1. Anne G. Fisher, Lou Ann Griswold
Chapter 26 Performance Skills: Implementing Performance Analyses to Evaluate the Quality of Occupational Performance
In this lecture, we will clarify the important concepts and terms presented in Chapter 26. Students will have an opportunity to apply their knowledge to do a performance analysis. This lecture will conclude with a discussion on the benefit of doing a performance analysis and consider how it supports our role as occupational therapists.
Notes to instructor: For this lecture, you will need a small ball for demonstration. A ball that is either “flat” or has extra bounce will make for a better observation.
There are suggested activities that might be used for in-class learning or homework on the Website to accompany this lecture and chapter.
There are also questions posted on the Website that might be useful in a class discussion.
Anne G. Fisher, Lou Ann Griswold

2. Learning Objectives After reading this chapter, you will be able to:
Describe the difference between (1) performance skills and (2) body functions.
Implement an analysis of performance skills (performance analysis) and document a person’s baseline quality of occupational performance.
Describe how the results of a performance analysis are used to collaboratively establish client-centered goals.

3. 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, and sociocultural 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 sociocultural influences

4. What did we observe? Observation
Two students come to the front of the room and bounce a small ball back and forth to one another (five passes of the ball) using one hand.
What did we observe?
Have students stand at different sides of the room, to illicit a greater challenge. Use a ball that is either flat so it does not bounce well or one that has extra bounce power.
Encourage others in the class to discuss what they saw each of the students do.
The next several slides help with observing skilled performance.

5. Performance analysis: motor skills
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.
This slide discusses some of the universal motor skills based on bouncing a ball back and forth between two people.
If one of the students had any difficulty, use the opportunity to describe the quality accordingly.
Any “errors” or poor quality gives an opportunity to point out that we all have some clumsiness in our motor skills. These issues do not indicate that the person needs OT. However, we do want to document what we see the person doing.
Listen for descriptions of performance, not thinking about the reason for the problem—that is a task analysis, which we will discuss in a moment.

6. Performance analysis: process skills
Bouncing a Ball—(cont.)
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.
Process skills refer the the efficiency of choosing, using, and organizing time, space, tools, and materials.

7. Performance analysis: social interaction skills
Bouncing a Ball—(cont.)
Performance analysis: social interaction skills
Gestured (e.g., nodded and pointed) that he or she 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 or she did not interrupt the social partner
The statements above reflect analysis of the quality of performance of social interaction skills.

8. Performance Analysis Analyzing quality of skills—observable actions
The universal performance skills provide a structure to guide analysis.
Motor skills
Process skills
Social interaction skills
When we just described the performance of bouncing a ball back and forth, we were implementing a performance analysis.
We were focused on observable actions.
Universal performance skills include motor skills, process skills, and social interaction skills. They are are identified in Table 26-1.

9. Skills—Observable Actions
Each link in the chain represents a discrete, observable action, an action that, when put with other actions, create the task.
We evaluate each link in the chain to analyze the quality of performance of each skill while a person is doing the task
The entire chain is the task, whereas each action represents a skill, for which we can rate quality of performance.
Analyzing at this level of detail helps us determine the skills that are challenging to the overall task performance.

10. Interpreting reasons for any problems in performance:
Task Analysis
Interpreting reasons for any problems in performance:
Person factors and body functions
Task demands
Environmental characteristics
Sociocultural influences
If students discussed their observation thinking about “why” there were any problems, point out they were doing a task analysis.
With task analysis, we consider possible causes of problems.
We think about person factors: body function, internalized routine, motivation.
We think about activity demands: tools and materials used, steps and timing of these, required actions, intended purpose or outcome.
We also can think about the environment: the space, available tools and materials, people in the environment, resources available.
Sociocultural influences: the cultural aspects, social expectations

11. 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
When doing a task analysis, we consider reasons why the person did not demonstrate good quality performance. Task analysis is different from performance analysis. We discuss it to help differentiate between different types of analyses.

12. 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
Activity analysis applies to an abstract analysis of the task and does not involve the person doing the task. (Note: Activity is what we observe, and a task is what a person will do or will have done.)

13. Purpose of Each Type of Analysis
Performance analysis
To describe the quality of a person’s performance during a task
Purpose:
To document baseline of occupational performance
To establish goals
Task analysis
To consider possible causes of problems in performing a task
To consider interventions to address underlying problems
Activity analysis
To analyze requirements of a task
To consider the task for possible use in intervention and options for modification of the task
Reconfirm the purpose of each analysis and then how each is used by an occupational therapist. Each type of analysis has a different purpose. The topic of Chapter 26 and the focus of discussion of this lecture is on performance analysis.

14. 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 OT?
We then:
Observe the client perform tasks that are important, challenging, and desired
Analyze the performance of observed task(s) and document our analysis
Write goals with the client, based on the observed performance of a task that is important, challenging, and desired
This process was illustrated with the case example in Chapter 26, for Maurice.
We begin the OT intervention process by gathering information about the client, from the client’s perspective. We listen to learn about tasks that are important to the client and tasks that the client would like to do but finds challenging—these are the tasks that we want to observe and consider for intervention.
Based on what the client would like to address in therapy, we, the client and occupational therapist, decide together what task the occupational therapist will observe.
After observing, we analyze the client’s performance and document the performance.
After sharing our analysis and documentation with the client, we will write goals, again with the client, based on the observation.
Because we began with tasks that were client driven, our goals will also be client driven.
Therefore, our evaluation and intervention will be client centered and occupation based.

15. 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. There are 16 universal motor skills defined in
Describe the quality of motor performance.
Physical effort and/or clumsiness
As the person:
Moves self and objects in environment during the task
Holds and manipulates task objects
There are 16 universal motor skills defined in
Table 26-1.

17. There are 20 universal process skills defined in
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 26-1.

18. Motor and Process Skills
Problems in either type of skill can lead to:
Safety concerns
Need for assistance
When might this information be useful?
Example of safety concern in motor skills:
In the case study in Chapter 26, we read that Maurice was at a safety risk when he was standing and bending and reaching to lift his shoes from the floor.
An example in process skill could be a person who organizes materials too close to the edge of the table so that they fall off and break or spill.
Discussion question has been posed in the slide:
When might this information be useful?
When making discharge decisions for someone
• To determine if they are able to go home
• To determine if the person needs supports to perform tasks safely and for what actions the support would be needed

19. 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?
A discussion question has been posed in this slide:
When do people use social interaction skills?
Help students to recognize that social interaction is required in most areas of occupation. Some examples are below.
+Work—to share information with, gather information from, and collaborate with colleagues
+Play or leisure—to make decision and collaborate
+Education—to share information with or gather information from teachers or peers
+IADL—to made decisions with or collaborate with partner or housemate around household chores
+PADL—to share information with personal care attendant
Note: Chapter 61 discusses communication and social interaction and occupational performance.

20. 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 so, we all do!
Good observations will capture these errors.
We all have some increased effort or inefficiencies when performing a task.
Encourage students to always document what they see and not “assume” that because the person does not have a diagnosis, that the person will not show some clumsiness or inefficiency.
Encourage students to observe and describe what they see.
Later, they will determine if the problems noted are significant.

21. 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
We cannot just add the number of skills in which the person had poor performance. A summation is not necessarily an indication of decreased task performance overall. We want to consider the overall quality in terms of risk of injury, need for assistance, timely completion of task, and the quality of the end product.
Risk of injury includes those to the person, tools, materials, or environment.
It is sometimes easier to think of examples when motor and process skills rather than social interaction skills result in risk of injury, need for assistance, completion of task, and quality of end product. Yet, the same indicators are true for social interaction skills, for example:
• Risk of injury applies to risk of injury to someone’s feelings or personal integrity.
• Need for assistance to get message across or to wait for someone to stop speaking before taking a turn.
• A social interaction may be completed too quickly so that the person does not ultimately gather intended information.
• The overall quality of social interaction may be decreased, for example, arguing rather than coming to a decision with a social partner.

22. 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. Steps of Performance Analysis
Step 1. Observe performance.
Step 2. Rate performance.
Step 3. List effective and ineffective skills.
Step 4. Cluster skills and write summary statements.
These steps are discussed in Chapter 26 and illustrated using the case study and one of the observed and described tasks.
Note: In step 2, performance can be rated in a standardized way, using a valid and reliable assessment tool, such as the AMPS or ESI. Or performance can be rated in a nonstandardized way, using the universal performance skills. Then we would use criteria of no problem, mild problem, moderate problem, or marked problem.

24. Step 1. Observe performance.
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 26.
Giving the students an opportunity to work through implementing a performance analysis will help them understand the value of a performance analysis.
The next several slides indicate the steps of implementing a performance analysis.
Students should use the description of an observation of Maurice as he prepares a glass of orange juice, presented in Chapter 26.

25. Implementing a Performance Analysis—(cont.)
Step 2. Rate performance.
Rate the quality of Maurice’s performance of this task using the universal performance skills in Table 26-1.
The rating of Maurice’s task performance when putting on his socks and shoes, presented in Table 26-3, will provide a model.
In-class learning activity—implementing a performance analysis for Maurice
This activity could be done in class in small groups or pairs or as a whole class.
Maurice was the case study example illustrated throughout Chapter 26.
Maurice was described putting on his socks and shoes, getting a glass of orange juice and planning upcoming meals to make a shopping list with his care provider. His performance is described for all of these tasks.
In Chapter 26, the authors have worked through the four steps of a performance analysis for the task of putting on socks and shoes and making a shopping list.
Their analyses of these tasks provide good examples of performance analysis.
Use the samples of a performance analysis for putting on socks and shoes in the chapter and the observations described for getting a glass of orange juice, near the beginning of the chapter, to analyze Maurice’s performance for the task of getting a glass of orange juice. Students may do steps 2, 3, and 4.

26. Maurice’s quality of ADL task performance—preparing a glass of juice
Implementing a Performance Analysis—(cont.)
Maurice’s quality of ADL task performance—preparing a glass of juice
ADL motor skills
Behavior observed
Rating
Stabilizes
Walks
This table serves to get students started.
As a class, you can fill in other skills along with observed behaviors and the rating of the quality of each skill.
Suggested skills, observations, and ratings are below:
Stabilizes Propped on counter when moving through the kitchen—moderate problem
Moves Effort pulling refrigerator door open—mild problem
Walks Propped with walking on level surface in kitchen—moderate problem
Transports Had difficulty carrying container of juice to counter—moderate problem
Calibrates Did not use enough force to pull open refrigerator door—mild problem
Initiates Paused before opening refrigerator and pouring juice—mild problem
Terminates Poured juice too long resulting in some juice spilling—moderate problem

27. Step 3. List effective and ineffective skills.
Implementing a Performance Analysis—(cont.)
Step 3. List effective and ineffective skills.
Effective skills
Ineffective skills
Effective skills for Maurice in this task include:
Bends
Reaches
Lifts
Sequences
Searches/Locates
Gathers
Organizes
Ineffective skills for Maurice in this task include:
Stabilizes
Walks
Transports
Terminates

28. Step 4. Cluster skills and write summary statements.
Implementing a Performance Analysis—(cont.)
Your comments
Clustering skills and writing summary statements reflects clinical reasoning. Students should be encouraged to group the skills in a logical manner. The following are samples only.
Stabilizes, Walks, and Transports: Maurice was moderately unsteady and propped along the counter for support when walking in his kitchen and when carrying the juice container to another workspace.
Terminates: When pouring juice into a glass, Maurice did not stop pouring resulting in a small amount of juice spilling over the top of the glass.

29. 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!
A performance analysis keeps occupational therapists focused on occupation.
An occupational therapist observes and analyzes the performance of a person doing a task that is important, challenging, and desired by the person.
The focus is on analyzing performance of “doing”—on occupation, not underlying body function, supporting the role of OT.
Furthermore, a performance analysis is described using objective language that is easily understood by the client and team members.
Because the focus is on tasks that a person wants to do better, performance analysis can lead to writing goals with the client that are client centered and occupation based.