Ch 6- Observational Assessment and Activity Analysis

What is it called when the occupational therapist brings a toy closer to the child so the child can successfully reach and grasp it during therapy?

• Compensating

• Adapting

• Grading

• Modifying

Answer explanation

Grading has been a defining feature of occupational therapy practice since the founding of the profession (Breines, 1986). “Grading is the process of making portions of the activity easier or more difficult based on the client’s performance” (Kuhaneck et al, 2010, p 113). The purpose of grading is to create “a bridge” or “scaffolding” to higher levels of performance (Breines, 1986, p. 200; Vogotsky, 1978). Grading makes the activity therapeutic. Grading is used commonly to train a client to participate in new activities or at a higher level of an activity, to target client factors, and to develop performance skills. This developmental intervention (Breines, 1986) is particularly well-suited for pediatric practice.

Which statement best describes the use of activity or task analysis?

• A foundational tool in occupational therapy for over a century.

• A technique used to evaluate motor deficits in pediatrics.

• Recently applied in some areas of pediatric occupational therapy.

• A tool used exclusively by occupational therapy practitioners.

Answer explanation

Integrating observations with a structured activity analysis can help practitioners hone their clinical observation skills. By consciously attending to the myriad of details within an activity analysis, occupational therapy students and practitioners sharpen their ability to observe multiple simultaneous and successive specifics as they unfold in real time. Proficiency and expertise in conducting activity observations and analyses come from repetition with this structured experience as well as developing clinical knowledge.

Pediatric occupational therapists use activity analysis to identify _____.

• Barriers and supports in participation

• Activity demands

• Opportunities for intervention

• All of the above/options

Answer explanation

ctivity analysis provides critical information to compare activities and their components. The clinician can determine which activities are best matched, which has elements that are more feasibly adapted, and which might provide a foundation of skills to apply with other activities. Occupational therapists identify that the greatest value of activity analysis is for selecting treatment activities that match the client’s goals and interests (Crepeau et al., 2014). Activity analysis helps occupational therapy practitioners select and craft activities that are occupationally relevant (Crepeau et al, 2014).The selected activity is aligned to the unique needs and abilities of the child or adolescent and provides an activity match that interests and motivates the client (O’Brien & Soloman, 2013; Spitzer, 2017b). Occupational therapists use activity analysis to determine an activity’s therapeutic capacity, age appropriateness, safety, gradeability, minimum skill level, availability, space/equipment/supplies; time requirements; cost; gender match; and cultural implications as well as consider the frame of reference and therapist’s skill (Crepeau et al., 2014; Polatajko et al., 2000; Thomas, 2015). Through modifying and grading factors such as these, the occupational therapy practitioner configures activities that are both attainable and appealing for the child or adolescent (Pierce, 2001a). See Box 6-10 for an example of using activity analysis and synthesis to guide activity selection and design in intervention.

Which statement best describes the relationship between general and client-focused activity analyses?

• A general activity analysis identifies the steps in the activity; whereas a client-focused activity analysis addresses the client factors required.

• Both are also described as occupation-based activity analysis.

• A general activity analysis focuses on the way the activity is commonly performed; and a client-focused activity analysis focuses on the way it is actually performed by an individual.

• A general activity analysis addresses personal meaning; and a client-focused activity analysis addresses its objective form.

Answer explanation

The general activity analysis starts with identification of the steps. The actual steps may be modified in a client-focused activity analysis. For each step, the activity demands and context are determined. Some demands and context elements may be consistent across multiple steps, but this must be ascertained. In the client-focused activity analysis, the occupational therapist also identifies factors related to personal meaning with each step. When a client-focused activity analysis is being conducted for assessment purposes, the occupational therapist also records the client’s performance of each step.

In what way do activity observation and analysis support pediatric occupational therapy intervention?

• Grading is based on standard protocols for the specific activity.

• Preparatory activities are selected to build specific skills efficiently without need for further design considerations.

• Activity synthesis integrates the results to identify alternate ways of performing activities.

• Usual modifications for the identified activity are implemented.

Answer explanation

Activity synthesis integrates the information in alternate ways to customize the activity to enable occupational performance (Mosey, 1986; O’Brien & Soloman, 2013). Specifically, the occupational therapist applies this detailed information in selecting or prioritizing the activity(ies) to address goals; determining modifications to an occupation, activity, or environment as well as ongoing grading of modifications to focus on participation and skill building (O’Brien & Soloman, 2013; Polatajko et al., 2000; Thomas, 2015). Activity selection, design, modification, and grading are the fundamental interventions in pediatric occupational therapy.

In collaboration with client and caregiver input, the occupational therapist determines whether to target a specific occupation or activity (such as putting on a jacket, writing one’s name, or playing a computer game with friends), broader categories of occupations (such as dressing, school work, or play), or therapeutic activities for preparatory skill building. Clinical reasoning for these decisions rests on activity observations and analysis, which may also include data from formal assessments. Activity analysis provides critical information to compare activities and their components. The clinician can determine which activities are best matched, which has elements that are more feasibly adapted, and which might provide a foundation of skills to apply with other activities.