Assessment of Motor and Process Skills Begin with the idea that the AMPS is an occupational therapy evaluation, and it reflects the unique focus of OT (occupational performance, the doing)

Assessment of Motor and Process Skills (AMPS) En observationsbedömning Används för att mäta kvaliteten på ADL-utförandet Standardiserad på över 100 000 klienter internationellt The AMPS is an observational assessment, used to evaluate people in the context of familiar and relevant tasks. The AMPS is used to measure the quality of task performance. The AMPS is a standardized assessment that can be used with clients aged three or older, with any diagnosis or disability. It is currently in use in Europe, North and South America, Asia, Nordic Countries, Australia, New Zealand, Israel, the United Kingdom, and South Africa.

En AMPS-bedömning Börjar med en intervju för att utröna vilka uppgifter som är välkända och relevanta Det finns 85 standardiserade uppgifter i AMPS, med svårighetsgrader från lätta till svåra Inkluderar observation av minst två valda ADL-uppgifter A core concept in the AMPS is the importance of client choice, as engagement in chosen and meaningful activities is at the core of occupational therapy. Client motivation and performance is believed to be best when he or she can choose the activity. An AMPS assessment begins, therefore, with an interview of the client so that the therapist can determine which standardized AMPS tasks are familiar, relevant and of sufficient challenge to the client. For an AMPS assessment, the client at least 2 AMPS tasks to perform from a subset of tasks offered by the therapist. The therapist must also ensure that the tasks offered as choices are hard enough to offer a “just right” challenge to the person – not too easy and not too hard. AMPS tasks include a variety of ADL tasks – personal ADL (eating, dressing, grooming, etc) and domestic ADL (simple to complex cooking, home maintenance, outdoor tasks, etc)

Standardisering av uppgifter Varje uppgift inkluderar: Specifika kriterier som måste uppfyllas för att bibehålla standardiseringen Flexibla alternativ som tillåter klient-centrerade sätt att utföra The standardized challenge of the tasks is maintained by establishing essential criteria that all clients who do this particular task must complete. Within these standardized guidelines, however, each task is flexible enough to allow a the client some choice and variety in the tools and materials he or she uses in completing the task.

Uppgift A-3. Kanna kaffe eller te – en eller två personer Huvudsyfte: Göra iordning en kanna kokt eller bryggt kaffe eller te Hälla upp i koppar Servera med en behållare mjölk eller grädde vid en bänk eller ett bord It is often helpful to show an example of a task. Task A-3 is a good one, because it has a variety of tools that can be used (electric kettle, drip coffee maker, stovetop percolator, etc.) as well as a variety of options of ingredients such as coffee, tea, and sugar. The “essential task” is a description of the basic steps of the task.

Kanna kaffe eller te – en eller två personer Specifika kriterier: Måste hälla kaffet eller téet i koppar Måste servera med en behållare mjölk eller grädde Specific criteria are things that must be done in order to maintain the standardized challenge of the task.

Kanna kaffe eller te – en eller två personer Valmöjligheter: Kaffe eller te Kaffe kan kokas eller bryggas i en kaffebryggare, Bistro-bryggare, eller perkulator Within the structure of the essential task and the specific criteria are options that allow for choice and for the client to be able to use tools and materials that are preferred and culturally relevant. Each of the 85 AMPS tasks has been standardized in this manner.

Kanna kaffe eller te – en eller två personer Valmöjligheter: Vatten till te kan värmas i vattenkokare, på spisen eller i mikrovågsugnen Sötningsmedel valfritt

Conceptual Model (Fisher, 2003) Because of copyright restrictions, the AMPS Conceptual model is not reproduced here. For an inservice, however, you could legally make one (1) overhead copy of the conceptual model (5th Edition of the AMPS Manual). When discussing the conceptual model, stress the following points: When the AMPS is given, the focus is on the quality of the occupational performance – the quality of the “doing”. Characteristics of the person, the environment, and the task the person does will impact the skill of the task performance we observe; but we when score the AMPS do not score these aspects, we score the quality of the doing. After scoring the AMPS, we can then interpret the results by considering the person, the task, an/or the environment. In OT practice, it has been common to start evaluation at the level of the person (e.g., ROM, strength, perception, memory, etc.) and to assume or infer relationships between body function impairments and global performance (bottom-up approach) In an AMPS assessment, we are not evaluating the person (motivation, body functions, etc.) nor are we evaluating the environment. We use the AMPS in a top-down manner, beginning with a client interview and progressing to observing the quality of his or her performance of chosen and meaningful tasks. We then assess the quality of the person’s ADL motor and ADL process skills – which are smallest, goal-directed units of performance. Lastly, we consider the impact of environmental features and body functions on the quality of performance we observed. You might also want to use Figure 2-2 (p. 26 in Volume 1 of the 5th Edition of the AMPS Manual) to discuss the AMPS in relation to the WHO/ICIDH-2 classifications of body functions, activities, and participation. If you do, feel free to make one overhead of Figure 2-2 to use in your presentation. Refer to section 2.4, (p. 25) of Volume 1 of the 5th Edition of the AMPS Manual for more information on AMPS and WHO/ICIDH-2. The AMPS ADL motor and ADL process skills are individual units of goal-directed action, scored at the WHO/ICIDH-2 level of activity. The interpretation of the AMPS scores takes into account the impact of elements of the person and the environment on the observed performance, and so is made at the WHO level of participation.

Utförande-färdigheter Motsvarar de målinriktade handlingar som är definierade under domänerna Aktivitet och Delaktighet i International Classification of Functioning Disability and Health - ICF (World Health Organization [WHO], 2001) A common source of confusion is the difference between skills and body functions. Stress the idea that skills are goal- directed actions (e.g., reaching for this glass from this cupboard) not the person’s reaching capacity (e.g., the person’s maximal degrees of humeral flexion).

Utförande-färdigheter De minsta enheterna av observerbart utförande som länkas ihop, en och en, i processen att bygga ett utförande av en uppgift If we think of a task performance as a chain – performance skills are the individual links that must be connected together to construct the entire chain (the task) Thus, the ADL motor and ADL process skills are the smallest observable units of performance, that when compiled together result in the task being completed

Aktivitetsutförande – en handlingssekvens Turns water off when pot is full Reaches for coffee can Walks to fridge Turns on water Grasps handle Fills pot with water Delay to support coffee pot Reaches for handle of fridge Pushes walker Pulls door open Performance skills are linked to construct the overall task performance

ADL Motoriska färdigheter Observerbara, målinriktade handlingar en person utför när hon Handhar och flyttar föremål i uppgiften Flyttar sig själv runt i upgiftens miljö What are motor skills? Note that they are goal-directed actions. They are not physical capacities. For example, within the context of preparing toast with strawberry jam and a cup of coffee, we can observe the person walking to the cupboard, pulling the cupboard door open, reaching for a coffee cup, grasping the cup, lifting the cup, and transporting the cup to the table. Build on the idea that the motor skills are performed one-by-one – the skills are linked together to “build” the entire task performance (e.g., the preparation of a pot of coffee)

ADL Motoriska färdigheter Flyttar sig själv & föremål Flyttar Lyfter Går Transporterar Kalibrerar Har flyt Upprätthålla görandet Orkar Håller tempo Kroppsplacering Stabiliserar Rätar upp Placerar Skaffa och hålla föremål Når Böjer Greppar Manipulerar Koordinerar Depending on the amount of time you have, you may or may not want to give a brief definition of the skills. Sometimes it is enough to give two or three definitions as examples.

ADL Process-färdigheter Observerbara, målinriktade handlingar en person utför när hon Väljer, handhar och använder redskap och material i uppgiften Utför enskilda handligar och steg i uppgiften Ändrar utförandet när problem stöts på Process skills are also goal-directed actions! They are not cognitive capacities such as problem solving or memory. For example, as a person is preparing toast and coffee, we can observe the person searching for, locating, and choosing the strawberry jam, gathering the jam to the workspace, pausing before opening the jar, supporting the jar of jam so that it does not slip, and using a spoon to scoop the jam onto the toast. Adaptation is a critical feature of the AMPS. When the person experiences a problem, we consider what he or she does about it. Do problems happen? If so, does he or she prevent the problem from recurring?

ADL Process-färdigheter Upprätthålla görandet Håller tempo Fokuserar Arbetar målinriktat Använda kunskap Väljer Använder Hanterar Frågar Organisera tid Inleder Fortsätter Gör I logisk ordning Avslutar Organisera rum & föremål Söker/Lokaliserar Samlar ihop Organiserar Återställer Navigerar Depending on the amount of time you have, you may or may not want to give a brief definition of the skills. Sometimes it is enough to give two or three definitions as examples.

ADL Process-färdigheter Anpassa görandet Lägger märke till/Agerar Anpassar miljö Anpassar beteende Drar nytta av These are the skills that deal with adaptation – the person’s skill at doing something to prevent motor or process problems from happening or recurring during the task performance.

Färdigheter är inte kroppsfunktioner! Greppar och Lyfter kaffepannan Sträcker sig mot kranen Märker när vattnet stiger Agerar genom att stänga kranen Kroppsfunktioner Grepp- och biceps-styrka Rörelseomfång skuldran Problemlösning Just to make the point again. . . Use examples from client populations that are relevant to your audience and/or practice setting. Also be sure use examples from whatever task (e.g., Pot of coffee) that you used earlier in the inservice.

Varje färdighet poängsätts på en 4-gradig skala 4 = kompetent utförande 3 = tveksamt utförande 2 = begränsat utförande 1 = bristande utförande Once you’ve presented the skill items, begin to talk about how the AMPS is scored on a 4-point scale. The scale is criterion-referenced (as opposed to being norm-referenced) with the criteria being competent performance. On many norm-referenced tests, “normal” people would get perfect scores. Because the AMPS is criterion referenced, even “normal” people will get some scores of 2 if they are doing a task that is hard enough. None of us perform with perfect competence all of the time – we all occasionally do things like drop an egg, trip, or discontinue actions for no apparent reason. Competent (4) = no problems observed with this skill in this task Questionable (3) = the therapist questions whether or not there was a problem Ineffective (2) = some increased effort or inefficiency noted – could be slight or more pronounced Unacceptable (1) = an unacceptable amount of effort or inefficiency, imminent safety risk, or need for assistance was noted

Poängen matas in i datorn Data-programmet justerar rådata utifrån Bedömarens stränghet Uppgiftens utmaning Momentets svårighetsgrad Computer scoring is what makes the AMPS such a sensitive tool. Through computer scoring, AMPS raw scores are adjusted for: The severity of the rater (this is why each person who gives the AMPS must be trained at an AMPS workshop and be calibrated) The challenge of the tasks that the person did (this is why the specific criteria of each task must be standardized) The difficulty of each motor and process skill item – lower scores on harder items are less of a big deal than lower scores on easier items. You might want to mention that the computer program is based on many-faceted Rasch measurement, which allows for this sort of complexity.

AMPS datagenererade rapporter Narrativ rapport (på engelska) Sammanfattande rapport över utförandet Rapport över rådata Grafisk rapport Rapport över utvecklingen It is nice to show samples of each of these. If you are using a case study, make copies of these reports for the case. AMPS Narrative Report: Helps the practitioner communicate the client’s overall task performance in a personalized, written report. Aspects included in the Narrative Report: 1. Tasks performed 2. Overall statement about the quality of the client’s performance 3. Skills that most impacted performance – a list and description of the skills that the therapist is most concern about 4. Overall ADL motor & ADL process ability, with reference to how the client performed as compared to his/her healthy peers 5. Summary of main findings Performance Skill Summary Report: Communicates an overall picture of the quality of the person’s ADL task performance. AMPS Raw Scores Report: Shows patterns in the client’s skills across different tasks. While it is not usually placed in the chart, it is helpful to assist therapist reasoning in the intervention planning phase. AMPS Graphic Report: The quantitative aspect of the AMPS (more detail on next slide) AMPS Progress Report: Provides detailed information about the change in ADL motor and ADL process ability, with reference to whether such changes are statistically and/or clinically meaningful.

Narrativ Rapport

Narrativ Rapport

AMPS Grafiska rapport Kvantitativa mått på klientens samlade motoriska och process-förmågor Justerade av datorn utifrån uppgiftens utmaning, bedömarens stränghet och momentens svårighet The person’s place on the lines of motor and process ability is calculated by the computer; and is adjusted for the challenge of the task, the severity of the rater, and the individual difficulty of each item. This report is useful to use in pre- and post- testing to show change over time. This is the report that is most interesting to third party payers.

AMPS Grafiska rapport Användbart för att visa på grad av fysisk ansträngning, effektivitet, säkerhet och/eller oberoende under utförandet av uppgifter Användbart vid planering av intervention

Start by orienting them to the Graphic report – ADL motor scale is an indicator of physical effort, ADL process is an indicator of efficiency, both scales help communicate safety and independence. Cut off indicators Motor 2.0: Persons below this cutoff experience increased effort during task performance. Older adults who are just beginning to have increased difficulty doing tasks (e.g., stiffness when bending down, some stiffness of fingers) should be near 2.0 on the motor scale. Process 1.0: 93% of persons below this cutoff need assistance to live in the community. (see section 7.13, Volume 1 of the 5th Edition of the AMPS Manual, (pp. 226-229 for more information on the development of the cut off indicators) Planning intervention: When a client has ability measures that are relatively low (e.g., below 0.0), he/she may be less responsive to restorative occupation, but possibly able to benefit from adaptive occupation. When the ADL process ability measure is below 0.0, more emphasis should be placed on caregiver training and/or environmental adaptations. When the graphic report is used in conjunction with the other reports (performance skill summary, narrative report, raw score report) – the therapist can target the intervention (restorative occupation and/or adaptive occupation) toward improving the performance of those specific skills that are effortful, inefficient, unsafe, and/or require assistance.

Fallstudie Introduktion om personen AMPS resultat Tolkning av AMPS resultat Mål Interventions- planering It is often very useful to include a case study in your inservice. Begin by introducing the client (client-centered performance context), the tasks that were performed, etc. Share with them some of the computer-generated reports for the client, paint a picture of the client’s performance. Discuss how you interpreted the results of the AMPS, and how you used this information to develop goals, plan intervention, and assess progress.

Diskussion & frågor As time allows, encourage questions and discussion.