作业治疗评估..ppt

作业治疗评估,讲者:区启明梁爱珠香港作业治疗师协会昆明医学院外聘教师二七年十二月昆明鸣谢：钟晶晶,GeneralclinicalmeasuresingeriatricOTpractice作业治疗常用的临床量度工具,Evaluationoffunctionalperformance对功能表现的评估ModifiedBarthelIndex(MBI)FunctionalIndependenceMeasure(FIM)LawtonsInstrumentalActivityofDailyLiving(LawtonIADL)Evaluationofcognition認知的评估Mini-mentalStateExamination(MMSE)Evaluationofmood情绪的评估GeriatricDepressionScale(GDS-15),OTmanagementinGeriatricPractice,3,ModifiedBarthelIndex改良的Barthel指数,developedbyMahoneyandBarthelin1965ModifiedbyShahetalin1989tomeasuretheabilityofself-careindependenceofpatientsadministeredbytrainedpersonnelratetheperformanceofapatientinaninstitutionalizedsettingthroughdirectobservationconsistof10self-careitems,4,Self-CareActivities,Feeding,BowelControl,BladderControl,Toileting,Stairclimbing,Grooming,Bathing,Transfer,Dressing,Ambulation,OTmanagementinGeriatricPractice,5,ModifiedBarthelIndex改良的Barthel指数,5-pointlikertscaleDifferentweightstoreflectthetimeandamountofactualphysicalassistancerequiredThetotalsumofitemscoresyield100indicatingcompleteindependenceinself-careperformanceThemostsuperiorandwidelyused(Gresham,1980;Dombory,1987;Wade,1988Shahetal.,1989),OTmanagementinGeriatricPractice,7,(Shahetal.,1989),OTmanagementinGeriatricPractice,8,ChineseBarthelIndexIntroduction中文的Barthel指数介绍,ChineseBarthelIndex是一个日常生活自我照顾能力的尺度。此尺度共有十项的活动，包括进食、个人卫生、穿衣、洗澡、如厕、大小便控制、床椅转移、步行和上落楼梯。每个活动的评级可分为五级，不同的级别代表了不同程度的独立能力。最低的是一级，而最高是五级。级数越高，代表独立能力越高。(Leung,Chanspecialarrangementneeded;verbalpromptneeded;slowinspeed;seldomtododuetowithdifficultybutabletodoifrequired)Score1:需要帮助needsomehelpScore0:unabletodo不能完成,OTmanagementinGeriatricPractice,26,UseofFunctionalAssessments功能评价的使用,SetupabaselineonfunctionallevelProgressmonitoringQuantifythechangesafterinterventionDischargeplanningPartofdecisionmakingofplacementrecommendationsAcommunicationtoolamongsettingsanddisciplines,OTmanagementinGeriatricPractice,27,FunctionalAssessment功能评估,Functionalperformanceofolderadultsinselfcareand/orinstrumentalADLcanberestrictedduetoinjury/illness.SupportingclientstoattainoptimalfunctionalindependenceisoneofthegoalsforOTgeriatricpractice.,Whatarethecommoncriteriausedinfunctionalevaluation?在功能评估中的共通标准是什么？,OTmanagementinGeriatricPractice,29,Commoncriteriausedinfunctionalevaluation,Independence/levelofassistance独立/需要协助的分级Frequency/Amountofphysicalorverbalassistancethataclientasksforduringtaskperformance患者在完成指定任务中所需要体力上的帮助/口头的提示程度/数量,OTmanagementinGeriatricPractice,30,Howaboutthesecriteria?这些标准怎么样？,Effort成果AmountofphysicaldifficultyorfatiguethatclientsdemonstratesduringtaskperformanceEfficiency效率Degreeofdisorganization,inappropriateuseoftimeandspacethatclientsdemonstratesduringtaskperformanceSafety安全性Clientspotentialofinjuringhimselforcausingdamagetoenvironmentsduringtaskperformance,OTmanagementinGeriatricPractice,31,AssessmentforCognitiveImpairment,InHongKong,prevalenceofmoderatetoseveredementiais6.1%inpeoplewhoaged70orabove(Chiuetal.,1998)24.6%inhighriskelderswhoarelivingininstitutionorhome(SSPSurvey2005),OTmanagementinGeriatricPractice,32,Mini-MentalStateExamination,DevelopedbyFolstein&Folsteinin1975BedsidescreeninginstrumentfordetectionofcognitiveimpairmentAdministrationtime:about10minutesReliablytestedacrossdifferentculturesSensitivetochanges,OTmanagementinGeriatricPractice,33,Mini-MentalStateExamination,Composedof6domainsOrientation(time&place)RegistrationAttention&calculationMemory(shortterm)Language&ComprehensionVisualspatialorientation,OTmanagementinGeriatricPractice,34,MMSE-Interpretation,GeneralAnaidtodocumentthepresenceofcognitiveimpairmentormonitorprogressofdiseaseSerialMMSEscoresissensitiveforprogressivemildcognitiveproblemEducationlevel,sensoryimpairments,languageandcommunicationproblemsmayaffectthereliabilityofthetest,OTmanagementinGeriatricPractice,35,MMSE-Interpretation,Score30:noimpairmentor=24:“normal”ingeneralpopulation20-23:cognitiveimpairedbutstillliveindependently20:usuallycannotliveindependently:problemsininstrumentalADL:stillmanagebasicADL,OTmanagementinGeriatricPractice,36,CantoneseMMSE,CantoneseversionofMMSEwasdevelopedbyChiuetalin1994SomeitemsrevisedaccordingtotheChinesecultureinHongKongValidationstudiesconductedforelderlypopulationCut-offscoresdevelopedaccordingtodifferenteducationlevelofsubjects,OTmanagementinGeriatricPractice,37,CantoneseMMSE,OTmanagementinGeriatricPractice,38,CantoneseMMSE,現在是什麼時候?年份季節月號數星期這裡是什麼地方?香港/九龍/新界地區(深水步/長沙灣)醫院名字部門層數,OTmanagementinGeriatricPractice,39,CantoneseMMSE,我會講三種東西的名字給你聽，講完之後請你重覆一次並緊記，因為幾分鐘後我會問你。蘋果、火車、報紙你用一百減七，然後再減七，一直減落去直至我叫停。現在我會講幾個數字請你倒轉讀出：我較早前請你記住的三種東西是什麼？,OTmanagementinGeriatricPractice,40,CantoneseMMSE,這樣是什麼東西？（手錶/鉛筆）請你跟我講句說話，姨丈買魚腸。現在檯上有一張紙，請你用左(右)手拿起張紙，用雙手對摺一次，然後放回檯上/交給我。請讀出紙上的字，然後照住去做。（拍手）請你講/寫出一句完整句子。這裡有一幅圖形，請你照住畫。,OTmanagementinGeriatricPractice,41,CMMSE-Interpretation,Cut-offScore22orbelow:forelderwithmorethan2yearsofeducation20orbelow:forelderwithlessthan2yearsbutmorethan6monthseducation18orbelow:forelderwithlessthan6monthsofornoeducation(Chiuetal.,2000),OTmanagementinGeriatricPractice,42,Characteristicsindifferentdiagnosticgroups,AlzheimersDiseaseUsuallythefirstdeficitsistheshorttermmemoryDisorientationtotimeandisfollowedbydisorientationtoplaceLanguagedeficitsstarttoappearlateUsuallycontinuetotrytogettherightanswer,OTmanagementinGeriatricPractice,43,Characteristicsindifferentdiagnosticgroups,StrokeDeficitsaremorepatchyNospecificprofileMayhaveaphasia/dysphasia(expressive,receptiveorglobal)Mayhavespeech/languageproblemsearlierthanAlzheimersdisease,OTmanagementinGeriatricPractice,44,Characteristicsindifferentdiagnosticgroups-Depression,SeemlessdistressedthanAlzheimerspatientsabouttheirproblemsMorelikelytoanswer“Idontknow”or“itdoesntmatter”WhenpressedtheyoftenknowtheanswerPresentedwith“disabilitygap”NoobviousSTMlossOthersymptoms:appetitechange,energyloss,weightloss,sleepdisturbance,mentionaboutsuicide,etc.,OTmanagementinGeriatricPractice,45,DevelopingtheCarePlan,Problemwithjudgment:Getapowerofattorney,advancedirectiveandstartbuildingasupportnetworkSTMloss:Usereminders,lists,cues,calendarsordiariesLanguagedifficulties:AvoidopenendedquestionsAvoididiomaticexpression,OTmanagementinGeriatricPractice,46,DevelopingtheCarePlan,Wordfindingdifficulties:KeeplanguagesimpleGiveadequatetimetorespondCommunicateoneideaatatimeAvoidwordswithmorethanonemeaning3-stepcommanddeficit:Giveoneinstruction/ideaatonetime,OTmanagementinGeriatricPractice,47,Whytheevaluationofmoodisimportantingeriatricpractice?情绪的评估为什么重要？,1115%oflocalelderlypeopleshoweddepressivesymptoms(Chi,Yip,Chiuetal.,2005)Poorself-ratedhealth,chronicpain,visionproblems,ADLimpairment,financialstrain,fewsocialsupportareassociatedwithanincreasedlikelihoodofgeriatricdepression(Chi,Yip,Chiuetal.,2005)Aversiveconsequencesofdepressivemoodincludeincreaseddisability,treatmentrefusal,suicidalattemptsoracts,andadecreasedqualityoflife.,OTmanagementinGeriatricPractice,48,GeriatricDepressionScale(Short-form)老人抑郁短量表,DevelopedbySheikh&Yesavagein1986ScreeningtoolforgeriatricdepressionAssessaffectiveandbehaviouralsymptomsofdepression