Occupational Therapy Lecture 2: Evaluation in OT PDF

OCCUPATIONAL THERAPY (OT.511) Lecture 2 : EVALUATION IN OT Ass.Prof. Marian Magdy Assistant Professor, MTI University What about the steps of OT evaluation?  The evaluation process is one of the most fundamental aspects of occupational therapy services. According to the Standards of...

OCCUPATIONAL THERAPY (OT.511) Lecture 2 : EVALUATION IN OT Ass.Prof. Marian Magdy Assistant Professor, MTI University What about the steps of OT evaluation?  The evaluation process is one of the most fundamental aspects of occupational therapy services. According to the Standards of Practice for Occupational Therapy, evaluation is “the process of obtaining and interpreting data necessary for intervention”.  Comprehensive evaluation allows the occupational therapist to establish goals and plan intervention. The occupational therapist uses a top-down approach, assessing what the child wants and needs to do and then identifying those factors that act as supports or barriers to the child’s participation in those childhood occupations.  Comprehensive Evaluation of the child Evaluation Component Description of the Occupational Tools, Informants Therapist’s Role Occupational profile Obtains information about the child’s Informal interview and developmental and functional strengths and observation. limitations. Interview with parents, Emphasis on child’s participation across teachers, and other environments caregivers. Assessment of Carefully assesses multiple areas of Structured observation, performance developmental focused questions to performance and functional behaviors and parents and caregivers underlying Standardized evaluations, reasons for limitations. Analysis of Analyzes underlying reasons for limitations in In-depth structured performance performance and behavior. observations, focused standardized evaluations. Environment Assessment and observation of the Focused observations, environment, focused interview of teachers and on supports and constraints of the child’s parents Developing an occupational profile of the child Initially the therapist develops an occupational profile of the child based on: Referral concerns Interviews with caregivers and the child Direct observations of the child performing self-care, play, and school-related activities. This profile describes the child’s past occupational history and experiences, his or her current performance in occupational areas (e.g., self-help, play, and school activities), and the caregiver’s (and child’s) priorities regarding the child’s participation in everyday activities. After identifying the limitations on the child’s participation, the therapist develops a working hypothesis regarding possible reasons for identified problems and concerns. The occupational profile is the foundation for the next step in the evaluation process, which is the evaluation and analysis of the child’s occupational performance. Evaluation methods Several evaluation methods are available to occupational therapists. The challenge for therapists is to determine which evaluation methods to select for a particular child.  Standardized Tests Characteristics Has a test manual include Purpose, population, technical information, administration, scoring, and interpretation. Has a Fixed number of items. Has a Fixed protocol for administration. Has a Fixed guideline for scoring. Types of Standardized Tests: 1- Norm- referenced 2- Criterion-referenced Norm-referenced measures are tests based on norms of a sample that represent the population to be tested. The child’s score on a norm-referenced test is compared with the scores of the normative sample. To evaluate the usefulness of a norm-referenced measure, the pediatric occupational therapist reads the test manual carefully to learn about the characteristics of the normative sample, how the norms were derived, and how to interpret accurately an individual child’s scores. Criterion-referenced measures are standardized tests that consist of a series of skills on functional or developmental tasks, usually grouped by age level or performance area. These tests compare the child’s performance on each test item with a criterion that must be met if the child is to receive credit for that item. The items on a criterion-referenced test are selected because of their importance to the child’s function on everyday tasks. Therefore, the items often become intervention targets when the child exhibits difficulty in successfully completing them. Information gained from criterion-referenced tests is particularly helpful for evaluation of the child’s functional skills and for planning appropriate intervention activities to enhance those skills. Analysis of occupational performance: The analysis of occupational performance includes an evaluation of the child’s physical, cognitive, and psychosocial performance and of important environmental factors that influence the child’s participation in everyday occupations. Evaluation of the child’s occupations consists of: the child’s performance skills (e.g., motor skills, process skills), performance patterns (e.g., habits, routines, roles), contexts (e.g.,cultural, physical, social, personal, spiritual, temporal), Activity demands (e.g., objects, space demands, social demands, sequencing and timing, required actions, required body functions and structures), and child factors (e.g., body functions and body structures). To gain an in-depth understanding of the child’s performance abilities and limitations, the occupational therapist evaluates the features of the environment in which the child performs the activities. Ecologic Assessments The examination and recording of the physical, social, and psychological features of a child’s developmental context. Ecologic assessments are concerned with the interaction between the child and his or her physical and social environments These assessments also consider the physical demands and social expectations of the child’s environment. Some of these methods include naturalistic observations, interviews, and rating scales. Ecologic measures that are often administered by occupational therapists include the Knox Preschool Play Scale, the revised HOME Inventory. Behavior Strategies for Testing Young Children ( important tips should be considered during you evaluation ) 1.Be prepared. Know your testing procedures so well that you can focus on the child’s behavior and performance, not on the test manual or your paperwork. 2. Be sensitive to the child’s and the parents’ physical and emotional needs. Whenever possible, adjust the pace of the examination to match the child’s style and acknowledge any concerns the parents may express. 3. Be purposeful in carrying out the examination. Keep the situation friendly, interesting for the child, and informative for the parent. 4-Be sure that the testing room supports the child’s optimal performance. The chair and table should be of the appropriate size, and lighting should be sufficient. Remove all auditory and visual distractions. Use test materials attractive to children. 5. Build a rapport with the child before physically interacting with or handling him or her. Some children may do better starting with tabletop tasks in which the child sits across from the examiner and observes the situation before being handled physically for motor testing. Other children may do better if allowed to engage in a spontaneous play situation while the examiner focuses on the parent interview before directly testing the child. Be flexible and follow the child’s lead whenever possible. 6-Use positive reinforcement that is meaningful to the child (e.g., praise, stickers, or a fun activity). Be sure to reinforce the child’s effort rather than his or her success. 7. Begin and end with some easy items for the child. This helps the child feel more comfortable at the beginning and provides a positive ending to the test session for both the child and the parents. 8. Watch the complexity of your language. Be clear and concise in your instructions to the child. 9-Be organized. Keep the test materials arranged in an area that is easily accessible to you but not to the child. Place an attractive toy (not from the test kit) on the table or nearby for the child to play with while you are not directly testing him or her. 10. Try to develop reciprocal interactions with the child. When you first show a test object, allow the child to explore it briefly in his or her own way before you give the test instructions. This extra time provides an excellent opportunity for informal observations. Then give the test instructions and allow the child to demonstrate his or her skill. If the child continues to be actively engaged with the object when you want to present the next test item, present the new test object as you remove the old one.