Occupational Function Assessment

Adult Assessment of Occupational Function

• Measurement of joint range can be done either actively (AROM) or passively (PROM)
• A goniometer is used to measure ROM
• AROM refers to the amount of motion at a joint achieved by the patient using their own strength
• PROM refers to the amount of motion at a joint achieved when the joint is moved by an outside force

Muscle Strength

• It refers to how well a muscle can exert force
• Weakness describes the reduction in power of a muscle or muscle group
• When weakness impairs the individual's occupational functioning, it is necessary to determine the degree and distribution of weakness to create an intervention plan
• Strength can be tested through MMT, dynamometer, or pinch gauge

Edema

• Edema is one cause of ROM limitation and/or pain
• Edema is quantified through circumferential or volumetric measurements

Endurance

• Endurance measures the ability to sustain effort and resist fatigue, and is also known as “activity tolerance"
• The better the cardiopulmonary and muscular function a person has, the better their endurance will be
• Muscular endurance specifically is the combination of muscular strength and the ability to perform multiple reps of a contraction without fatigue
• Endurance is measured statically and dynamically during an activity
  • The Borg scale is used to measure self-perceived ranges
  • The talk test is used to identify when a client is past their exertion threshold
  • Endurance is measured by its muscular aspects- MMT, grip, pinch
  • Static tests measure the amount of time a contraction can be held
  • Dynamic tests measure the number of repetitions during a repetitive activity

Sensory Assessment

• Sensory function or sensibility influences body processes like joint and muscle movement
• When sensibility is impaired, can disrupt a person's habits, routines, and roles, which challenges daily occupations

Types of Sensory Impairments

• Cortical impairment affects the brain, which may impact proprioception and fine touch
• Spinal cord impairment: may result in paresthesia, tingling, and pins and needles in region-specific dermatome patterns
• Peripheral Nerve Injury: damage to single nerve root to the extremity area results in loss of sensation ex. Carpal Tunnel- median nerve
• Limb loss sensory impairment results in phantom limb/pain

Common Sensory Assessments

• Awareness or perception tests assess touch, pain, temperature, movement, proprioception, and vibration
• Stereognosis uses the Moberg pick up test to assess awareness of a blinded object, and the ability to discern it without looking at it
• Graphesthesia assesses the ability to recognize symbols written on skin
• Two-point discrimination can be done statically or dynamically and is most reliable on fingers/hands
• Touch localization assesses the ability to localize where stimuli is “placed” on the body
• The Semmes-Weinstein monofilament test can be used to detect thresholds for light and deep touch and protective sensation

Documentation of Sensory Results

• Document the type of test, skin area tested, and response to testing
• Utilize sensory maps and standardized tests compared to norms to assess sensory results
• Summarize evaluation findings as absent, intact, or impaired

Pain Assessment

• Pain is very subjective, and self-report measures provide the most valid measure of the experience
• Pain can be measured through:
  • Visual analog scale
  • Numerical rating scale

Visual-Perceptual Assessment

• Unilateral Inattention describes decreased awareness of the body and spatial environment on the side contralateral to the brain lesion
• Unilateral inattention is most common in right brain lesions/strokes, leading to left sided inattention

Common Screening Tests for Visual Perception

• Clock drawing test
• Comb and razor test

Other Visual Perceptual Deficits

• Form Constancy: difficulty reading along with ADLs and can not find persona
• Figure ground perception: trouble with laundry, unsafe drivings, or can only play with one toy
• Visual closure: unsafe driving, trouble cooking, or difficulty playing cards
• Spatial orientation: difficulty reading and writing
• Depth perception: Spilling, tripping/clumsy, running into objects, decreased abilities in sports
• Visual memory: Difficulty spelling, reading, and remembering routes, as well as losing or misplacing items
• Visual motor integration: clusiness, different handwriting/signature, or difficulty with typing
• Visuocognition impacts planning and organization, results in becoming disorganized, or display decreased reading comprehension

Assessment of Motor Control

• Motor control describes the “ability to regulate or direct the mechanisms essential to movement"
• Motor control emerges from the interaction of multiple systems and involves multiple brain regions
• Injury to the CNS effects motor control
• Weight bearing facilitates motor control

Impact of Motor Control Dysfunction

• Cortical lesions may result in hemiplegic posture or pattern of spasticity: retraction/depression of scapula, internal rotation of shoulder and hip, flexion of elbow wrist and fingers, pronated forearm, lateral flexion of trunk toward the involved side, elevation/retraction of pelvis, extension of hip and knee, supination of foot, and plantar flexion of ankle and toes
• Hypotonia describes less than normal resistance to passive elongation, and affected limbs feel limp and heavy

Muscle Tone

• Hypertonia describes more than normal resistance to passive elongation and may result in neural spasticity and mechanical soft tissue stiffness
• Spasticity produces velocity dependent increase in tonic stretch reflex and exaggerated tendon reflexes
  • The neural component of hypertonus
• Clonus displays oscillating contraction/relaxation of a limb segment that is caused by alternating patterns of stretch reflex and inverse stretch reflex of spastic muscle, and presents like a tremor or tapping of leg
• Clasp knife phenomenon/reflex relates to resistance to passive stretch of a spastic muscle that suddenly gives way
• Loss of fractionation describes inability to move a single joint without producing unnecessary movements in other joints
  • This results in stereotyped movement patterns instead of selective flexible movements
• Apraxia describes the inability to perform goal directed motor activity in the absence of paresis, ataxia, sensory loss, or abnormal muscle tone
  • Characterized by omissions, distributed order of submovements within a sequence, clumsiness, perseveration, inability to gesture, or use common tools/utensils
• Lead pipe rigidity describes hypertonus in both agonist and antagonist muscles

Cerebellar Lesions

• Cerebellar lesions do not have smooth movements
• Intention tremors
• Dysmetria describes the inability to judge distances accurately
• Dyssynergia describes the decomposition of movement
  • Movements that are broken up into a series of successive simple movements rather than one smooth movement
• Dysdiadochokinesia describes the impairment in the ability to perform repeated alternating movements exampples- pronation and supination
• Adiadochokinesia describes loss of ability to perform rapid alternating movements
• Ataxia describes unsteadiness, incoordination, or clumsiness of movement
  • Ataxia may result in gait that is wide based, unsteady, staggering, with a tendency to veer from side to side

Basal Ganglia Lesions

• Tremors at rest or non-intention tremors
• Cogwheel rigidity displays rhythmic interrupted resistance of muscles being stretched when the wrist/elbow is quickly flexed
• Hypokinesia describes slowness or poverty of movement
  • Akinesia describes difficulty initiating voluntary movements

Other Lesion Presentations

• Bradykinesia displays slowness in carrying out movements from Parkinson’s
• Festinating gait presents as small, fast, shuffling steps that propel the body forward at an increasing rate, while the client demonstrates difficulty stopping or changing directions
• Athetosis displays slow, writhing involuntary movements particularly in neck, face, and extremities
  • Muscle tone will either be increased or decreased, and ceases during sleep
• Dystonia displays powerful, sustained contractions of muscles that cause twisting and writhing of a limb or whole body
  • Often results in distorted postures of trunk and proximal extremities
• Chorea involves sudden involuntary purposeless, rapid, jerky movements, or grimacing
  • Primarily in distal extremities (e.g Huntington's disease)
• Hemiballismus displays unilateral chorea in which there are violent, forceful, flinging movements of extremities on one die of the body
  • Particular proximal muscles

Assessments of Motor Skills

• Assessment of Motor and Process Skills (AMPS) assesses motor skills in natural settings using client-chosen occupations and measures ADLs based on performance
• Motor Assessment Scale (MAS) assesses everyday motor activities, evaluates upper limb motor function and is most useful for patients with some distal function
• Action Research Arm Test (ARAT) uses simulated everyday activities to evaluate upper limb motor function
• Wolf Motor Function Test (WMFT) documents outcomes related to UE interventions using basic reaching fine motor control
• Motor Activity Log (MAL) is a self-report related to actual use of UE

Muscle Tone Assessments

• Muscle Tone: evaluated by the resistance of a muscle to passive elongation or stretching (slight resistance to passive stretch is normal)
• Hypotonia: presents as less than normal resistance to passive elongation, extremity feels floppy and heavy
• Hypertonia: presents as more than normal resistance to passive elongation
  • Spasticity: particular type of hypertonia in which the muscle spasms are increased by movement
  • Assessed clinically by observing a muscles response to a passive stretch as measured by the Modified Ashworth Spasticity scale (MASS), while using subjective rating

Examples of Impacts of Impairment on Function

• Apraxia results in awkward grasp/pinch patterns when retrieving objects for self feeding along with difficulty in maintaining orientation of grooming objects toward the body and during hand manipulation such a shuffling cards
• Ataxia prevents the ability to coordinate reach pattern while bathing/leisure and produces nystagmus or rapid involuntary movements of the eye along which interferes with reading or paying bills
• Bradykinesia increases the time needed to perform ADLS with increased difficulty getting up/down from a chair, or throwing/catching ball
• Chorea, athetosis, and balliusm interferes with sleep/rest patterns due to flailing limbs and impacts feeding/swallowing, and limits participation in written communication
• Dysmetria presents as overshooting/undershooting when trying to retrieve items, navigate curbs, or have difficulty climbing steps
• Hypotonicity decreases the ability to maintain an upright position while seated in a chair or standing position while preparing meals resulting in slouching
• Intention tremors result in spillage of food from a spoon during feeding and makes it difficulty putting toothpaste on a brush or typing
• Paresis decreases the ability to stabilize/manipulate grooming objects, retrieve items, or standing and the individual will display weight shifting movements or shaking
• Spasticity and Rigidity makes it difficult for an individual to open the hand/position the arm, which makes placing affected limbs into clothes, or turning in bed challenging

Clinical Classification by Grade

• Grade 0: no increase in muscle tone
• Grade 1: slight increase in muscle tone that is manifested by a catch and release or by minimal resistance at end of ROM when the affected joint is moved in flexion or extension
• Grade 1+: slight increase in muscle tone that is manifested by a catch, followed by minimal resistance throughout the reminder (less than half ) of ROM
• Grade 2: ,marked increase in muscle tone though most of ROM, but affected parts are easily moved
• Grade 3: considerable increase in muscle tone, passive movement difficult
• Grade 4: affected part/parts rigid in flexion or extension

Paresis versus Motor Control

• Paresis refers to weakness, involving an inability to selectively control joint movement are common after damage to brain resulting in stroke
• To assess cortical injury, observation during activity engagement will display: abnormal posturing of limbs or deviations in trunk, compensatory motor strategies, weakness of specific muscle groups, incorrect timing of movement, and incoordination of combined movements
• Manual muscle test may be difficult to measure given the standardized measures due to changes in tone and compensatory movements
• Document any gross motor movements and note any compensatory patterns when assessing motor control

Clinical Assessments of Motor Control

• Fugl-Meyer assessment: used to measures extent to which clients can isolate and coordinate individual joint movements, evaluates the upper extremity to assess motor recovery after stroke
• Functional Upper Extremity Levels (FUEL): used and recognized in many clinics, used in occupational therapy, and comes as Toolkit with motor control interventions for Cooper's Hand Therapy, and tests one's levels of motor control

Assessing Function of Motor Control

• Non Functional or Lowest Level of Motor Control - individual displays involved UE not incorporated into ADLS, decreased awareness of involved UE and does not not displace AROM
• Dependent Stabilizer - individual displace involved UE incorporated into activities as a stabilizer but is placed by the less involved UE or caregiver, displacement of Some AROM present- scapular, gravity eliminated, but Unable to initiate placement but increased awareness of involved UE during functional tasks
• Independent Stabilizer- displays Some AROM present- able to position independently without use of other UE in activities, Used primarily as a weight to stabilize, No active hand use
• Gross Assist - display involved arm as and are used actively to assist in simple functional activities May still be influenced by synergistic movements or have extreme weakness, will displays Gross grasp but no functional release and Fine motor coordination is not functional
• Semi-functional Assist -displays involved Arm that displays used in ascites that require active motor control for pushing, pulling, and standing, displaces Gross grasp and release developed, and some individual finger movements Measurements for grasp, pinch, and coordination are below norm, and Hand is able to assist with fastenings
• Functional assist- involves involved arm display full AROM with the use of involved UE that does all activities for fine motor task while remains assertive UE with mild awkwardness/weakness
• Fully functional is when Involved UE has returned to full function, Able to use as dominant UE along with Measurements with in WNL

Assessing Clinical Coordination

• coordination, ability to produce accurate, smooth and controlled movements
• Assessed by observing patients engaging in ADLS through:
  • Finger to nose, finger nose finger, pronation/supination, mass grasp - alternating between opening/closing, finger opposition or tapping foot or hand
• Graded subjectively using the following ordinal scale
  • 5 = normal, 4 = minimal impairment, 3 = moderate impairment, 2 = severe impairment, 1 = cannot perform

Standard Clinicalized Tests

• box and block test (BBT) to asses coordination
  • Number of wooden blocks transfered from from 1 box to another box of equal size within in 60 seconds
• perdue Pegboard Test with Board of 4 cups across top and 2 vertical rolls of 25 small holes
  • Testing to Move the Board
  • move as many pins as possible within in 30 seconds
• assed using the Nine hole peg test assessing the recorded time of putting pegs on board and removing

Assessment of Motor Planning

• assessment of skill that allows one to Remember and perform steps to make a motor memory during performing of a motor task Ex: riding a bike
• Motor plans known as praxicons, and Stored in left inferior parietal lobe for use
• assessed to prevent of Motor apraxia (ideomotor apraxia): prevents ability perform purposeful actions despite Having Normal muscle and and sensory functions
• asses thro imitation of gestures or Performing Transitive Movements or object such as teeth Brushing and Nontransitive Movement such a saluting on command or demonstration
• Cambridge Apraxia Battery, Limb Apraxia Test, Kaufman Hand Movement Test, and Ideomotor Apraxia Test, including a Florida Apraxia Screening Test
• ADL observations to measure disabilities in those with Apraxia
  • Assessing 4 apecific adLS like - Washing Face and Upper Body, Putting on Shirt and Blouse, Preparing Food or a Individual task chosen therapist
  • Scoring based on independence Initiation and Executive Control within Ranging 0-3 (highter scoress indicate more several impairment)

Clinical NeuroAssessments related to behavior

• ADL focused occupation-based neurobehavioral evaluation (A-ONE) uses O : Dependent or 4 = independent

Assessing Balance

• evaluation of ability to have Even distributed weight while enabling Someone remain Upright and Steady (required for activities With in sitting and Standing)
• Achieving or Maintaining Balance as requirement of Coordination of Musculoskeletal and Sensorimotor Neural and Process with in Vestibular, Visual or Tactile , Proprioceptive info
  • asses clients Factor performance skill
• Impaired motor coordination balance will lead to - Decrease to Trunk Strength or Weakness in Lower Extremities, a Side affects Of Medications , High to Low Blood Pressure
  • Multifactorial Post Stroke: Reduced Weight Bearing With Sensation or Unilateral or Attention and Delayed reactions:
• impaired Balance in the leading cause of failing and Decline motor Skill
• Screening Of Balance Skills:

Balance Skills

• Observation; with Equal shoulders as leaning and enable ability to Maintain While Supported sitting on edge corner of bed, Ability to Extend or Flex trunk Racing Body and crossing Midline
• screen sitting balance with Gradin first
• Grading test to Detect Severity first (Grad Includes Static and Dynamic or balance and standing) and grades qualified With Assistive Device with -
  • Standardized Assessments or Berg (scales or Functinal Reach)
• asses thout Measure Maximum Forward Reach in Standing Position

Standardized Assessments

• statis sitting scales:
  • with Normal Ability or maintain unsupported sitting balance against Maximal Resistance
  • with Ability or maintia ability to Maintain While Maintain While Maintain Min Maintain Balance Chair
  • with Ability to use Maintain with or Chair

Static Scales of Body

• Normal: Ability to maintain unsupported standing balance against Maximal Resistance
  • With stand unsupported or With support use to Maintain to Maintain Without with Loss
• Require or help
  • Require maximum assistance and support to maintain standing ability

Assesing Daily Liviavtes

• Assess Daily Living - that Assess Ability carry basic Activity During Including - Activities of Daily LIving or instrumental or Leisture or
• Bathing or toileting for - Or Device
• Assess Daily Living- chart Reviews to asses the - restrictions or contra indications and comobibities to Equipment

Assess Client with OT

• OT Should Review all Notes From Asses Client information and PLOF or HOme or Support System -
• Helps under stsnd client Abilities with interest and roles with habbits
• Clinet Should full Understand DO NOT ask WHAT IS YOUR ROLES what This Special Assess ADL the clients that Perform from (self-report) or Per Base

Clinet

• Assess clients in - kleinbell scale that is in Sub-Acule settings with no Longer Sitting or
• No Longe subacute (SNF) (in patient or with in Home setting) IDEALLY Assess client factors (range of motion), strength, sensation, balance, or awareness before beginning
• Functional Independence - asses sub acute settings (SNF) or Settings
• -- still to test what client do well still out

Section GG Levels

• Full Independent
• level of or support with or Clients provide with balance for cause of Therapist Hands Clinet Dynamic the Safety NOT During or
• Level Clients to + Moderate Assist Level Section Moderate -Assist Help do All the Efort.
• withs and factor.

Assessing Clinical Coordination

• client or are is at levels what

CVA Conditions

• variety - by the Deficiencies brain to Supply and and Progrss by factor and and Size

Stroke Causes

• brain of adults the Americans a Stroke an in 25 % to Requires
• Risk factor factors Lifestyle The
• brain

Etiology

• the The Clot That System 10 % Stroke-from
• Can Arteriovenous Anyeurism that Stroke resembleStroke

Functional Brain

• snake - The Be Control Brain with - Hear what's

Ateria Stroke of

• the a Arteria the Common 70 with
• Heminopa or left

PCA

• the is 20 common of
  • vertigo that Unilaterally

Impaiement Recovery and

• strokes on and on UE activity with • The on and • The to to
• by • Assessments with • OT and

Goal

• The that this client

Treatment

• the
• ADLS The Patient The

Assessments of Therapy OT

• or from and
• that
• the

With

• to an of of stroke

The Assestment

• 748
• is

Functional Training

• and
• for

The

APX Tests

• Cognitive - Cognitive Strategy traning; internal/external strateigies to overcome daily challenges
• Gesture Training - Transitive Gesture - Using Common Objetive - Intrantitive Symbolic/Gesture
• ** the to the
• ** The with

Apraxic

• To with for with problems

Training The

• The to and
• With The for Training

This lesson covers assessment techniques for occupational function, including joint range of motion (ROM) measurement using a goniometer, muscle strength testing, edema quantification, and endurance assessment. It highlights the importance of these assessments in creating effective intervention plans.