Occupational Therapy Assessments
Accurate, reliable evaluation of a child is a difficult but rewarding service occupational therapists offers. In order to gather all the necessary information occupational therapists use various methods to inform their decision making process. A combination of standardized, non-standardized tests, interviews and skilled observations are used to determine the child's status.
Skilled Observation:
The ability to keenly observe, accurately record a child's behaviour objectively is an essential skill in OT. In Rett Syndrome, it may be difficult to administer a standardized test. Skilled observation may be more tolerable to the client. Winnie Dunn describes skilled observation as the most powerful tool for a therapist.
She explains the following necessary competencies (Case-Smith & O'Brien, 2010):
- Do not interfere with the natural course of events
- Pay attention to the physical and social features of the environment that support of limit a child's performance
- Record the child's behaviour in observable and neutral terms
When skilled observations are used, therapists must have a systematic, objecting recording procedure so that the data collected is reliable. (Note: This method may be used to determine splinting and feeding needs)
Seating and Mobility Assessment:
Due to the nature of RTT, a large portion of girls will not be able to independently ambulate. The use of a mobility aid or wheelchair will be very likely and the right match will need to be made. There are various methods of assessing wheelchair and seating needs for this population. It is important to consider other devices and attachments that will accompany the wheelchair such as switches, communication boards etc.
The purpose of a seating/mobility assessment is to gather and analyze information when recommending equipment for complex clients. (Seating/Mobility Procedure, 2004)
Areas to address during the evaluation:
It is clear that the needs of the individual is complex and unique. This list is not exhaustive. To view the full procedure click on the image.
Due to the nature of RTT, a large portion of girls will not be able to independently ambulate. The use of a mobility aid or wheelchair will be very likely and the right match will need to be made. There are various methods of assessing wheelchair and seating needs for this population. It is important to consider other devices and attachments that will accompany the wheelchair such as switches, communication boards etc.
The purpose of a seating/mobility assessment is to gather and analyze information when recommending equipment for complex clients. (Seating/Mobility Procedure, 2004)
Areas to address during the evaluation:
- General information and client/ family goals
- Weight bearing/ transfers and lifts ability
- Wheelchair mobility - method of propulsion
- Self Care: method of eating, bowel and bladder management
- Perceptual cognitive status
- Communication skills/ needs
- Environment: space, terrain, ramps etc
- Physical assessment of position in seating system
- Spinal alignment: Scoliosis is commonly found in RTT
- Dimensional documentation: measurements
- Seating/ Cushion for skin integrity and comfort
- Sitting tolerance, weight shift sensation
- (Seating/Mobility Procedure, 2004)
It is clear that the needs of the individual is complex and unique. This list is not exhaustive. To view the full procedure click on the image.
Hand/ Fine Motor Focus: Loss of hand function skills during early childhood – usually to a very low level is a hallmark of RTT. Poor hand function is one of the core diagnostic criteria – single most informative early sign of RTT. Assessing these skills can greatly inform the OT's intervention plan.
- Quality of Upper Extremity Skills Test (QUEST)
- Purpose: To evaluate movement patterns and hand function in children from ages 18 months to 8 years
- 4 domains – dissociated movements (64 items), grasp (24 items), weight bearing (50 items) and protective extension (36 items)
- Each item comprises several subitems and there are a total of 174 items which are coded on a dichotomous scale of can or can’t do
- Administered within play context. Duration: approximately 30-45 minutes.
- (DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S,1992).
Access the online manual: http://www.canchild.ca/en/measures/quest.asp
2. WeeFIM (Pediatric Functional Independence Measure)
- Measures the need for assistance and the severity of disability in children between the ages of 6 months and 7 years
- The WeeFIM instrument consists of a minimal data set of 18 items that measure functional performance in three domains: self-care, mobility, and cognition.
- 0-3 Module is a questionnaire that measures precursors to function in children 0-3 years old who have a variety of disabilities. The 0-3 module can be administered to parents by interview or self-report and is useful across many settings, including early intervention and preschool
- To use the WeeFIM assessors need to attend training and pass an online exam to become credentialed.
- (Ottenbacher, K.J., Msall, M.E., Lyon,N., Duffy, L.C., Ziviani, J., Granger, C. V., Braun, S., Feidler, R.C., 2000).
Sensory Profile
- Questionnaire completed by caregivers or teachers
- Evaluates how sensory needs impact functional activities of child
- Identifies triggers that may cause sensory distress to the child
- Created for children 3 to 10 years old
- Categories:
- Sensory Seeking
- Emotional Reactive
- Low Endurance/Tone
- Oral Sensory Sensitivity
- Inattention/Distractibility
- Poor Registration
- Sensory Sensitivity
- Sedentary
- Fine Motor/Perceptual
The following focus on visual perception and integration skills. These skills are relevant to the use of communication devices as some individuals with RTT can purposely use their eyes to communicate. Some aspects of these assessments may be difficult to administer depending on the level of the child's fine motor control and severity of apraxia.
Developmental Test of Visual Perception (Third Edition) (DTVP-3)
Beery- Buktenica Developmental Test of Visual-Motor Integration, 5th Edition (Beery VMI)
Developmental Test of Visual Perception (Third Edition) (DTVP-3)
- A norm-referenced too that measures the visual perception and visual-motor integration skills in children 4 to 10 years of age
- May be difficult to administer depending on writing skills
- (Therapro Inc., 2012).
Beery- Buktenica Developmental Test of Visual-Motor Integration, 5th Edition (Beery VMI)
- Standardized tool used to screen for visual-motor integration deficits
- Short format used with children ages 2 to 8 years old
- The Short Format present drawings of geometric forms arranged in order of increasing difficulty that the individual is asked to copy
- (Pearson, 2014)
Video-Based Evaluation:
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Cognitive Assessments:
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Case-Smith, J., & O’Brien, J.C. (Eds.) (2010). Occupational therapy for children (6th ed.). Maryland Heights, MO: Mosby Elsevier
DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1992). QUEST: Quality of Upper Extremity Skills Test. Hamilton, ON: McMaster University, Neurodevelopmental Clinical Research Unit.
Fyfe et al. (2007). Development of a video-based evaluation tool in Rett syndrome. Journal of Autism and Developmental Disorders, 37(9):1636-46.
Ottenbacher, K.J., Msall, M.E., Lyon,N., Duffy, L.C., Ziviani, J., Granger, C. V., Braun, S., Feidler, R.C., (2000). The WeeFIM instrument: Its utility in detecting change in children with developmental disabilities. Archives of Physical Medicine and Rehabilitation, 1317-1326.
Pearson. (2014). Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition, The (BEERY™ VMI). Retrieved from, http://www.pearsonclinical.com/therapy/products/100000663/the-beery-buktenica-developmental-test-of-visual-motor-integration-6th-edition-beery-vmi.html
Pearson. (2014). Sensory Profile™. Retrieved from, http://pearsonassess.ca/haiweb/Cultures/en-CA/Products/Product+Detail.htm? CS_ProductID=SENSORY-PROFILE&CS_Category=ot-sensory-processing&CS_Catalog=TPC-CACatalog
Percy, A. (2014). Rett Syndrome: Coming to terms with treatment. Advances in Neuroscience, 2014, 20.
Seating/ Mobility Procedure. (2004, October 15). Island Health (Vancouver Island Health Authority). Retrieved July 23, 2014, from http://www.viha.ca/NR/rdonlyres/E10427B1-97F6-43AB-80BA-BC65F9C69F0B/0/seating_procedure.pdf
Therapro Inc. (2012). Developmental Test of Visual Perception Third Edition. Retrieved from http://www.therapro.com/Developmental-Test-of-Visual-Perception-Third-Edition-DTVP-3-P322391C7662.aspx
- Components include a parent-report checklist, and video filming and coding protocols that contain items on eating, drinking, communication, hand function and movements, personal care and mobility
- Maybe more feasible than task/paper-based assessments
- Families asked to film their daughter picking up and holding a selection of large objects (toy, small ball, cup, utensil) and a small object
- Describes reach, accuracy, initiation of movement, pre-shaping of the hand, transfer, raking or pincer grasp to pick up small objects
- Viewing other activities that gives additional opportunities for observation
- (Fyfe et al., 2007)
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Cognitive Assessments:
- Cognitive function in RTT cannot be assessed effectively due to the inability of these girls to demonstrate purposeful hand skills and effective communication.
- Recently, advances in computer-based technology utilizing eye gaze tracking have provided a means of communication that suggests a level of interaction and comprehension not previously recognized
- Using eye gaze technology is becoming a promising method in collection reliable results
- It is important to consider the child's slow response time when allowing them to answer. More than a few seconds and often as long as half a minute are required to elicit a response to specific requests.
- Assessing cognitive function in RTT is still extremely problematic and will require objective assessment of these techniques
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Case-Smith, J., & O’Brien, J.C. (Eds.) (2010). Occupational therapy for children (6th ed.). Maryland Heights, MO: Mosby Elsevier
DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1992). QUEST: Quality of Upper Extremity Skills Test. Hamilton, ON: McMaster University, Neurodevelopmental Clinical Research Unit.
Fyfe et al. (2007). Development of a video-based evaluation tool in Rett syndrome. Journal of Autism and Developmental Disorders, 37(9):1636-46.
Ottenbacher, K.J., Msall, M.E., Lyon,N., Duffy, L.C., Ziviani, J., Granger, C. V., Braun, S., Feidler, R.C., (2000). The WeeFIM instrument: Its utility in detecting change in children with developmental disabilities. Archives of Physical Medicine and Rehabilitation, 1317-1326.
Pearson. (2014). Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition, The (BEERY™ VMI). Retrieved from, http://www.pearsonclinical.com/therapy/products/100000663/the-beery-buktenica-developmental-test-of-visual-motor-integration-6th-edition-beery-vmi.html
Pearson. (2014). Sensory Profile™. Retrieved from, http://pearsonassess.ca/haiweb/Cultures/en-CA/Products/Product+Detail.htm? CS_ProductID=SENSORY-PROFILE&CS_Category=ot-sensory-processing&CS_Catalog=TPC-CACatalog
Percy, A. (2014). Rett Syndrome: Coming to terms with treatment. Advances in Neuroscience, 2014, 20.
Seating/ Mobility Procedure. (2004, October 15). Island Health (Vancouver Island Health Authority). Retrieved July 23, 2014, from http://www.viha.ca/NR/rdonlyres/E10427B1-97F6-43AB-80BA-BC65F9C69F0B/0/seating_procedure.pdf
Therapro Inc. (2012). Developmental Test of Visual Perception Third Edition. Retrieved from http://www.therapro.com/Developmental-Test-of-Visual-Perception-Third-Edition-DTVP-3-P322391C7662.aspx