1. Reflections
Week 2 OTR 615
Chapter 3-5

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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)

10. 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.

11. 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.

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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