The Assessment of Motor and Process Skills of persons with psychiatric disorders

Clinical and personal predictors of functioning in affective disorders: Exploratory results from baseline and 6-month follow-up of a randomised controlled trial

Comprehensive knowledge of factors causing and sustaining functional impairment in patients with affective disorders is warranted. The aim is to investigate associations between clinical factors (such as affective symptoms) and personal factors (such as personality traits, coping strategies, and childhood trauma experiences) on functioning and improvement of functioning in patients with affective disorders. This exploratory study includes data from 103 patients with bipolar disorder and unipolar depressive disorder. Clinician-rated functioning was assessed at baseline using the Functioning Assessment Short Test (FAST), and performance-based functioning was assessed at baseline and 6-month follow-up using the Assessment of Motor and Process Skills (AMPS). Data on clinical and personal factors were collected at baseline. Personal factors were measured by the Eysenck Personality Inventory (EPQ), Coping Inventory for Stressful Situations (CISS) and Childhood Trauma Questionnaire (CTQ). Pearson correlations and multiple linear regression models were used to analyse the association of clinical and personal factors with baseline functioning (FAST) and to identify predictors of improvement in functioning (AMPS) from baseline to follow-up. At baseline, greater depressive symptom severity, the personality trait neuroticism, emotional coping, and childhood trauma all correlated with poorer functioning (higher FAST scores). In multiple linear regression models, depression severity, emotional coping and childhood trauma were significant predictors of poorer functioning. More childhood trauma was a predictor of less functional improvement measured by AMPS at 6-month follow-up. In conclusion, maladaptive coping styles and depressive symptoms contribute to functional impairment in patients with affective disorders, while childhood trauma has a negative impact on long-term functional outcomes.

Survey on the Acceptance of Ambient Sensors in Solo and Older Couple-Only Households in Japan

For this study, an online survey was conducted to discover the preferences of older adults when they used sensors in their households, rather than the preferences of the researchers who developed them. The sample size was 400 Japanese community-dwelling people aged 65 years and older. The numbers of samples for men and women, household composition (single-person/couple-only household), and younger senior (younger than 74 years old) and older senior (older than 75 years old) were equally assigned. The survey results showed that "informational security" and "constancy of life" were considered more important than other factors when installing sensors. Furthermore, looking at the results regarding the type of sensors that face resistance, we found that both cameras and microphones were evaluated as facing slightly strong resistance, while doors/windows, temperature/humidity, CO₂/gas/smoke, and water flow were evaluated as not facing such strong resistance. The elderly who are likely to need sensors in the future also have various attributes, and the introduction of ambient sensors in elderly households may be further advanced by recommending applications that are easy to introduce based on the attributes of the target population, rather than discussing all of them in general.

Quality of ADL task performance in persons with schizophrenia: Looking beyond independence

BACKGROUND

Persons with schizophrenia may experience decreased ability to perform activities of daily living (ADL) indicated by need for assistance in everyday life. Others are independent, but their quality of ADL task performance in terms of effort and efficiency may still be impacted.

AIMS/OBJECTIVES

The overall purpose of this study was to explore the quality of ADL task performance in subgroups with schizophrenia (independent/needing assistance).

MATERIALS AND METHODS

Participants were in- and outpatients at a Psychiatric Hospital diagnosed with schizophrenia (n = 83). Their quality of ADL task performance was evaluated using the Assessment of Motor and Process Skills (AMPS). Evaluations were conducted at the hospital. Two subgroups (A: independent and B: needing assistance) were created based on AMPS ADL ability measures.

RESULTS

The majority in both subgroups had AMPS ADL ability measures within the risk zones. Further, the majority in subgroup A had ADL ability measures within age expectations but below mean for well persons of the same age. Both ineffective motor and process skills were identified in both subgroups.

CONCLUSIONS/SIGNIFICANCE

Occupational therapy is indicated for persons with schizophrenia, both for independent persons and for persons needing assistance. This is to prevent decline in or to enhance ADL ability.

Impact of visual field loss post-stroke on activities of daily living: a prospective cohort study

This study investigated the ADL performances of people with VFL after an acute stroke using an observation-based evaluation of ADL skills, the Assessment of Motor and Process Skills. The AMPS was administered on initial assessment and at ≥11 weeks follow-up on 58 adults with a mild stroke, with (n = 16) and without VFL (n = 42), over a 13-month period. The AMPS guidelines on clinically relevant difference of 0.30 logits were used to determine the differences of the groups' ADL performance on initial assessment and follow-up. The study found that the ADL motor and process scores did not differ significantly on initial assessment. The study observed no clinically relevant difference between the ADL motor and process scores of between the VFL and non-VFL on initial assessment and follow-up but demonstrated clinically relevant improvements in ADL motor and process scores of both groups from initial assessment to follow-up. VFL does not have an additional negative impact on ADL performance of those with a mild stroke and does not impede improvement of ADL performance over time.

From word list learning to successful shopping: The neuropsychological assessment continuum from cognitive tests to cognition in everyday life

Cognitive deficits are common after brain injury and can be measured in various ways. Many neuropsychological tests are designed to measure specific cognitive deficits, and self-report questionnaires capture cognitive complaints. Measuring cognition in daily life is important in rehabilitating the abilities required to undertake daily life activities and participate in society. However, assessment of cognition in daily life is often performed in a non-standardized manner. In this opinion paper we discuss the various types of assessment of cognitive functioning and their associated instruments. Drawing on existing literature and evidence from experts in the field, we propose a framework that includes seven dimensions of cognition measurement, reflecting a continuum ranging from controlled test situations through to measurement of cognition in daily life environments. We recommend multidimensional measurement of cognitive functioning in different categories of the continuum for the purpose of diagnostics, evaluation of cognitive rehabilitation treatment, and assessing capacity after brain injury.

Affective disorders: eliminate WArning signs and REstore functioning-AWARE-a randomised controlled multimodule intervention study, presentation of design and intervention

INTRODUCTION

Affective disorders are associated with impaired overall functioning and quality of life (QoL). Despite different medical and psychological treatment options, the prognosis remains largely unchanged. Consequently, the field needs new intervention strategies especially targeting patient groups with impaired functioning. This study aims to improve functioning and QoL in patients with affective disorders using a comprehensive 360° intervention.

METHODS AND ANALYSIS

Affective disorders: eliminate WArning signs And REstore (AWARE) functioning is a randomised, controlled, parallel-group design study. Participants will be 120 outpatients, men or women, aged 18-65 years, with a diagnosis of bipolar disorder or major depressive disorder. Inclusion requires an objectively rated impaired functioning defined as a score ≥11 according to the Functioning Assessment Short Test. Participants will be randomised to 6-month AWARE intervention or treatment as usual (TAU). The AWARE intervention is a 360° multimodal intervention based on the International Classification of Functioning Brief Core Set for bipolar and unipolar disorder targeting functioning.The primary outcome is improvement of observation-based activities of daily living (ADL) ability using Assessment of Motor and Process Skills. Secondary outcomes are changes from baseline to endpoint in functioning, QoL, stress, cognition and physical health.Our hypothesis is that the AWARE treatment in comparison with TAU will improve observed ability to perform ADL, patients self-perceived level of functioning and QoL.Status: currently recruiting patients.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from The Regional Ethics Committee in the Capital Region of Denmark. All patients will be provided oral and written information about the trial before informed consent is obtained. The study results will be disseminated by peer-review publications. If the present AWARE intervention shows beneficial effects, the goal is to use it as a template for future interventions addressing disability in patients with affective disorders as well as for patients within other diagnostic categories.

TRIAL REGISTRATION NUMBER

NCT04701827; Clinicaltrials.gov.

Preliminary study of time estimation of daily activities in patients with chronic schizophrenia by questionnaire survey

Introduction

Few studies have investigated time estimation of daily activities in patients with mental illness. Therefore, we conducted a preliminary study to extract the characteristics of time estimation in patients with schizophrenia.

Method

We conducted an investigation using the Questionnaire of Time Experience in Daily Activities in patients with schizophrenia and healthy controls. We compared the results between schizophrenia patients and healthy controls using t-tests.

Results

Thirty-four people participated in each group. T-tests showed significantly shorter length of time answers in the schizophrenia group for question 4, (“How long does it take you to go out after waking up in the morning?”). For question 5 (“When you have to take a bus, how long before departure time do you arrive at the bus stop?”) and question 6 (“You have an appointment with your friend. How long beforehand do you arrive at the appointed place?”), the answers of the schizophrenia group were significantly longer than the healthy controls.

Conclusion

Time estimations of some daily activities of patients with schizophrenia were significantly different from those of healthy controls. This study will support the next phase of psychometric testing of the Questionnaire of Time Experience in Daily Activities, after which the results will applicable to practice.

Identification of Tools for the Functional and Subjective Assessment of Patients in an Aquatic Environment: A Systematic Review

Aquatic therapy is one of the most common treatments for alleviating musculoskeletal pathologies. Its effectiveness has been evaluated with functional tests and questionnaires. Functional tests are used in aquatic therapy; however, in most cases, they are carried out in a non-aquatic environment and, as such, their results may differ from those of tests performed in an aquatic environment. A systematic review was performed to assess the accuracy of functional tests and patient-reported outcomes to assess aquatic therapy interventions. The authors conducted a literature search in July 2019. In total, 70,863 records were identified after duplicates removed. Of these, 14 records were included about functional tests assessment in aquatic environment and 725 records for questionnaires. The majority of the tests had also been assessed in a dry environment, allowing differences and similarities between the tests in the two environments to be observed. Different variables have been assessed in tests included in the present systematic review (cardiorespiratory, neuromuscular, kinematic, physiological, kinetic responses and rating of perceived exertion) which are included in the manuscript. Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and the 12-item Short Form Health Survey were the assessments most commonly used by the different authors.

Reliability and validity of the self-reported Activities of Daily Living Scale for people with mental illness

Background/objectives

Patient-reported outcome measures have been found to be an effective method of reflecting client perspectives on their personal health condition. The primary aim of this study was to determine the reliability and validity of the self-reported Activities of Daily Living Scale (sf-ADLS) using Rasch analysis in Taiwan.

Methods

A total of 455 people were included in this study; 224 were persons with mental illness and 231 were healthy adults. We applied Rasch analysis as the means of testing the psychometrics of the scale.

Results

The final version of the sf-ADLS used in this study included 14 items, with no differential item functioning being discernible on the gender variable. The scale was found to be of use in classifying the subjects into four levels of independence.

Conclusions

The revised sf-ADLS conforms to the Rasch measurement model in the formulation of a unidimensional scale. The scale can be used to measure the level of independence with acceptable reliability (internal consistency as 0.9) and validity.

Implementing the Assessment of Motor and Process Skills (AMPS) in the Workplace: A Comparison of the Experiences of Occupational Therapists and New Graduates

Learning to use new skills through continuing professional education courses is an important part of continuing professional development, contributing towards the evidence of competence to practise. Few studies have examined how such new learning is used in professional practice.

This study investigated the experiences of occupational therapists when learning to use the Assessment of Motor and Process Skills (AMPS) and whether years of experience or clinical area affected how the AMPS was used in practice. Twenty-three occupational therapists who undertook a 5-day AMPS course completed three questionnaires over a 10-month period. Thirteen were senior level occupational therapists and 10 were new graduates about to commence employment in their first post.

Significant differences between the two groups were found in three areas: the new graduates experienced more difficulties when starting to use the AMPS, completed fewer assessments and found workplace difficulties more time consuming. The two groups shared many difficulties when learning to use a new skill and implementing it within workplace teams, but the analysis of the ranking of these difficulties using the Mann-Whitney U test demonstrated no overall difference between the two groups. Successful implementation of the AMPS for all the participants depended on having sufficient time for new learning to take place and on support from managers so that they could change elements of practice to accommodate the use of new skills.

Cross-Cultural Validation of the Assessment of Motor and Process Skills (AMPS)

The purpose of this study was to verify the assertion that underlying motor and process skill items and tasks defined in the Assessment of Motor and Process Skills (AMPS) are cross-culturally free from bias between North America, Scandinavia and the United Kingdom. Using many-faceted Rasch analysis, the hierarchical order of AMPS motor and process skill items and culture-general tasks were compared in order to test the assertion of bias-free assessment across regions. The unidimensionality of the AMPS motor and process skills and tasks through evaluation of their goodness-of-fit to the Rasch model was also investigated.

The results revealed that the hierarchical order of all the AMPS motor and process skill items and culture-general tasks remained stable among the three regions examined, verifying cross-cultural freedom from bias of the skill items and tasks between these regions. All items in North America met the criteria for goodness-of-fit on both the motor and the process scales of the AMPS, while only 4% of the items failed to meet these expectations in Scandinavia and the United Kingdom. It was concluded that the AMPS motor and process scales and tasks are unidimensional, demonstrating internal scale validity.

The Assessment of Motor and Process Skills: An Evaluation of the Impact of Training on Service Delivery

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 effects of the AMPS training on such a service are discussed, with recommendations for managers planning the distribution of limited training budgets and the implications for service development needs.

Occupational Performance of People Diagnosed with Schizophrenia in Supported Housing and Outreach Programmes in Australia

This study compared the occupational performance in activities of daily living (ADL) of people diagnosed with schizophrenia in two settings: 25 people in residential rehabilitation facilities and 18 people receiving intensive outreach support in their homes in urban Australia. All participants were assessed with structured interviews, the Assessment of Motor and Process Skills (a performance-based measure of ADL ability) and the Life Skills Profile (an informant-report measure of disability).

Hypothesised differences in ADL performance between the two settings were not supported. Mean ADL process ability, based on the AMPS process skills subscale, indicated that the majority (58%) of the 43 participants needed some assistance in community living, irrespective of where they lived and the types of support received. Many participants (42%) performed ADL tasks with relative ease, efficiency, safety and independence as measured by AMPS, indicating that they could live in housing arrangements with outreach support. However, the ADL process ability measures for two-thirds of these participants indicated that they would struggle in community living in the absence of outreach support.

Given these findings, the eligibility criteria and screening for residential and outreach support services need re-examination and performance-based assessments of ADL ability could improve the identification of housing-related support needs. Occupational therapists have expertise in this area to develop individualised supports that enable a greater choice of living arrangements for people diagnosed with schizophrenia.

Differences in Activities of Daily Living Process Skills of Persons with and without Alzheimer's Disease

The purpose of this study was to determine if persons with dementia of the Alzheimer type (DAT) differed from nondisabled older controls in the actual, experienced difficulty of specific process skills that affect performance of activities of daily living (ADL). A two-group comparison was performed and all participants were evaluated in either clinical or home environments to which they had been familiarized. Participants (341 persons with DAT and 287 controls) were selected from the standardization sample of the Assessment of Motor and Process Skills (AMPS) computer-scoring software. The demographic characteristics of the two groups were comparable. The AMPS was used to evaluate the effort, efficiency, safety, and independence of 20 ADL process skills that are compiled to enact performance of familiar ADL tasks. The raw data for each sample was subjected to many-faceted Rasch analysis to determine item difficulty calibrations of the ADL process skill items for each group. Actual item difficulty calibrations of 19 ADL process skills differed meaningfully between the two groups. The results indicated that it is possible to identify specific ADL process skills that are actually easier or more difficult for each group. In addition, the results supported earlier research that has demonstrated that the underlying cognitive and physical impairments demonstrated by persons with DAT do manifest as ADL disability, negatively impacting their ability to perform ADL tasks.

Test-Retest Reliability of the Assessment of Motor and Process Skills in Elderly Adults

We examined the test-retest reliability of the Assessment of Motor and Process Skills (AMPS) in a heterogeneous sample of 55 elderly adults. Subjects were reassessed within 1 to 10 days (M=4.0, SD=2.7 days). The subjects' Time 1 and Time 2 ability measures were highly correlated (Motor: r(55)=.88, P<.001; Process: r(55)=.86, P<.001). Measures were stable in 92% of the subjects. Significant variability occurred in only 8% (N=9) of the subjects' ability measures. Measurement error was a concern less than 2% of the time; 6% of the subjects' measures differed as a reflection of real changes in their task performances. Although some variability was attributed to fluctuations in subjects' medical conditions or motivation to adhere to the task requirements, not all of it could be attributed to a specific factor. These data provide support for the reliability of the AMPS, and serve as a reminder that not all test—retest differences represent measurement error.

Relationships between Cognitive Abilities and the Process Scale and Skills of the Assessment of Motor and Process Skills (AMPS) in Patients with Stroke

The purpose of this study was: 1) to determine the strength of the relationships between cognitive components at the body function/impairment level to the assessment of motor and process skills (AMPS) at the occupational performance/activities level in persons following stroke; and 2) to examine which cognitive components best explain the variance of the AMPS score. Stroke is a major cause of disability in older age that can result in motor and/or cognitive impairments leading to functional disability. The assessment of AMPS is an activity of daily living (ADL) and instrument activity of daily living (IADL) evaluation that measures two aspects enabling occupational performance and motor and process skills. Subjects included 30 hospitalized patients 4 to 5 weeks following stroke. Among them were 17 men and 13 women with a mean age of 71.33 (SD = 8.39) who had been independent in ADL prior to the event. Instruments included the AMPS IADL tasks, Thinking Operations from the LOTCA, Contextual Memory Test, Rey Complex Figure-copy, Star cancellation from the BIT, and COGNISTAT. The study supports the existence of moderate relationships between cognitive components and the AMPS' process scale and skills, and the results add information about relationships between cognitive impairments and occupational performance that can help in treatment planning.

Development of a new assessment scale for measuring interaction during staff-assisted transfer of residents in dementia special care units

Background

Mobility problems and cognitive deficits related to transferring or moving persons suffering from dementia are associated with dependency. Physical assistance provided by staff is an important component of residents’ maintenance of mobility in dementia care facilities. Unfortunately, hands-on assistance during transfers is also a source of confusion in persons with dementia, as well as a source of strain in the caregiver. The bidirectional effect of actions in a dementia care dyad involved in transfer is complicated to evaluate. This study aimed to develop an assessment scale for measuring actions related to transferring persons with dementia by dementia care dyads.

Methods

This study was performed in four phases and guided by the framework of the biopsychosocial model and the approach presented by Social Cognitive Theory. These frameworks provided a starting point for understanding reciprocal effects in dyadic interaction. The four phases were 1) a literature review identifying existing assessment scales; 2) analyses of video-recorded transfer of persons with dementia for further generation of items, 3) computing the item content validity index of the 93 proposed items by 15 experts; and 4) expert opinion on the response scale and feasibility testing of the new assessment scale by video observation of the transfer situations.

Results

The development process resulted in a 17-item scale with a seven-point response scale. The scale consists of two sections. One section is related to transfer-related actions (e.g., capability of communication, motor skills performance, and cognitive functioning) of the person with dementia. The other section addresses the caregivers’ facilitative actions (e.g., preparedness of transfer aids, interactional skills, and means of communication and interaction). The literature review and video recordings provided ideas for the item pool. Expert opinion decreased the number of items by relevance ratings and qualitative feedback. No further development of items was performed after feasibility testing of the scale.

Conclusions

To enable assessment of transfer-related actions in dementia care dyads, our new scale shows potential for bridging the gap in this area. Results from this study could provide health care professionals working in dementia care facilities with a useful tool for assessing transfer-related actions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-015-0003-6) contains supplementary material, which is available to authorized users.

Occupational therapy evaluation: use of self-report and/or observation?

BACKGROUND

The Occupational Therapy Intervention Process Model (OTIPM) serves to guide occupational therapists in their professional reasoning. The OTIPM prescribes evaluation of task performance based on both self-report and observation. Although this approach seems ideal, many clinicians raise the issue that time to perform evaluations is limited. It is, therefore, relevant to examine whether similar information concerning task performance can be obtained using self-report or observation.

OBJECTIVE

The aims were to investigate what information can be obtained regarding the quality of ADL task performance based on self-report and observation, respectively, and to examine the relationship between measures of self-reported and observed quality of ADL task performance.

METHODS

The quality of ADL task performance among 20 adults with depression was evaluated using the ADL Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS).

RESULTS AND CONCLUSIONS

Results indicated that participants both reported and demonstrated increased effort and/or fatigue, increased use of time, need for assistance, and safety problems. However, little relationship was found between measures of self-reported and observed quality of ADL task performance, supporting the use of both self-report and observation as part of the evaluation phase outlined in the OTIPM.

Study protocol: to investigate effects of highly specialized rehabilitation for patients with multiple sclerosis. A randomized controlled trial of a personalized, multidisciplinary intervention

BACKGROUND

Multiple sclerosis (MS) is a complex, chronic and progressive disease and rehabilitation services can provide important support to patients. Few MS rehabilitation programs have been shown to provide health improvements to patients in a cost-effective manner. The objective of this study is to assess the effects in terms of changes measured by a variety of standardized quality of life, mastery, coping, compliance and individual goal-related endpoints. This combination provides the basis for analyzing the complexity of MS and outcomes of a personalized rehabilitation.

METHODS/DESIGN

Patients with MS referred to hospital rehabilitation services will be randomized to either early admission (within two months) or usual admission (after an average waiting time of eight months). They will complete a battery of standardized health outcome instruments prior to randomization, and again six and twelve months after randomization, and a battery of goal-related outcome measures at admission and discharge, and again one, six and twelve months after randomization.

DISCUSSION

The results of the study are expected to contribute to further development of MS rehabilitation services and to discussions about the design and content of such services. The results will also provide additional information to health authorities responsible for providing and financing rehabilitation services.

TRIAL REGISTRATION

Current Controlled Trials (ISRCTN05245917).

Understanding living skills: first steps to evidence-based practice. Lessons learned from a practice-based journey in the Netherlands

Living skills training is a commonly used but sparsely described and researched - occupational therapy - intervention for people with severe mental health problems. A service improvement project was established in a mental health organization in the Netherlands starting in 2006 to design more effective living skills training courses for individuals and groups. The steps of the evidence-based practice process underpinned the project. Theoretical and empirical evidence was derived from an extensive literature review. This was supplemented by the preferences of clients and their families as an equally valued source of evidence as is the experience and knowledge of a range of mental health professionals. Information from these three sources provided building blocks for the development of living skills training, resulting in an individual process guideline and two group courses. Implications for practice is that living skills training needs to be part of multidisciplinary treatment and can be best provided in the client's natural context. Limitations of this study are the lack of an evaluation of both the group courses and of the individual process guideline, also due to the continuous implementation in an ever-changing context. There is further need for research into the clinical and cost effectiveness of living skills training, both for individuals and groups, to support evidence-based decision making and service planning.

The Effectiveness of Occupational Performance Outcome Measures within Mental Health Practice

Introduction:

The routine use of outcome measures is essential to the maintained delivery of quality care and the continued commissioning of mental health occupational therapy services. Occupational therapists are required to demonstrate that intervention is successful in an evidence-based, valid and reliable way. Therefore, this critical review aims to address the issue of choosing an appropriate occupational performance outcome measure for use within mental health services.

Method:

Evidence was critically appraised for the effectiveness of the Assessment of Communication and Interaction Skills (ACIS), Occupational Therapy Task Observation Scale (OTTOS), Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), all recommended for use by occupational therapists within mental health practice.

Findings and discussion:

The review identifies that there are a limited number of clinically based studies evidencing the validity and reliability of occupational performance outcome measures. It also identifies a paucity of literature concerning service user experience of outcome measures, bringing into question how client centred and meaningful these tools are.

Using an IADL Assessment to Identify Older Adults Who Need a Behind-the-Wheel Driving Evaluation

Occupational therapists need to routinely assess driving ability in hospital and/or rehabilitation settings. The purpose of this study is to determine if the Assessment of Motor and Process Skills (AMPS), an observational tool of instrumental activities of daily living, could discriminate between older adult drivers who pass, pass with restrictions, or fail a behind-the-wheel (BTW) evaluation. Forty-six participants were evaluated with a BTW driving assessment and the AMPS. Two one-way ANOVAs found significant differences for both the motor and process scores suggesting the AMPS can be used as a screening tool for driving. Results also showed no significant difference in age between those participants who passed, failed, or needed restrictions supporting the concept that driving abilities are related more to function, not age. Exploration of minimum scores is discussed.

Cerebellar ataxia in youths at risk for bipolar disorder

OBJECTIVE

Structural, biochemical, and functional cerebellar abnormalities occur in individuals with or at-risk for developing bipolar disorder (BD), but the clinical implications of these abnormalities are unknown. The present study examined cerebellar function in youths who were at familial risk for BD by comparing ataxia battery scores of youths with a bipolar parent to those of healthy youths.

METHODS

Trained raters administered an ataxia battery, consisting of three tasks, to children (aged 8-12 years) with at least one parent with BD type I (BDI) who themselves did not have BDI (at-risk or AR group, n = 21) and healthy comparison children (aged 8-12 years) with parents free of DSM-IV Axis I psychopathology (HC group, n = 23).

RESULTS

AR youths performed worse than HC youths on the Sharpened Romberg test (subjects standing heel-to-toe) and standing on one foot with eyes open (p < 0.02).

CONCLUSIONS

The results indicate that youths at familial risk for BD have more difficulty performing a Sharpened Romberg test than a HC group, suggesting that midline cerebellar dysfunction may be a biomarker for the future development of BD. Further studies examining the relationships among youths at risk for BD, coordination abnormalities, and cerebellar dysfunction are needed.

[Kitchen and schizophrenia: a crossroad activity of an ecological, occupational and neuropsychological assessment]

In this exploratory study, the authors examine the various occupational and neuropsychological assessments used to analyze deficits qualitatively and quantitatively in patients with schizophrenia. Considering that it is necessary to further explore their repercussion on the performance of activity of daily living (ADL) and domestic activities (DA), they thus attempt to verify if the distinction between two levels of functional autonomy could translate at the cognitive and clinical levels in (25) 23 patients included in a program destined to young adults (schizophrenia spectrum DSM-IV criteria) in Montréal. These patients had the opportunity, within the clinical program, to submit to neuropsychological evaluations as well as evaluations offered by the occupational therapy service thanks to a tool frequently used by occupational therapists entitled Assessment of Motor and Process Skills (AMPS). The objective of this article is to conjugate two possible perspectives, drawn from two different disciplines, on a very current human activity such as "preparing meals" in people suffering from schizophrenia and which functioning of daily life is disturbed.

Neurologic examination abnormalities in children with bipolar disorder or attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) are frequently comorbid and overlapping diagnoses. To move beyond diagnosis toward unique pathophysiology, we evaluated both ADHD and BPD children for neurologic examination abnormalities (NEAs) in comparison with normal control (NC) children.

METHODS

We performed the Revised Physical and Neurological Examination for Soft Signs in three groups (ADHD, BPD, NC). Then, a rater blind to diagnosis evaluated their motor performance. Results were analyzed with a multiple analysis of covariance.

RESULTS

Subjects with ADHD were impaired on repetitive task reaction time. In contrast, pediatric BPD subjects, both with and without comorbid ADHD, were impaired on sequential task reaction time.

CONCLUSIONS

This differential pattern of NEAs by diagnosis suggests pathophysiologic differences between ADHD and BPD in children. Repetitive motor performance requires inhibition of nonrelevant movements; ADHD subjects' impairment in this domain supports the hypothesis that ADHD involves a core deficit of fronto-striato-basal ganglia neurocircuitry. In contrast, BPD subjects' impaired sequential motor performance is consistent with behavioral data showing impaired attentional set-shifting and reversal learning in BPD subjects. Further study, going beyond symptom description to determine pathophysiologic differences, is required to refine neuronal models of these often comorbid diagnoses.

Gender differences in the performance of activities of daily living11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To verify that the activities of daily living (ADL) motor and process skill items and tasks in the Assessment of Motor and Process Skills (AMPS) are free from gender bias, and to compare mean differences in ADL motor and process ability between men and women.

DESIGN

Descriptive comparison; convenience sample.

SETTING

Existing data from the AMPS database.

PARTICIPANTS

Potential participants included nonwell persons (age range, 18-99y) matched within 3 age groups, first by functional level and then by diagnostic category. The resulting sample included 9250 men and 9250 women.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The AMPS, a standardized observational assessment of the quality of ADL task performance.

RESULTS

None of the AMPS task calibrations and 1 motor skill item calibration (Lifts) demonstrated an observable difference between men and women. Men had higher ADL motor ability (F(1,18494)=11.58, P<.01) and women had higher ADL process ability (F(1,18494)=76.18, P<.01).

CONCLUSION

The results suggest that the AMPS is free of gender bias. Although differences were found between men and women in mean ADL motor and process ability, they were not considered clinically detectable differences.

Validity of a performance assessment of activities of daily living for people with developmental disabilities

BACKGROUND

Since clients with different types of developmental disabilities often experience difficulties in activities of daily living (ADL), it is critical that assessments of ADL are evaluated in order to ensure that one can make valid judgements based on the results of the appraisal. The purpose of the present study was to evaluate the validity of a specific performance assessment instrument, the Assessment of Motor and Process Skills (AMPS), when used by occupational therapists with clients with developmental disabilities. Unlike global ADL assessments, the AMPS is used not only to evaluate the level of ADL dependence, but also to estimate the quality of each specific action performed when a person is performing ADL tasks.

METHODS

Data were gathered from 1724 participants with different developmental disabilities, including intellectual disability (ID), cerebral palsy and spina bifida. Many-Facet Rasch (MFR) analysis was used to examine person-response validity, and task and item scale validity.

RESULTS

Goodness-of-fit statistics showed that the tasks and items had acceptable scale validity. The participants had acceptable person-response validity on the ADL motor scale, but had slightly lower than expected levels of person-response validity on the ADL process scale. The results indicate that clients with more severe forms of ID may have a higher proportion of different performance profiles in ADL than is expected by the MFR model of the AMPS. Since the proportion of participants who did not meet the criteria was only 3% lower than expected and in accordance with other studies, the difference may not be clinically meaningful. Otherwise, the results indicated that the AMPS is a valid tool when used with clients with developmental disabilities.

CONCLUSIONS

Further research is needed to evaluate the use of the AMPS in clinical assessment and intervention planning for this group of clients.

Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor

Chronic thalamic stimulation (CTS) has a documented good effect on tremor in patients with Parkinson's disease (PD) and essential tremor (ET). This study evaluates whether the alleviation of impairment, i.e., tremor, translates into improvement of the patient's ability in performing instrumental activities of daily living (IADL). Thirteen patients were assessed with an occupational therapy tool called Assessment of Motor and Process Skills (AMPS). This observation-based scale rates the patient's motor and process skills needed to perform a given task. The evaluations were done at a mean of 13 months after surgery in the patient's home, and included assessments of IADL with the CTS activated and switched off, respectively. The results showed that most patients improved to variable degrees in their IADL ability when the thalamic stimulation was on. The improvement was more marked in patients operated on for tremor of their dominant hand. The improvement concerned mainly the skill items related to the patients' abilities of coordination, calibration, endurance, and accommodation during IADL task performance. The authors concluded that for some patients with tremor, CTS can improve independence in domestic activities of daily living.

Male and female performance on the assessment of motor and process skills

OBJECTIVE

To examine the validity of the assertion that men and women do not differ significantly on the Assessment of Motor and Process Skills (AMPS), a functional assessment tool used to evaluate the interaction between component motor and process skills and IADL (instrumental or domestic activities of daily living) performance capacity.

DESIGN

Descriptive comparison. Using many-faceted Rasch analysis, the AMPS motor and process scales were examined for differential item response between gender subgroups. Mean motor and process ability measures of age-matched groups of male and female subjects were also compared.

PARTICIPANTS

A convenience sample of more than 3,500 men and women from the standardization sample for the pilot version of the AMPS computer-scoring software. The subjects had a variety of physical disabilities or psychiatric diagnoses.

MAIN OUTCOME MEASURES

Hypotheses were as follows: (1) no differential item response would be found on the motor or process scales; (2) if differential item response was found, it would not have an impact on the final estimation of client ability; (3) men and women would not differ in mean AMPS motor or process ability.

RESULTS

Of the 36 AMPS items, only one (Lifts) differed between men and women. This differential item response did not disrupt the final estimation of client ability. Men and women did not differ in mean motor ability. Women on the whole were more able than men in mean process ability.

CONCLUSIONS

The AMPS is valid for use across gender subgroups. Men and women do not differ in AMPS motor ability, but overall, women are slightly more able than men in AMPS process ability.

Differences between persons with right or left cerebral vascular accident on the Assessment of Motor and Process Skills

OBJECTIVE

Persons with right and left cerebral vascular accident (RCVA and LCVA) differ in terms of discrete impairments, but there is limited information with regard to how such impairments translate into differences in disability. The following hypotheses were tested: (1) persons with stroke have lower instrumental or domestic activities of daily living (IADL) ability than do matched nondisabled controls, (2) persons with RCVA do not differ from persons with LCVA in IADL ability, and (3) persons with RCVA and LCVA differ in specific motor and process skills that affect IADL performance.

DESIGN

Descriptive comparison.

SETTING

Subjects were tested in settings where rehabilitation services were received (home or clinic).

SUBJECTS

71 persons with RCVA, 76 persons with LCVA, and 83 community-living nondisabled individuals drawn from the Assessment of Motor and Process Skills (AMPS) database, matched for age, gender, and number of tasks performed.

MAIN OUTCOME MEASURE

AMPS, designed to measure type and severity of impairments manifested in the context of IADL performance. The AMPS was administered to all subjects in accordance with standardized testing procedures.

RESULTS

The two stroke groups did not differ significantly in IADL ability, but both stroke groups had significantly lower IADL performance than did the nondisabled subjects. On the AMPS motor scale, persons with RCVA demonstrated greater impairment in pacing, transporting, and coordinating two body parts. Persons with LCVA demonstrated greater impairments in calibrating movements. No differences were found between the two groups in AMPS process skills.

CONCLUSIONS

Persons with RCVA and LCVA have hemisphere-specific differences in motor impairments, but do not differ significantly in IADL ability.