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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ACTIVITY ANALYSIS 3

REFERENCES

Allen, C.K. 1987. Activity: Occupational Therapy’s Treatment Method. American Journal of        Occupational Therapy. 9(41): 563-575

American Occupational Therapy Association. 2007. Specialized Knowledge and Skills in              Feeding, Eating, and Swallowing for Occupational Therapy Practice. American         Journal of Occupational Therapy. 61: 686-700

Earley, D., Herlache, E., & Skelton, D.R. 2010. Use of Occupations and Activities in a                 Modified Constraint-Induced Movement Therapy Program: A Musician’s Triumphs   Over Chronic Hemiparesis From Stroke. American Journal of Occupational Therapy.  5(64): 735-744

Fidler, G.S. & Velde, B.P. 1999. Activities: Reality and Symbol. Deciphering the Messsage:        The Activity Analysis. SLACK Incorporated

Fisher, A.G. 1998. Uniting Practice and Theory in an Occupational Framework. American            Journal of Occupational Therapy. 7(52): 509-521

Neistadt, M.E., McAuley, D., Zecha, D., & Shannon, R. 1993. An Analysis of a Board Game      as a Treatment Activity. American Journal of Occupational Therapy. 2(47): 154-160

Sietsema, J.M., Nelson, D.L., Mulder, R.M., Mervau-Scheidel, D., & White, B.E. 1993. The         Use of a Game to Promote Arm Reach in Persons With Traumatic Brain Injury.           American Journal of Occupational Therapy. 1(47): 19-24

Steinback, T.M. 1986. Purposeful Activity and Performance. American Journal of                         Occupational Therapy. 8(40): 529-534

Trombly, C.A. 1995. Occupation: Purposefulness and Meaningfulness as Therapeutic                    Mechanisms. American Journal of Occupational Therapy. 10(49): 960-972

ACTIVITY ANALYSIS 2

Explain one of the activity analysis that can be taken.

            One of the activities that can be used to apply the terminologies of activity analysis is make a cup of hot coffee. Components of the task include; a cup is on the table with the coffee solute, put hot water into the cup, take the spoon and gently stir the ingredients in that cup with an anticlockwise repeated rotation, put a few of warm water into the cup and then stir again gently with an anticlockwise repeated rotation, sit down on the chair and drink. Steps of activity being analysed is stirring the coffee. Equipment and supplies necessary for this activity is a cup, a spoon, a coffee sachet, hot and warm water, table and chair.

            A sink and other kitchen materials should be available in the work area. There should be ample room around the work table so that the performer is not crowded and can move freely between the table and the drawer up over the head of the performer on the wall of the kitchen. Lighting should be adequate for clear visualization of equipment involve and work area. Position of the performer in relation to the work surface and equipment: The performer is standing beside the table, at a comfortable distance for reaching and manipulating the tools involved. The cup is centred in front of the performer, and the spoon and hot/warm water bowl are right and near the cup. Starting position of the performer: Standing erect; shoulders are slightly abducted, bringing both hands to the center work place; elbows are flexed respectively. Movement of pattern used to perform the steps under analysis: Thumb radial abduction, flexion of the metacarpophalangeal (MP) and interphalangeal (IP) joints of index and middle fingers; flexion and extension of thumb while stirring. A fine motor or manual skill is use when the performer hold the spoon while stirring the coffee. After a moment, the spoon is release and the action of stirring is stop for a while.

            Tactile input or need for discrimination of temperature or texture is use when the performer needs to put hot/warm water into the cup, taking the spoon, a cup, and a sachet of coffee. She need to determine the temperature of the water either it is hot or vice versa. For proprioceptive joint motion and position sense, the performer received sensory modality by being aware of joint position and motion during stirring. Vestibular (balance, sense of body, head motion) can be received by maintaining standing posture while performing activity. Visual sensory modality is received when the performer seeing the equipment such as a cup, a spoon and also the environment she involve in. Olfactory smell of sensory modality received by smelling a slight odor of coffee. Pain sensory modality is received while the performer reaching out the hot water to be put into the cup.

            The directions of making a cup of coffee is complex because the performer need to identify a lot of different types of things such as a cup, water, a spoon, a sachet of coffee where all of these have variety in shape, colour, texture and temperature respectively. The performer need to memorize the stirring activity as it is use frequently in this activity. Concentration and attention required is moderate. The performer focuses on the cup and knows when the spoon slightly hit the wall of the cup. The repeated sequence of stirring is in an anticlockwise direction.

The activity analysis involve in making a cup of coffee in this activity focuses on the activity of stirring and determining the temperature of the water. This activity is vital for the performer to distinguish between different types of temperature, texture and smell. The action of stirring is one of the steps to be taken before the performer to have a drink.  Thus, the act of stirring can help the performer to engage in an activity of daily living (ADL) like eating. According to American Occupational Therapy Association (2007), eating is the ability to keep and manipulate food or fluid in the mouth and swallow it; eating and swallowing are often used interchangeably. The understanding of the activity analysis of this activity can be expand by identifying the properties inherent in a given occupation, task or activity, as well as the skills, abilities and capacities required to complete it.

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ACTIVITY ANALYSIS 1

The importance of activity analysis in Occupational Therapy Practice. Explain one of the activity analysis that can be taken.

Activity analysis is a process used to identify the properties inherent in a given occupation, task, or activity, as well as the skills, abilities, and capacities required to complete it. Fidler and Velde (1999) proved that in their book title as Activities: Reality and Symbol, there are a number of different perspectives that influence how activities are studied and assessed. In therapeutic recreation, activity analysis is taught and used as a prequisite for program planning. Activity analysis is viewed as a procedure for examining the inherent characteristics of activities to select those most appropriate to perform objectives. Analysis includes asessment of the cognitive, physical, interpersonal, social, affective and administrative factors. The outlines and ratings scales for such analyses are impressively thorough and are a valuable resource for the study of activity analysis.

Besides that, Claudia Kay Allen (1987) explain that a philosphical framework to explain the value of using activity as a treatment method is the challenge pursued for this lectureship. Primary resources came from Soviet psychology, the only social science discipline using the concept of activity as a focus of study. The focus of study selected for occupational therapy is disability, which is explained within the context of doing an activity. The patient’s purpose for doing an activity is described by the degree of sensorimotor thought processed during a functional state. A hierarchy of activity analysis is used to begin the development of typologies for feasible operations, satisfactory results, and desirable activities. The philosophical framework is applied to three types of patient populations that pose problems in stating treatment objectives, patients that have (a) a good prognosis but one that is associated with alternative explanations for change, (b) a poor prognosis associated with a lifelong disability, and (c) a grave prognosis associated with a progressive loss of functional abilities. A refined treatment hypothesis is suggested: Therapeutic activity compensates for disability by using remaining capabilities to accomplish desirable activities with satisfactory results. Hence, the desirable activities according to the patients need and preferable can be accomplished through well-planned of constructed activity analysis.

Activity analysis can help the therapist to look at a specific individual's functional deficits and choose an activity that has meaning or purposeful to the client and that will facilitate occupational performance. Trombly (1995) stated that the model of occupational functioning leads her to conceptualize occupation both as treatment end goal and as means to remediate impairments. In both dimensions, meaningfulness and purposefulness are key therapeutic qualities. Purposefulness is hypothesized to organize behavior and meaningfulness to motivate performance.

Furthermore, Steinback (1986) proved that individuals will be motivated to perform longer when the activity is purposeful. Fifteen male and fifteen female subjects performed activities designated as purposeful and non-purposeful that required the same muscle function. Subjects continued each activity to a predefined level of perceived exertion. The number of repetitions performed, the heart rate, and electromyogram (EMG) recordings were compared for the purposeful and non-purposeful activities. Results showed a significantly greater number of repetitions performed on the purposeful activities (p = .001) recorded at equal levels of exertion. The hypothesis that individuals will be motivated to perform longer when the activity is purposeful was supported empirically, thereby substantiating a basic premise of occupational therapy. Thus, activity analysis is used to select an activity to remediate deficient capacities and abilities or, knowing the person’s skills, abilities, and capacities, to ensure successful completion of the activity or to motivate engagement in activity.

When activity analysis is completed and the desired of a specific activity that the client wants and needs to do are understood, the client’s specific skills and abilities are then compared with the selected desired activity. Crepeau (2003) explained that occupation-based activity analysis places the person (client) in the foreground. It takes into account the particular person’s (client) interests, goals, abilities, and contexts, as well as the demands of the activity itself. These considerations shape the practitioner’s efforts to help the… person (client) reach his/her goals through carefully designated evaluation and intervention.

Nelson (1988) believe that purpose can be derived from the meaning one makes of a situation but according to Fisher (1994),  meaning can be derived from one’s purpose for engaging in the activity. Meaning and purpose, when considered in relation to occupation, are inextricably interrelated. Fisher (1998) proved that purposefulness is important, but it is not enough. Occupation is both purposeful and meaningful. If we can identify activities that have potential to be meaningful to the person, we can use them to increase motivation and a sense of purpose. In this process, we cannot confuse our purposes or meanings with those of our clients. Four global groups of activities that occupational therapy practitioners use in practice are described—exercise, contrived occupation, therapeutic occupation, and adaptive occupation. Therapeutic occupation and adaptive occupation are proposed as the legitimate activities of occupational therapy.

Activity analysis is used as part of the therapeutic intervention. The activity analysis suitable for the patient is designed to reach the goals of the patients in improving their impairments respectively. Sietsema et al. (1993) study the principle of occupational therapy and motor learning theory in the context of neurodevelopmental treatment techniques. Ten trials of occupationally embedded intervention (playing Simon,™ a computer-controlled game) were compared with 10 trials of rote arm-reach exercise. A counterbalanced design was structured so that each subject experienced each condition one week apart. Subjects were 17 men and 3 women with traumatic brain injury who exhibited mild to moderate spasticity in the upper extremity. Maximum distance from hip to wrist during active reach of the affected extremity was measured by digitization of videotape with the Motion Analysis™ EV-3D system. Results indicated that the use of the game elicited significantly more range of motion than the rote exercise (t (19) = 5.77, p < .001). These results support the use of an occupationally embedded intervention for persons with traumatic brain injury and add to the theoretical base of occupational therapy.

In addition to that, Neistadt et al. (1993) explained that  occupational therapists often use tabletop board games in treatment to help adult clients with physical disabilities improve the perceptual, cognitive, sensory, and fine motor skill components of occupational behavior. Detailed activity analyses of these types of activities, including performance norms, are not available in the occupational therapy literature. Such analyses would help therapists consider the multiple skill demands of tabletop games and allow more systematic grading of these treatment activities. This paper presents a model for analyzing therapeutic activities in relation to relevant motor learning and cognitive–perceptual literature. Included in this analysis are a description of the activity, examination of its component skills and of the qualitative features of activity performance, suggestions for grading and for treatment goals, and some preliminary performance standards derived from a pilot study of 18 adults without physical disabilities.

Moreover, Earley et al. (2010) addressed the use of therapeutic occupations and activities within a modified constraint-induced movement therapy (mCIMT) approach for a 52-year-old female violinist four year after ischemic stroke. Analysis of occupational performance was completed before and after intervention using a modified version of the Fugl-Meyer Sensorimotor Evaluation, the Motor Functioning Assessment, the Arm Improvement and Movement Checklist, and information obtained from a client journal maintained throughout treatment. The mCIMT protocol included use of constraint of the affected arm, with emphasis placed on participation in meaningful occupations and activities. Improved function in the affected extremity was noted at the conclusion of mCIMT. After completion of therapy, the client reported a return to playing violin. The findings from this case report suggest that use of meaningful occupations and activities integrated into a mCIMT protocol may be effective in addressing skills deficits for clients with upper-extremity chronic hemiparesis.

In conclusion, activity analysis is used to understand the demands that a specific desired activity takes places on a client. It is used as a part of therapeutic intervention, help the client reach his/her goals through carefully evaluation and intervention, help the therapist to select an activity to remediate deficient capacities to ensure successful completion of the activity or to motivate engagement in activity.

 

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