Occupational Therapy Assessment
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Direct answer
Before any instrument leaves the drawer, occupational therapy assessment starts with the occupational profile: what this person needs and wants to do, where performance breaks down and why. Standardised tools then quantify the picture — the Canadian Occupational Performance Measure captures self-perceived performance and satisfaction on a 1–10 scale, the AMPS observes motor and process skills during real tasks, and the FIM or Barthel Index grades independence in daily activities. Interview, observation and measurement are combined, and crucially the same tools are repeated after intervention, because an assessment you cannot re-administer cannot prove change.
What you must remember
- Two-stage assessment: build the occupational profile, then analyse occupational performance by observing actual occupations in context (top-down), supported by bottom-up impairment testing.
- COPM: semi-structured interview; the patient scores each identified problem for performance and for satisfaction from 1 to 10; a change of 2 or more points is the accepted clinically important difference.
- AMPS (Assessment of Motor and Process Skills): observation of 16 ADL motor and 20 ADL process skill items while the person performs two chosen everyday tasks.
- FIM: 18 items — 13 motor, 5 cognitive — each scored from 1 (total assistance) to 7 (complete independence); Barthel Index: 10 activities scored 0–100.
- Impairment measures: goniometry for range of motion, manual muscle testing on the Oxford 0–5 scale, sensory charting, volumetry for hand oedema.
- Hand function tests: Nine-Hole Peg (fine dexterity), Purdue Pegboard, Jebsen–Taylor Hand Function Test.
- Cognitive and developmental screeners: MoCA (more sensitive than MMSE for mild impairment), Beery VMI for visual-motor integration, Denver II for developmental screening up to 6 years.
- The end product is a problem list plus SMART goals — specific, measurable, achievable, relevant, time-bound — written so the same scales can re-measure them.
One patient, an assessment built around her day
A 58-year-old seamstress with severe COPD sits winded after walking to the department. The interview opens with her day, not her diagnosis: bathing is "possible but frightening", cooking she has abandoned, and her granddaughters' care she still refuses to give up. On the COPM she rates bathing performance 3 and satisfaction 2, meal cooking 4 and 2, and the therapist notes these as the target problems. Observation comes next and is deliberately occupational: she is asked to prepare a cup of tea at the therapy kitchen while pulse oximetry runs, and the process skills become visible — she carries everything at once, omits the planned rest, bends repeatedly to the low shelf, and desaturates to 86% by minute six. Bottom-up measures then explain what was seen: grip strength, shoulder range, a Borg breathlessness score against activity. The synthesis, not any single score, is the assessment: her problem list reads "unable to pace self-care and kitchen activities within oxygen limits", and the goals follow — shower-seated bathing with a long-handled sponge within four weeks, a staged cooking routine with a perching stool within six. At review the COPM is re-scored by the same interviewer in the same way, and the 2-point rise is her evidence of benefit.
Where students slip
Score direction trips people every year: FIM 7 means independent (not 1), while on the COPM higher is better on both scales — recite the anchors before the exam. The AMPS item counts (16 motor, 20 process) and the FIM structure (18 items; 13 motor, 5 cognitive) are one-mark regulars. The deeper error is bottom-up-only assessment — testing grip and range and never watching the person attempt an actual meal — which measures impairment but tells you nothing about participation. And candidates who change the outcome measure at review have thrown away the before-and-after comparison that justified the whole intervention.
Frequently asked questions
What scale does the COPM use, and what change matters?
Performance and satisfaction are each rated 1–10 by the patient; a change of 2 or more points on re-testing is treated as clinically important.
How is the FIM scored?
Eighteen items (13 motor, 5 cognitive), each from 1 for total assistance to 7 for complete independence; the maximum total is 126.
What does the Barthel Index measure?
Ten basic daily activities — feeding, bathing, grooming, dressing, continence, toileting, transfers, mobility, stairs — scored 0–100.
What are the Oxford manual muscle testing grades?
0 no contraction, 1 flicker, 2 full range with gravity eliminated, 3 full range against gravity, 4 against resistance, 5 normal.
What separates top-down from bottom-up assessment?
Top-down starts from the person's occupations and observes performance in context; bottom-up tests isolated impairments (ROM, strength, sensation) to explain the performance failure.
Why choose the MoCA over the MMSE?
The MoCA is more sensitive to mild cognitive impairment and covers executive function, which the MMSE under-detects.