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Flashcards in Top-Down Eval Deck (21)
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This is the initial step in the evaluation process

Occupational Profile. This provides an understanding of the client's occupational history and experiences, patterns of daily living, interests and values, and needs. The client's reasons for seeking services, strengths and weaknesses in relation to performing occupations and daily life activities, areas of potential occupational disruption, supports and barriers, and priorities are also identified.


The step in the evaluation process during which the client's assets and problems or potential problems are more specifically identified.

Analysis of occupational performance. Actual performance is often observed in context to identify supports for and barriers to the client's performance. Performance skills (e.g., coordination and trunk stability when performing occupation), performance patterns (habits, routines, roles), context or environment, client factors ((Values, Beliefs, Spirituality, Body Functions (sensory, mental, cardiovascular), and Body Structures)), and activity demands are all considered, but only selected aspects may be specifically assessed/ Target outcomes are identified (OTPF-3)


The steps to Top-down eval include:

1. Chart Review
2. Occupational History Interview
3. Assessment of Occupational Performance
a. occupations
b. context and environment
c. performance patterns (habits, routines, rituals,
4. Assessment of Client Factors and Performance
-Client Factors: values, beliefs, spirituality, body
functions (sensory, mental, cardiovascular), and
body structures
5. Synthesis and Summary
-Assets and areas for improvement
-Long-term and short-term goals
-Intervention Plan


T/F: Interventions that seek to improve performance component function without evaluating and improving occupational performance cannot be considered OT

True. This Top-Down approach is essential to occupation-centered care


This process begins with occupational performance and follows with occupational performance skills, client factors, and performance contexts

Top-Down approach!


This process identifies and treats components or client factors/skills interfering with occupation, moves into occupation
E.g., with SCI start strengthening to work towards dressing

Bottom-Up approach


During an evaluation, you are trying to capture four major pieces of information:

activities with specific performance limitations, cause of the limitations, ability to modify the performance, and kinds of intervention that may work to improve performance


Upon completion of the assessment, what does the OT do?

Work on an intervention Plan. Information from the occupational profile and various assessments is analyzed and a problem list is generated.


During assessment, problem statements should include...

Problem statements should include a description of underlying factor (performance skill, pattern, client factor, contextual or environmental limitation, activity demand) and its impact on the related area of occupation


The intervention plan is based upon...



Process of Evaluation results and establishing an intervention Plan includes:

Use information from occupational profile and various assessment
Obtain the client’s/family’s goals for OT
Use theoretical knowledge and professional reasoning skills
Determine the client’s assets and limitations
Develop long-and short-term goals
Decide upon intervention approaches
Determine interventions to be used to achieve stated goals
Identify intensity, frequency, and duration of treatment (could be site-dependent)
Include recommendations and referrals to other professionals or agencies

“…directed by the client’s goals, values, beliefs, and occupational needs…a collaborative effort between the therapist and the client or, if the client is unable, the client’s family or caregivers” (Smith, 2013, p.123).


In acute rehab, you have to use this assessment:



What assessments you use depend mostly upon what?

Where you work


This assessment includes 10 categories of activities of independence rating. Gives a broad profile, based on a point system (gives overall score), concrete yes/no (operational definitions), used for research, placement

The Barthell Index (BI). Pretty good validity and reliability?
Used a lot more than some of the others…
Good for research… specific data – not in clinic for small changes
Not used as much as FIM b/c/ FIM is required for adult inpatient rehab
If can do it alone get score of 10, if needs help gets 5


This assessment addresses ADL's e.g., dressing, mobility, elimination, bathing and hygiene, eating, and emergency communication. It is an objective assessment and describes items in behavioral terms

Klein-Bell ADL Assessment.
Objective… describes items in behavioral terms
Validity and reliability established
Sensitive--reflects small changes over time
Scoring: achieved or failed
Provides information for treatment planning
Scoring: achieved = with/without equipment, no verbal or physical assistance.
170 items—time consuming
May not be appropriate for acute care where very fast paced


This assessment is an "OT Occupational Performance Assessment" and rates functional performance and motor and process skills

Assessment of Motor and Process Skills (AMPS)
OT observes and evaluates in natural environment
Rates functional performance AND motor and process skills
Motor skills: move oneself or task objects
Process skills: logically sequence actions over time, select & use appropriate tools, adapt performance when problem arise

56 personal and domestic ADL to choose from
Measures quality of performance and energy, efficiency, safety, or independence of goal-directed actions
Measures beyond % of assistance
Involves CHOICE (meaning)
SIX STEPS: client selection, interview, task selection by client, preparation of client and test environment, administration and scoring.
OTPF 3rd version is based off of the language in the AMPS
Look at how you’re doing occupation, motor skills, thinking, executive function, physical, process skills
All computerized
Must be AMPS certified


AMPS administration includes...

Therapist presents 3-5 occupations from manual (based on interview)
Client chooses 2-3
Manual includes specific task guidelines and flexible task guidelines
4 point scale: competent, questionable, ineffective, markedly deficient
Computerized scoring done after completing training course
Establish task contract collaboratively
30-40- mins. In task-related environment.
MUST complete training course, including rater calibration to utilize effectively for validity and reliability


Which of the following ADL assessments is most sensitive to changes in the client's performance?
a. Functional Independence Measure (FIM)
b. Klein-Bell
c. Barthel Index
d. Canadian Occupational Performance Measure (COPM)

b. Klein-Bell


Which of the following ADL assessments is most sensitive to client's perceptions?
a. Functional Independence Measure (FIM)
b. Klein-Bell
c. Barthel Index
d. Canadian Occupational Performance Measure (COPM)



T/F: Environmental Assessments can include home assessments and community assessments, but usually not workplace assessments

False. Environmental assessments can include all of these


T/F: Not all assessments need to be "formally" completed.

True. Observations are just as important
Using your clinical knowledge, clinical insight, and clinical judgment to make decisions
Assess as soon as client enters door
Many standardized assessments don’t address ecological validity (don’t relate to real world such as spelling “world” backwards; can perform transfer in ADA bathroom in hospital but very different environment of own bathroom at home)
Try to simulate as best as can
Can make recommendations based off of observations e.g., suggest look for dysphagia when observe trouble swallowing