OT 11 Finals - 1 PDF

FIELDWORK 3 WORK EVALUATIONS LEARNING OBJECTIVES After reading this module, you will be able to: - Understand OT theory and frame of reference related to work - Describe the role of OT in occupational or industrial rehabilitation - Describe the different evaluation methods in...

FIELDWORK 3 WORK EVALUATIONS LEARNING OBJECTIVES After reading this module, you will be able to: - Understand OT theory and frame of reference related to work - Describe the role of OT in occupational or industrial rehabilitation - Describe the different evaluation methods in occupational or industrial rehabilitation - Use ergonomic checklists in the evaluation of a selected client PRE – TEST Let’s see how much you know about work evaluations in OT. Write T on the blank if the statement is correct and F if the statement is incorrect. 1. The Person-Environment-Occupation Model looks at the _________________ dynamic relationship between the person, environment, and his occupation. 2. In the Occupational Adaptation Frame of Reference, any _________________ occupational challenge to the individual adversely affects his mastery of a desired occupation. 3. Functional Capacity Evaluations measures general skills or _________________ capacities of the worker. 4. Functional Capacity Evaluation are done in two to four hours _________________ over the course of two days. FIELDWORK 3. Work Evaluations. April 2021.  5. Work samples are hands-on evaluations that measure dexterity, _________________ coordination, and use of tools. 6. Testing procedures of psychometric tests can rarely be _________________ modified. 7. Accurate information about a particular type of work can be _________________ obtained when Job Demands Analysis is done informally. 8. Worksite evaluations involve assessing the work, the worker, _________________ and the workplace. 9. Ergonomic evaluations are done only for healthy workers to _________________ prevent injury. 10. Static posturing is a risk factor for injury in the workplace. _________________ OT THEORY AND FRAME OF REFERENCE RELATED TO WORK Occupational therapy theory, practice, and research have always approached performance from a holistic perspective. One model, the Person-Environment-Occupational Model emphasizes the complex, dynamic relationships among the person, environment, and the occupation. It describes occupational performance as the outcome of a dynamic, interwoven relationship that exists among individuals, their roles and occupations, and the environments in which they live, work, and interact. According to this model, occupational therapy intervention seeks to enable optimal performance in occupations that client defines as important. For instance, an OT who works with a client who has had a disability must consider the client’s personal strengths and limitations in the performance of self care, his psychological adjustment to his disability, and mobility skills in preparation for return to work. Variables in the home and office environment must be assessed and modified to optimize independence in functioning. 2 The occupational adaptation frame of reference suggests competence in a person’s occupational response. To obtain competence, the person must interact with the occupational challenges within the environmental context. A person’s performance is largely dependent on the level of desire for mastery, the environment’s demand for mastery, and the resulting press for mastery. How a person responds adaptively determines whether the person will experience relative mastery in his or her occupations. The strength of this desire influences the achievement of mastery. The occupational environment presents challenges to an individual’s performance. Physical, social, and cultural aspects of the environment can either facilitate or impede performance based on the individual’s aptitudes and adaptive capacity. Occupational therapists can act as facilitators of the environment. They can address both the person system deficits and the environmental demands to facilitate a person’s mastery in his or her preferred work occupation. For this frame of reference, an OT who is working with a client who has had a disability will need to consider the client’s level of motivation to return to work and the tasks that his job requires. The desire for mastery may be high if there is a need to return to his job to financially support his family. The office setting might present physical challenges for him and redesign of the area will need to be considered to optimize his ability to perform his job. EVALUATION IN OCCUPATIONAL OR INDUSTRIAL REHABILITATION The range of services provided to injured workers and industry is often encompassed by the terms “industrial” or “occupational”. Occupational therapists are integral in providing these services, and this area of practice provides a tangible way for therapists to experience the tremendous reward of seeing lives changed through their efforts. Occupational or Industrial Rehabilitation include the following evaluations: Functional Capacity Evaluation The functional capacity evaluation (FCE) is an integral assessment tool that is used for work injury prevention and rehabilitation. FCEs define an individual’s functional abilities and/or limitations in 3 the context of safe, productive work tasks. An FCE itself involves a process of systematically gathering and testing information and making and testing hypotheses about performance, often in relation to an occupation in context. The therapist begins by reviewing referral information related to a client’s medical and work history. A series of test activities are then administered to measure whether the person has the abilities to meet the required job demands, to determine a level of disability, or to demonstrate the need for, and progress in, rehabilitation (Harwood, 2004). Physicians, employers, insurers, and benefits adjudicators often rely on FCEs to provide definitive answers in a variety of situations involving work. Results of these evaluations have significant implications for further rehabilitation efforts, employment, compensability determinations, and cash benefits. FCEs include a wide range of evaluation activities. The simplest evaluations involve a series of standardized tasks with measured weights and distances and a trained observer; these are available for upper extremity as well as back and lower extremity activities. Other approaches use machines to measure average and peak forces, velocity, and range of motion in several different planes. In these situations, workers are generally asked to exert a maximal effort. Job simulation, using tasks and equipment that are specific to a particular job, has recently become more popular, in part because of the Americans With Disabilities Act (ADA) requirement that valid testing should be job-specific and focus on a comparison of capacity to actual job demands (Lechner, 1998). The concept of matching job or workplace demands to the capabilities and limitations of a worker is a fundamental assumption underlying FCE application. One of the most important aspects of an FCE is that the measurement of capacity is specific to the demands that the job poses. The estimates of job demands are inexact generalizations that have not been scientifically validated. A formal job analysis is desirable for FCEs that are intended to measure the ability to work at a specific job. Discussions with employees and written company job descriptions are also helpful in obtaining accurate assessments of job demands. FCEs are usually performed in the clinic and may range from 2 to 4 hours in duration over the course of a two-day period. Protocols often extrapolate from tasks that are stereotypical or performed at near-maximal levels for a short period of time to predict ability to sustain job activities 4 for a full workday and workweek. Performance on FCE tasks are often compared with population or coworker norms, as actual job force requirements are not often estimated during this process. It is important for therapists to use good observational skills throughout the assessment to ensure a client’s safe performance (King, 2004). Vocational Evaluations Vocational evaluations are “a comprehensive process that systematically uses work, real or simulated as the focal point for vocational assessment and exploration to assist individuals in their vocational development.” The following factors are addressed in the traditional vocational evaluation model: physical and psychomotor capacities; intellectual capacities; emotional stability; interests, attitudes, and knowledge of occupational information; aptitudes and achievements (vocational and educational); work skills and work tolerances; work habits; work-related capabilities; and job-seeking skills. These assessments can last from 3 to 10 consecutive days, depending on the goals of the assessment. Vocational evaluators generally conduct these types of assessments in private vocational agencies; however, some occupational therapists also have been involved in conducting these evaluations in public and private medical or nonmedical settings. Vocational rehabilitation, worker’s compensation, and long-term disability carriers pay for these services, but most medical plans do not. Categories of vocational or work evaluations include the following: CATEGORY AND EXAMPLES OTHER REMARKS DESCRIPTION Psychometric Tests - Inadequate norm groups Wide variety of paper-and- - Restrictive standardized pencil and apparatus tests to administration procedures measure general intelligence, personality, achievement, - Limited ability in modifying abilities, aptitudes, interests test procedures 5 a. Aptitude or Achievement Weschler Intelligence Scale Tests: measures intelligence Peabody Individual Achievement Scale b. Interest Inventories and Reading-Free Vocational Checklists: used to gain Interest Inventory insight into the client’s interests, desires, and work Interest Checklist (NPI) objectives Occupational Aptitude Survey and Interest Schedule c. Performance Tests: hands- Purdue Pegboard on evaluations that measure dexterity, coordination, and Minnesota Rate of use of tools (usually purely Manipulation Test motor skills) Crawford Small Parts Dexterity Test Work Sample - Resembles actual work Well-defined work activity which involves tasks, - Provides opportunities to materials, and tools which observe work behaviors, are identical to those in an physical functioning, and a actual job or cluster of jobs variety of other areas Has four categories Single Trait: measures a single worker trait or characteristics Cluster Trait: measures a VALPAR Component Work group of traits that are Samples 1, 4, 8, 9, 11, 201 inherent to a job Simulated Job: replicate a VALPAR Component Work segment of the essential Sample 19 work factors, materials, equipment, supplies, and tasks of one or more jobs 6  Actual Job: measures a client TOWER work factors on only one job Singer Career System There are generally two different types of vocational evaluation: a general vocational evaluation and a specific vocational evaluation. A general vocational evaluation is a comprehensive assessment to evaluate a person’s potential to do any type of work. For an individual who has never worked, does not have a job to return to, or cannot return to previous job because of a disability, this type of evaluation is beneficial in determining one’s aptitudes, abilities and interests to explore all reasonable options for work. A general vocational evaluation could help identify other vocational interests and abilities by exploring a person’s cognitive and motor skills and physical and mental tolerances that could be applied to a different occupation. A specific vocational evaluations assesses a person’s readiness to return to a particular occupation. Job Demands Analysis Assessing the physical demands of a job by JDA is often beneficial in the rehabilitation process inasmuch as recommendations for initiation or return to work require objective information about both the client’s abilities and the job itself. A well-written job description that includes the essential tasks of the job, physical requirements, cognitive aptitudes, educational requirements, equipment operated, and environmental exposure assists in selecting suitable candidates for employment, setting compensation packages, and making appropriate return-to-work decisions after an injury. Approaches to a JDA include questionnaires, interviews, observations, and formal measurement. It is common to interview incumbents or supervisors about the job requirements. Such an informal approach often leads to narrative descriptions with little functional information and questionable accuracy of demand estimates. As with other types of assessment, it is important to have an objective process for analyzing the demands of the job. In the context of attempting to make return-to-work decisions based on matching the results of an FCE with the job description, many FCEs include a JDA component. However, these are often subjective interviews with the client and can lack accuracy regarding the physical demands. 7 Worksite Evaluations Worksite evaluations are on-the-job assessments to determine whether an individual can return to work after the onset of a disability or whether a person can benefit from reasonable accommodations to maintain employment. A worksite evaluation is usually conducted after a job analysis has been done. After this information has been obtained, the occupational therapist schedules a time with the employer and the worker to meet at the worksite..When the occupational therapist meets the employer and worker at the worksite, the occupational therapist assesses the work, the worker, and the workplace. The evaluation begins with an analysis of the essential functions that may require accommodation. The occupational therapist should have an idea of what these functions are, based on the information obtained, before going to the worksite. The desired outcome of the work tasks should be emphasized, not just the process of performing the essential function. The occupational therapist should find out certain details, such as how the outcome will be affected if a particular task is done incorrectly, in a different sequence, or omitted; whether there are quotas, standards, or time constraints that must be met; and whether the frequency with which a task is done will affect the outcome. Activity analysis is a useful tool for evaluating a person at the worksite. It can be used to address all areas, including motor, sensory, cognitive, perceptual, emotional and behavioral, cultural, and social. When assessing a person’s ability to carry out the essential functions of the job, the occupational therapist has expertise in breaking down the tasks and determining the parts of the task with which the worker is having difficulty or may have difficulty over the course of a workday. The occupational therapist can suggest accommodations to allow the worker to carry out the essential functions of the job. The final step in the worksite evaluation is to assess the work environment. The environment outside the immediate work area should be evaluated (parking if driving or access to public transportation; access into the building, break room, and restroom), as well as the workstation itself. All work areas that the worker may use need to be investigated to identify obstacles and solutions to increase accessibility. The location and placement of machines, supplies, and 8 equipment that the worker needs to access should be assessed, as well as other environmental factors such as lighting, temperature, and noise level. Taking photographs or video recordings at the worksite can be very useful; however, permission must be obtained from both the employer and the worker to do so. The occupational therapist should also bring a tape measure to measure the height of work surfaces, width of doorways, and other factors, depending on the person’s needs. Drawing a layout of the work area to scale on graph paper is also very helpful, especially when the worker is in a wheelchair. Critical measurements can be recorded on the diagram. The outcome of the worksite evaluation is to determine whether the person can safely and adequately carry out the essential functions of the job with or without any reasonable accommodations. Ergonomic principles should be considered and applied when recommending reasonable accommodations. The process of identifying reasonable accommodations requires cooperation between the person with the disability, the employer, and the occupational therapist. Each person has valuable insights and information to contribute to the process of identifying the best accommodations. The occupational therapist analyzes the need for modification of the equipment that the worker is using or modification of the workplace to help the person perform with greater efficiency, effectiveness, and safety. Ergonomic Evaluation The ergonomic evaluation is an important assessment and intervention tool when used as part of a comprehensive rehabilitation or injury prevention program. This tool can be used along the entire continuum of prevention services. Ergonomic evaluation can be performed during workstation and work methods planning to assist in efforts to prevent worker injury. Ergonomic evaluation can also be performed for workers in whom symptoms of a work-related musculoskeletal disorder (WMSD) develop and for workers who come to therapy for rehabilitation and are ready to return to work, the goal being to prevent reinjury. Finally, ergonomic assessment can be useful in modifying a job in preparation for a disabled worker’s return to work with the goal of preventing further injury related to the disability. 9 The ergonomic evaluation should begin with the occupational therapist scheduling a time to meet with both the worker (or workers) to be assessed and the direct supervisor of the work area. The evaluation should be scheduled during the normal work hours of the worker. The goal is to obtain the best understanding of what actually occurs during a typical work shift, so the conditions should be closely approximated. It is extremely important that the actual worker be present. The purpose of the evaluation is to look at the fit between the specific worker and the specific job methods, equipment, and setup. If any element is missing, the evaluation is of little or even no value. Ideally the occupational therapist evaluator will arrive at the worksite and meet first with the direct supervisor of the work area to be evaluated. The supervisor will be asked to give an overview of the circumstances leading up to the request for ergonomic evaluation. The occupational therapist will want to know what kinds of injuries are occurring in the work area, when the problem started, and how many employees have been affected. The supervisor will be able to review how the organization has dealt with the problem to date. Frequently, the supervisor will also describe what sorts of psychosocial and environmental influences may be affecting the situation. Occasionally, an ergonomic assessment is requested before any problems occur at all. The supervisor may explain that the employer is just trying to be proactive. In either case, this brief encounter with the supervisor will give an observant occupational therapist evaluator a very good feel for the organization’s management culture and organizational priorities. After the supervisor interview, the occupational therapist evaluator will want to see the work area and meet the employees. The supervisor may give the evaluator a brief tour of the work area and describe the job tasks and methods that occur there. If the supervisor has identified any problem areas (areas that the supervisor thinks are contributing to injury), the supervisor should be encouraged to point these out. This part of the evaluation will give the evaluator an understanding of how management views the situation. Next, the evaluator will ask to meet with the workers. Once alone with the workers, it is important to establish some level of trust. The evaluator will explain to the workers why the organization has asked for an ergonomic evaluation. It should be explained that the purpose of the evaluation is to make the job safer and more comfortable for the workers. The workers should be encouraged to give the evaluator a tour of the work area and to 10 explain their job tasks. If there are any discrepancies between management’s understanding of the job situation and the workers’ understanding of the same, the evaluator must seek definitive clarification. Finally, the workers should be asked to begin performing the job as normally as possible. The evaluator will be watching and perhaps videotaping or taking notes. The evaluator should assure the workers that the information that is being recorded will be used to develop strategies to make the job tasks safer and more comfortable to perform. The evaluator must stress that she wants the workers to do the job just like any other day. The evaluator will not begin analysis of the work methods until at least 10 minutes has elapsed to allow the workers time to fall into a more normal work pattern. The ergonomic workstation and work methods assessment should focus on identifying known risk factors for MSDs. It is often very useful to videotape the work area and work methods performed. Recording the workers performing their job tasks will allow the evaluator to return to her office and further analyze the data. If the evaluator plans to videotape any work areas or work methods, she should ask permission from the company before taping. It is becoming increasingly more difficult to gain permission for in-house videotaping because of confidentiality and trade secrets concerns. However, some companies are still willing to allow videotaping for the purpose of ergonomic evaluation. Always obtain prior written permission allowing you to videotape in-house.In light of these concerns, it may be helpful to develop an ergonomic checklist to assist in performing the on-site evaluation. The checklist should include the most common ergonomic risk factors and should be tailored to the specific needs and conditions of the workplace that the occupational therapist intends to evaluate (see Appendices). Risk factors to look for include the following: 1. Forceful exertions: Heavy lifting, pushing, pulling, twisting, gripping, or pinching. Handling heavy tools, equipment, or products. Difficulty maintaining control of equipment or tools or lifting and moving an object of asymmetric size. Also using inappropriate or inadequate tools. 2. Repetition: Performing the same motion or series of motions continually or frequently for an extended period. 11 3. Awkward or static posturing, either repetitively or for prolonged periods: Assuming positions that place stress on the body, such as reaching above shoulder height, kneeling, squatting, leaning over a work surface, using a knife or keyboard with the wrists bent, twisting the torso while lifting, or looking at a computer monitor off to one side, which causes the neck to twist all day. Also, sitting all day at a desk with poor posture. 4. Contact stress: Pressing the body or part of the body (such as a hand or forearm) against hard or sharp surfaces and edges (e.g., using the hand as a hammer, resting the forearms on a sharp desk edge while typing, and using pliers with the handle pressing into the palm). 5. Excessive vibration: For example, from power tools or sitting in a truck cab all day while driving. Once the workstation and work methods risk factors have been identified and the workers have had a chance to familiarize themselves with the occupational therapist, focus should turn to the psychosocial aspects of the job. Frequently these factors will surface during the evaluation process without any prompting whatsoever. Factors such as workload and productivity stressors, quality of the relationship between the workers and other coworkers and the supervisor, genuine job task enjoyment, and overall health and fitness cannot be overlooked. Work-related musculoskeletal injury is never the result of any one factor; rather, it is the accumulation of a variety of risk factors and situations that ultimately result in injury. Occupational therapists look at the entire occupational profile to determine what is occurring. Finally, it is important to ask the workers for their perspective on problem areas or risk factors in their work area. If their perspective matches what has been identified in the ergonomic evaluation of the work area and work methods, the workers should be encouraged to share their ideas for correcting the problem. Although the occupational therapist is the expert in workstation and work methods analysis, the on-site workers know their job better than anyone. The workers have probably spent hours formulating and discussing how they would change things if ever given the chance. Ask them. Often, one will find a wealth of knowledge and many useful ideas for reducing or eliminating risk factors in the people who perform the job. It is important to exercise caution before using each suggestion. As the expert, it is the occupational therapist’s responsibility to ensure that the changes implemented will 12 serve to reduce and prevent injury. Sometimes, worker-driven suggestions inadvertently cause new problems if not assessed appropriately by the ergonomic consultant. SUMMARY In industrial or occupational rehabilitation, several forms of evaluation can be done by the occupational therapist depending on the needs of the worker, the company, or both. The occupational therapy practitioner not only evaluates the worker, the work, and the workplace but also the relationship among them. The factors that affect worker performance are identified and are addressed accordingly by the occupational therapist. POST - TEST Let’s see how much you learned about work evaluations in OT. Write T on the blank if the statement is correct and F if the statement is incorrect. 1. The Person-Environment-Occupation Model looks at the _________________ dynamic relationship between the person, environment, and his occupation. 2. In the Occupational Adaptation Frame of Reference, any _________________ occupational challenge to the individual adversely affects his mastery of a desired occupation. 3. Functional Capacity Evaluations measures general skills or _________________ capacities of the worker. 4. Functional Capacity Evaluation are done in two to four hours _________________ over the course of two days. 5. Work samples are hands-on evaluations that measure dexterity, _________________ coordination, and use of tools. 6. Testing procedures of psychometric tests can rarely be _________________ modified. 13  7. Accurate information about a particular type of work can be _________________ obtained when Job Demands Analysis is done informally. 8. Worksite evaluations involve assessing the work, the worker, _________________ and the workplace. 9. Ergonomic evaluations are done only for healthy workers to _________________ prevent injury. 10. Static posturing is a risk factor for injury in the workplace. _________________ REFERENCES The texts in this module are largely adapted from the following: Crepeau, E., Schon, E., and Schell, B.eds (2009). Willard and Spackman’s Occupational Therapy, 11th ed. Maryland: Lippincott Williams and Wilkins. Pendelton, H. and Schulz-Krohn, W, eds (2018). Pedretti’s Occupational Therapy for Physical Dysfunction, 8th ed. Missouri: Elsevier Inc. 14 APPENDIX A: GENERAL ERGONOMIC RISK ANALYSIS CHECKLIST General Ergonomic Risk Analysis Checklist Check the box if your answer is “yes” to the question. A “yes” response indicates that an ergonomic risk factor that requires further analysis may be present. Manual Material Handling _ Is there lifting of loads, tools, or parts? _ Is there lowering of loads, tools, or parts? _ Is there overhead reaching for loads, tools, or parts? _ Is there bending at the waist to handle loads, tools, or parts? _ Is there twisting at the waist to handle loads, tools, or parts? Physical Energy Demands _ Do tools and parts weigh more than 10 lbs? _ Is reaching greater than 20 inches? _ Is bending, stooping, or squatting a primary task activity? _ Is lifting or lowering loads a primary task activity? _ Is walking or carrying loads a primary task activity? _ Is stair or ladder climbing with loads a primary task activity? _ Is pushing or pulling loads a primary task activity? _ Is reaching overhead a primary task activity? _ Do any of the above tasks require five or more complete work cycles to be done within a minute? _ Do workers complain that rest breaks and fatigue allowances are insufficient? Other Musculoskeletal Demands _ Do manual jobs require frequent, repetitive motions? _ Do work postures require frequent bending of the neck, shoulder, elbow, wrist, or finger joints? _ For seated work, do reaches for tools and materials exceed 15 inches from the worker's position? _ Is the worker unable to change his or her position often? _ Does the work involve forceful, quick, or sudden motions? _ Does the work involve shock or rapid buildup of forces? _ Is finger-pinch gripping used? _ Do job postures involve sustained muscle contraction of any limb? 15 Computer Workstation _ Do operators use computer workstations for more than 4 hours a day? _ Are there complaints of discomfort from those working at these stations? _ Is the chair or desk nonadjustable? _ Is the display monitor, keyboard, or document holder nonadjustable? _ Does lighting cause glare or make the monitor screen hard to read? _ Is the room temperature too hot or too cold? _ Is there irritating vibration or noise? Environment _ Is the temperature too hot or too cold? _ Are the worker's hands exposed to temperatures less than 70° F? _ Is the workplace poorly lit? _ Is there glare? _ Is there excessive noise that is annoying, distracting, or producing hearing loss? _ Is there upper extremity or whole body vibration? _ Is air circulation too high or too low? General Workplace _ Are walkways uneven, slippery, or obstructed? _ Is housekeeping poor? _ Is there inadequate clearance or accessibility for performing tasks? _ Are stairs cluttered or lacking railings? 16 APPENDIX B: NORDIC MUSCULOSKELETAL QUESTIONNAIRE 17 18 APPENDIX C: SYMPTOM SURVEY 19  Assessment in Physical Dysfunction - Finals ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ Can be used for re-evaluation Topic 15: Workplace Evaluation ○ For us to see they’ve improved based on the ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ intervention Thea Sheila Alonto (11-21-24) Measurement of capacity i specific to the demands that the job poses ○ Focus on the job alone How do we assess the work? We look at the parameters. Performed in clinic and range in 2-4hrs in duration over Us to be able to prevent as an OT injuries from occurring in the the course of a two-day period workplace. ○ Ideally, it should check different types of skills ○ Ability to reach, stand, sit Objectives: ○ Dexterity coordination Understand OT theory and FOR related to work ○ Depending the type of work the person wants to Describe the different workplace evaluation methods engage in Perform a worksite evaluation More of looking at the general job skill of the clx OT Theory and FOR Related to Work Vocational Evaluations Person-environment-occupation model “A comprehensive process that systematically uses work, How all three are related to each other real or simulated as he focal point for vocational Even in different settings assessment and exploration to assist individuals in their Person- abilities which underlie, support, and enable vocational development” performance of multiple tasks Looking at job skills in relation to particular work ○ What makes the person function ○ Mas specific ○ What are the underlying skills to perform Categories activities and occupations Psychometric tests Environment- physical and social context of individual ○ Wide variety of paper-and-pencil and apparatus ○ Looking at the culture of the workplace, how are tests to measure general intelligence, the coworkers (relationship to e/o), personality, achievement, abilities, aptitudes, ○ Culture of the company depends on its origin interest. Iba ang PH companies sa Japanese ○ Includes aptitude or achievement test, interest companies and checklists and performance tests Occupation- influenced by objects used to perform item ○ Inventory test such as: Reading free vocational ○ What would be need to use interest inventory Does not require reading to answer Point lang ang picture and most Occupational Adaptation FOR interesting for the clx ○ Usually done for clx with developmental disability ○ Not just workers we want to prevent from injuries but soon to be workers as well ○ Tool to measure IQ: Work sample For the clx to achieve mastery by first having a desire ○ Well-defined work activity which involves tasks, Occupational environment - desires our need materials, and tools which are identical to those ○ Meet the demand of the occu environment in an actual job or cluster of jobs They are interrelated to e/o ○ Include single trait, cluster trait, simulated job or actual job Evaluation Methods ○ Smth that is based from a real job Functional capacity evaluation and Vocational evaluation ○ Equipments used IRL ○ Looks at clx factors Job demands analysis Job Demands Analysis ○ Largely looks at occupation Parang activity analysis Workshite and ergonomic eval Involves assessing the physical demands of the job ○ Looks at the environment Basis is job description Include questionnaire, interview, observations and formal Functional Capacity Evaluation (FCE) measurement Define an individual’s functional abilities and/or Crucial to our profession limitations in the context of safe, productive work tasks Worksite Evaluation On-the-job ax to determine whether an individual can return to work after the onset of an disability or whether a Series of test activities to measure whether the person has person can benefit from reasonable accommodations to the abilities to meet the required job demands maintain employment ○ To determine a level of disability, or to Already had the possibility demonstrate the need for, and progress in ○ Potential to return to work rehabilitation ○ What change should be done in the workplace to accommodate the individual ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 1  Assessment in Physical Dysfunction - Finals Done after job analysis sort of psychosocial and environmental influences may be The OT schedules a time w/ the employer and the worker affecting the situation (organization’s mx culture and to meet at the worksite organizational priorities) Beings w/ an analysis of the essential fx tha may require ○ Considering psychosocial factors accommodation ○ Usually if yung culture ng company is not health Desired outcome of the work tasks should be emphasized, focused, there won’t be ergonomic programs. not just the process of performing he essential fx OT goes to the work area and meet the employees to gian ○ Also concerned with the output understanding on how mx views the situation ○ Not just the process, but the output as well ○ Interview the workers to see how things are and Considers the ff see how management will handle the situation ○ How the outcome will be affected if a particular Any discrepancies b/n mx’s understanding of the job task is done incorrectly in a different sequence situation and worker’s understanding of the same job are or omitted clarified ○ Whether there are quotas, standard or time Workers are asked to begin performing the job while OT constraints that must be met records observations ○ Whether the frequency with which task is done Focus is to identify known risk factors for musculoskeletal will affect the outcome d/o ○ Difficult tasks for the worker Assess the work environment which includes Risk factors for Musculoskeletal d/o (ergonomic ○ Environment outside the immediate work area hazards) To check for accessibility Repetitive motion ○ Workstations and work areas that the worker ○ Your job requires you to do tasks repetitively may use such as spooning sampling ○ Location and placement of machines, supplies, Awkward/ prolonged posture and equipment that the worker needs to access Forceful exertion ○ Other physical factors such as lighting, ○ Pulling, pushing, lifting heavy objects temperature and noise level Contact stress ○ In contact with sharp or edge Vibration Ergonomic evaluation (worksite eval) ○ Exposure to vibration Can be performed during workstation and work methods ○ Jobs such as planning to assist in efforts to prevent worker injury: Aka cumulative trauma d/o ○ for workers in whom symptoms of a ○ Frequency and duration matter work-related musculoskeletal disorder (WMSD) develop ○ for workers who come to therapy for rehabilitation and are ready to return to work; useful in modifying a job in preparation for a disabled worker's return to work the OT schedules a time to meet with both the worker (or workers) to be assessed and the direct supervisor of the work area during the normal work hours goal of the evaluation is to look at the fit between the specific worker and the specific job methods, equipment, and setup Can be done if the worker is identified to be at risk for injury. Either of several things: ○ OT conducting ergonomic eval bcs worker has slight injury to prevent worsening of condition ○ Identify particular department there’s an increase in ms d/o ○ Company does not wait for anything but just want a healthy workplace and identify certain Work related musculoskeletal d/o (WRMSDS) hazards Sudden or sustained exposure to ergonomic hazards Supervisor will be asked to give an overview of the which result in d/o that affect muscles, bones, cartilages, circumstances leading up to the request for ergo eval d/t tendons, or nerves the ff: ○ What kind of injuries are occuring in the work S/Sx of WRMSDS area Decreased grip strength ○ When the problem started Loss of mm fx ○ How many employees have been affected Inability to perform everyday tasks ○ ie. a doctor observes he has these patients with Pain common condition and common company from Tingling sensation certain department and WHY is it happening OTs also focus at the psychosocial aspects of the job Supervisor will be able asked to review how the which includes: organization has dealt with the problem to date and the ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 2  Assessment in Physical Dysfunction - Finals ○ workload and productivity stressors ○ quality of the relationship between the workers and other coworkers and the supervisor: ○ genuine job task enjoyment ○ and overall health and fitness workers are also asked for their perspective on problem areas or risk factors in their work area Person ○ Not only look at what the person can do but, HOW they do it Following safety precautions Smn who knows but does not follow Work station Environment 1. - No ○ How the company is 6. - No Occupation Chair should have arm rest ○ What are the processes to do the job properly 12. - No Place where you can perform work eval: Too far from table bcs sometimes there’s no enough leg Office room ○ Very str8forward Yes- Industrial No- there but no ○ Mas masakit sa ulo NA- not present sa observation ○ Maraming analysis pa ○ The pay is very high 2 finger breadths- comfortable distance to your legs What credentials are needed? Hahaha The chair has no lumbar support Lumbar support- curved chair Worksite eval - doing an eval for return to work for disabled ptx Ergo eval- focus is to prevent WRMSDs or those at risk Almost the same process Worksite eval can also be used for re-ax? Dl free ol Activity: Using OSHA VDT Checklist ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 3  Assessment in Physical Dysfunction - Finals General ergonomic risk analysis checklist Name of evaluator If there answer is no, it’ problematic Name of client Manual material handling Physical energy demands Other musculoskeletal demands Computer workstation Environment General workplace In PH 4 types of hazards Biologic Chemical Physical Ergonomic Psychosocial hazard - only in other countries Industrial: ILO Ergonomic Checkpoints Materials storage and handling Hand tools Machine safety Workstation design Lighting premises Control of hazardous substances and agents Welfare facilities Work organization ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 4  Assessment in Physical Dysfunction - Finals ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ₓ˚. ୭ ˚○ ○ Expected of us to be competent as OTs by Shared topic 17: Clinical Reasoning sharpening our clinical reasoning skills which ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ₓ˚. ୭ ˚○ leads to job satisfaction Miss A (11-22-24) Job satisfaction ○ When just taking orders from smn higher than Questions to ask before evaluation: you, there’s no job satisfaction (?) What ax should I use? Safe and efficient practice Quality delivery of services Clinical reasoning Respect for profession Tacit (understanding w/o stating) knowledge or skill ○ Being able to defend your clinical reasoning in ○ Smth that’s implied front of different professions ○ Thought process Professional autonomy At the heart of practice ○ What differs us from OT assistance or technicians bcs they are the one who Aspects of clinical reasoning implements the management that the licensed OT did Scientific reasoning Why we do the things we do Logical; applies scientific method ○ In different settings (hospitals, centers and ○ Asking questions to identify problem schools) ○ Make hypothesis Multisensory process health professional use in ○ Test hypothesis ○ Planning, directing, performing and reflecting ○ Conclude - coming up with an intervention plan on clx care Forms: ○ Seeing problems as a clx experience them in ○ Diagnostic order to provide relevant and quality care ○ Procedural ○ Being able to make sense of what we see, hear What are the common conditions that results to this and feel What theories and research are available to guide Do we engage in sound clinical reasoning or intervention? How well do you do it? Case sample: R CVA ○ What are the s/sx? Basis of clinical reasoning ○ Work is affected Experience ○ What’s the impact to the family ○ Already built of mental picture of different ○ Explore the marital status diagnosis ○ Imagine what is important based on the Diagnostic reasoning demographics of the person Investigative reasoning Knowledge ○ Analyze the cause of the condition using OT ○ Knowing what to expect before they come in intervention Skills Analysis of cause or nature of conditions requiring ○ Technical How do these problems manifest (performance patterns, Administering assessments performance skills, clx factors? What Qs to ask ○ What is his specific skills in eating ang ○ Interpersonal nabudlayan sa? TUS - how we approach our clxs ○ Aside from motor difficulties, what are other Knowing HOW to ask cause? Physical environment or no one to assist Observation him? Establishing rapport First step: problem-sensing Reflection Making a picture or set boundaries for the problem ○ Think about your decisions and actions ○ What to include and exclude? ○ Different types Focus on occupational performance problems In action - as we are doing smth, we Formulate a pre-assessment image of the clx reflect Choosing the needed part of the assessment to perform On action - after the ax was done, you lang forgot to ask smth hence, asking it next ○ Not lahat ng available assessments time Case sample: You receive a referral for Bryan, an 11 y/o boy from For action - how can I do it better next Ateneo de Iloilo. The referral from the developmental pediatrician time? only indicated, ‘He has handwriting difficulties’ What knowledge are you trying to recall and retrieve from Value of clinical reasoning your ‘knowledge bank’ as you read the referral? Promotes ○ Well developed FMS Sound and defensible clinical decisions What are you expecting from Bryam in terms of s/sx, ○ Our CIs will ask us why we chose this level of function, etc.? intervention ○ Independent in ADLs Learning What are you expected to do during the first meeting? Competence ○ Observe ○ Assess FMS ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 5  Assessment in Physical Dysfunction - Finals ○ Interview the primary caregiver Procedural reasoning Following protocol for assessment Second step: problem-definition (getting more information about Reasoning in which therapist considers and uses the problem by doing the ff:) intervention Cue acquisition -> chunking May be science-based or may reflect the habits and ○ Cues we must pay attention to as OTs culture of the intervention setting During interview, observation and Thinking of 'body as machine’ doing tests What evaluation and intervention protocols are Lab tests, diagnostic tests How are clx like this usually handled in my setting? ○ Framing the problem is important bcs it will lead you to what assessments you will use Narrative reasoning ○ Cue: mother said her baby said mama and papa Reasoning to understand the meaning that a dsx, illness, before but when the baby turned 1 y/o nawala or disability has to an individual Typical for children w/ ASD Thinking about the clx’s life story disrupted d/t disability, ○ Important to chunk or categories the cues involves recrafting it Pattern recognition What occupations are most important to this person? Hypothesis generation ○ What is this cue telling us about the clx’s Pragmatic reasoning problem? Practical aspect of practice ○ Come up with several hypothesis to see a lot of Reasoning used to ir therapy possibilities into practical cues (scheduling, payment for services, equipment availability) Cue interpretation and personal (therapists’s skills, life situation contexts) ○ Child is hyperactive and I will do a feeding ax of an in-ptx clx w TBI. I will ○ Don’t limit your interpretation sa isa lang schedule my session so that it is around lunch time. ○ Does this cue fit with the hypothesis I came up I’ supposed to evaluate a baby and I know around 10am with? there’s a rowdy children sa gym area so I need to find a Hypothesis evaluation different place or different time to evaluate the baby ○ Which cues support my hypothesis? Or do i need to look for another hypothesis? Ethical reasoning ○ You need to have multiple cues to support the Reasoning directed to analyzing an ethical dilemma, hypothesis generating alternative solutions and determining actions to be taken Case sample: Interactive reasoning What cues can you pick up from the interview? Thinking toward building positive interpersonal ○ Legibility of written work relationships with clxs What other questions do you need to ask to have a better How can I put this person at ease? picture What cultural factors do I need to consider? ○ How does he perform when not under pressure? How can we collaborate during eval and tx? ○ When did it start? Conditional Reasoning OT Diagnosis Most complex Reflects both a process and outcomes of evaluaion Thinking abt the entire clx ○ Shows our thinking process ○ Considering a lot of things Helps structure and summarize our diagnostic reasoning Blending different aspects of clinical reasoning Consists of four components ○ thinking abt the whole condition ○ Descriptive ○ anticipate possible outcomes over short or long Occupational performance difficulty period of time ○ Explanatory ○ Success is contingent upon clx’s participation What is causing the difficulty Will you be able to achieve these goals? General phrase the cause of the ○ Important in setting goals problem Difficult for us to project what will happen to them in the ○ Cue next few months? More details of explanatory component ○ Pathological Anchor goals and intervention on the diagnosis Depending on the diagnosis, Example: ○ Difficulty completing writing tasks secondary to problems in motor and process skills as evidenced by tactile sensitivity, poor visual-perceptual skills, poor attention span, poor concentration secondary to ADHD. ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 6  Assessment in Physical Dysfunction - Finals ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ Topic 14: ADLs and IADLs ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ Miss A (11-28-24) ADL ADL dependence correlated w/ poor QoL, increased health care costs, increased risk of mortality, and institutionalization If dependent in ADLs ○ Loss of purpose = burden to family ○ Loss of self-esteem ○ Sense of privacy is affected Ie. assistance in toileting Consider the priorities and needs of the clx When assessing for ADLs, w/ mild cognitive impairment, ADLs is not affected but more on IADLs that we need to focus on General procedure Chart review ○ Information on medical precautions or contraindications ○ Exact prescription from the doctor ○ Some restrictions such as in ptx, for partial wght bearing or non bearing activities ONLY ○ Bed rest or neck brace for doing out of bed activities or if movement if contraindicated ○ Info on initial ADL status Occupational profile ○ C/C IADLs ○ Goals Supports the ADLs Wants to, need to, expected to do Supervising smn else ○ HPI ○ Performance pattern RRH ○ Environmental and personal context ○ How these areas are affected ADL ax ○ Self-report Clx rates their performance ○ Performance-based Thx observing the clx doing the actual task Contextual and environmental fators (incl a home ax) Ax SHOULD be done in natural context ○ Doing it out of context may lead to disorientation ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 7  Assessment in Physical Dysfunction - Finals ○ Ie. feeding is best done in meal time esp. w/ ptx Standardized ax for ADLs w/ cognitive impairment Made by professionals who are not OT Move from simple to complex tasks Barthel Index ○ From ADLs to IADLs FIM ○ Ie. transfers - ○ More comprehensive ○ Simple tasks such as in sitting positions ○ In hospitals, this is primarily used ○ From brushing hair to shaving hair ○ Good predictive ability Consider clx safety and privacy ○ Has decision making tree ○ When doing transfers, using gait belt ○ We can’t have this manual while having the ○ Privacy: in dressing ax, it should be done in a interview secluded room ‘Can the individual complete the task?’ vs. ‘does the individual recognize that the task needs to be done?’ ○ Performance skills and cognitive and psychosocial component ○ Differentiate b/n the two Functional Independence Measure Ask for premorbid condx Can also be used for informal ax Katz Index ○ 1 or 0 point ○ Used more for in long term care ○ Not the level of performance Made by OT IADL- financial mx Performance Ax of self-care skills Does the clx have the prerequisite skills for handling ○ More comprehensive money? Ax of Motor and Process Skills (AMPS) ○ Cognitive and perceptual skills ○ You need training to be able to use this ○ Motor skills ○ Not used much IADL- Community Mobility Lawton-Brody Instrumental Activities of Daily Living Proceeds to a more complex task Scale Physical abilities ○ For IADLs ○ Balance ○ Stabilization Moving out of our comfort zone ○ Grasp Developed by OTs Cognitive Occupational performance inventory of sexuality and ○ Attention intimacy ○ Spatial awareness ○ Screening tool ○ Arithmetic skills (when mag pay) Finding out if the clx is interested in ○ Memory their sexuality assessed Knowing the route Sex can be addressed in OT Social interaction skills intervention ○ Giving cues to driver To see if the clx is ready ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 8  Assessment in Physical Dysfunction - Finals ○ In-depth self ax It looks at different aspects of sexuality such as sexual expression, etc. Self-graded What are the factors ○ Performance measure How satisfied, confident, etc. Sexuality and intimacy contextualized ax tool Learning activity (lec) ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 9  OT 11: Assessment of Occupational Performance 2 ASSESSMENT OF ADL’s & IADL’s Learning Activity (Lecture) Using the copies of the assessments listed below, relevant journal articles, and other learning resources provided, complete the following table. Assessment Target population Mode of Items and scoring Strengths and limitations Who can administer administration Barthel Index Stroke, The Barthel index asks 10 items: Strengths other neuromuscular, the individual who will 1. Feeding (0,5,10) - Looks at the physical (Aly, Kass, Xyll) musculoskeletal disorders, administer to observe 2. Bathing (0,5) aspect almost oncology patients the client perform the 3. Grooming (0,5) exclusively Age: 18+ items indicated in the 4. Dressing (0,5,10) - quick, easy, and free tool. 5. Bowels (0,5,10) to administer Anyone can administer as 6. Bladder (0,5,10) no training is needed. As For some items such Limitations: 7. Toilet Use (0,5,10) long as you are familiar as bladder control, and - does not consider the with the task and the level toilet use you may ask 8. Transfers (Bed to Chair and Back) (0,5,10,15) psychological aspect of independence the client the client or their - Does not assess needs to perform the task caregiver. 9. Mobility (On Level Surfaces) (0,5,10,15) cognitive, you could administer the emotional, or social Barthel index. Note that direct testing 10. Stairs factors is not needed to - Self-Report Bias: administer Higher Scores: Indicate greater Overestimation or independence. underestimation of No training required Lower Scores: Reflect the need abilities if based for more assistance with daily solely on tasks. patient/caregiver report. - not sensitive to change among ptx w/ mild stroke - what a ptx does and not what ptx could do Functional Independence ptx w/ stroke, SCI, PD, The therapist observes 18 items: Strengths: Measure MS, pain mx, and brain the patient while using - 13 motor tasks - comprehensive ax injury. paper and pencil. - 5 cognitive tasks - (+) reliability and (Aly, Kass, Xyll) 1. Eating validity Age: adults; 18-64+ Cost: Not free 2. Grooming - sensitive to change 3. Bathing - standardized scoring Required training to read Time to administer: 4. Dressing - Upper the article/manual 30-45 mins 5. Dressing - Lower Limitations: 6. Toileting - low ceiling effect for 7. Bladder ptx w/ stroke 8. Bowel - limited cognitive ax 9. Transfers: Bed, Chair, - training required Wheelchair 10. Transfers: Toilet 11. Transfers: Tub, Shower 12. Walk/Wheelchair 13. Stairs 14. Comprehension 15. Expression 16. Social interaction 17. Problem Solving 18. Memory rated on 7-point ordinal scale; from total assistance (1) to complete independent (7) INDEPENDENT 7- Complete Independence 6- Modified Dependence DEPENDENT Modified Dependence 5- Supervision or Setup 4- Minimal Contact Assistance 3- Moderate Assistance  COMPLETE DEPENDENCE 2- Maximal Assistance 1- Total Assistance 0- Activity Does Not Occur The maximum total score is 126 which indicates the highest level of function and 18 is the lowest score. Katz Index Mixed Population Observation of client 6 Items Strength performance - Bathing - Assess basic ADLs (Marz, Tin, Herald) Older Adults and Geriatric - Dressing - Sensitive to change in Care Paper and Pencil - Toileting declining health - Transferring status Age: 18-64 Time to administer: 5 - Continence - Useful in creating a or more minutes - Feeding common language No Training required Scoring about patient - 6 (independent) function - 3-5 (partially dependent) - 2 or less (dependent) Limitation - Does not asses more advanced ADLs - Limited ability to measure small increments of change Performance Assessment Arthritis + Joint conditions, Paper and Pencil 26 items Strength of Self-care Skills Cardiac Dysfunction, - 5 functional mobility - Criterion referenced (Marz, Tin, Herald) Multiple Sclerosis, Observation - 3 basic activities of daily - 2 versions; Clinic and Parkinson’s disease & living (BADL) or self-care Home Movement disorders, Time to administer: 3 tasks - all 26 core tasks of the Pulmonary disorders, hours - 14 IADLs with cognitive PASS are validated Spinal cord injury and emphasis (IADLS-C) and reliable Stroke recovery Cost: Not Free - 4 IADLs with physical - It looks at the emphasis (IADL-P) adequacy of process Ages 17 and above and quality of Scoring: performance & No certification needed for safety administration but Independence - can be used for required training through - 3 (no assist given) adolescent , adult reading an article or a and elderly adult - 2 (no lvl 7-9 ; occasional 1-6) manual - 1 (no lvl 9 ; occasional lvl 7- 8 ; continuous lvl 1-6) - 0 (lvl 9 ; continuous lvl 7-8 ; Limitations unable to initiate, continue, - The time to administer or complete subtask or task is 1.5 to 3 hours Safety - Training requirement - 3 (safe practices were of reading an article observed) or a manual is - 2 (minor risks were evident needed but no assistance provided) - Instrument is not free - 1 (risks to safety were observed and assistance given to prevent potential harm) - 0 (risks to safety of such severity were observed that task was stopped or taken over by assessor to prevent harm Adequacy - Process - 3 (sub tasks performed with precision & economy of effort and action) - 2 (occasional lack of efficiency, redundant or extraneous action ; no missing steps) - 1 (subtasks generally performed w/ lack of precisions and/or economy of effort and action) - 0 (subtasks are consistently performed w/ lack of precision and/or economy of effort & action)  - Quality - 3 (optimal) - 2 (acceptable) - 1 (marginal) - 0 (unaccceptable) Assessment of Motor and Ages 2 and above, and: Paper and pencil 36 items in total Strengths: Process Skills - persons with any type Time to administer: 16 items: ADL Motor Skills - Conducted in naturalistic of diagnosis or 30-40 minutes 20 items: ADL Process environments (Tian, Gab, Pau, Tina) disability; Skills - Standardized ADL - well persons; and performance analysis - those who have not Scoring: - Requires no special yet received a equipment 4: competent performance formal diagnosis, 3: questionable effectiveness - Applicable across but who may be at various cultures 2: ineffective performance risk for functional 1: severely deficient decline Limitations: - Costly; requires certification prior to administration - Cannot be administered to patients who are confined to bed or are unwilling to participate in simple ADL tasks - May be time-consuming to administer (30-40 mins) - Not suitable for evaluation of children below 2yo - If information is to be used for documenting the efficacy of OT interventions, quality assurance, or research, it must be computer- scored - The use of AMPS item or total raw scores for documenting efficacy of intervention or for research is never