/she relates and interacts with.

Information Gathering Gain understanding of clients strengths and limitations Review of medical record Informal interviews with client and or family/caregivers Administration of standardized assessments Administration non-standardized assessments, behavior observations, and conduct hypothesis testing using functional activities Conduct site visits at the client’s home, workplace or both Testing refers to the measurement of a client's capacity or ability Evaluation refers to the meaningful interpretation of these finding

Standardized Assessments Provide a uniform procedure to administer and score the assessment Provides normative data that allows us to compare the scores with the scores obtained by representative groups from the population Reliability and validity provided by the assessment manuals in promoting specific procedures and formal basis for interpreting results Standardized assessment communicate to other peers the clients strengths and limitations Standardized test should be used responsibly

Non-Standardize Assessments Do not have a uniform procedure for administration and scoring Cannot be relied on to accurately measure change in client performance over time Cannot be relied on determining effectiveness of a therapy program

Tabletop Assessments and Checklist Bottom-up approach to assessment The assessment of Unilateral neglect Draw-The-Clock Test Crossing out letter test Human Figure or Face Test Alternating Simultaneous Stimuli Test Solet Test of Apraxia Self Awareness Questionnaire

Hypothesis-testing Approach to Evaluation Non-standardized approach The aim of the hypothesis-testing approach is… Gather detailed knowledge of the impact and problems Understand variables impacting client performance Type of therapeutic input and structure facilitating client performance Information for the therapist to use to determine which cognitive or perceptual problems are impeding performance in daily living activities

Stages of Hypothesis approach Client Observations and Identification of Problem Areas Analysis of Client Strengths and Weaknesses Hypothesis Formation Activity Selection and Analysis Activity analysis Hypothesis testing Client variables Environmental variables Task variables Therapist variables Hypothesis Confirmation or Disconfirmation Behavioral Goal and Objective Writing

Review of Standardized Assessments The Arnadottir Occupational Therapy Neurobehavioral Evaluation (A-ONE) The Structured Observational Test of Function (SOTOF) The Assessment of Motor and Process Skills (AMPS) Allen Cognitive Level Test (ACL) Chessington Occupational Therapy Neurological Assessment Battery (COTNAB) Rivermead Perceptual Assessment Battery (RPAB) The behavioral Inattention Test (BIT) Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) Rivermead Behavioral Memory Test (RBMT)

Problem areas and Writing goals Generate a list of strength and problems Problem list is prioritized to reflect clients goals Goals and objectives should reflect the client’s strengths, problems, prognosis, and expected level of recovery Best goals reflect the shared aims and values of the client, family and the therapist Goal is a statement about a long-term aim that the client will achieve through participation in the therapy program Goals are concerned with occupational performance Objectives are more precise that a goal because it includes the desired outcome and the ways it will be measured.

Interventions Principles Guidelines that support practice Interventions are conducted within the theoretical framework Therapist is able to articulate remediation, adaptation, or combination approach in therapy A range of occupations and activities should be used as interventions Remediation approach must provide opportunities for the generalized skills learn in one activity or environment to others Clients family and friends should be included Mechanisms for the evaluation of intervention must be in place before intervention begins.

Approach to Intervention Remedial Approach Based on the belief that the human brain is capable of recovery through neural plasticity and reorganization of function. Intervention aims to stimulate recovery by retraining specific components of lost abilities using tabletop or computer-based activities Adaptive Approach Relying on teaching the client to modify the environment and the ways in which tasks are completed and to use intact skills to complete activities Groups Meet to work on specific skills areas or to provide an opportunity for members to share experiences and support each other Education Important component of the therapy process Teach Back Approach

Activity selection, analysis and grading Three approaches towards activity selection Therapist to choose activities based on the challenges they present and opportunity promoting stimuli to the client Client to choose motivating and interesting activities Therapist and Client to choose activities together based on therapeutic value and client interest Grading refers to any modification made to the activity to ensure it is at the Just right level so that the client is optimally challenged

Activity selection, analysis and grading Discharge Planning Housing Return to work Driving

Evaluation and Intervention with Concentration Impairment directing thoughts and actions toward a stimulus or stimuli Attention Encompasses the capacity to detect and orient to stimuli Capacity Amount of information processing a person can do in a given time Control An individuals ability to direct concentration capacity

Concentration Sustained Concentration The capacity to concentrate on relevant information during occupations Focused (selective concentration) The capacity to concentrate on an occupation despite environmental visual or auditory stimuli Divided and Alternating Concentration Divided is the capacity to respond simultaneously to two or more tasks Alternating is the capacity to move flexibly between tasks and respond appropriately to the demands of each tasks

Evaluation and Intervention with Memory and Learning Impairment The capacity to store experiences and perceptions or recall and recognition Three activities are related to memory Acquisition or learning Storage or retention Retrieval or recall Learning Is described as a relatively permanent change in the capacity for responding that, resulting from practice and experience, persists with time, resists environmental changes and can be generalized in response to new tasks and situations

Taxonomies Taxonomies Orderly classifications based on commonalities or relationships Memory Taxonomies Sensory Modality Transmission channels for sense-generated impulses Divided into four categories: Olfactory and Gustatory, Auditory , Visual, tactile and kinesthetic Temporal Taxonomy Relates to duration Compose of three types of memory storage: Sensory memory, Short term memory, long term memory Real-World Memory Taxonomy Describes memory in 5 categories: (1) plans and actions, (2)places, objects and events, (3)people faces and names,(4) personal experiences (5) conversation

Taxonomies Negative Symptom Taxonomy or amnesia Retrograde Inability to use information acquired before an injury, illness, or onset of amnesia Loss of memory of personal events Loss of memory of personal facts Anterograde Inability to acquire and retain new information Mixed Memory Taxonomies Emotional Memory Retention of an emotional event Eyewitness, flashbulb, repressed Metamemory Individuals subjective knowledge about his capacity to acquire, retain, and recall information Memory regarding task, regarding one’s self or own memories, memory strategies

Taxonomies Learning Taxonomies Short-term learning Temporal lines – longevity of learning’s effects Short-term learning Occurs when a repeated stimulus causes a simple increase or decrease in the number of responses at the cellular level Intermediate-term learning Occurs when a repeated stimulus leads to a controls response or habituation. Long-term learning Conditioning occurs when a repeated stimulus leads to a behavioral stimulus-response pattern

Taxonomies Interventional type Taxonomy Behavioral learning Cognitive learning Behavioral-cognitive learning Modality Taxonomy Motor learning Verbal learning