Occupational therapy assessments
This blog entry will cover adult occupational therapy assessments including: The COPM, Berg Balance Scale, MoCA, the Kettle Test, Nine-hole peg test, ACLS, FIM and AMPS.
Selecting Occupational Therapy Assessments for Adults
The practice setting and context of occupational therapy for adults varies widely. From geriatrics to physical disabilities, and acute rehabilitation to mental health, client needs, occupational profile, goals, and length of stay will vary greatly. As will the occupational therapy assessments you select. Some settings will call for a very complex evaluation with multiple assessments, while others may only allow for a 15 minute informal screen. Below are selected occupational therapy assessments and tools that can be used with a diverse range of clients.
Canadian Occupational Performance Measure (COPM)
The COPM is sometimes described as an ‘objective-subjective’ test. This may sound like a contradiction but the tool actually quantifies subjective measures. Here is how it works: The client identifies what they consider to be ‘problem’ areas in their daily lives. The client then rates their performance on a scale of 1-10 and their satisfaction with their performance the same scale. This provides excellent information about the client’s priorities and is a great tool for collaborative goal planning. As a bonus, the COPM is inexpensive and comes in both paper and digital formats.
Berg Balance Scale
The Berg Balance Scale is another occupational therapy assessment tool designed to provide objective measures to quantify the ability of a client to balance in a variety of scenarios. It is a quick assessment and only requires a few materials: Two chairs (with and without armrests); a stopwatch; a step; a ruler; and a clear area 15ft long. Items the therapist will observe and rank include transfers, picking up an item from the floor, and reaching forward. The scale is easy to score and contains a cut-off score in which clients are at risk of falling. The Borg Balance Scale may also inform the therapist of other performance areas to address.
Montreal Cognitive Assessment (MoCA)
The MoCA is a cognitive screen that takes only about 15 minutes to administer. In that 15 minutes, you will learn about your client’s short term memory, working memory, attention and concentration, executive functioning, visuospatial abilities, and orientation to time and place. Not only is the paper screen easy to both administer and score, but now there is a MoCA application with automatic scoring. This assessment is an excellent choice for teletherapy evaluations as well.
The Kettle Test
The Kettle Test is unique in that it is a free performance-based test. However, some materials are required, including an electric kettle, kitchenware, ingredients to make coffee and tea, and distractor items. Depending on your client, it will take 10-30 minutes to administer. When the task is broken down, there are 13 points of measurement that are scored on a 4-point scale based on their performance. For example “client turns on the kettle” or “client indicates that they are finished” could be scored high (performed independently) or low (needed physical demonstration or assistance). A nice benefit of the Kettle Test is that it is both functional and honors client choice (the client selects which hot beverage they would like to make).
Nine-Hole Peg Test
The nine-hole peg test is a timed activity that assesses fine motor dexterity. The materials consist only of nine pegs, a peg-holder, and a stopwatch. After a demonstration the client is instructed to use one hand to fill the holes with pegs and then take them out. It only takes a few minutes to teach and administer the test and is generally done on both left and right sides. The therapist uses the time to compare to a list of norms. This assessment is often used for clients with brain injury, Parkinson’s, spinal cord injuries or other neurological diagnoses.
The Allen Cognitive Level Screen-5 (ACLS)
Another option for occupational therapy assessment is the ACLS. The physical materials of the ACLS includes a leather rectangle with holes around the edges, needles, and two different kinds of thread. This screen can give insight regarding your patient’s functional cognition. By engaging in increasingly complex tasks, your client will learn and problem solve with and without visual demonstrations. Note for practitioners: If it has been a while since you have administered this assessment, you’ll want to review it and make sure the tool is set up ahead of time. To get accurate results it is important to match the language given by the manual and provide exactly the prompts in the script. While this screen is not an option for telehealth evaluations, a disposable version is now available for settings that have strict infection control procedures.
Functional Independence Measure (FIM)
This widely used occupational therapy assessment measures self-care, transfers, locomotion, social cognition, communication, and bowel and bladder control. Self-care areas that are evaluated include feeding, grooming, bathing, upper and lower body dressing, and toileting. Based on observations, the therapist records the level of assistance needed for each category on a scale of 1 (total dependence) to 7 (complete independence). This information can help therapists track progress, decide on the most appropriate setting for rehabilitation, and ensure that the client has necessary assistive devices to stay safe.
Assessment of Motor and Process Skills (AMPS)
This occupational therapy assessment addresses areas of motor skills and cognitive skills including the ability to sequence, initiate and terminate, and pace one’s self. It begins with an interview so that the therapist can receive background information and ensure that the ADL tasks are relevant for the client. Next, the client decides which functional tasks that they would like to perform and the therapist assigns numerical values based on performance. Certification is needed to administer the AMPS. This is achieved by taking a course (online or in-person) and paying an associated fee.
Occupational therapy assessments for adults are as diverse as the clients we serve. Starting at a new place of employment or serving a new population? Ask around to see what other therapists are frequently using and what the facility has access to. What is your go-to OT assessment for adults? Comment below to share!
If you work with both adults and children, you may find our Pediatric Occupational Therapy Assessments blog helpful as well.
Occupational therapy assessments help OTs with developing goals for occupational therapy; linking the found problems and diagnosis with the correct CPT codes for occupational therapy and serve as a base for writing both assessment and SOAP notes.
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