作业治疗评估教学课件.pptx

1、作业治疗评估作业治疗评估讲者讲者:区启明区启明梁爱珠梁爱珠香港作业治疗师协会香港作业治疗师协会二七年十二月二七年十二月昆明昆明 鸣谢：钟晶晶鸣谢：钟晶晶General clinical measures in geriatric OT practice作业治疗作业治疗常用的临床量度工具常用的临床量度工具Evaluation of functional performance 对功能表现的评对功能表现的评估估Modified Barthel Index(MBI)Functional Independence Measure(FIM)Lawtons Instrumental Activity of

2、 Daily Living(Lawton IADL)Evaluation of cognition 認知認知的评的评估估Mini-mental State Examination(MMSE)Evaluation of mood 情绪的评情绪的评估估Geriatric Depression Scale(GDS-15)Modified Barthel Index 改良的改良的Barthel 指数指数developed by Mahoney and Barthel in 1965Modified by Shah et al in 1989to measure the ability of self-

3、care independenceself-care independence of patientsadministered by trained personnel rate the performance of a patient in an institutionalized setting through direct observationconsist of 10 self-care items3OT management in Geriatric PracticeSelf-Care Activities Feeding Bowel ControlBladder ControlT

4、oiletingStair climbing Grooming Bathing Transfer Dressing Ambulation 4Modified Barthel Index改良的改良的Barthel 指数指数5-point likert scale Different weights to reflect the timetime and amount of actual physical assistanceassistance required The total sum of item scores yield 100 indicating complete independ

5、ence in self-care performanceThe most superior and widely used(Gresham,1980;Dombory,1987;Wade,1988&Shah,1989)BI is commonly used by local Occupational Therapists.Over 95%of OT settings use the instrument to measure self care independence of patients5OT management in Geriatric PracticeModified Barthe

6、l Index改良的改良的Barthel 指数指数The modified BI(MBI)improved the sensitivity of the BI at both the item and scale levelshigher content reliability =0.87 of the MBI,than original BIinternal consistency was reported as 0.90 and 0.93 for admission and discharge stroke rehabilitation respectively(Keith,1988;Sh

7、ah et al.,1989)6OT management in Geriatric Practice(Shah et al.,1989)7OT management in Geriatric PracticeChinese Barthel Index Introduction中文的中文的Barthel 指数介绍指数介绍Chinese Barthel IndexChinese Barthel Index是一个日常生活自我照顾能力的尺度。此尺度共有十项的活动，包括进食、个人卫生、穿衣、洗澡、如厕、大小便控制、床椅转移、步行和上落楼梯。每个活动的评级可分为五级，不同的级别代表了不同程度的独立能力。

8、最低的是一级，而最高是五级。级数越高，代表独立能力越高。(Leung,Chan&Shah 2007)8OT management in Geriatric PracticeChinese Barthel Index Rating Criteria中文版的中文版的Barthel 指数评分标准指数评分标准基本的评级标准基本的评级标准：一完全依赖别人去完成整项活动。二某程度上能参与，但在整个活动的过程中都需要别人提供协助才能完成。三能参与大部份的活动，但在某些过程中仍需要别人提供协助才能完成整项活动。四除了在准备或收拾时需要协助，病人可以独立完成整项活动；或进行活动时需要别人从旁监督或提示，以策安全

9、。五可以独立完成整项活动而毋需别人在旁监督、提示或协助。注：【整个活动的过程】可介定为有超过一半的活动过程【准备或收拾】是指一些可在测试前后去处理的非紧急活动过程 9OT management in Geriatric PracticeChinese Barthel Index Feeding中文版的中文版的Barthel 指数进食指数进食进食的定义是用合适的餐具将食物由容器送到口中。整个过程包括咀嚼及吞咽。评级标准评级标准：一完全依赖别人协助进食。二某程度上能运用餐具，通常是匙羹或筷子。但在进食的整个过程中都需要别人提供协助。三能运用餐具，通常用匙羹或筷子。但进食的某些过程仍需要别人提供协助

10、。四除了在准备或收拾时需要协助，病人可以自行进食；或过程中需有人从旁监督或提示，以策安全。五可自行进食，而毋需别人在场监督、提示或协助。10OT management in Geriatric PracticeChinese Barthel Index Feeding先决条件：先决条件：病人有合适的座椅或靠背支撑食物须放置于病人能伸手可及的盛盘或桌子上进食方式：进食方式：口部进食或使用喉管进食准备或收拾活动：准备或收拾活动：例子：戴上及除下进食辅助器具 考虑因素：考虑因素：哽咽并不视作进食的一部份，但如哽咽令安全受到影响，则表现应被降级不需考虑病人在进食时身体是否能保持平衡，但如安全受到影响，

11、则表现应被降级喉管进食的过程并不需考虑插入及取出喉管11OT management in Geriatric PracticeFunctional Independence Measure 功能独立性的评价功能独立性的评价Developed by Granger,Hamilton,&Sherwin in 1986 Measure severity of disability in terms of burden burden of careof careReflect both the impact of impairment and ability to compensate for los

12、sesFocus on actual task accomplishmentType and amount of assistance required for effective performance of basic daily living12OT management in Geriatric PracticeFunctional Independence MeasureFunctional Independence MeasureStructureStructureTwo domains:motor and cognitive 18 functional items6 self-c

13、are activities 自我照顾活动2 sphincter control 大小便控制3 mobility tasks 转移2 locomotion tasks 运动2 communication tasks 交流3 social cognition社会认知13OT management in Geriatric Practice6 Function Categories&18 Items6个功能范畴及个功能范畴及18个条目个条目lEating Dressing UBlGrooming Dressing LBlBathing ToiletinglBladder ManagementlBo

14、wel ManagementlBed,Chair,WheelchairlToiletlTub or ShowerlWalk/WheelchairlStairslComprehensionlExpressionlSocial InteractionlProblem SolvinglMemory14OT management in Geriatric PracticeFIM Scoring:Level of AssistanceFIM 评分：辅助分级评分：辅助分级7=Complete Independence6=Modified Independence5=Supervision,Setup or

15、 Standby Prompting4=Minimal/Contact Assistance or Prompting3=Moderate Assistance or Prompting2=Maximal Assistance or Prompting1=Total AssistanceTotal Score Range:18-126Moderately dependent:10015OT management in Geriatric PracticeGeneral Description of FIM Levels of Function and Their ScoresStartDoes

16、 Subject need help?NoDoes Subject need more than reasonable time or a device or is there a concern for safety?NoSCORE 7COMPLETE INDEPENDENCESCORE 6MODIFIED INDEPENDENCEYesNo helperYesHelperDoes Subject do half or more of the effort?YesNoDoes Subject need total assistance?YesNoSCORE 1SCORE 2TOTAL ASS

17、ISTANCEMAXIMUM ASSISTANCEDoes subject need setup or supervision,cueing or coaxing only?YesSCORE 5SUPERVISION OR SETUPNoDoes Subject need only incidental assistance?YesSCORE 4MINIMUM ASSISTANCENoSCORE 3MODERATE ASSISTANCE16OT management in Geriatric PracticeLawton Instrumental ADL Scale 工具性的工具性的ADL量表

18、量表Developed by Lawton&Brody in 1969Chinese version validated by Tong&Man in 2002 To measure the ability of instrumental activities of daily living independence of patients that are essential for community livingConsisted of 9 itemsAdministered by trained personnel Rate the performance of a patient i

19、n home and community settingsFormat of administration:self report,proxy,observation,performance-based17OT management in Geriatric PracticeLawton Instrumental ADL Scale工具性的工具性的ADL量表量表Distinct characteristics of IADLMulti-step&more complex,require high level of social,physical and mental skillsIncreas

20、ed interaction with environment Failure of performance affects community participation and/or reintegrationPoor IADL predicts poor future health and functional status (Kovar&Lawton 1994)Target populationPre-discharge,out-patient,community-dwelling older people 18OT management in Geriatric PracticeLa

21、wton Instrumental ADL ScaleEqual weights are assigned to each item to reflect the amount of actual assistance or supervision required Performance is rated against a four-point scale ranging from score 0 for inability to perform the task to score maximum i.e.3 for total independenceThe total sum of i

22、tem scores yield 27 indicating complete independence in instrumental ADLAn average score is usually obtained for interpretation19OT management in Geriatric Practice日常家居及日常家居及社社区活动能力评估区活动能力评估一一“你能唔能够自己用电话呢你能唔能够自己用电话呢?”包括找电话号码包括找电话号码,打及接听电话打及接听电话二二“你能唔能够自己搭车呢你能唔能够自己搭车呢?”包括自己上到正确的车包括自己上到正确的车,俾车钱俾车钱/买车票

23、买车票,上上/落车落车(假设你必须要搭交通工具去一个假设你必须要搭交通工具去一个 远的地方例如探朋友远的地方例如探朋友/睇医生睇医生)20OT management in Geriatric Practice日常家居及社區活動能力評估日常家居及社區活動能力評估3)“你能唔能夠自己買野呢你能唔能夠自己買野呢?”包括自己揀貨品包括自己揀貨品俾錢及攞番屋企俾錢及攞番屋企(假設你必須要到附近商店買食物或假設你必須要到附近商店買食物或日用品日用品)4)“你能唔能夠自己煮食呢你能唔能夠自己煮食呢?”包括自己諗食乜包括自己諗食乜準備材料準備材料煮熟食物及煮熟食物及放入碗碟裡放入碗碟裡(假設你必須要自己準備兩

24、餐假設你必須要自己準備兩餐)21OT management in Geriatric Practice 日常家居及社區活動能力評估日常家居及社區活動能力評估5)“你能唔能夠自己做家務呢你能唔能夠自己做家務呢?”包括簡單家務包括簡單家務(如抹檯如抹檯執床執床洗碗洗碗)及及較重的家務較重的家務(如抹地如抹地/窗窗)(假設你必須要假設你必須要自己做家務自己做家務)6)“你能唔能夠應付簡單的家居維修呢你能唔能夠應付簡單的家居維修呢?”例如換燈泡例如換燈泡維修檯及上緊螺絲等維修檯及上緊螺絲等(假設假設你必須要自己做你必須要自己做)22OT management in Geriatric Practice

25、日常家居及社區活動能力評估日常家居及社區活動能力評估7)“你能唔能夠自己洗衫呢你能唔能夠自己洗衫呢?”包括清洗及曬自己的衫包括清洗及曬自己的衫被被床單等床單等(假設你必須要洗自己的衫假設你必須要洗自己的衫,被被,床單等床單等)8)“你能唔能夠自己服用藥物呢你能唔能夠自己服用藥物呢?”包括能依照指示在正確的時間內服用正確的包括能依照指示在正確的時間內服用正確的份量份量(假設你必須要自己查藥油或食藥等假設你必須要自己查藥油或食藥等)23OT management in Geriatric Practice日常家居及社區活動能力評估日常家居及社區活動能力評估9)“你能唔能夠處理自己的財務呢你能唔能夠

26、處理自己的財務呢?”包括日常錢銀的找續包括日常錢銀的找續交租交租/水電費及到銀行水電費及到銀行提款提款(假設你必須要買假設你必須要買自己交租自己交租/水電費及水電費及有將錢放在銀行有將錢放在銀行)24OT management in Geriatric PracticeLawton Instrumental ADL Scale Rating CriteriaScore 3:independent to do 独立完成Score 2:独立完成但是存在困难independent to do but with difficulty(i.e.poor safety;special arrangemen

27、t needed;verbal prompt needed;slow in speed;seldom to do due to with difficulty but able to do if required)Score 1:需要帮助need some help Score 0:unable to do 不能完成25OT management in Geriatric Practice Use of Functional Assessments 功能评价的使用Set up a baseline on functional levelProgress monitoringQuantify t

28、he changes after interventionDischarge planningPart of decision making of placement recommendations A communication tool among settings and disciplines26OT management in Geriatric PracticeFunctional Assessment 功能评功能评估估Functional performance of older adults in self care Functional performance of olde

29、r adults in self care and/or instrumental ADL can be restricted due to and/or instrumental ADL can be restricted due to injury/illness.injury/illness.Supporting clients to attain optimal functional Supporting clients to attain optimal functional independence is one of the goals for OT geriatric inde

30、pendence is one of the goals for OT geriatric practice.practice.27OT management in Geriatric PracticeWhat are the common criteria used in functional evaluation?在功能评在功能评估估中的中的共通共通标准是什么？标准是什么？THANK YOUSUCCESS2022-10-1429可编辑Common criteria used in functional evaluationIndependence/level of assistance独立

31、独立/需要协助的分级需要协助的分级Frequency/Amount of physical or verbal assistance that a client asks for during task performance患者在完成指定任务中所需要体力上的帮助/口头的提示程度/数量30OT management in Geriatric PracticeHow about these criteria?这些标准怎么样？这些标准怎么样？Effort 成果成果 Amount of physical difficulty or fatigue that clients demonstrates

32、during task performanceEfficiency 效率效率Degree of disorganization,inappropriate use of time and space that clients demonstrates during task performanceSafety 安全性安全性Clients potential of injuring himself or causing damage to environments during task performance31OT management in Geriatric PracticeAssess

33、ment for Cognitive ImpairmentlIn Hong Kong,prevalence of moderate to severe dementia is 6.1%in people who aged 70 or above(Chiu et al.,1998)l24.6%in high risk elders who are living in institution or home(SSP Survey 2005)32OT management in Geriatric PracticeMini-Mental State ExaminationlDeveloped by

34、Folstein&Folstein in 1975lBedside screening instrument for detection of cognitive impairmentlAdministration time:about 10 minuteslReliably tested across different cultureslSensitive to changes33OT management in Geriatric PracticeMini-Mental State ExaminationComposed of 6 domainsOrientation (time&pla

35、ce)RegistrationAttention&calculationMemory(short term)Language&ComprehensionVisual spatial orientation34OT management in Geriatric PracticeMMSE-InterpretationGeneralAn aid to document the presence of cognitive impairment or monitor progress of disease Serial MMSE scores is sensitive for progressive

36、mild cognitive problemEducation level,sensory impairments,language and communication problems may affect the reliability of the test35OT management in Geriatric PracticeMMSE-Interpretation Scoreu30 :no impairmentu or=24:“normal”in general populationu20-23 :cognitive impaired but still live independe

37、ntlyu 20 :usually cannot live independently :problems in instrumental ADL :still manage basic ADL36OT management in Geriatric PracticeCantonese MMSE Cantonese version of MMSE was developed by Chiu et al in 1994Some items revised according to the Chinese culture in Hong KongValidation studies conduct

38、ed for elderly populationCut-off scores developed according to different education level of subjects37OT management in Geriatric PracticeCantonese MMSE38OT management in Geriatric PracticeCantonese MMSE現在是什麼時候現在是什麼時候?年份年份季節季節月月號數號數星期星期這裡是什麼地方這裡是什麼地方?香港香港/九龍九龍/新界新界地區地區 (深水步深水步 /長沙灣長沙灣)醫院名字醫院名字部門部門 層數

39、層數39OT management in Geriatric PracticeCantonese MMSEl我會講三種東西的名字給你聽，講完之後請你重我會講三種東西的名字給你聽，講完之後請你重覆一次並緊記，因為幾分鐘後我會問你。覆一次並緊記，因為幾分鐘後我會問你。蘋果、火車、報紙蘋果、火車、報紙l你用一百減七，然後再減七，一直減落去直至我你用一百減七，然後再減七，一直減落去直至我叫停。叫停。l現在我會講幾個數字請你倒轉讀出：現在我會講幾個數字請你倒轉讀出：l我較早前請你記住的三種東西是什麼？我較早前請你記住的三種東西是什麼？40OT management in Geriatric Practi

40、ceCantonese MMSEl這樣是什麼東西？（手錶這樣是什麼東西？（手錶/鉛筆）鉛筆）l請你跟我講句說話，姨丈買魚腸。請你跟我講句說話，姨丈買魚腸。l現在檯上有一張紙，請你用左現在檯上有一張紙，請你用左(右右)手拿起張紙，用雙手拿起張紙，用雙手對摺一次，然後放回檯上手對摺一次，然後放回檯上/交給我。交給我。l請讀出紙上的字，然後照住去做。請讀出紙上的字，然後照住去做。（拍手）（拍手）l請你講請你講/寫出一句完整句子。寫出一句完整句子。l這裡有一幅圖形，請你照住畫。這裡有一幅圖形，請你照住畫。41OT management in Geriatric PracticeCMMSE-Interp

41、retation Cut-off Scoreu22 or below:for elder with more than 2 years of educationu20 or below:for elder with less than 2 years but more than 6 months educationu18 or below:for elder with less than 6 months of or no education (Chiu et al.,2000)42OT management in Geriatric PracticeCharacteristics in di

42、fferent diagnostic groupsAlzheimers DiseaselUsually the first deficits is the short term memorylDisorientation to time and is followed by disorientation to placelLanguage deficits start to appear latelUsually continue to try to get the right answer43OT management in Geriatric PracticeCharacteristics

43、 in different diagnostic groupsStrokelDeficits are more patchylNo specific profile lMay have aphasia/dysphasia(expressive,receptive or global)lMay have speech/language problems earlier than Alzheimers disease44OT management in Geriatric PracticeCharacteristics in different diagnostic groups-Depressi

44、onlSeem less distressed than Alzheimers patients about their problemslMore likely to answer“I dont know”or“it doesnt matter”lWhen pressed they often know the answer lPresented with“disability gap”lNo obvious STM losslOther symptoms:appetite change,energy loss,weight loss,sleep disturbance,mention ab

45、out suicide,etc.45OT management in Geriatric PracticeDeveloping the Care PlanProblem with judgment:lGet a power of attorney,advance directive and start building a support networkSTM loss:lUse reminders,lists,cues,calendars or diariesLanguage difficulties:lAvoid open ended questionslAvoid idiomatic e

46、xpression46OT management in Geriatric PracticeDeveloping the Care PlanWord finding difficulties:lKeep language simplelGive adequate time to respondlCommunicate one idea at a timelAvoid words with more than one meaning3-step command deficit:lGive one instruction/idea at one time47OT management in Ger

47、iatric PracticeWhy the evaluation of mood is important in geriatric practice?情绪的评估为什么重要？情绪的评估为什么重要？11 15%of local elderly people showed depressive symptoms(Chi,Yip,Chiu et al.,2005)Poor self-rated health,chronic pain,vision problems,ADL impairment,financial strain,few social support are associated w

48、ith an increased likelihood of geriatric depression(Chi,Yip,Chiu et al.,2005)Aversive consequences of depressive mood include increased disability,treatment refusal,suicidal attempts or acts,and a decreased quality of life.48OT management in Geriatric Practice Geriatric Depression Scale(Short-form)老

49、人抑郁短量表老人抑郁短量表Developed by Sheikh&Yesavage in1986 Screening tool for geriatric depressionAssess affective and behavioural symptoms of depressionMainly focus on psychological aspects of depression rather than somatic items49OT management in Geriatric PracticeGeriatric Depression Scale(Short-form)struc

50、ture and format15 items Self-report using a dichotomous format(yes/no)Time reference:past weekScore interpretation:A cut-off score 8 was established for elderly HK Chinese people(Boey&Chiu,1998;Chiu,Lee,Wing,et al.,1994)50OT management in Geriatric Practice老人抑鬱短量表老人抑鬱短量表-測驗形式測驗形式-測驗時間約五至十分鐘測驗時間約五至十分