🎯 Principles of Occupational Therapy Assessment

Occupational therapy assessment is distinguished by its holistic and person-centered approach. It is not limited to measuring deficiencies but focuses on the impact of these on participation in activities meaningful to the patient. The conceptual framework of the International Classification of Functioning (ICF) guides this process.

The Objectives of Assessment

• Identify abilities and limitations: Understand what the patient can do and what poses difficulty
• Analyze activities: Determine which activities are important for the patient and which are compromised
• Evaluate the environment: Identify facilitators and barriers in the physical and social environment
• Define goals: Establish relevant and measurable therapeutic goals with the patient
• Measure progress: Have baseline data to evaluate the effectiveness of the intervention

The PEOP Model in Practice

🏠 Functional Assessment

The functional assessment measures the patient's ability to perform activities of daily living. It is at the heart of occupational therapy expertise and directly guides rehabilitation and readjustment goals.

Functional Independence Scales

• MIF (Functional Independence Measure): International reference, evaluates 18 items in 6 domains (personal care, sphincter control, mobility, locomotion, communication, social cognition). Score from 18 to 126.
• Barthel Index: Simpler, 10 items assessing basic ADLs. Widely used in geriatrics and post-stroke. Score from 0 to 100.
• Lawton IADL: Assesses instrumental activities (telephone, shopping, cooking, cleaning, laundry, transportation, medication, finances). Particularly relevant for assessing home autonomy.
• COPM (Canadian Occupational Performance Measure): Semi-structured patient-centered interview that identifies occupational priorities and self-evaluates performance and satisfaction.

Observation in Situations

🧠 Cognitive Assessment

Cognitive functions (attention, memory, executive functions, praxis) play a major role in performing daily activities. The occupational therapist evaluates their functional impact rather than isolated deficits, complementing neuropsychological assessments.

Cognitive Screening Tests

• MOCA (Montreal Cognitive Assessment): Quick screening (10-15 min) for mild cognitive impairments. Evaluates attention, memory, language, executive functions, visuospatial abilities. Score out of 30, threshold at 26.
• MMSE (Mini Mental State Examination): Classic test of orientation, memory, attention, language, constructive praxia. Score out of 30, less sensitive to mild impairments.
• Clock Drawing Test: Quick assessment of executive and visuoconstructive functions. Simple and very informative.

Functional Assessment of Cognitive Functions

Cognitive assessment in occupational therapy particularly focuses on the impact of disorders on daily activities: does the patient forget the steps of a recipe? Do they have difficulty managing their budget? Can they use a new phone? These observations directly guide compensation strategies.

💪 Motor and Sensory Assessment

The assessment of motor and sensory abilities is essential to understand the physical limitations impacting daily activities. It guides the choices of technical aids and rehabilitation strategies.

Upper Limb Assessment

• Box and Block Test: Measures gross manual dexterity. The patient moves as many cubes as possible from one compartment to another in one minute. Well-normed and easy to administer.
• Nine Hole Peg Test: Assesses fine dexterity. The patient places and removes 9 pegs as quickly as possible. Sensitive and reproducible test.
• Purdue Pegboard: Measures fine and bimanual motor coordination. Four sub-tests with different manipulation tasks.
• Jebsen-Taylor Test: Assesses manual function through 7 daily living tasks (writing, turning cards, picking up objects...).

Analytical Measures

Balance and Transfer Assessment

• Tinetti Test: Assesses static and dynamic balance and gait. Score out of 28, fall risk if below 24.
• Berg Balance Scale: 14 items assessing balance in different situations. Score out of 56, widely used in neurology.
• Timed Up and Go: The patient stands up, walks 3 meters, turns around, and sits back down. Normal time is less than 10 seconds.
• Transfer Assessment: Observation of transfers from bed to chair, chair to toilet, analyzing strategies and difficulties.

🏡 Environmental Assessment

The physical and social environment directly influences participation in activities. The occupational therapist assesses the fit between the patient's abilities and the demands of their environment to propose relevant adaptations.

Home Visit: Key Elements

• Outdoor Accessibility: Steps, ramp, door widths, intercom, mailbox
• Indoor Circulation: Corridor widths, thresholds, flooring, clutter
• Bathroom: Access to shower/bathtub, toilet height, grab bars, maneuvering space
• Kitchen: Height of countertops, access to storage, safety (gas, electricity)
• Bedroom: Bed height, access to storage, lighting, nighttime path to the toilet
• Social Environment: Presence of caregivers, organization of human assistance, isolation

Home Assessment Tools

"Home assessment is not just a technical visit. It is an opportunity to understand how the person actually lives, what their habits, fears, and wishes are for maintaining their independence at home."

— Recommendations from ANFE

💻 Digital Assessment Tools

Digital technology is transforming assessment in occupational therapy by offering new tools that are more precise, engaging, and allow for longitudinal tracking of performance. Cognitive stimulation applications often integrate evaluation features.

Advantages of Digital Tools

• Measurement Precision: Exact timing, automatic score calculation, reduction of errors
• Longitudinal Tracking: Performance history, evolution graphs, detection of changes
• Standardization: Uniform instructions, controlled testing conditions
• Patient Motivation: Engaging interface, immediate feedback, less clinical aspect
• Time Savings: Automatic scoring, report generation

👶 Specificities of Pediatric Assessment

Assessing children requires specific tools and an approach that considers normal development, the school and family context, and the need for a playful evaluation adapted to age.

Development and Coordination Tests

• M-ABC2 (Movement Assessment Battery for Children): Assessment of motor coordination, screening for DCD (Developmental Coordination Disorder)
• Beery VMI: Assessment of visuomotor integration, copying geometric shapes of increasing complexity
• BHK (Quick Writing Assessment Scale): Analysis of writing quality and speed
• NEPSY-II: Comprehensive neuropsychological battery for children, covering several cognitive domains

Sensory Assessment

📝 Writing the Assessment Report

The occupational therapy assessment report is a legal document that synthesizes the results of the evaluation, establishes an occupational therapy diagnosis, and defines the intervention project. Its writing must be rigorous and clear.

Typical Structure of the Report

• Administrative Information: Patient identity, prescriber, date of assessment
• Reason for Consultation and History: Pathology, history, ongoing treatments
• Initial Interview: Patient's request, living situation, occupational priorities
• Results of Assessments: Tests used, scores, clinical observations
• Summary and Occupational Therapy Diagnosis: Strengths, limitations, environmental factors
• Intervention Project: Goals, means, frequency, expected duration
• Recommendations: Technical aids, adaptations, referrals

Best Writing Practices

"A good assessment report is one that allows a colleague to immediately understand the patient's situation and continue care with full knowledge of the facts."

— Professional Recommendations