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Occupational Therapy Evaluation For Adults A Pocket Guide Point Lippincott Williams Wilkins 2Nd Edition Pdf full chapter pdf docx
Occupational Therapy Evaluation For Adults A Pocket Guide Point Lippincott Williams Wilkins 2Nd Edition Pdf full chapter pdf docx
Occupational Therapy Evaluation For Adults A Pocket Guide Point Lippincott Williams Wilkins 2Nd Edition Pdf full chapter pdf docx
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With the completion of this 2nd edition, we have many people to
acknowledge. First, we want to thank our families, friends, and colleagues for
their patience, humor, motivation, and support during this project. Without
them, the road to completion would have been a much longer journey with
less laughter and many detours. We would also like to thank Lisa Nugent
from the UNH photography department for taking all of the photos in this
edition. She made the therapists and clients comfortable and was extremely
organized, making the process appear effortless. Graduate student, Jessica
Floyd, compiled information on the many assessments presented in this book
with her endless hours of research, for which we are ever so grateful. We
would also like to acknowledge Jerry Neistadt for his permission to revise the
original work of his late wife, Maureen Neistadt, to provide occupational
therapy students and therapists updated information that will be beneficial in
any practice setting. Finally, we would like to thank Elizabeth Crepeau PhD,
OT, FAOTA, who wrote the dedication for this book, recognizing Maureen
Neistadt.
Since the first edition in 2000, our profession has evolved with the
introduction of the Occupational Therapy Practice Framework (2008) that
outlines for us our domain and processes that guide our practice. Our
centennial vision encourages us to become “powerful, widely recognized,
science driven, evidence based, and globally connected” as a profession. To
fulfill this vision, our outcome in working with clients of diverse needs is to
meet their occupational goals. In order to do that effectively, we need to
focus on supporting their engagement in their occupations through the
integrity and effectiveness of our evaluations and interventions.
Jim Hinojosa, BS, MA, PhD
Professor
Department of Occupational Therapy
New York University
New York, New York
8 Evaluating Cognition
• Evaluation Approaches
• Cognitive Screening Measure for the Assessment of Mental Functions
• Evaluating Foundational Cognitive Processes
◦ Evaluating Level of Arousal
◦ Evaluating Levels and Types of Attention
◦ Evaluating Memory
• Higher-Order Cognitive Function
◦ Evaluating Executive Functioning
◦ Self-Awareness
• Resources
• Case Study
• Review Questions
Chapter 4
4-1 Case Formulating for Occupational Therapy at the Referral Stage
4-2 Semistructure Interview Tools for Initial Interviews
Chapter 5
5-1 Guidelines for Interpreting Kappa Coefficients (κ)
Chapter 6
6-1 Assessment of Roles and Responsibilities
6-2 Comprehensive Assessments of Occupational Performance (Including ADLs, IADLs, and Other
Areas of Occupation)
6-3 ADL Assessments
6-4 Instrumental Activities of Daily Living Assessments
6-5 Work Assessments
6-6 Social Participation Assessments
6-7 Leisure Assessments
Chapter 7
7-1 General Terminology Associated with Motor Function
7-2 MMT Grading Systems
7-3 Postural Control
7-4 Motor Reflex Grading Scale
7-5 Motor Movement
7-6 Muscle Tone
7-7 Motor Recovery/Control
7-8 Balance
7-9 Client Factors—Dexterity/Fine Motor Coordination
7-10 Met Values for Some Occupational Performance Areas
7-11 Blood Pressure Categories
7-12 Client Factor—Sensation
7-13 Client Factor—Pain
7-14 Client Factor—Endurance
Chapter 8
8-1 Cognitive Screening Measures
8-2 Assessments for Arousal
8-3 Assessments for Attention
8-4 Assessments for Memory
8-5 Executive Functioning Assessments
8-6 Assessments for Self-Awareness of Cognitive Dysfunction
Chapter 9
9-1 Visual-Perceptual Hierarchy Terms
9-2 Common Visual Field Loss Deficits
9-3 Oculomotor Function
9-4 Oculomotor Disorders
9-5 Types of Agnosia
9-6 Types of Visual Discrimination
9-7 Types of Apraxia
9-8 Body Scheme Disorders
9-9 Vision and Perception Assessments
Chapter 10
10-1 Home Assessments
10-2 Work Assessments
10-3 Community Assessments
Chapter 1
1-1 American Occupational Therapy Practice Standards: Standard II
Chapter 2
2-1 The Types of Intervention Approaches
2-2 Intervention Methods
2-3 Outcomes Identified in the Occupational Therapy Practice Framework
2-4 Roles of Occupational Therapy Practitioner
Chapter 4
4-1 Common Precautions Related to Client Health and Safety
Chapter 5
5-1 Correlation Coefficients
5-2 Checklist of Useful Questions to Ask When Considering an Assessment
Chapter 6
6-1 Terminology and Abbreviations Used in Determining Levels of Assistance
Chapter 7
7-1 Upper Extremity (UE) AROM Screen
7-2 General Precautions when Evaluating ROM
7-3 Procedures for Measuring PROM and AROM
7-4 General MMT Precautions
7-5 Procedure for MMT
7-6 Procedures for Testing Muscle Tone
7-7 Modified Ashworth Scale
7-8 Description of Synergy Patterns
7-9 Common Deep Tendon Reflexes Assessed
7-10 Procedure for Sensory Testing
7-11 Common Questions to Ask Clients About Pain During an Assessment
7-12 Measuring Resting HR at the Radial Artery
7-13 Measuring BP (Manually)
7-14 Procedure to Measure Hand Edema Using a Volumeter
7-15 General Precautions in Assessing Edema
7-16 Procedure in Assessing Hand Edema Using the Figure-of-Eight Technique
Chapter 8
8-1 Mental Functions
8-2 Types of Attention
8-3 Types of Memory
Chapter 9
9-1 Procedure for Confrontation Testing Using One Examiner
9-2 Procedure for Screening Convergence
9-3 Procedure for Screening Saccades
9-4 Procedure for Screening Visual Tracking/Pursuits
Chapter 10
10-1 Principles of Universal Design
10-2 Components of ADA
10-3 Risk Factors for Musculoskeletal Disorders
10-4 Resources
Chapter 11
11-1 The Occupational Therapy Evaluation Process Top–Down Occupation-Based Approach
Chapter 1
1-1 Integrated Representation of the AOTA Process of Service Delivery and the Canadian Practice
Process Framework
1-2 Steps of the Initial Evaluation Process from a Top–Down Approach
Chapter 2
2-1 AOTA OTPF: Domain of OT
2-2 The AOTA OTPF Process of Service Delivery Model
Chapter 5
5-1 The Normal Distribution and Associated Standard Scores
Chapter 6
6-1 ADL-Lower Extremity Dressing Using a Sock Aid
6-2 ADL-Lower Extremity Dressing Using a Long-Handled Shoehorn
6-3 ADL-Bed Transfer with Assistance
6-4 ADL-Toilet Transfer with Supervision
6-5 ADL-Tub Transfer with Assistance
6-6 IADL-Home Management
6-7 IADL-Driving a Modified Vehicle
Chapter 7
7-1 Goniometer
7-2 Sample ROM Recording Form
7-3 Washington ROM Sheet
7-4 Starting Position of Shoulder Flexion
7-5 Shoulder Flexion
7-6 Shoulder Abduction
7-7 Elbow Flexion
7-8 Elbow Extension
7-9 Forearm Pronation
7-10 Forearm Supination
7-11 Wrist Extension
7-12 Wrist Flexion
7-13 Starting Position for Wrist Deviation
7-14 Wrist Radial Deviation
7-15 Wrist Ulnar Deviation
7-16 Thumb IP Flexion
7-17 Thumb MP Flexion
7-18 Thumb Abduction
7-19 Thumb Extension
7-20 Clinical Reasoning Process of ROM Assessment
7-21 Dynamometer and Pinch Gauge
7-22 MMT for Shoulder Flexion
7-23 MMT for Shoulder Abduction
7-24 MMT for Elbow Flexion
7-25 MMT for Elbow Extension
7-26 MMT for Forearm Supination
7-27 MMT for Forearm Pronation
7-28 MMT for Wrist Extension (Gravity-Eliminated Plane)
7-29 MMT for Thumb Extension
7-30 Clinical Reasoning of Upper Extremity Muscle Strength
7-31 Grip Test
7-32 Lateral Pinch
7-33 Two-Point Pinch
7-34 Three-Point Pinch (Palmer Pinch)
7-35 Dermatome Chart
7-36 Semmes-Weinstien Filaments
7-37 Radial Pulse Testing
7-38 Blood Pressure Testing
7-39 Hand Volumeter
Chapter 8
8-1 Hierarchy of Cognitive Processing
8-2 Rancho Levels of Cognitive Functioning
Chapter 9
9-1 Visual-Perceptual Hierarchy
9-2 Visual Field Deficits with Associated Lesion Sites
Chapter 10
10-1 Computer Workstation Evaluation. Parkland Medical Center Computer Workstation Evaluation
10-2 General Work Evaluation. Parkland Medical Center Computer Workstation Evaluation
10-3 Follow-Up Job-Site Evaluation. Parkland Medical Center Computer Workstation Evaluation
Chapter 11
11-1 Pathway One: Based on Provisional Planning for Sophia Lord to be Discharged Home
11-2 Pathway Two: Initial Discharge Planning for Sophia Lord to be Discharged Home is Revised
when Sophia’s Evaluation Indicates Mild Cognitive Impairment Making It Unsafe for Her to
Live Independently
THE EVALUATION PROCESS IN
OCCUPATIONAL THERAPY
American Occupational Therapy Practice Standards: Standard II. Screening, Evaluation, and
Reevaluation (American Occupational Therapy Association Commission on Practice
[AOTACP], 2010).
1. An occupational therapist is responsible for all aspects of the screening, evaluation, and
reevaluation process.
2. An occupational therapist accepts and responds to referrals in compliance with state or
federal laws, other regulatory and payer requirements, and AOTA documents.
3. An occupational therapist, in collaboration with the client, evaluates the client’s ability to
participate in daily life by considering the client’s history, goals, capacities, and needs; the
activities and occupations the client wants and needs to perform; and the environments
and context in which these activities and occupations occur.
4. An occupational therapist initiates and directs the screening, evaluation, and reevaluation
process and analyzes and interprets the data in accordance with federal and state law,
other regulatory and payer requirements, and AOTA documents.
5. An OT assistant contributes to the screening, evaluation, and reevaluation process by
implementing delegated assessments and by providing verbal and written reports of
observations and client capacities to the occupational therapist in accordance with federal
and state laws, other regulatory and payer requirements, and AOTA documents.
6. An OT practitioner uses current assessments and assessment procedures and follows
defined protocols of standardized assessments during the screening, evaluation, and
reevaluation process.
7. An occupational therapist completes and documents OT evaluation results. An OT
assistantcontributes to the documentation of evaluation results. An OT practitioner abides
by the time frames, formats, and standards established by practice settings, federal and
state law, other regulatory and payer requirements, external accreditation programs, and
AOTA documents.
8. An OT practitioner communicates screening, evaluation, and reevaluation results within
the boundaries of client confidentiality and privacy regulations to the appropriate person,
group, organization, or population.
9. An occupational therapist recommends additional consultations or refers clients to
appropriate resources when the needs of the client can be best served by the expertise of
other professionals or services.
10. An OT practitioner educates current and potential referral sources about the scope of OT
services and the process of initiating OT services.
FIGURE 1-1 Integrated Representation of the AOTA Process of Service Delivery and the
Canadian Practice Process Framework.2,5
Most OT professional associations throughout the world outline an OT
process for their members. The American Occupational Therapy Association
has incorporated the Framework for Process of Delivery within the AOTA
Occupational Therapy Practice Framework (2008) (OTPF)2 (see Chapter 2).
The Canadian Association for Occupational Therapists (CAOT) has the
comprehensive Occupational Performance Process Model (OPPM), which
incorporates the core concepts of occupational performance and client-
centered practice.4,6 More recently, in 2007, the CAOT published the
Canadian Practice Process Framework (CPPF).5 Similarly, there are a
number of process models proposed by OT scholars. Fisher (2009)7 offers the
Occupational Therapy Intervention Process Model (OTIPM) as a way for
practitioners to think and practice OT from an occupational perspective. The
OT process, as outlined in any of these frameworks/models, is fundamental to
the integrity of the profession, as they structure and organize the form of
practice and bring uniformity to the implementation as well as incorporate
common language/documentation to be utilized in practice.
The OT evaluation process has two core steps. The first is developing an
occupational profile of clients, and the second is the analysis of
occupational performance. The occupational profile is a description of a
client’s occupational history, patterns of living, roles, interests, values, needs,
priorities, support systems, challenges, strengths, and goals.2 The analysis of
occupational performance integrates data gained about a client using a variety
of evaluation strategies and assessments such as direct observation of a client
performing occupational tasks or the administration of standardized and
nonstandardized assessments to measure specific impairments of body
functions and structures. The occupational therapist, the client, and others
whom the client identifies as his/her significant support/care providers (i.e.,
spouse, partner, parents, or adult children) use this information to understand
what supports and hinders the client’s ability to perform his/her desired and
required daily tasks and occupations. The sum of the evaluative process is
used to define the client’s strengths and problems, prioritize client’s needs,
and establish measurable goals that are meaningful to the client. The overall
goal is always an achievable client-driven outcome that promotes the client’s
ability to engage in occupations.2
The evaluation process is often depicted as linear (Figure 1-2), whereas
often in practice, a client’s evaluation process is blended, and steps occur
concurrently. For example, at an initial interview to obtain a client’s
occupational profile, functional assessments, interventions, and discharge
planning may be conducted at the same time. This is common in settings such
as an acute inpatient hospital where the patients’ stay is short term. In
contrast, in health care/community facilities in which the therapy relationship
with the client is likely to be weeks or months, the evaluation process may be
more sequential (i.e., linear).
FIGURE 1-2 Steps of the Initial Evaluation Process from a Top–Down Approach.
5. Are the assessments that are congruent with a frame of reference(s) used
to guide the client’s therapy? Frames of reference are defined and
discussed in Chapter 3.
Clinical Tip
Pre and posttest use of assessments that have been shown to have a high
degree of sensitivity can identify change and can be beneficial in providing
the client with tangible feedback and for documenting efficacy of therapy.
The terminology in this text is consistent with the AOTA OTPF (2008)
promoting consensus around language use in the profession.
• Client: The OT profession uses the term client to broadly refer to a person,
family, or people who live, work, and/or have significant relationships with
the person referred to OT. The client can also be an organization, a
community, or population who is the recipient of OT services. It is
anticipated that in the 3rd edition of the AOTA practice Framework the
term client will not include an organization. In this textbook, we have
chosen to mainly refer to the person who is receiving OT services as the
client.
• Patient: In the predominant medical model culture of a hospital setting, the
health care team typically refers to the individual receiving care as a
patient. We follow this usage for recipients of inpatient treatment, but in
all other contexts we will refer to a person receiving OT as a client.
• Evaluation and Assessment: The term evaluation is used to define the
comprehensive process of gathering information about a client through
multiple methods such as an interview, direct observation, and the
administering of qualitative and quantitative assessments to measure a
client’s performance, deficits, and impairments. The evaluation process
includes interpretation of the assessments and information collected to
formulate client goals, plan and implement interventions, and monitor
progress. The term assessment is used to describe specific instruments,
tools, or strategies that the occupational therapist uses to determine
occupational performance skills or measure client factors; for example,
impairments in body functions or structures. The International
Classification of Functioning, Disability and Health (ICF)13 includes
deficits in sensation, muscle strength, and/or memory as impairments in
body functions.
Assessment may be paired with terms such as instrument or tool for
added clarity and often are defined or categorized further by psychometric
properties, for example, standardized or nonstandardized, and criterion
referenced or norm referenced. In Chapter 5, the terminology associated
with the psychometric properties of assessments is explained.
• World Health Organization and the ICF terminology: The OT
profession uses terminology that is consistent with the World Health
Organization’s (WHO) ICF.13 Designed as an international framework and
classification system to describe function and disability using a
biopsychosocial client-centered perspective, the ICF provides a framework
and offers a common language to define health and health-related
conditions concerning human functioning and the restrictions in activities
and participation due to impairments in body structures and functions. The
ICF system complements the International Classification of Diseases
(ICD-10)12 diagnostic system. The ICD-10 is used to code illness/disease
often in conjunction with the use of Current Procedural Terminology
(CPT) codes for diagnostic services and reimbursement.1 OT practitioners
will encounter both systems in their work, but it is the ICF that is
philosophically consistent and most closely aligned with the profession’s
view of health, participation, and function and disabilities within a context.
Concepts of the ICF are congruent with terminology of the AOTA
OTPF. The ICF incorporates interrelated concepts from the perspectives of
Functioning and Disability and Contextual Factors. Functioning and
disability is comprised of Body Functions and Structures, and Activity and
Participation, while the contextual factors encompass an individual’s
Environment and Personal Factors.13 Functioning is the integrity of body
functions and body structures to perform tasks (i.e., activity) in life
situations (participation). Disability refers to a negative outcome of a
health condition that compromises an individual’s ability to participate in
life situations.13 This term, disability, is widely misused as an illness or a
person’s medical diagnosis, whereas the preferred usage pertains to an
individual’s inability to perform tasks and participate in life.13 Two
concepts of the ICF that parallel OTs occupation-based, top–down
approach to client evaluation are:
◦ Capacity is a person’s ability to execute tasks in a controlled environment
and is measured when a client is asked to perform a variety of simulated
tasks in the OT clinical setting.
◦ Performance is the person’s functional engagement when executing tasks
in his/her natural environment. This is measured when a client is
observed, preferably in a naturalistic environment, performing his/her
typical occupational tasks.
These ICF constructs explain how two people who have the same
diagnosis, severity of disorder, and a similar capacity to perform tasks in
a controlled environment demonstrate different functional abilities in
their occupational performance. This difference is attributed to the
influence of their personal factors and the characteristics of their
environment. OT aims to reduce the variance between capacity and
performance to optimize a person’s participation.
• Evidence-based practice: An OT practitioner demonstrates evidence-based
practice when he or she integrates evidence gained through research (e.g.,
studies related to the effectiveness of therapy) with his/her clinical
knowledge to make informed decisions about a client’s OT evaluation and
interventions. Evidence-based practice assumes that a practitioner engages
in ongoing self-directed learning to remain current with the clinical
evidence and that he or she critically evaluates the source and quality of
the research and information used. Evidence derived from all research
methods (e.g., naturalistic, qualitative, or positivistic quantitative design)
has value to the profession. Rigorous, positivistic research yields the most
reliable data and is the gold standard for research measuring the
effectiveness of therapy.
There are rarely right decisions or actions in practice; more often, there are
best decisions and/or actions.10 This pocket guide is designed as a resource to
assist student occupational therapists, as well as novice and experienced
occupational therapists, in understanding the evaluation process. The
information provided in this pocket guide to evaluation supports OT
practitioners when they are evaluating and working with adult clients to make
optimal clinical decisions and to explain these clinical decisions to clients
using the current scientific knowledge and evidence.
Since the original pocket guide in 2000, there have been many
developments and changes in the profession. In this revised edition, we
present how these developments influence the evaluation process and provide
the reader with an updated comprehensive review of evaluation strategies,
procedures, and the assessments that currently support client evaluation in
OT. The overall organization of the pocket guide models a top–down
occupation-based process within the AOTA OTPF, while individual chapters
are structured using bottom–up and top–down approaches in the presentation
of assessments. The pocket guide is intended to be inclusive and presents
international perspectives, and we have identified when assessments are
available in other languages. Chapters 2 and 3 provide a reader with
information and principles that are germane to the evaluation of adults and
the practice of OT, since optimal use in an evaluation procedure, strategy,
and/or assessment requires a practitioner to explain clearly how and why he
or she will use an assessment/procedure and to identify the expected
outcomes. This requires a conceptual basis (model of practice) to formulate
and inform clinical reasoning. Furthermore, the rationale for choosing actual
assessments is based on observations and knowledge of an individual client,
knowledge of his/her condition, and frames of reference being applied to
Another random document with
no related content on Scribd:
Revue Hispanique (1911), t. XXV, págs. 114-133. Consúltense: M.
Menéndez y Pelayo, Antología de poetas líricos, etc., t. V, págs.
lxxxviii-cxliv; B. Sanvisenti, I primi influssi di Dante, del Petrarca e
del Boccaccio sulla Letteratura spanuola, Milano, 1902, págs. 127-
186; M. Schif, La Bibliothèque du marquis de Santillane, París, 1905
(Bibliothèque de l'École des Hautes Études, fasc. 153); A. Vegue y
Goldoni, Los sonetos "al itálico modo" de don Íñigo López de
Mendoza: estudio crítico y nueva edición de los mismos, Madrid,
1911.
El autor quiso que su libro "sin bautismo sea por nombre llamado
Arcipreste de Talavera, dondequier que fuere levado". Pero cada
editor mudó el título á su talante. Pérez Pastor tomó para su edición
de 1901 del Corbacho el códice iij-h-10 de la Biblioteca de El
Escorial, citado por Gallardo (t. III, 666), que es del siglo xv,
anotando las variantes de las ediciones incunables de Sevilla, 1498,
y Toledo, 1500, con las que corrige y completa el códice, el cual
parece escrito en 1466; pero el libro, según su epígrafe, fué
compuesto por Alfonso Martínez de Toledo, Arcipreste de Talauera,
en hedat suya de quarenta annos, acabado a quinze de Março,
anno del nascimiento del Nuestro Saluador Ihesu X.º de mil e
quatroçientos e treynta e ocho annos. Copia de un original de la
Chronica, coetáneo del autor, y que sacó Pedro Rodríguez
Campomanes, está en la Academia de la Historia, y merece
publicarse. Un códice de las Vidas hay en la Nacional (1178); otro en
El Escorial (b, iij, 1); otro en la biblioteca de M. Pelayo. El cargo de
Capellán en Toledo, etc., se halla en nota autógrafa que puso en su
ejemplar de la Crónica Troyana, que para en la casa de Alba. Hay
documento (Archivo de la capilla de los Reyes Nuevos) donde firma
el primero como el más antiguo de los capellanes, año de 1466.
Pérez Pastor (edic.): "El Léxico del Arcipreste de Talavera es tan
variado y original, que desde antiguo llamó la atención de los
eruditos, ya porque algunas voces usadas en este libro no se
encuentran en ningún autor de los que han escrito en castellano, ya
también porque el autor tomó muchas palabras y frases del lenguaje
popular y recogió no pocas del mismo arroyo". Es probable que á
Martínez de Toledo deba atribuirse una de las versiones castellanas
de los libros De summo bono, de San Isidoro, que se hallan en la
Biblioteca Nacional.