What is Occupational Therapy?

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1 Introduction to Occupational Therapy Services What is Occupational Therapy? Alice Chan, OTI Tai Po Hospital a health profession that focuses on promoting health and well being through engagement in meaningful and purposeful activities, i.e. occupations. Occupational therapy involves helping people perform daily activities that are essential and significant to their health and well being through the involvement in valued occupations. World Federation of Occupational Therapists, 2004 include but are not limited to activities of self-care, the act of enjoying life and the ways that individuals contribute to the social and economic aspects of their community. Crepeau et al., 2009 Aims & Objectives Maximize patients potential in independence in self care, work and leisure Enhance community integration through education to patients and caregivers on ADL performance skills and techniques, self management of own disease process, life style re-design Facilitating patients and caregivers adaptation to their disabilities, both changes in physical and psychological aspects 1

2 Domain of Occupational Therapy Practice The Multidisciplinary Team Patient and Caregiver Adopted from: Center on Human Development and Disability, Clinical Training Unit, University of Washington Common Evaluation Tools Barthel Index (BI) Functional Independence Measure (FIM) Mini Mental State Examination (MMSE) Functional Need Assessment (FNA) Barthel Index BI First published in 1965 by Mahoney F & Barthel D Purpose Measure performance in basic Activities of Daily Living (ADL) Establish degree of independence from any help Monitor improvement in ADL over time Populations tested Stroke, neurological disorders, geriatrics, brain injury Assess 10 ADL /functional mobility activities feeding, bathing, grooming, dressing, bowels, bladder, toilet use, bed/chair transfers, mobility on level surfaces and stairs Scoring original score modified by Granger et al in 1979 (0-100) and further refined by Collin et al, 1988 (0-20) and Shah et al in 1989 Basically, the higher the score the more independent the person; 0 (totally dependent) to 100 (completely independent) Interpretation (Sinoff and Ore, 1997) , independent 60-79, needs minimal help with ADL 40-59, partially dependent 20-39, very dependent <20, totally dependent Barthel Index Form 2

3 Functional Independence Measure FIM Introduced in 1986 as BI was considered too simple and unresponsive Purpose Measure functional independence in personal activities of daily living (13 items) and measures of communication and social cognition (5 items) Useful for assessment of progress, usually assessed during admission and pre-discharge Populations tested Stroke, spinal cord injury, brain injury, multiple sclerosis, orthopedic conditions, geriatrics Comprises 18 items 13 motor tasks : eating, grooming, bathing, upper body dressing, lower body dressing, toileting, bladder management, bowel management, bed to chair transfer, toilet transfer, shower transfer, locomotion, stairs and 5 cognitive tasks : cognitive comprehension, expression, social interaction, problem solving, memory Scoring 7-point ordinal scale for each task that ranges from complete dependence (1) to complete independence (7) Interpretation Scores range from 18 (lowest) to 126 (highest) Admission FIM >70 associated with achieving non-dependence by discharge whereas admission score < 50 remained dependent (Ween et al, 2000) Functional Independence Measure Form Mini-Mental Mental State Examination MMSE Introduced by Folstein et al in 1975 Purpose Used to screen for cognitive impairment Commonly used to screen for dementia Also used to estimate the severity of cognitive changes in an individual over time Populations tested Used to assess cognitive impairment in various populations Consists of 11 simple questions or tasks grouped into 7 cognitive domains Orientation to time, orientation to place, registration of 3 words, attention and calculation, recall of 3 words, language use, and visual construction (comprehension and basic motor skills) Scoring Direct observation of completion of test items/ tasks Interpretation A score of < 24 (maxi 30) is generally accepted cutoff indicating the presence of cognitive impairment (Dick et al, 1984) Consideration of age and education 27-30: normal 21-26: mild cognitive impairment 11-20: moderated cognitive impairment 0-10: severe 3

4 MMSE Form Functional Need Assessment CFNA Published in 1990 by S.B. Dombrowski, M. Kane, N.B. Tuttle and W. Kincaid Purpose Measure patient s ability to initiate and perform basic Activities of Daily Living (ADL) Populations tested people with chronic mental illness 26-item performance-based measure instrument covers multiple areas of adaptive functioning (subscales) such as personal hygiene or kitchen skills Each subscale further comprises of five items in a developmental sequence E.g. the personal hygiene subscale consists of 5 items which are arranged in the order from the most primitive task (identify or demonstrate use of implements for personal hygiene) to the most complex task (independent in personal hygiene) Scoring A person will receive a score of 5 for each of the items he or she successfully performs, or a score of 0 for failing to perform any item under a subscale Maxi score 5x5x26 The total score is then converted into an average score by dividing it by 26 Basically, the higher the score the better the functioning Interpretation (Law, 1999) The recommended cut-off scores for the independent living, halfway house, and long stay care home groups were 605/ , 550/ /610, and 450/ /555 respectively Functional Need Assessment Form ADL Training Occupational Therapy Interventions 4

5 Household Management Functional Assessment & Training in Simulated Environment Work Rehabilitation Remedial Activities Splinting and Positioning Pressure Therapy 5

6 Seating and Positioning Computer Access and Cognitive Rehabilitation Seating picture adopted from: Otto Bock Environmental Control System Patient and Caregiver s s Education Home (School, Workplace) Assessment Outdoor Training 6

7 Community Living Skills Training Assistive Equipment Prescription Enhance patients ADL independence Facilitate community living Alleviate caregivers stress and physical efforts Promote quality of life Rippled mattress Wheelchair Wheelchair parts Seat cushion Back support Commode/shower chair Hoist Hospital bed Ripple Mattress Minimize pressure/contact between body and lying surface Reduce the occurrence of pressure sores especially at bony prominences Stage 1 4 Stages of Pressure Sores Stage 2 Types Ripple Mattress Stage 3 Stage 4 Cell A+B Low air loss Requires constant power supply and regular cleaning /change of air filter 7

8 Wheelchair Manual Wheelchair Manual Powered dependent self basic special Picture Adopted from: Invacare & Quickie Power Wheelchair Special control / input Battery charging Special Power Wheelchair Recline /Tilt-in-space for pressure management RWD Scooter 3 wheel or 4 wheel MWD FWD Standing Picture Adopted from: Invacare Picture Adopted from: Invacare & Lifestand Accessories Seat Cushions and Back Supports Hand positioner and arm tray Head support Table-top Picture Adopted from: Otto Bock 8

9 Common Deformities and Body Postures Improper Sitting Posture Poor circulation Skin breakdown Pressure sores Proper Sitting Posture Choosing Appropriate Seat Cushion Evenly distribute pressure in sitting position Stable base to maintain sitting position for functional performance Picture Adopted from: Invacare, Roho & Sunrise Medical Pressure Relieving Cushions ³ (Foam-gel) (Foam Contoured) (Air) Picture Adopted from: Invacare & Roho ý ±º (Rigidizer) 9

10 Back Support Built-in or add-on Different depth and contour Commode/Shower Chair Stationary Self-propelling laterals Dependent type Picture Adopted from: Invacare & Otto Bock Transfer bench Picture Adopted from: Invacare & Tilt-in-space Hoist Hospital Bed Facilitate nursing care and change of lying position Types Ceilingmounted Picture Adopted from: Invacare & Viking Mobile Function height adjustable Picture Adopted from: Invacare manual reclining position power Knee adjustment 10

11 References 1. Collin, C., Wade, D.T., et al (1988). The Barthel ADL Index: a reliability study. Int Disabil Stud 10(2): Dick, J., Guiloff, R., et al (1984). Mini-mental state examination in neurological patients. Journal of Neurology, Neurosurgery & Psychiatry, 47(5): Folstein, M.F., Folstein, S.E., et al (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: Granger, C.V., Dewis, L.S., et al (1979). Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil 60 (1): Law, K.M. (1990). Validation of functional needs assessment (Chinese version) for people with chronic schizophrenia. M Phil Dissertation. Hong Kong Polytechnic University. 6. Mahoney, F. & Barthel, D. (1965). Functional evaluation: the Barthel Index. Md Med j 14: Shah, S., Vanclay, F. and Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 42 (8): Sinoff, G. and Ore, L. (1997). The Barthel Activities of Daily Living Index: selfreproting versus actual performance in the old-old (>75 years). J Am Geriatr Soc. 45: Tombaugh, T.N. and Mclntyre, N.J. (1992). The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40: Ween, J. et al (2000). Neurorehabil & Neural Repair. 14:

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