Activities of daily living in persons with intellectual disability: Strengths and limitations in specific motor and process skills

As there is a wide range of abilities among clients with intellectual disability, occupational therapists should use assessments of activities of daily living that specify clients' strengths and limitations to guide and target interventions. The aim of the present study was to examine if activities of daily living performance skills differ between adults with mild and moderate intellectual disability. Three hundred and forty-eight participants with either mild intellectual disability ( n  = 178) or moderate intellectual disability ( n  = 170) were assessed using the Assessment of Motor and Process Skills to examine the quality of their activities of daily living skills. The overall activities of daily living motor and activities of daily living process hierarchies of skill item difficulties remained stable between groups. Although participants with moderate intellectual disability had more difficulty overall with activities of daily living motor and activities of daily living process skills, they were able to carry out some of these activities equally as well as participants with mild intellectual disability. The findings are discussed in relation to the planning of specific interventions to improve the ability of clients with intellectual disability to carry out activities of daily living.     

Client-Centred Occupational Therapy for Persons with Mental Retardation: Implementation of an Intervention Programme in Activities of Daily Living Tasks

The aim of this study was to implement a single-case design to evaluate the outcomes of a specified occupational therapy intervention programme. The intervention programme was based on a client-centred top-down approach and followed the Occupational Therapy Intervention Process Model. The interventions included both restorative and adaptive strategies to improve performance of the activities of daily living (ADL) tasks the participants defined as relevant and meaningful. Three women with moderate mental retardation living alone in apartments with support from professionals were included in the study. The Assessment of Motor and Process Skills was used to evaluate for changes in ADL motor and ADL process ability. The Assessment of Awareness of Disability was used to evaluate changes in the client's awareness of disability. The results showed improvements for all participants but patterns of changes were different between the participants and the outcome variables. ADL process ability was the only outcome variable that improved in all participants. The results are discussed in relation to the design used for evaluating intervention efficacy. Future improvements in the process of evaluating occupational therapy interventions are suggested.     

Workers' compensation insurance agents' satisfaction with occupational therapy activities of daily living assessments

Background and Aim:  Little is known about insurance agents' (insurers) satisfaction with the services provided by occupational therapists when they assess injured workers' activities of daily living (ADL). Demonstration of accountability and provision of high-quality services are important to the occupational therapy profession. The aim of this study was to evaluate insurers' overall satisfaction with occupational therapy ADL assessments for injured workers, including communication, timeliness of reports, equipment provision, knowledge of insurers' requirements and the workers' compensation process, and provision of a professional opinion. Relationships between insurers' overall satisfaction with ADL assessments, degree of experience in their job, formal qualifications and roles within their organisation were also investigated.
Method:  A telephone survey was developed and administered to a sample of 40 claims officers and injury management advisors from 10 Victorian Work Cover Authority authorised agents.
Results:  Insurers were generally satisfied with occupational therapy ADL assessments. They were less satisfied with occupational therapists' knowledge of workers' compensation system requirements and how occupational therapists made decisions when recommending household services.
Conclusion:  To improve services to the insurance industry, occupational therapists need to better understand relevant legislative frameworks.     

Menstrual management and intellectual disability: New perspectives

Assessment and education in self-care, ‘activities of daily living’ (ADL) have provided a traditional focus among occupational therapists. Available literature supports the teaching of self-care skills to clients who have severe and profound intellectual disability. Although some programmes have been developed to deal with menstrual management for women with mild and moderate intellectual disability, studies addressing the needs of women with more severe disabilities (high support needs) are sparse, and generally involve only small numbers of women. A menstrual management project based at the University of Queensland developed a model of intervention to assist with menstrual management for women with high support needs. Case studies illustrate three key areas of intervention: (1) assessment of the women's actual or potential menstrual management skills; (2) increasing awareness of attitudes towards menstruation for women who have intellectual disability, among people assisting them; and (3) provision of a range of information, processes and resources to assist educators, families and others providing personal assistance, with informed menstrual management for these women. Positive gains made by four women with high support needs are presented. Relevant issues and difficulties are discussed.     

Towards an ADL Taxonomy for Occupational Therapists

One of the main concepts in occupational therapy is human occupation. In occupational therapy there is a need for a common conceptual framework to assess and describe the ability of patients to perform occupational activities of daily living. The aim of this report was to develop a taxonomy concerning the activities of daily living (ADL). In the taxonomy, occupation has been defined and related to common concepts of disability. Ordinary ADL terms have been categorized into three levels: occupational forms, activities and actions. Different actions are components of and subordinated to superior activities. Experience shows that the ADL taxonomy contributes to a valid (content and construct) assessment of ADL, a common language for OTs and to a clearer picture of the patient's performance in daily life activities. Key words: ADL, conceptual framework, assessment.     

Commentary on the paper “Reliability and validity of the Swedish version of the Fatigue Impact Scale (FIS)”

Abstract

Limited awareness of disabilities is common in mild cognitive impairment and dementia. In order to get a broader base in planning interventions, it is important to consider a person's awareness of his/her disability encountered in performance. The aim of this study was to examine the relationship between occupational performance and awareness of disability in older adults with mild cognitive impairment or dementia. Thirty-five older adults were evaluated with the AMPS (Assessment of Motor and Process Skills) and with the AAD (Assessment of Awareness of Disability). Many-faceted Rasch models generated individual measures of ADL performance and awareness of disability. Non-parametric correlation statistics were used to analyse the relationships. The findings showed that there was an overall positive relationship between occupational performance and awareness of disability. However, individual variations in the sample implied that limitations in performance were not equivalent to a limited awareness of disability. In conclusion, awareness of disability should be individually evaluated when planning interventions together with clients and their families.     

Using the Assessment of Motor and Process Skills to measure functional change in adults with severe traumatic brain injury: A pilot study

Aim:  To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS).
Methods:  This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation.
Results:  Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation ( z = – 2.70 , p  =  0.01 ; z = – 2.81 , P =  0.01 , respectively).
Conclusions:  The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.     

Choosing the most appropriate environment to evaluate independence in everyday activities: Home or clinic?

Background and Aim:  To better document independence in activities of daily living (ADL), particularly with persons with traumatic brain injury, the influence of the context in which performance-based assessments are administered must be considered. This paper examines the issue of context in ADL assessment according to specific criteria.
Main Findings:  Overall, the limited number of studies found to have investigated the influence of context (home, clinic) on performance-based ADL assessments in persons with cerebral damage does not provide clear evidence to support the superiority of either environment.
Conclusion:  The issue of context in ADL assessments has been minimally documented and can be explained by the complexity of data collection. Occupational therapists will need to address this issue.     

Beyond good practice: Issues in working with people with intellectual disability and high support needs

Many more people with an intellectual disability now live in the community as a result of de-institutionalization. Occupational therapy is one service that assists people with intellectual disabilities to participate as fully as possible in their local communities. Despite the potential benefits of occupational therapy, there is little written about the types of interventions used and the effectiveness of their outcomes with people with intellectual disabilities. The present interview study about current occupational therapy practice with people with intellectual disabilities and high support needs was conducted with experienced Australian clinicians. Positive outcomes for clients with high support needs were achieved in two ways: (i) by what therapists do; and (ii) by the features of the therapy relationship. In addition, interventions that indirectly empowered clients and changed others' perceptions were seen to have the most positive effect. The findings are discussed with regard to current occupational therapy literature and implications for occupational practice and education are presented.     

Profile of paediatric occupational therapy practice in Australia

Background:  The purpose of the present study was to describe a profile of Australian paediatric occupational therapy practice in terms of theories, assessments and interventions used with the most frequently seen client groups.
Methods:  An ex post facto survey design was utilised. A purpose-designed survey was mailed to 600 occupational therapists identified by OT Australia as working in paediatrics.
Results:  The response rate was 55% ( n =  330). Respondents in the sample worked chiefly with children with developmental delays, learning disabilities, neurological impairments, and infants/toddlers. Theoretical models used by paediatric clinicians that were common to the most frequently seen client groups focused on sensory integration/multisensory approaches, occupational performance, and client-centred practice. Assessment tools most frequently used were the Test of Visual Motor Integration, Sensory Profile, Bruininks-Oseretsky Test of Motor Proficiency, Handwriting Speed Test, and Motor-Free Visual Perception Test. The most often used treatment methods across the four most frequently seen client groups were parent/caregiver education, sensory integration/stimulation techniques, and managing activities of daily living.
Conclusions:  Paediatric occupational therapists appeared to draw on a range of theoretical models. With the exception of the Sensory Profile, the assessment and treatment methods most frequently used are not congruent with the most commonly used theoretical models. It is critical that the assessment and treatment methods used are conceptually consistent with the theoretical models that guide practice. Occupational therapists need to examine the evidence and determine whether their clinical practice is grounded in the best contemporary theoretical models, assessments and interventions.     

Disaggregating Activities of Daily Living Limitations for Predicting Nursing Home Admission

ObjectiveTo examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts.ConclusionsLooking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures.     

A Cultural Intervention Model for Developmentally Disabled Adults:

This paper describes Chavarim, a non-traditional community based program, founded in the Jewish cultural context. Chavarim is a socialization and life-skill development program for Jewish adults with developmental disabilities. The program incorporates occupational therapy precepts of independent living, community integration, cultural identification and development of life roles. Specific details of program development and implementation will be included. While this paper is concerned with service delivery in the area of developmental disabilities, recommendation for the applicability of the model for occupational therapy intervention with other cultural groups will be discussed. In this author's opinion, for a person with a disability to be adequately prepared to meet the challenges of full community integration, the meaning of culture in daily life must be understood and incorporated into life-skill training programs. This is an account of how one occupational therapist developed an innovative program to meet the challenge of the task.     

Associations Between Adolescent Risk Behaviors and Injury: The Modifying Role of Disability

BACKGROUND:  Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents.
METHODS:  The cross-sectional Health Behavior in School-Aged Children Survey was administered to a representative sample of 7235 Canadian students (grades 6-10) in 2002. Students who reported at least 1 functional difficulty due to a health condition were classified as having a disability. Engagement in up to 6 individual risk behaviors and a summative multiple risk behavior score were considered the primary exposures. Primary outcomes included medically attended injury experienced during a 12-month period.
RESULTS:  Sixteen percent of students reported a disability. Almost all risk behaviors and all injury outcomes were more common among students with disabilities than in those without disabilities (eg, older age group's smoking: 17.5% vs 8.9%, p = <.01; medically attended injury: 67.4% vs 51.4%, p = <.01). Clear risk gradients were observed between engagement in multiple risk behavior and all injury outcomes. The association between multiple risk behavior and injury was accentuated by disability status among older students, particularly for students with disabilities who engaged in frequent multiple risk behavior (adjusted risk ratio 1.8, 95% CI: 1.6-1.9).
CONCLUSIONS:  Canadian students with disabilities who engage in risk behaviors experience higher risks for medically attended injury than their nondisabled peers who engage in those same risk behaviors. Injury prevention programs that focus on risk-taking behavior should integrate the needs of this high-risk group of adolescents in order to prevent additional disability.     

Differences in awareness between persons with left and right hemispheric stroke

Abstract

Aim: The aim of this study was to investigate whether there are any differences in awareness of ability between persons with left and right hemispheric stroke. Methods: The sample consisted of data from the Assessment of Awareness of Ability (A³) database, primarily consisting of clients admitted to occupational therapy services. In total the study included 183 data records from clients, 78 with left and 105 with right hemispheric stroke. Awareness of ability was assessed using the Assessment of Awareness of Ability (A³). Differences in awareness were investigated using t-tests, CI, effect size, and differential item functioning. Results: No significant overall mean difference (t-test = 1.31, p = 0.19) in awareness between left and right hemispheric stroke was identified. However, significant differences (p < 0.05) were identified on three specific items included in the A³. In these cases, persons with right hemispheric stroke showed a more limited awareness. Conclusion: Persons with right hemispheric stroke have more pronounced problems with being aware of limitations in specific ADL performance skills compared with persons with left hemispheric stroke.     

Living with Parkinson's disease: Elderly patients' and relatives' perspective on daily living

Background/aim:  Parkinson's disease is a progressive neurodegenerative disorder resulting in significant disability. We examined how Parkinson's disease affects daily living from the perspective of both patients and relatives.
Methods:  Qualitative interviews were performed with seven patients with Parkinson's disease and nine relatives from families other than those of the interviewed patients. Patients and relatives were recruited from an outpatient geriatric unit at a university hospital in Sweden. The interviews were transcribed and analysed qualitatively.
Results:  A conceptual framework encompassing aggravating factors, consequences in daily living and facilitating factors is presented. Patients perceived activity restrictions, changed habits, decreased socialisation and anxiety. Relatives reported changed roles and habits, decreased socialisation, strain and anxiety about the future. Facilitating factors included accessibility, strategies and psychological support for both patients and relatives.
Conclusions:  The results show that Parkinson's disease affects daily living not only for patients but also for relatives. They need to be seen, heard and supported in this burden. Services must be adapted to the needs of both patients and relatives with accessibility to health-care facilities with deep knowledge about the disease and its consequences. The identified factors are areas of concern in occupational therapy.