Entry Terakhir Hari Terakhir 2013

As salam..Sedar tak sedar, hari ni dah masuk hari terakhir sang penulis berada di tahun 2013. Nak diceritakan, banyak yang berlaku pada sang penulis sepanjang tahun ini. Mari sang penulis nak ceritakan sikit pada korang semua yang membaca entri terakhir di tahun 2013 ini. Kenangan, sangat manis untuk dilupakan, ada kalanya juga pahit tapi yang pahit tu nantinya in shaa Allah akan menjadi manis baik cepat mahupun lambat.

Januari-June

Sang penulis disibukkan dengan praktikal di Hospital Selayang where I met Encik Thillai, Puan Ayu, Puan Husna dan Encik Mi. Hospital Selayang tak berapa nak mencabar tempatnya berbanding Hospital Kuala Lumpur dan Hospital Klang. Selama sang penulis berada di Hospital Selayang, banyak bimbingan daripada Encik Thillai terutamanya, yang mana sang penulis hormati dan kagumi beliau dari segi seorang terapis, sang penulis menyaksikan bahawa beliau seorang yang sangat baik dan mengambil berat tentang semua pesakitnya, beliau mampu melihat sesuatu secara menyeluruh dan mampu menghayati sesuatu keadaan dari segi perspektifnya sendiri. Beruntung dapat bos macam dia kalau kerja. hehehe.

Sang penulis juga menghadiri daurah seperti Ini Sejarah Kita, Syahadatul Haq dan sebagainya di tempoh masa sebulan ini. Sang penulis berkesempatan mengenali figura-figura hebat dalam dakwah yang mana sang penulis juga sangat kagumi kerana mampu menyeimbangkan antara dakwah dan juga keperluan duniawi. Sang penulis juga diuji dengan ujian uhkhwah yang amat pada tempoh ini. Sang penulis yakin mereka merasakan ada kedinginan dalam ukhwah yang sang penulis lahirkan pada zahirnya di pandangan mereka. Maafkan sang penulis, tapi sang penulis merasai ada sesuatu jurang antara ukhwah kita. In shaa Allah dan alhamdulillah, kini sang penulis mengerti dan memahami ukhwah itu dengan lebih baik lagi. huhu.

Pada tempoh bulan Januari hingga Jun ini juga, sang penulis berkesempatan menyertai OPKIM di Melaka dan mendapat keluarga angkat di sana, buat pertama kalinya. Makanan, tempat tinggal dan layanan yang istimewa dapat sang penulis rasakan di sana. Kedamaian tempatnya juga masih terpateri dalam ingatan sang penulis. Ibu angkatku juga mengakui bahawa kami adalah anak-anak angkat yang paling happening dan paling meriah sepanjang beliau mendapat anak angkat sebelum ini. Yang sedihnya adalah, ibu angkatku meeniggal dunia setelah lebih kurang 2-3 bulan kami meninggalkan Melaka akibat penyakit tua. Sang penulis masih tidak sempat untuk bertemu kembali dengan keluarga angkat sang penulis. Timbul juga rasa rindu untuk ke sana, tapi segan pun ada andai pergi sendiri tanpa adik beradik angkat yang lain. Dan dalam program OPKIM ni, sang penulis jadik Exco Publisiti dan buat and design banner untuk program ni, kitorang warna, lukis n sebagainya pada most of the banner yang perlu kami buat.

Selain itu, sang penulis juga ditawarkan untuk menjadi organisasi induk Fiesta Sinergi Intelek di mana sang penulis digandingkan dengan seorang pelajar lelaki perubatan. Sang penulis sebenarnya tak pernah digandingkan dengan mana-mana lelaki sepanjang dapat jadi organisasi di kolej. Alhamdulillah, sang penulis dapat harungi meskipun sang penulis tahu, sang penulis lebih banyak bekerja di belakang tabir dan tidak dilihat oleh pengarah sang penulis ketika itu. Pengalaman sang penulis membuat pengumuman di setiap blok kolej perempuan itu tidak dapat sang penulis lupakan. Tak pernah sang penulis buat tapi sang penulis rasakan ini adalah pengalaman yang berharga buat sang penulis. huhu. 

Program lain termasuklah Makan Malam Kolej. Sang penulis jadik Exco Publisiti untuk program tersebut. Sebelum program, sang penulis disibukkan dengan penyiapan poster, video teaser dan video penyampaian anugerah manakala Exco lain dan seorang AJK kami lagi terlibat dalam penyiapan yang lain. Nak diceritakan, makan malam ini adalah yang terbaik pernah dilihat oleh orang atasan UKM yang hadir di majlis tersebut yang mana special khas kami jemput dari pentadbiran di UKM Bangi. Alhamdulillah, sang penulis berjaya mengawal keseluruhan flow majlis di belakang pentas, background pentas, muzik, dan sebagainya yang terlibat sama. Sayangnya, sang penulis tidak dapat bercantik-cantik mungkin hahaha, untuk menyertai rakan-rakan sang penulis pada majlis tersebut kerana disibukkan dengan penyelarasan dan pengawalan pentas/majlis di belakang dewan bersama technician dari tempat tersebut.

Then, sang penulis juga terlibat dalam organisasi Makan Malam Terapi Carakerja. Ini juga interesting, kami 12 orang bertungkus lumus menjadikan majlis ini menjadi. Biarpun simple, tapi nampak grand and tidak berapa mengambil duit setiap orang yang datang. Sang penulis sangat menghargai semua coursemate sang penulis, kami saling menerima kekurangan dan kebaikan masing-masing selama kini lebih kurang dua tahun lebih. Sang penulis tidak ikut serta dalam aktiviti koir dan nyanyi bersama di atas pentas dalam majlis ini kerana sang penulis sedar sang penulis bukan jenis yang sebegitu.

Final exam Sem 2 Tahun 2 alhamdulillah i did my best and i struggle a lot at that time. Alhamdulillah, sang penulis berpuas hati dengan result yang keluar pada masa itu. During weekend, sang penulis selalu keluar dengan sahabat sang penulis pergi ke perpustakaan negara yang sangat dekat dengan asrama kami. nak study kat bilik pada waktu itu adalah sesuatu yang mustahil kerana sang penulis ada masalah dari segi pengawalan masa tidur akibat terlalu selesa berada di bilik sendiri.

Farewell and welcoming party juga dibuat dalam tempoh ini, sang penulis menyertai party kali ini yang dibuat di Times Square, kami makan di Secret Recipe ketika ini. Lawak jugak apabila teringat dengan pekerja Secret Recipe tempoh hari yang mana kami order masakan secret recipe di sungai wang melalui telephone manakala tempat kami makan adalah di secret recipe Times Square. Sang penulis berjaya menyiapkan button sempena majlis ini dan semua orang dapat seorang satu button yang berwarna biru ini. heh.

Kami juga makan bersama Encik Hiba semasa hari terakhir kelasnya di Hale's Kitchen, beliau yang dah ada Master in OT, banyak cerita tentang pengalaman beliau sepanjang belajar dan menjadi seorang OT. Beliau juga yang bersama dalam program komuniti kami yang dibuat di IQ70+.

July-December

Awal bulan September sang penulis berkesempatan menjejajkan kaki ke Kedah dan Pualau Pinang. Kenangan yang tak dapat dilupakan bersama dengan insan-insan yang friendly, dapat makan free dan kenal keluarga tunang kakak di Kedah. Hehehe. Adik dapat masuk USM, thatz why nak join sekali cuti seketika di Kedah sebelum hantar adik ke USM. Sang penulis berpeluang tengok sawah padi dan ambik gambar sebanyak mungkin, melalui jambatan Pulau Pinang yang sungguh indah itu. SubhanAllah. Oh ye, sang penulis dikenengkan dengan orang Kedah pulak masa ni, diorang main-main jer tapi sampai hari ni masih jugak nak usik sang penulis balik. I know it is juz sebahagian cara untuk sang penulis berukhwah sesama muslimah dengan mereka. :)

Tahun 3 bermula, sem 1 tahun 3 yang sangat hectic dapat aku rumuskan, tahun ni kami dapat junior mweheheh. dah dua tahun kami jadi junior sebab tahun sebelumnya course kami tak ambik intake tahun satu. Pengalaman kali pertama dapat junior, macam tu lah, macam yang kami rasakan dulu sebagai junior. Tahun ini sang penulis tidak lagi disibukkan dengan program-program kolej, sang penulis banyak menumpukan kepada study dan dakwah.

Sang penulis menyertai Lan berambeh anak Sarawak di PWTC, yang menghimpunkan semua anak Sarawak yang tinggal di Semenanjung. A grand majlis, sang penulis berkesempatan menemui beberapa kawan lama di majlis ini, dapat makan free, dapat kawan baru. Yang tak boleh dilupakan, makan malam tu diorang bukak pertandingan bola sepak di antara ngap sayot dengan negeri apa entah masa tu dan ngap sayot menang ketika itu. Riuh dewan dengan pekikan, tepuk tangan bersama juga dengan Taib Mahmud yang turut hadir memeriahkan suasana.

Sang penulis mula menjadi murabbi buat pertama kalinya saat ini. huhu. alhamdulillah dan kini masih lagi belajar menjadi murabbiah dan mutarabbi yang sentiasa belajar dan tidak pernah merasa puas untuk belajar. Ilmu Allah itu luas, tak tergambar dengan kata mahupun pandangan. Sampai bila pun, sang penulis takkan sempurna. Adalah suatu cabaran untuk sang penulis menyampaikan sesuatu dan pada masa yang sama memperbaiki diri sendiri. In shaa Allah, Allah sentiasa bersama sang penulis, akhwat juga sentiasa membantu dan menyokong sang penulis.

Pagi Ahad Tak Tidor (PATT) dibuat di Titiwangsa ketika ini yang menghimpunkan semua akhwat kawasan ketika itu. Ramai gak yang datang dan sang penulis ketika itu berkesempatan menjadi antara tulang belakang yang menjayakan program itu alhamdulillah. Niat semua kerana Allah, pasti Allah bantu. Sang penulis mengenali akhwat dari institusi belajar tempat lain dan berpeluang bersama mereka berganding bahu menjayakan program ini. Sang penulis mulai sedar, biarpunbagaimana kelemahan kita yang ada, kelemahan itu boleh jadi akan jadi suatu kekuatan andai disalurkan pada jalan dakwah dan tarbiyah. Sang penulis kagumi akhwat yang bagi penyampaian pada hari tersebut.

Tahun 3 sem 1 ini sang penulis mengenali Dr. Chai, sang penulis suka dengan personalitinya, beliau ada identitinya sendiri sebagai OT. I like her style and personality which someday in the future, sang penulis juga mahu punya personaliti dan stail sendiri. Beliau dari Sarawak, dan sang penulis kira sangat banyak pengalamannya dalam bidang OT sehingga dapat title Dr sebab berjaya habiskan PhD di oversea. I adore her as a person who strive to achieved her dreams. heh. :D

Tahun ini juga sang penulis terlibat dengan Mukhayyam. Masuk hutan seperti biasa tapi kurang mencabar sedikit berbanding sebelumnya, masa ni sang penulis belajar untuk climb bukit guna tali dan turun. First time! and it was really fascinating and I can't forget about that experience. Hehehe, pengisian semasa daurah yang begitu mantap daripada figura-figura hebat dalam dakwah dan tarbiyah juga tidak kurang menambah lagi pengalaman yang manis di mukhayyam kali ini. Sang penulis juga berkesempatan mengenali seorang akhwat yang kami selalu panggil kak ninja iaitu ketua kumpulan kami disebabkan dia selalu menjaga dan nampak lah kepimpinan dia dalam menjaga kami ahli kumpulannya. 

Makan bersama Encik T dan Dr. Chai di Fullhouse. Sweet memories, kami 12 orang lagi merancang sesuatu yang mengharukan Encik T pada hari itu. Hari terakhir dia sebagai clinician OT di UKM kerana dipindahkan ke KSKB Sungai Buloh. Ambil gambar bersama dan sebagainya. mwehehehe.

Praktikal OT kali ni dibuat di Hospital Kuala Lumpur:

Minggu 1: Geriatrik

Sang penulis belajar mengenali dan hold on pesakit yang sudah tua, agak mencabar kerana mereka suka bercerita sehingga melarat dan takes time untuk sang penulis mendapatkan maklumat mengenai pesakit. Alhamdulillah saat ini sang penulis berjaya mencabar diri sang penulis untuk membentangkan case home visit di hadapan consultant dan medical team yang lain. Kali pertama membentangkan isi home visit dalam bentuk berbeza yang mana slide yang sang penulis buat jadi rujukan ramai pihak setelah itu. Alhamdulillah ya Allah, semua ini adalah suatu process untuk belajar. Tak dinafikan sang penulis memang kena tembak teruk masa bentang case study tempoh hari (bukan home visit), barangkali juga kerana selesa dengan cara sang penulis belajar di Hospital Selayang yang agak comfort zone menyebabkan sang penulis merasa agak tercabar dan susah untuk adaptkan diri di Hospital Kuala Lumpur.

Minggu 2-3: Neuro-Med

Di sini sang penulis belajar merendahkan ego sang penulis dan mengenali siapa sang penulis sebenarnya pada pandangan orang lain. Ada banyak benda yang perlu sang penulis perbaiki untuk menjadi seorang OT yang profesional dan berjaya suatu hari nanti. Terima kasih yang tidak terhingga buat sesiapa yang sentiasa bersama sang penulis ketika itu, support sang penulis ketika down and up. I appreciate you all. :') Thanks jugak pada sesiapa yang menegur sang penulis ketika itu, sang penulis yakin teguran anda adalah untuk kebaikan sang penulis suatu hari kelak agar sang penulis tidak melakukan hal yang sama di tempat lain in shaa Allah. I try my best.

Minggu 4: Psikiatri

Minggu yang sang penulis sangat nanti-nantikan. Sang penulis punyai minat dalam melihat dan hold on pesakit yang ada mental illness. Entah, tapi setiap kali ada pesakit mental illness datang ke department ni, hati sang penulis membuak-buak ingin tahu mengapa merekajadi begitu dan sang penulis juga di sini berjaya menggunakan kelebihan yang ada pada diri sang penulis untuk membuat aktiviti berkumpulan bersama pesakit. Sang penulis mengetuai sesi aerobic pada pagi itu, suruh diorang buat bulatan and kami main muzical chair, nyanyi bersama, introduce self menggunakan muzic dan bola yang dipassingkan. Pengalaman yang tidak dapat dilupakan, praktikal yang sangat sang penulis sukai. heheheh.

Tutup cerita praktikal. Kakakku kahwin pada beberapa hari lepas bersama dengan suaminya dari Kedah, yes, abang iparku dari Kedah. Masa tu praktikal dan sang penulis tetap mahu balik kerana itu adalah wedding kakakku dan sang penulis tidak mahu ketinggalan untuk bersama di hari besarnya. huhu. Tapi, bila tiba masa untuk balik, sang penulis dan ibu sang penulis merasa sebak begitu juga dengan ahli keluarga sang penulis yang lain, tempoh sang penulis berada di Sarawak tidak lama dan ibu pula tak sempat nak melayan dan bersama kami sangat disebabbkan sibuk melayan tetamu disebabkan itu ibu rasa sebak apabila kami meninggalkan rumah pada hari tu. (Len kali tak nak balik kalau tengah sibuk gitu, n balik cuma 2 hari)

Dan sekarang, minggu belajar sempena final exam yang akan datang. Doakan sang penulis berjaya dapat 3.00 ke atas in shaa Allah. kali ini. :')

Demikianlah cerita di tahun 2013, mungkin ada tertinggal cerita di mana2. Sekian.

Kuala Lumpur.

People Judging and is Always

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Actually I am really really can't stand it when someone we know always judge us. Okay, I change it to we, we always don't like it when someone judge us, I think is because of our ego. Ego, some people have high ego some people is somewhat like being hide inside the feelings, can't see by others. But we need those people who can correct us no matter who they are and who we are, we need that advice so that we will not drown so far from this journey. I always say this, we sometimes are too busy trying to get what we want, then without even realize we hurt ourself, we hurt our imaan, we forget Allah who is the Most Powerful.

In one day, how many times we mention His name? In one day, how many times we remember about him? This all can prove how much we put Him first in our life, does Allah just your Rabb when you are in trouble? Allah, the presence of Him, sometimes we take it for granted. He knows what we feel, He knows what we want, He knows what we won't talk to others. That words that can't simply speak out by words and voice. He knows it all. Our inner self, insight of our soul, always fight to choose between that bad or devil voices. It depends on us, what we choose.

Allah love that we go back to Him no matter what. Always have that feeling of wanted to learn, for learning is not just temporary, it happen throughout our life. After we graduated, we learn other area of life, perhaps work knowledge and experience, family matters, friendship, financial management n etc. This is all Allah's knowledge, we learn it all from His willing for us. Its sad indeed, when our heart becomes so black, rigid and is hard to melt. Sad and is sad very sad when we know the cause of it but still playing with the fire, letting ourself injured throughout the journey. May Allah protect us always, and hope that we always remember Him in everything we do. In shaa Allah.

Kuala Lumpur 

Menuding Jari

Terlalu sibuk menuding jari pada satu pihak sehingga melupakan diri sendiri juga mungkin membuat kesilapan. Manusia, tidak pernah sempurna dan tidak akan pernah sempurna kecuali Rasulullah SAW yang maksum itu. Tidak dapat tidak, pasti akan melakukan kesilapan baik secara sedar mahupun tidak sedar. Kejadian yang berlaku di sesetengah tempat di mana saling menyalahkan antara satu sama lain di mana bila orang atasan mula mengkritik akan kesilapan orang bawahan. Akhirnya orang bawahan mungkin takut dan cuba mencari alasan agar tidak dipersalahkan, lalu kemudian menyalahkan orang bawahan lain begitu sahaja.

Maka berlakulah sesi pergaduhan yang seakan tidak akan pernah habis. Seakan tidak tahu di mana kah penghujungnya. Dalam hal ini, kesemua pihak perlu berlapang dada. Sesiapa yang pertama meminta maaf itulah yang terbaik tak kira sama ada dia bersalah atau yang lain yang bersalah. Hubungan dengan manusia sama juga perlu dijaga sebagaimana kita menjaga hubungan dengan Allah. Hidup kita bermasyarakat, tidak akan pernah lari daripada mengharungi dan menemui pelbagai jenis dan personaliti manusia yang bervariasiti. 

Sudah pasti dan mungkin juga ada sesetengah manusia yang kita rasa kita tidak cukup ngam untuk bersama mereka sentiasa atau berurusan dengan mereka. Percaya atau sebaliknya, kematangan itu dapat ditunjukkan apabila kita mampu menerima orang yang kita tidak suka dengan menunjukkan wajah manis because this is life. We can't expect to have things juz the way we want to be. They also is human, we also is human. Ada perasaan, ada rasa kecil hati andai dilayan berbeza dengan orang lain.

Allah juga melihat pada hati manusia, hati-hati dengan hati dan ego kita. If salah, mengaku salah. Kadang terlampau menjaga diri dan melindungi diri, hati kita terluka baik cepat atau pun lambat.

Kuala Lumpur

Nak Kawen?

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Marriage. The topics that people in young ages find it to be interesting things to talk about. When we talk about marriage, things that pop up in our mind is the happiness being with someone we love, walking through the life as long as being with our partner is somewhat enjoyable. However, all and all, its not about that sweet things about marriage, its beyond than that. Marriage is not a simple thing, preparation before that is more vital than the marriage itself. Marriage can prevent from zina but ia not only that, there is more reason to get marriage. Don't make our mind too rigid to think that marriage is all about being happy.

The cost need to be face for the marriage, before and after marriage should be counted. Such a very young ages to make the topic of marriage as a big issue in our living life before the right time. I think it is such a waste of time, I am talking from my previous experience. There is more other important things to think of instead of burdening our mind with marriage things. Somehow also, we think a lot about this things without knowing that people around us such as family and friends is the peoples who need the most of our love. Allah should be place at the first place.

Because the time may not be the right time, and someone we meet may not be the right man. Is not wrong to fall in love or have a crush on someone, perhaps he/she didn't know we have feelings for them. Let it be, Allah knows it. Sometimes we have to sacrifice what we want for the sake of Allah, for Allah's redha is what we want the most throughout this life onwards. Keep it to the halal one, make yourself expensive and have your own principles so that we will not drown along the way to meet Him. Nobody say it is easy, though this is our jihad and mujahadah to fight for His jannah. In shaa Allah. Is more appropriate to think about other things for now. Allah knows the best who we are going to be married with, right? So leave it all to Allah. :)

Kuala Lumpur.

Some People Just Don't Get It

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Some people just don't get it when we give something that is not obviously shown by our action. Perhaps, that is the only way we can give to them, because saying it right by words is worthless, in the end, we are the one being blame by them. This things really pissed me off but that is life, we can't always have positive outcome in what we do in our life. That's the challenge. I may not know who you are and you also may not know who I am.

People say action speaks louder than words. I agree it to some point in life. But still, some people just don't get it until like forever. Think like it is useless to continue giving a hint by the action, but it show that we give up to take the challenge. Too much thinking, worried and compare who we are with other may cause us to lose our real goals. Worried lead to waste of time. Just go for it cause we don't know what our future prepare for us. All and all, He, Allah knows what best for us. Maybe we don't see what Allah plan for us now, its our turn to go for it and never give up for He always with us. 

Kuala Lumpur

I Can't Accept That, Sorry

I just finished watching the video on the types of service or self-care an OT should provide to someone who have disability. It is some kind of sensitive topics to be discuss in mostly Malay races in Malaysia. Many of them refuse to participate if the therapist offer to assess that kind of assessment. But through this assessment, then only that we can figure out the solution for the patients.

All and all, I still need some time to accept that kind of services and self-care to the patient/client itself. I think that types of intervention can be apply to if the patient agree to commit. But to me, it is very contra to the norm and the moral value of some culture especially Islamic culture. It is a non-moral things to do if the therapist and client agree to perform the activity. It is also important to identify the needs of the patient regarding their condition. However, if there are an agreement between client and therapist, then I couldn't say anything more.

I just can't really totally accept that kind of intervention. I am really sorry. Although the client want it to be done, I just can't do it. Go and ask other therapist to help you. I guess that is what I will tell the patient/client if they ask me to help him/her in that particular area of function.

Kuala Lumpur

Syawal Day 1 and Day 2

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Semalam kami sekeluarga beraya sakan gi umah family yang jauh2 seperti Kuala Tatau, Tatau, Kampung Jepak and so on. Tapi jalan yang paling tak berapa selesanya adalah jalan menuju ke Sibu iaitu jalan kami menuju ke Tatau.

Sampai je ke Tatau, umah saudara, nampak budak Cerebral's Palsy. Sejenis penyakit yang kebanyakannya menyerang masa umur masih muda, terus minda Sang Penulis dok fikir apa yang telah dipelajari semasa di UKM. Segala assessment and intervention bermain2 di minda yang sesuai untuk budak tu. Then I realized that being Occupational Therapy to be is such a worth thing to study coz we can also apply it to our own life. And my family start to ask me anything about the disease. I juz answer what I can answer. Heh.

Then hari tu, beraya di rumah nenek ni. Dia kata Sang Penulis ni doktor untuk menyenangkan dia mengingati siapa Sang Penulis. Umur pun dah tua, takut tak ingat jadi dibuatlah satu perkataan sesuai buat diri.

And yes, walaupun dok beraya still asyik fikir masalah yang tak sudah2. Sorry guys I am juz tired of waiting and being judge by others. I juz like what I want to do so I don't care what people say. Can they respect my decision? Or they expect me too high then finally disappointed about me? 

Bintulu, Sarawak.

Hidup Dalam Boneka Sendiri

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Hidup dalam boneka sendiri,

Dia terpana akan keindahan yang sebentar cuma,

Apa yang dilihat tidak seperti apa yang dirasa,

Apa yang dirasa tidak seperti apa yang dilihat,

Apa yang diungkapkan tidak seperti tindakannya,

Apa yang dibuat tidak seperti yang diungkapkan.

Dan biarlah dia sendiri,

Dengan boneka dunianya sendiri,

Dicipta kerana hanya berdiri sendiri,

Cerita indah di luar kotak masa ini ternyata hanyalah sebuah cerita,

Tiada dia di dalam cerekarama itu,

Hanya angin bayu yang disangkakan,

Derap langkah tetap harus dijalani,

Kerana hidup bukan sekadar itu.

Biarlah,

Biarlah dia sendiri yang menanggung sesak rasa ini,

Siapa lagi yang mahu ambil peduli?

Adakah cerekarama di luar kotak masa itu tahu tentang dia?

Ternyata dia dan ceritanya cumalah boneka,

Boneka yang dicipta sendiri,

Yang nantinya bakal kelam dek masa yang mencemburui,

Dia harus pergi,

Itu lebih baik.

Bintulu, Sarawak.

KINEMATICS IN OCCUPATIONAL THERAPY 2

REFERENCES

Spaulding, S. J. 2005. Meaningful motion: biomechanics for occupational therapists. Elsevier Churchill Livingstone Printed in China.

Hall, S. J. 2012. Basic Biomechanics. Linear Kinematics of Human Movement. 6th Ed. McGraw-Hill Companies.

Beichner, R. J. 1996. The impact of video motion analysis on kinematics graph interpretation skills. American Journal of Physics. 64(10) : 1272

Zaciorskij, V. M. 1998. Kinematic Geometry of Human Motion: Body Posture. Kinematics of human motion. Library of Congress Cataloging-in-Publication Data.

Santosh, R. 2011. Hand kinematics: Application in clinical practices. Indian Journal of Plastic Surgery. 44(2): 178–185.

KINEMATICS IN OCCUPATIONAL THERAPY 1

Kinematics is the geometry, pattern, or form of motion with respect to time. Kinematics, which describes the appearance of motion, is distinguished from kinetics, the forces associated with motion. Linear kinematics involves the shape, form, pattern, and sequencing of linear movement through time, without particular reference to the forces that cause or result from the motion. Careful kinematic analyses of performance are invaluable for occupational therapy practice. When people learn a new motor skill, a progressive modification of movement kinematics reflects the learning process. This is particularly true for young children, whose movement kinematics changes with the normal changes in anthropometry and neuromuscular coordination that accompany growth. Likewise, when a patient rehabilitates an injured joint, the occupational therapist or clinician looks for the gradual return of normal joint kinematics. Understanding movement is crucial to effectively helping individuals with movement difficulties. If we do not understand some of the characteristics of movement, it is hard to explore the problems that movement difficulties create. When an occupational therapist works with an individual who has difficulty with movements, the therapist needs to understand the characteristics of the movements and how these actions impact occupations. (Sandi J. Spaulding 2005)

One specific performance areas in occupation that I chose for basic activities of daily living are functional mobility. Functional mobility is a movement from one position or place to another (during performance of everyday activities), such as in-bed mobility, wheelchair mobility, and transfers. For example wheelchair, bed, car, tub, toilet, tub/shower, chair, floor ). It also includes functional ambulation and transporting objects. (Susan J. Hall 2012) Kinematic models of the human body are those that represent its mobility and neglect all other aspects (for example is the mass distribution). The models are classified as anthropomorphic, also called skeletal, or functional. Skeletal models visually resemble the construction of the human body; the body segments are (typically) modelled as solid links and the human joints as the joints of the model. In functional models, the body segments are modelled as nodes of a graph (of a tree) and the joints as arcs connecting the nodes. The model represented in figure below consists maximally of 18 rigid segments and 17 joints and possesses 41 Degree of Freedom.

Kinematic model of human body. Filled circles designate the joints that are usually included in the model. Open circles are for the joints that are included only in some models.

To estimate the total mobility of the body all joints and body segments must be considered. According to estimations, there are 148 movable bones and 147 joints in the human body.  The total mobility can be estimated using a slightly modified Gruebler's formula, in which classes of joints instead of the number of DOF are used:

Where F is the mobility of the body (the total number of DOF), N is the number of movable bones, i is the class of the joint (based on the number of imposed constraints, i = 6 - f, where f is the number of DOF), and j, is the number of joints of the class i. It has been estimated that the human body has 148 movable bones connected by the joints, 29 joints of the 3rd class (with three DOF), 33 joints of the 4th class (with two DOF), and 85 joints of the 5th class (with one DOF). The total mobility of the human body is

F = (6.148) - (4.33) - (5.85) = 888 - 87 - 132 - 425 = 244

Thus the human skeletal system is highly redundant. It has 244 DOF and its manoeuvrability is 238. To position an end effector in space, the brain must specify not 6 but 244 variables, of which 238 are redundant and may be used to perform the motor task in an optimal way.  (Zaciorskij Vladimir M 1998) Knowledge of kinematics is important in Occupational Therapy practice. The therapist will able to improve their practice techniques when working with the patient. This is because the therapist will more readily see movement substitution (an awkward movement that occurs sometimes because the needed muscle force is absent). Besides that, the therapist will be able to document movement speed changes and other aspects of movement so they can better observe and document changes as treatment progresses. Furthermore, one can understand the implications of adapting and accommodating movements more efficiently. (Sandi J. Spaulding 2005) Understanding the kinematics of human movement is of both a basic and an applied value in medicine and biology. Motion measurement can be used to evaluate functional performance of limbs under normal and abnormal conditions. Kinematic knowledge is also essential for proper diagnosis and surgical treatment of joint disease and the design of prosthetic devices to restore function.

One clinical case study that can be use is patient with Osteoarthritis namely as Sandy, female, 62 years old. She has good health state, suffered with osteoarthritis for 3 years, this accompanied by varicose vein and thrombosis. She does not taking any medication. In past was taking anti-inflammatory. Previously, she complains pain in the left knee affecting walking ability preventing to go up or down stairs. She has difficulty in walking down stairs. Alteration of joint movement in a hand, the normal transmission of force requires that the joint axis stays in its relationship to both bones at the joint and the joint glides in a normal pattern. In case of Sandy, there is an alteration of pattern of movement around an axis. The axis may change considerably when the joint no longer glides or when the joint subluxates or collapses.  In severe derangement of the joint surface as in intra-articular fracture or in dislocated or collapsed joint, the axis of the joint surface is lost altogether. An example is excisional arthroplasty where the joint no longer moves about the axes of rotation. The type and the range of motion are entirely different from those of a normal joint. This pattern of motion is a poor compensation and is only useful in limited situations where the adjacent joints can compensate. An example is the excisional arthroplasty for osteoarthritis (OA) of the base of thumb, where the aim of surgery is to relieve pain and retains stability at the basal joint, motion being provided by the distal MCP joint and IP joints. However, introducing a fibrous joint on a basal finger or a thumb joint, one changes the way the joint moves, the joint mechanics and the moment arm of all the muscles at that joint. This invariably leads to an imbalance in the distal joints as seen with thumb MCP joint hyperextension with silastic or excisional arthroplasty of the CMC joint. There is nothing wrong with the MCP joint itself, but the altered mechanics of the basal joints leads to a change in forces of the muscles on the distal joints, deformity, pain and eventually OA (Brand). (Santosh Rath 2011)

Robert J. Beichner on 1996 explained the impact of video motion analysis on kinematics graph interpretation skills. Video motion analysis software was used by introductory physics students in a variety of instructional settings. 368 high school and college students took part in a study where the effect of graduated variations in the use of a video analysis tool was examined. Post‐instruction assessment of student ability to interpret kinematics graphs indicates that groups using the tool generally performed better than students taught via traditional instruction. The data further establishes that the greater the integration of video analysis into the kinematics curriculum, the larger the educational impact. An additional comparison showed that graph interpretation skills were significantly better when a few traditional labs were simply replaced with video analysis experiments. Hands‐on involvement appeared to play a critical role. Limiting student experience with the video analysis technique to a single teacher‐led demonstration resulted in no improvement in performance relative to traditional instruction. Offering more extensive demonstrations and carrying them out over an extended period of time proved somewhat effective. The greatest impact came from a combination of demonstrations with hands‐on labs. (Robert J. Beichner 1996)

In a nut shell, the therapist will able to improve their practice techniques when working with the patient. A progressive modification of movement kinematics reflects the learning process. The therapist will be able to document movement speed changes and other aspects of movement so they can better observe and document changes as treatment progresses. It is basically apply to prevent injury and improve rehabilitation in terms of technique analysis and exercise given to the client.

 

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KINETICS IN OCCUPATIONAL THERAPY 2

REFERENCES

Smith, S.E. 2013. wiseGEEK. What is kinetics? http://www.wisegeek.com/what-is-kinetics.htm [15 May 2013]

American Occupational Therapy Association. 2008. Occupational therapy practice               framework: Domain and process. American Journal of Occupational Therapy. 62(2): 625-683

Arthur, E.C. 2008. Biomechanical analysis of fundamental human movements.Library of    Congress Cataloging-in-Publication Data.

Graham, J.V., Euztace, C., Brock, K., Swain, E., Irwin-Carruthers, S. 2009. The Bobath        concept in contemporary clinical practice. Top Stroke Rehabilitation. 16 (1): 57-68

Heidi McHugh Pendleton, Winifred Schultz-Krohn. 2007. Pedretti’s Occupational Therapy   Practice Skill for Physical Dysfunction. Sixth Edition. Occupational Performance and   the Performance Areas: Evaluation and Intervention Part III. India: Elsevier, a division of Reed Elsevier India Private Limited.

Encyclopaedia Britannica. 2013. Dynamometer. http://global.britannica.com/EBchecked/topic/175219/dynamometer [29 May 2013]

KINETICS IN OCCUPATIONAL THERAPY 1

Kinetics is a branch of classical mechanics that is focused on the movements of various bodies and the forces that can act on both bodies in motion and bodies at rest. Some people confuse the term with “kinematics,” because the two words sound similar, and they both have to do with the science of motion. In fact, “kinetics” itself is an out-dated term. Scientists prefer to say “analytical dynamics” or simply “dynamics.” The science of motion in the form of kinematics relies on some very clearly-defined laws, such as the concept that an object in motion tends to remain in motion. Kinetics expands upon these laws, adding some additional principles that help to explain what happens when external forces act on an object. This branch of classical mechanics recognizes the fact that many things can influence the outcome of a series of events, ranging from whether an object is dropped or hurled, to the obstacles the object encounters on its way to a destination. Many people are unconsciously aware of the laws of kinetics, because they use them on a daily basis, whether they are tossing a dirty fork into the sink from across the kitchen or designing bridges. Kinetics application is relevance in Occupational Therapy in various ways. It is basically apply to prevent injury and improve rehabilitation in terms of technique analysis and exercise given to the client. (Smith 2013)

One specific performance areas in occupation that I chose are leisure. Leisure is a non-obligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep. (American Journal of Occupational Therapy, 2008). Example of leisure activities is playing basketball which involves jumping movement of human body. Jumping is acceleration of body parts upward to increase the mutual force between us and the earth above the force of body weight. Sir Isaac Newton penned three laws of motion that capture the essence of movement of bodies, human as well as inanimate. These laws have stood the test of time in our state of being close to the earth and travelling at modest speeds. One in particular, the third law, states that "action and reaction are equal and opposite." If you accelerate your arms upward, the muscular force required to do this has an equal and opposite reaction pushing the remainder of your body against the ground at your feet. The reaction to this force is that of the earth pushing up on you. When being try on your bathroom scales, you will see your weight apparently increase and decrease. The reason is that the bathroom scale is a force transducer that measures the ground reaction force. The subsequent apparent decrease in force is due to upward deceleration of the arms, which requires a downward force on the arms and an equal upward force on the remainder of the body. If our initial upward arm motion is sufficiently vigorous, the ground reaction force will go very high and subsequently drop to zero as we jump upward off our bathroom scale. This is jumping. We experience jumping as going upward because the earth is our reference for all things stable.

Kinetics knowledge can be applied in clinical practice for gait analysis of the patient. The integration of posture and movement utilizes anticipatory and reactive postural control mechanisms. The postural orientation of the individual relative to the base of support and gravity determines the movement strategies that will be accessible and effective. The alignment of body segments both at the initiation of movement and throughout the evolvement of movements plays a critical role in the postural control strategies utilized. The alignment of body segments in relation to each other and the base of support and the expression of postural control in relation to gravity and the environment are the key areas of focus in stroke rehabilitation and the treatment of other neurological conditions. (Graham et al. 2009)

One clinical case study for physical dysfunction is Pyia, who is a 75-year old woman who has treated for breast cancer 8 years earlier. She developed metastases, with an onset of acute, bilateral lower extremity weakness and loss of sensation. For 2 days she felt “unsteady” when she was walking and had one fall. By the time she was admitted to the hospital, she was unable to walk. After few weeks later, Pyia was asked to identify what areas of occupational performance were still problematic for her, what she could do well, and what her goals were. She replied that she was happy to be walking better but felt endurance was still a problem. She used the walker independently in the home but still needed assistance to get up and down stairs. (Heidi McHugh Pendleton and Winifred Schultz-Krohn. 2007) The kinetics application here can be explained by the third of Newton’s laws of motion which states that every applied force is accompanied by a reaction force. For every action, there is an equal and opposite reaction. During gait, every contact of foot with the floor or ground generates an upward reaction force. In the case of Pyia, she used walkers instead of her own foot due to the physical dysfunction. The upward reaction force is generated to the Pyia’s walkers while she walks instead of her foot.  The weight of Pyia is distributed over the walker so that she can also have good postural control while walking and maintain a stable gait with respect to the force from the ground.

One of biomechanics instrumentation for kinetics application is the use of dynamometer.  The client should be seated with the shoulder adducted and neutrally rotated, the elbow flexed at 90 degrees, forearm in neutral position, and wrist between 0 and 30 degrees extension between 0 and 15 degrees of ulnar deviation. It is important for the client to have an appropriate position while the therapist is taking the joint measurement of the patient. The force against gravity to the weight of the client can affect the reading of the grip strength of the dynamometer. Dynamometer is a device for measuring mechanical force, or power, transmitted by a rotating shaft. Since power is the product of torque (turning force) and angular speed, all power-measuring dynamometers are essentially torque-measuring devices; the shaft speed is measured separately. Among force-measuring devices are a flexible metallic ring that bends when a force is applied in such a manner as to tend to collapse it—the amount of bending being a measure of the applied force—and a hydraulic “load cell” that measures compressive loads in terms of fluid pressure. (Encyclopaedia Britannica 2013) A dynamometer has been designed for measuring isometric forces in human body limb segments.

Isokinetic contraction is the muscular contraction that accompanies constant velocity limb movements around a joint. The velocity of movement is maintained constant by a special dynamometer. The resistance of the dynamometer is equal to the muscular forces applied throughout the range of movement. This method allows the measurement of the muscular forces in dynamic conditions and provides optimal loading of the muscles . However, during movements in the vertical plane, the torque registered by the dynamometer is the resultant torque produced by the muscular and gravitational forces. The error depends on the angular position and the torque potential of the tested muscle group. Several methods have been developed for the correction of gravitational errors in isokinetic data. The torque output also contains artefacts that are associated with the inertial forces during acceleration and deceleration periods before the development of the constant pre-set angular velocity. For an accurate assessment of muscle function, only constant velocity data should be analysed.

The most frequently used isokinetic parameters are the maximum torque and the angular position where it was recorded, the torque output at different angular velocities of movement, the torque ratio of reciprocal muscle groups and the torque output during repeated contractions. The unique features of isokinetic dynamometry are optimal loading of the muscles in dynamic conditions and constant preselected velocity of movement. These features provide safety in the rehabilitation ofpatients with muscular and ligamentous injuries. Isokinetic dynamometry has also been used for the training of various muscle groups in order to improve the muscular performance in dynamic conditions. The movement velocity of different activities can be simulated during training in order to improve the training effect. Data acquisition and analysis have been improved by using computer systems interfaced to isokinetic dynamometers. Recently developed computer systems provide correction for gravitational and inertial errors, accurate computation of isokinetic parameters and real-time display of the torque output .

In a nut shell, knowledge of kinetics is important in Occupational Therapy practice. It is basically apply to prevent injury and improve rehabilitation in terms of technique analysis and exercise given to the client. Therapist observes the client’s movement and relates it to the ground or gravitational force with respect to the mass or weight of the client. Any postural impairments or physical dysfunction can affect the result of the client’s areas of occupation and performance areas respectively. The conditions face by the client should also being include in other to identify the best technique will be given to the client.

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AVAILABILITY, RELIABILITY, VALIDITY OF AMPS 2

REFERENCES

Ay-Woan Pan & Fisher, A.G. 1994. The Assessment of Motor and Process Skills of Persons With Psychiatric Disorders. American Journal of Occupational Therapy. 48(9): 775-780

Bernspång, B. & Fisher, A.G. 1995. Validation of the Assessment of Motor and Process       Skills for Use in Sweden. Scandinavian Journal of Occupational Therapy. 2(1): 3-9

Doble, S.E., Fisk, J.D., Fisher, A.G., Ritvo, P.G. & Murray, T.J. 1994. Functional      competence of Community-Dwelling Persons with Multiple Sclerosis Using the Assessment of Motor and    Process Skills. Archives of Physical Medicine and Rehabilitation. 75(8):843-851

Doble, S.E., Fisk, J.D., Lewis, N., Rockwood & Kenneth. 1999. Test-Retest Reliability of the Assessment of Motor and Process Skills in Elderly Adults. Occupational Therapy                 Journal of Research. 19(3): 203-215

Fisher, A. G. 1993. The assessment of IADL motor skills: An application of many-faceted   Rasch analysis. American Journal of Occupational Therapy. 47: 319–329

Fisher, A.G. & Jones, K.B. 2010. Assessment of Motor and Process Skills. Development,     Standardization, and Administration Manual. 7th Ed. Fort Collins, CO: Three Star Press

Hebert, R. & Brayne, C. 1995. Epidemiology of Vascular Dementia. Neuroepidemiology. 14(5): 240-57

Kirkley, K. N. & Fisher, A. G. 1999. Alternate Forms Reliability of the Assessment of Motor and Process Skills. Journal of Outcome Measurement. 3(1): 53-70

Lockhart, B.P & Lestage, P.J. 2003. Cognition Enhancing or Neuroprotective Compounds for the Treatment of Cognitive Disorders. Why? When? Which? Exp Gerontol. 38:119-128

McAdam, K., Thomas, W. & Chard, G. 2001. The Assessment of Motor and Process Skills: an Evaluation of the Impact of Training on Service Delivery. The British Journal of            Occupational Therapy. 64(7): 357-363(7)

McNulty, M.C. & Fisher, A.G. 2001. Validity of Using the Assessment of Motor and Process Skills to Estimate Overall Home Safety in Persons with Psychiatric Conditions. The American Journal of Occupational Therapy. : Official Publication of the American Occupational Therapy Association. 55(6):649-655

Multiple Sclerosis Society of Canada. 2008. Key Facts for Those Affected by Multiple Sclerosis. Transl. Andree Maisonneuve. Canada: Arcade Press Ltd.

Oakley, F. & Sunderland, T. 1997. International Psychogeriatric. Journal of Assessment of Motor and Process Skills as a Measure of IADL Functioning in PharmacologicStudies of People With    Alzheimer's Disease: A Pilot Study. 2(9): 197-206

AVAILABILITY, RELIABILITY, VALIDITY OF AMPS 1

The type and extend of use of occupational-based assessment in Occupational Therapy practice. Availability, Reliability, and Validity.

            The type of occupational-based assessment in Occupational Therapy practice that I choose is Assessment of Motor and Process Skills (AMPS). Fisher and Jones (2010) explain that the AMPS is an innovative observational evaluation designed to be used by occupational therapists to evaluate the quality of a person’s performance of activities of daily living (ADL) in natural, task-relevant environments. However, studies also proved that the mechanism of AMPS can also be applied in Instrumental Activities of Daily Living (IADL). AMPS are another type of assessment besides Modified Barthel Index and Canadian Occupational Performance Measure which can be used to evaluate change in occupational performance problems over time.

Fisher and Jones (2010) shows that the unique design of the AMPS allows the occupational therapist to compare the quality of performance of a person who performed different AMPS tasks each time he or she was evaluated. In a like manner, the AMPS can be used to compare performance among groups of persons who each performed a different set of AMPS tasks. The AMPS provides occupational therapists with a powerful and sensitive tool that can assist in planning effective interventions and documenting the effectiveness of occupational therapy interventions. The AMPS provides a vocabulary that the occupational therapist can use to describe the quality of a person’s occupational performance — what and how a person does what he or she needs and wants to do, given the demands of the ADL task and the resources and demands of the physical and social environment. Thus, the patient’s limitations can also be analysing by using this type of assessment as well as to prepare the occupational therapist in planning the next interventions to be given suitable for the patient.

McAdam et al. (2001) conduct a study involving thirty-six occupational therapists that completed a training course on the Assessment of Motor and Process Skills (AMPS), held in the West Midlands, took part in a follow-up evaluation. This examined the effectiveness of the AMPS training on the occupational therapy service delivery. Twenty-eight structured interviews were carried out with occupational therapists from the West Midlands region and eight postal questionnaires returned from occupational therapists outside the region. The outcome indicated that observation skills had improved and that the AMPS was an appropriate tool to use for the purposes of assessment, guiding intervention and measuring outcomes of occupational therapy. There were variations in the ease with which the AMPS was administered with different client groups, but 89% of the occupational therapists were still using the AMPS at 9 months following training across a range of services. The main difficulties encountered were a lack of access to a computer and the additional support needed for the AMPS to be fully integrated into clinical practice. The adaptability of the AMPS as a standardised assessment and outcome measure makes it a good choice of tool to use across an occupational therapy service.

The reliability of this assessment is proved by Oakley and Sunderland (1997) which help to explain the usefulness of the Assessment of Motor and Process Skills (AMPS) as an outcome measure of instrumental activities of daily living (IADL) in pharmacologic studies of people with Alzheimer's disease. The AMPS simultaneously measures motor and process skills and their effect on the ability of the person to perform familiar IADL tasks. They administered the AMPS to 11 Alzheimer inpatients in a 31/2-month, double-blind, placebo-controlled, crossover study of fluoxetine and selegiline administered as single agents and in combination with physostigmine. Results indicated that there was a significant difference in IADL ability among study conditions for process skills, but not for motor skills, thereby suggesting that the AMPS is useful as a sensitive outcome measure of IADL ability in drug trials with this population.

Lockhart and Lestage (2003) state that dementia is generally defined as “a state of serious emotional and intellectual deterioration” and affects memory, language, visuospatial skills, cognition and personality. Its prevalence increases markedly after 75 years of age; making it a disease of older persons. Hebert and Brayne (1995) proved that Alzheimer disease (AD), a progressive neurodegenerative disease, is one of the most prominent forms of dementia and accounts for 70% of all cases. The prevalence of AD has been estimated  to double every 5 years after the age of 65 and rises to 47% in people over 85 years of  age.

Besides that, Kirkley and Fisher (1999) proved that the alternate-forms reliability of the Assessment of Motor and Process Skills (AMPS) where alternate forms means different pairs of AMPS tasks, was studied with 91 people who have who had performed four AMPS tasks. Results support use of the AMPS activities of daily-living motor and process scales.  In addition to that, Doble et al. (1999) proved the findings of a study of 55 elderly adults support the test-retest reliability of the Assessment of Motor and Process Skills, it illustrate the utility of alternative methods for examining the reliability of individual subjects' measures, and indicate that not all test-retest differences represent measurement error.

Moreover, another Doble et al. (1994) journal also proved the use of AMPS. The journal explain the Assessment of Motor and Process Skills (AMPS) is an observational measure of functional competence in instrumental activities of daily living (IADL) that was designed to overcome the limitations of self-reports and proxy reports. The AMPS allows simultaneous evaluation of the underlying motor and process (organizational/adaptive) skills necessary for competent task performance. They examined the IADL performance of 22 community-dwelling patients with mild to moderate Multiple Sclerosis (MS) in comparison to nondisabled subjects matched for age and gender. Functional competence of the MS subjects, as measured by the AMPS, was poorer than that of the control group. Many MS subjects who would not have been expected to have IADL difficulties on the basis of ratings of neurologic impairment were impaired in their IADL performance. For some patients, IADL impairment reflected deficits in their motor and process skills, whereas for others, process skill impairments alone were responsible for deficient task performance.

Multiple Sclerosis Society of Canada (2008) explains that Multiple Sclerosis (MS) is a disease that may affect the brain, spinal cord and optic nerves (central nervous system). MS is thought to be an autoimmune illness, which means that the immune system incorrectly identifies the body’s own tissue as a target of attack. In the case of MS, the immune system attack affects myelin, the fatty coating that protects the nerve fibres of the central nervous system. Damaged myelin may form scar tissue (sclerosis). Often the nerve fibre itself may be affected. When any part of the myelin coating or nerve fibre is damaged, messages moving through the central nervous system can be disrupted. Damaged areas are often called “lesions” or “plaques”.

McNulty and Fisher (2001) explain the validity of this assessment by evaluating the ability in activities of daily living (ADL) of 20 participants with the AMPS before discharge from an inpatient psychiatric unit. Within approximately two weeks of their discharge, the participants' home safety was evaluated within their home settings using the Safety Assessment of Function and the Environment for Rehabilitation. To form a basis for comparison, a second administration of the AMPS was administered concurrently with the home safety evaluation. Moderate positive relationships were found between ADL motor and ADL process ability and home safety in both the clinic and the home; however, analyses of the sensitivity, specificity, and overall predictive values revealed that home ADL process ability was the best predictor of home safety for participants who were categorized as less safe in the study. Findings suggest that clinic ADL evaluations using the AMPS give a reasonable estimate of home safety for participants categorized as having more home safety risk. For participants categorized as having less home safety risk, clinic ADL evaluation using the AMPS produced significantly less accurate estimates than ADL evaluations conducted in the home. These results indicate that home safety estimates may be most accurate if they are based on home rather than clinic ADL process ability measures.

Bernspång and Fisher (1995) conduct a study on the validation of the AMPS for use in Sweden. AMPS is an observational assessment of the extent to which motor and process skill deficits impact on domestic or instrumental daily living task performance (IADL). The validity of the AMPS scales was evaluated in terms of (a) unidimensionality of the items and tasks that comprise each scale, (b) person response validity, and (c) the ability of the scales to differentiate among clients of varying levels of functional ability. The results of a multi-faceted Rasch analysis revealed overall scale and individual response validity of both AMPS scales. The AMPS motor and process scales also differentiated significantly between clients who were judged to be independent, to require minimal assistance, or moderate to maximum assistance in order to live in the community. The results of this study support the validity of using the AMPS evaluation technique in Sweden.

Ay-Woan Pan and Fisher (1994) also proved the validity of the Assessment of Motor and Process Skills (AMPS) by evaluating a heterogeneous sample of subjects with psychiatric disorders. Sixty subjects, ranging in age from 16 to 72 years, participated in this study; 30 were persons without disorders living in the community; 30 had diagnosed psychiatric disorders. Two univariate F tests were used to test the hypothesis that mean AMPS measures would differ significantly between the group with and the group without psychiatric disorders. The hypothesis was supported for both AMPS motor and process scale measures. As would be expected among a sample that includes many higher functioning persons, many subjects with psychiatric disorders did just as well as subjects in the group without psychiatric disorders. Motor as well as process skill abilities of persons with psychiatric disorders were evaluated. Because the AMPS provides more specific features than other global functional instruments, it can help clinicians plan treatment and intervention more effectively. Further examination of the motor and process skill deficits within and among diagnostic subgroups and of the effect of medication and prolonged hospitalization on AMPS motor and process abilities is indicated.

In conclusion, AMPS is a suitable occupational-based assessment in Occupational Therapy practice because it has evidence of availability, reliability and validity. The assessment of occupational performance can take place at different stages of the occupational therapy process (such as initial referral or during the intervention process) and in different settings (such as in the client’s home, school, hospital, community locations). Assessment is necessary to establish a baseline of a client’s occupational performance skills which may include activities of daily living such as play and leisure, self-care and etc. on which service planning and therapy intervention can be based. Assessment is vital to inform our decisions regarding specific clients and programs.

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