COURSE FULL

DESCRIPTION: The Upper Limb Performance Assessment is an ecologically valid, criterion-referenced, two-stage assessment of upper limb contributions to task performance (Ranka, & Chapparo, 2011). It can be used with any client who demonstrates difficulties with any aspect of reach, grasp and release regardless of cause. Stage One, Task Performance Mastery (TPM), is used to analyze and assess the degree to which a person can perform the motor steps of any needed or desired task in context. Errors are identified using a specific classification system. Steps performed without error are used to calculate a performance mastery percentage score. Stage Two, the Comparative Analysis of Performance –Motor (CAP-M), is used to identify specific elements of movement disorders that contribute to errors identified in Stage One. Stage Two is based on a comparative method of observation. The ability of the ULPA to measure subtle, incremental changes in performance of client specific tasks has been demonstrated (Crippin, Ranka, Nott, Barden & Baguley, 2012). The symptoms identified through the CAP-M are used to select and apply impairment-focused interventions, and to embed these interventions within task oriented therapy programs that aims to improve mastery. Reliability and validity of the ULPA has been demonstrated (Barden, Nott, Baguley & Chapparo, in press; Crippen, Ranka, Nott & Baguley, 2012; Rae, Copley & Ranka, 2010).

OBJECTIVES:
1. Describe elements of the ULPA and understand its psychometric properties.
2. Compare and contrast the ULPA with other assessments of the upper limb function (eg. MAS, ARAT, GAS).
3. Assess and score task performance mastery from videotaped client examples using Stage One.
4. Assess and score motor strategy application behaviours applied to tasks on dimensions of reach, grasp and release from videotaped client examples Stage Two.
5. Use findings from the ULPA to write specific, measureable mastery and strategy application goals, discuss implications for intervention, and calculate and graph outcomes.

AUDIENCE: Qualified Occupational Therapists

The Comparative Analysis of Performance

Ranka, J. (2007, 23-26 June). The Comparative Analysis of Performance (CAP-M): An occupation embedded method of assessing motor capacity. Poster presented at the 4th Asia Pacific Occupational Therapy Congress, Hong Kong

A major expectation of occupational therapists is to identify the occupational performance limitations of clients, to identify the causes of these limitations and to design intervention to restore or compensate for lost skills and abilities. Although numerous assessments of task performance and measures of impairment exist, few examine the motor, cognitive, perceptual, intrapersonal or interpersonal component operations that support occupational performance within the context of everyday task performance. The lack of occupation-embedded assessments of occupational performance skill and component ability requires that occupational therapists rely on skilled observation. However, there is also a lack of formal structures of skilled observation.

The purpose of this session is to present a suite of structured skilled observation tools that have evolved out of the Occupational Performance Model (Australia). These tools are based on a method of procedural task analysis that results in calculation of a mastery score. This is followed by an assessment of the reasons for reduced mastery using a comparative format, the Comparative Analysis of Performance (CAP). CAPs exist for motor operations (CAP-M), sensory operations (CAP-S), cognitive operations (CAP-C), intrapersonal operations (CAP-IAP) or interpersonal operations (CAP-IER). Findings from CAP assessments provide therapists with specific information on which to design intervention to achieve mastery outcomes.

This session is designed for therapists who wish to learn more about skilled observation and educators who teach occupational therapy process and task analysis. At the end, participants will be able to carry out an assessment of mastery and the component operations that support mastery for selected videotaped case examples.

Development of an OT Scale

Fayle, S., & Ranka, J. (2006, 23-28 July). Development of an occupational therapy scale of upper limb occupational performance following CVA. Poster presented at the 14th Congress of the World Federation of Occupational Therapists, Sydney

A primary aim of occupational therapy is to enhance performance and participation of people whose occupational performance has been compromised by physical, cognitive or psychosocial impairments or delays, as well as, environmental constraints. Many of the clients seen by occupational therapists have compromised occupational performance as a result of conditions and impairments that affect the arm and hand in different ways. Occupational therapists are expected to identify the occupational performance limitations that exist and, at least, be knowledgeable about the conditions and impairments that cause these limitations.

Contemporary occupational therapy practice is typically described as client-centred, collaborative and occupation-focused. Is this the reality? Many practice contexts demand quick decision-making and rapid service delivery. Therapists have little time to gain a view of life from the perspective of the client and his or her role partners. Therapists are expected to be directive and prescriptive rather than collaborative. Methods used in practice are often technique-focused and this is encouraged, somewhat, by the current evidence-based health care paradigm. How do we assert and demonstrate our unique role in the health care team? Employers and clients are entitled to data that demonstrates occupational therapy outcomes, yet measures of occupational therapy outcome are few and often do not fit the expectations of administrators. Policy-makers and employers continue to explore the concept of a multi-skilled workforce, and educators are being urged to develop generic professional preparation programs. How will we maintain our place in health care?

The purpose of this paper is to explore the challenges facing occupational therapy practice further and to present ideas for how to address them. Specifically, I will present a framework for client-centred, occupation-focused practice that encompasses the totality of practice regardless of the clients seen, the context of practice or the techniques used. Case examples of clients with a variety of arm and hand disorders will be used to illustrate key points. I will then demonstrate how this model can be used to assert our unique place in health care. A summary of the research evidence about occupation-focused practice in upper limb and hand therapy will be presented, and a client-centred method of collecting specific evidence about outcomes in occupational performance will be described. Finally, I will discuss my perspective on the research imperatives facing practice and make suggestion for how this research can be carried out.