ADL IADL Evaluation in Children

Enrico C. Aguila OT 180: Evaluation Techniques in Occupational Therapy for Physical Dysfunctions July 6, 2009

ADL activities that are oriented toward taking care of ones own body; also called Basic Activities of Daily Living (BADL) or Personal Activities of Daily Living (PADL)

IADL activities that are oriented toward interacting with the environment and that are often complex generally optional in nature (i.e. may be delegated to another)

What activities are performed? When, where and how is the activity performed? What do you want to investigate? Independence Efficiency Safety Adequacy

Qualitative Performance is described. Descriptions are used to formulate inferences about performance related to the evaluation parameters of interest.

Quantitative Performance is measured. Numbers are assigned May help determine the following: Severity Improvement Deterioration

Nominal Numbers are assigned to categories for grouping, naming or labeling (1=physical impairment, 2=sensory impairment) Cannot be added or subtracted Ordinal Rank ordering of scores (1=dependent, 2=maximally assisted)

Interval Unit of measurement has the same quantitative meaning at any point on the scale Ex. Weight loss for 2 people Can be added or subtracted, not multiplied and divided Ratio Definite zero point and equal-sized interval size Ex. Time to complete an ADL

Value

Independence

Safety

Adequacy (efficiency, quality, acceptability) Difficulty Pain Fatigue and dyspnea Duration Societal standards Satisfaction Experience Resources Aberrant activity behaviors

Questioning Subjectivity may reduce reliability Less expensive and less labor intensive Safer

Observing Increased reliability Increased ability to detect change Time consuming Costly in terms of space, equipment and personnel

Testing Systematic, structured questions, observations and scoring Norm-referenced or criterion-referenced

Top-down approachPerformance in areas of occupation

Bottom-up approachClient factors

Performance patterns

Performance skills

Performance skills

Performance patterns

Client factors

Performance in areas of occupation

Engagement in occupations to support participation

Collaborative Process

Occupational Profile Analysis of occupational performance

Plan Implementation Review

Caregiver and child interviews Canadian Occupational Performance Measure (COPM)

Clients occupational history and experiences Activities that the child engages in (performance patterns) Activities that are expected but the child does not engaged in When did the child start performing the specific ADL/IADL? Caregivers goals, concerns and priorities Contexts that facilitate or inhibit engagement

Observation Testing Context based, as much as possible Or simulates context based performance Observe safety precautions

Author(s) Age Range Main Purpose(s)

Haley, et.al 6 months to 7.5 years Assesses self-care, functional mobility an social functioning through structured interview and/or observation; considers level of functional assistance and use of adaptive devices

Author(s) Age range Main Purpose(s)

Fisher, 1994 Versions for adults, adolescents and young children The child is asked to perform 5-6 tasks from a list of 56 calibrated tasks Measures process and motor skills as they relate to task performance Provides information about how the child is performing in a given context Used to predict performance in ADL areas


Sparrow, et al. 1984 Birth to 18 years Measures communication, daily living, socialization and motor skills Uses a behavioral rating scale that is completed through a structured interview


Law et.al., 1994 Can be completed by the parent on the childs behalf Measures the childs or the parents perception of the childs performance and satisfaction in areas of selfcare, leisure, and productivity Helpful for prioritizing intervention goals and for measuring functional outcomes


Henry et al., 1999 Child and adolescent-adult versions Self report measure to be completed during a structured interview Based on the MOHO Addresses strengths and weaknesses related to volition, habituation, performance and environment


Hamilton and Granger, 1991 Child version for 6 months to 6 years Universal tool designed to measure rehabilitation outcomes related to functional skills, including self-care, mobility, sphincter control, communication and social cognition


Klein and Bell, 1982 All ages, except infants and toddlers Rating scale that measures 6 areas of function; Dressing, elimination, mobility, bathing, grooming, eating and emergency telephone communication

Self Care Eating, grooming, bathing, dressing of upper body, dressing of lower body, toileting

Sphincter Control Bladder management, bowel management

Locomotion Walk/wheelchair, stairs

Communication Communication, expression

Mobility Bed, chair, wheelchair, toilet, tub, shower

Social Cognition Social interaction, problem solving, memory

7 6 5 4 3 2 1

Complete Independence (timely, safely) Modified Independence (extra time, devices) Supervision or Set-up (cuing, coaxing, prompting) Minimal Assistance (performs 75% or more of the task) Moderate Assistance (performs 50% - 74% of the task) Maximal Assistance (performs (25% - 49% of the task) Total Assistance (0performs less than 25% of the task)

Total Assistance the person puts forth less than 25% of the effort necessary to do a task.

Maximal Assistance the person puts forth less than 50% of the effort necessary to do a task, but at least 25%.

Moderate Assistance the person puts forth between 50% and 74% of the effort necessary to do a task, and requires no more than helping or touching.

Minimal Contact Assistance the person puts forth 75% or more of the effort necessary to do a task, and requires no more help than touching.

Supervision or Setup the person only needs someone to standby and cue or coax him/her (without physical contact) so that he/she can do a task can also be obtained if a helper is needed to set up items or assistive devices for the person

Modified Independence no helper is needed and the person needs an assistive device can also be obtained when no help is needed but the person takes more than a reasonable amount of time to do a task or may complete the task in an unsafe manner

Total Independence no helper is needed and the person performs the task safely, within a reasonable amount of time, and without assistive devices or aids

IndependentTotal independence

Modified DependenceSupervision or set-up Minimal contact assistance

Complete DependenceMaximal assistance

Modified independence

Moderate assistance

Total assistance

NO HELPER

Does subject need help? Y

N

Does subject need more than reasonable time or a device or is there a concern for safety? Does subject need setup or supervision, cuing or coaxing only? N

N Y

Score 7

Score 6Y

Does subject do half or more of the effort? NWITH HELPER

Y

Score 5

Does subject need total assistance? Y N

Does the subject need only incidental assistance? N Y

Score 1

Score 2

Score 3

Score 4

Interview

Observation

Analysis

Evaluation of skills and child factors

Determine the role of performance contexts and activity demands

Form hypotheses as to what are the probable cause of the ADL-IADL problems Perform specific evaluation procedures Spasticity muscle tone LOM range of motion assessment Weakness muscle strength assessment Process skills cognitive assessments

Analyze the demands of the context and the activity Are they matched with the clients capacities If not performance deficit

Person factors

Environment/Context

Task/Activity

Factors limiting performance

Factors facilitating performance

Person factors Task factorsPerformance deficits

Contextual factors

Identify which factors contribute to the difficulty or inability to perform the ADL/IADL Go back to the PTE analysis State the problem as a deficit in the occupational area secondary to the identified factors Difficulty in feeding secondary to weak grasp and spasticity of both upper extremities Inability to indicate toilet needs because of absence of communication skills

ADL IADL Evaluation in Children

Documents

Transcript of ADL IADL Evaluation in Children