1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 22: Performance Skills: Implementing Performance Analyses to Evaluate Quality of Occupational Performance Anne G. Fisher and Lou Ann Griswold

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives 1.Differentiate between: (a) performance analysis, (b) task analysis, and (c) activity analysis and the purpose of each. 2.Describe where a performance analysis occurs in the evaluation process. 3.Implement a non-standardized performance analysis. 4.Document the results of a performance analysis. 5.Describe how a performance analysis supports occupational therapy practice.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Clarifying Concepts Performance analysis What we observe the person doing —describing quality of performance, specifically motor, process, and social interaction skills Task analysis Analysis of factors that influence quality of task performance —thinking about person factors, body functions, environmental characteristics & socio-cultural influences Activity analysis Analysis of the task in a general sense —thinking abstractly about what doing the tasks requires in terms of person factors, body functions, task demands, environmental characteristics, and socio-cultural influences

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Observation Two students come to the front of the room and bounce a small ball back and forth to one another (5 passes of the ball), using one hand –What did we observe?

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bouncing a Ball Performance Analysis: Motor Skills Walked to the front of the room without effort Carried the ball to one side of the room without effort Bent and reached to catch the ball without stiffness Turned the ball in hand to bounce it back with dexterity Used two body parts (two hands or chest) to catch Used force that was adequate to bounce the ball across the room The statements above reflect analysis of the quality of performance of motor skills

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bouncing a Ball Performance Analysis: Process Skills Searched/located and gathered the ball effectively from instructor Used the ball as a ball Handled the ball with care so it did not drop Initiated bouncing the ball without a delay The statements above reflect analysis of the quality of performance of process skills

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bouncing a Ball Performance Analysis: Social Interaction Skills Gestured (e.g., nodded and pointed) that s/he was ready for the ball Turned toward and then looked at the other person Replied to messages with relevant comments related to playing ball Timed responses such that he/she did not interrupt the social partner The statements above reflect analysis of the quality of performance of social interaction skills

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performance Analysis Analyzing quality of skills—observable actions Universal Performance Skills provide a structure to guide our analysis of: –Motor skills; –Process skills; and –Social interaction skills

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Skills—Observable Actions

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Task Analysis Interpreting reasons for any problems in performance –Person factors and body functions –Task demands –Environmental characteristics –Socio-cultural influences

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Task Analysis for Bouncing a Ball Ball was flat or too bouncy Ball was too small Not a big enough space to play ball Many people watching Expectation of good performance in a class

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Activity Analysis for Bouncing a Ball Environment –Open space –Another person with whom to bounce ball Task demands –Ball (required object) –Catch and then bounce ball (steps and sequence of steps) Person factors –Internalized routine for playing ball Body functions –Shoulder and elbow movements (flexion, extension) –Motor planning –Vision –Visual perception –Emotional regulation

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Purpose of Each Type of Analysis Performance Analysis To describe the quality of a person’s performance during a task Purpose: Document baseline of occupational performance Establish goals Task Analysis To consider possible causes of problems in performing a task Purpose: Consider interventions to address underlying problems Activity Analysis To analyze requirements of a task Purpose: Consider the task for possible use in intervention and options for modification of the task

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Putting Performance Analysis in Context of Practice Gather information from client –What is important for client to do? –What is challenging for client? –What would client like to address in occupational therapy? We then observe the client perform tasks that are important, challenging, and desired We analyze the performance of observed task(s) and document our analysis We write goals with the client, based on the observed performance of a task that is important, challenging, and desired

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performance Analysis Focus on the quality of performance for each observable action (each link in the chain seen earlier) –Motor skills –Process skills –Social interaction skills Rate the quality of each action using standardized assessment tools or nonstandardized ratings of: –No problem –Mild problem –Moderate problem –Marked problem

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Motor Skills Describe the quality of motor performance –Physical effort and/or clumsiness As the person: –Moves self and objects in environment during the task; and –Holds and manipulates task objects There are 16 universal motor skills defined in Table 22-1

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Process Skills Describe the quality of process skills –Efficiency As the person: –Organizes time –Organizes space and objects –Adapts performance as needed to prevent problems from occurring or reoccurring There are 20 universal process skills defined in Table 22-1

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Motor & Process Skills Problems in either type of skill can lead to –Safety concerns –Need for assistance When might this information be useful?

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Social Interaction Skills Describe the quality of social interaction skills to –Share information –Gather information –Problem solve or make decisions –Collaborate –Acquire goods or services –Converse socially When do people use social interaction skills?

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performance Skill Problems Consider the universal performance skills Do you ever: –Fumble your pencil or other object? –Have a potato or apple slip from your grip when you are peeling it? –Delay to support and object so that it almost falls? –Pause before starting the next step? –Pause while you are doing an action? –Look away from your task? Of course, we all do! Good observations will capture these errors.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Determining If Problems in Performance Skills Are Significant We need to consider the overall quality of a task performance and how the performance skills contribute to the overall quality –Risk of injury –Need for assistance –Timely completion of task –Quality of end product

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Good Observations Allows occupational therapists to accurately –Analyze and describe performance –Identify problems in performance skills that contribute to overall decreased task performance –Document baseline performance

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps of Performance Analysis Step 1—Observe performance Step 2—Rate performance Step 3—List effective & ineffective skills Step 4—Cluster skills & write summary statements

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing a Performance Analysis Step 1—Observe performance Maurice—Preparing a glass of orange juice Re-read the observation description of Maurice pouring a glass of orange juice in the case study presented at the beginning of Chapter 22

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing a Performance Analysis Step 2: Rate Performance Rate the quality of Maurice’s performance of this task using the Universal Performance Skills in Table 22-1. The rating of Maurice’s task performance when putting on his socks and shoes, presented in Table 22-2, will provide a model.

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maurice’s Quality of ADL Task Performance—Preparing a Glass of Juice ADL motor skills Behavior observedRating Stabilizes Walks

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing a Performance Analysis Step 3: List Effective & Ineffective Skills Effective Skills Ineffective Skills

28. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementing a Performance Analysis Step 4: Cluster Skills & Write Summary Statements

29. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Benefits of Performance Analysis Focuses on tasks that client wants to do better Focuses on analyzing the quality of doing—not underlying body function Uses language that is clear, objective, and understandable by the client and others Leads to writing goals that are client-centered and based on occupation Keeps occupational therapists focused on occupation!