IADL/BADL assessments
Functional Independence Measure (FIM) - clientele
- Age 7+ yrs, anyone (i.e. stroke, special conditions: aphasia, neglect) many languages, rehab setting
The Pediatric Evaluation of Disability inventory (PEDI), OPIs
- BADL Functional skills related to: >Self Care > Mobility > Social Function Considers caregiver assistance and modification
Alpha FIM - A Purpose, OPIs
- Degree of disability experienced upon admission. Estimate burden of care of # of hours needed to help with care --> Info used to triage client -BADL's : 6 Areas (eating, grooming, bowel management, toilet transfer, memory, expression OR bowel manag., bed to chair transfer, toilet transfer, walk, memory, expression)
Physical Self-Maintenance Scale (PSMS) - Clientele
- Geriatrics - Ages 60+ - Community, hospital, rehab, or institution
Assessment of Motor and Process Skill (AMPS) format, length or time
- Over 100 available tasks to choose from (choose 2-3 meaningful to client to perform) - Calibrated according to level of difficulty - Standardized observational assessment
Independent Living Scale (ILS) - Scoring
- Score 2 = correct answers questions 1 = answers questions partially, dependent on someone 0 = incorrect, does not know > raw scores converted to standard
Assessment of Motor and Process Skill (AMPS) - scoring
- Score on 16 ADL motor and 20 ADL process skill items according to 4 point ordinal scale (1=deficit, 2=ineffective, 3=questionable, 4=competent) - Considers effort, efficiency, safety & independence - Time = 1 hr
Kitchen Task Assessment (KTA) - clientele
-Anyone you are concerned of cognitive functioning who is living at home (AD)
The Pediatric Evaluation of Disability inventory (PEDI) (A) - Purpose
-Assess functional capabilities/performance in children -Monitor progress in performance -Evaluate therapeutic or rehab process across inpatient, outpatient, and acute care settings
weeFIM clientele
-Infants 6 months to 7yrs
Kitchen Task Assessment (KTA) - A, purpose
-Measures level of cognitive support required by a person with Alzheimer's Disease to complete cooking task successfully - Record change in performance over time -IADL
Functional Independence Measure (FIM) scoring
-Score on 7 pt scale 1 = total assistance (0%) 2 = max assist (subject= 25+%) 3 = mod assist (subject = 50+%) 4 = min assist ( subject = 75+%) 5 = supervision (cuing) 6 = modified indep (equipment, no helper) 7 = total independence (timely, safe). Add up scores in 13 motor & 5 cognitive to get total, ranges 18-126. Lower score = greater disability. - Pre/post evaluation, helps guide treatment - Monitor change over time / effectiveness of rehabilitation
Kitchen Task Assessment (KTA)
-Scoring 0 = independently competent 1 = verbal cue 2 = physical assistance 3 = incapable Ranges from 0-18, higher = more impaired.
Kitchen Task Assessment (KTA) - format & time
-Setup environment (pudding mix, milk in fridge, sauce pan, spoon, scraper, measuring glass, small dishes, instructions, stove) - Observe client making pudding -Areas scored = initiation, organization, performance of all steps, sequencing, judgement and safety, completion -Time: ~15 mins, longer depending on person
Functional Independence Measure (FIM) format, equipment and time
-Standardized measure (observation or given as interview) 18 items in 6 areas of functioning -Time: 15 mins, up to ~30-45 mins depend on measure -Equipment = any client uses to fulfill ADL
Independent Living Scale (ILS) - Time
45 mins administer, 10 min score - Should be done in private setting (rehab, home, psychiatric setting
Physical Self-Maintenance Scale (PSMS) - Time
5 mins
FIM score and hours of care, 60 / 80 / 90 / 100 / 110
60 = ~4 hr care 80 = ~2 hr care 90 = 1 hr care 100 = min or no assist 110 = none
Assessment of Living Skills and Resources (ALSAR) - clientele
60+ english speakers
The UCSD Performance-based Skills Assessment (UPSA) - Scoring
Add each domain Divide # of Q by score in each section Multiply by 20, Total score /100.. higher score = higher function
Alpha FIM - format
Administered within 72 hour of admission -Can repeat measure before discharge -6 items; walk less than 150 ft eating, grooming, bowel management, toilet transfer, memory, expression OR more than 150ft bowel management, bed to chair transfer, toilet transfer, walk, memory, expression
Independent Living Scale (ILS) - (B) - Purpose
Adult competency in activities of independent living (IADL) Info used to determine if person can live independently, need modifications, etc.
Independent Living Scale (ILS) - Clientele
Adults (65+) - Psychiatric diagnosis (mental health), cognitive impairments or decline following dementia, injury such as TBI/stroke - Intellectual disabilities
The UCSD Performance-based Skills Assessment (UPSA) - clientele
Adults who want to live independently
Assessment of Motor and Process Skill (AMPS) - B Clientele
Age 2+
Alpha FIM clientele
Anyone in acute care setting who has an illness, short stay, short contact with therapist -- BADL
Functional Independence Measure (FIM) - A Purpose, OPIs
BADL Self care, sphincter control, mobility, locomotion, communication, social cognition -Designed to measure the degree of disability experienced -Level of patient disability influences burden of caring for them
Kohlman Evaluation of Living Skills (KELS), OPI's
BADL & IADL =self-care, safety & health, money management, transportation & telephone, and work & leisure
weeFIM , OPIs
BADLs -Self Care (eating, grooming, bathing, dressing, toileting, bladder, bowel manage) -Mobility (transfer w/c & chair, transfer toilet, transfer tub/ shower, locomotion walk or crawl or use w/c, locom stairs) - Cognition (comprehension, expression, social interact, problem solve, memory)
What are some barriers to IADLs?
Context-specific: Sensitive to environmental conditions IADL depends on familiarity with the environment in which these tasks are performed, with pre-determined social and role expectations
Assessment of Motor and Process Skill (AMPS) - B Purpose, OPIs
Familiar tasks of client to evaluate performance capacity for IADL and motor & process skills underlying that IADL --> Determines if someone needs OT, care services etc IADL -Motor (movement during task performance i.e. coordinated, positioned, reach, manipulate) -Process Skills (decisions to complete task i.e. sequence, choose, initiate)
Assessment of Living Skills and Resources (ALSAR) -format, length or time
Format: Interview, supplemented with observations if needed(create questions, use suggested) 11 items in areas of functioning Time: ~30 mins
Physical Self-Maintenance Scale (PSMS) (B) - Purpose, OPIs
Gauge self-maintaining and instrumental activities of daily living in elderly - Used over time to measure functional change - Used in planning and assessing treatment BADL & IADL
Independent Living Scale (ILS) - OPIs
IADL (memory/ orientation, manage money, manage home/ transportation, health/safety, social adjustment)
Kohlman Evaluation of Living Skills (KELS), Scoring & Time
Independent (competent) or needs assistance. Scores can also be NA or "see now" (neither independent or needs assistance, additional explanations) = 30-45 mins Lawton Instrumental Activities of Daily Living Scale (IADL Scale) - B
The Pediatric Evaluation of Disability inventory (PEDI)- Format
Interview format, semi structured questions 3 functional dimensions -Functional Skills Scale -Caregiver Assistance Scale -Modification Scale
Kohlman Evaluation of Living Skills (KELS) (B) -Purpose
Measures mastery of areas of concern for entering or re-entering community with intention to live independently
Physical Self-Maintenance Scale (PSMS) - Scoring (who does it)
Observer = BADL Self report = IADL
The Pediatric Evaluation of Disability inventory (PEDI), clientele
Parent report of children 6 month to 7.5 yrs - May be used if functional development is delayed -Many languages
The UCSD Performance-based Skills Assessment (UPSA) - Equipment
Props to test performance in activities (currency, role play cards like bill, letter, route maps, recipe cards, etc), timer, telephone - Finance (count paper and coin money - asked question on information in a invoice/bill) scores 0-11 -Communication (role play with telephone) scores 0-12 - Organize/plan (newspaper article and answer questions) score 0-14 - Transport (bus schedule, answer questions) score 0-9 - Household management (recipe for rice dessert, pick missing items to buy) score 0-4
Assessment of Living Skills and Resources (ALSAR) - A Purpose, OPIs
Quantify likelihood client is able to accomplish task --> predict risk for negative health outcomes and assist intervention plan IADL (telephoning, reading, leisure, medication manage, money manage, transportation, shopping, meal preparation, laundering, housekeeping and home maintenance)
AlphaFIM scoring
Record current ability 7 point scale 1 = total assistance -25% of task on own] 2 = max assist 25-49% of task] 3= mod assist 50-74% - needs phys assist 4= min assist 75%+, no more help than touching 5= supervision/setup -all tasks with cue, stand by, setting up items 6 = modified indep - no helper, needs devices, time, concern for safety tho 7 = total independence -no device, no help, good time Score add up FIM 13 raw motor score, add 5 cognition scores, total score by adding up
Basic Activities of Daily Living
Refers to self care tasks necessary for maintaining oneself •Typically includes eating, dressing, grooming, bathing, toileting, mobility - tasks universal to human health •Performance of BADL is specific to context (i.e. environment, culture, personal factors)
The UCSD Performance-based Skills Assessment (UPSA) (A) - Purpose, OPIS
Role play test to evaluate functional capacity in 5 domains of basic living skills (IADL) to live independently IADL demands - Financial skills, communication, organization / planning, transportation and household management
Assessment of Living Skills and Resources (ALSAR) - scoring
Score - each task client is rated as independent (0), partially dependent (1), dependent (2). - each task resource is rated as consist. available (0), inconsist. avail (1), not avail (2). - Both scores for each item are combined to get risk score. Possible scores: 0-0=0, 0-1= 0, 1-0 = 1, 2-0= 2, 2-1= 3, 2-2 = 4 > add up each of the 11 risk scores to get R score - R over 20 = moderate risk, +30 = high risk
The Pediatric Evaluation of Disability inventory (PEDI)- scoring
Score every functional dimension as directed -Bit more complicated to score, standardized, normative scores need to calculate computer
weeFIM - A, Purpose
Similar purpose of FIM for children (measure the degree of disability experienced, change over time, and effectiveness of rehabilitation) - Disability severity
weeFIM scoring
Similar scoring to FIM/Alpha FIM = 1-7 1= max assist add up self care total, mobility total, and cognition total. Can combine subtotals to WeeFIM total -Compare scores to normative age ranges
Kohlman Evaluation of Living Skills (KELS), Format
Standardized -Reads instructions to client 5 Areas measured: Self-care, safety/health, transportation, money, telephone, work/leisure
Independent Living Scale (ILS) - Format
Standardized Assessment based on verbal responses Subscales memory/orientation, manage money, manage home/transportation, health/safety, social adjustment
The UCSD Performance-based Skills Assessment (UPSA) - Format & time
Standardized assessment (preset questions to ask client), Role play -Actual performance is scored Time = 30-45 mins
weeFIM format, equipment
Standardized measure -Observation of child or given to parent as interview or self report 18 items in 3 domains - Before administering each item, read the definition of what "grooming" or "eating" etc is to be sure the client understands the concept you are asking about.
Physical Self-Maintenance Scale (PSMS) - Format
Targets observable behaviours & completed by OT or self administered 6 Items = BADL toileting, feeding, dressing, grooming, physical ambulation, bathing 8 Items = IADL ability to use telephone, shopping, food prep, housekeeping, laundry, mode of transportation, responsible for own meds, handle finances
Does BADL or IADL's require a higher level or competency?
They are both multi-stepped occupations but IADLs usually require a higher level of competency
The Pediatric Evaluation of Disability inventory (PEDI)- Time
Time = 45-60 mins, 30-45 if experienced
Kohlman Evaluation of Living Skills (KELS), Clientele
Usually elderly to be discharged back into community in future -Any population that encounters cognitive condition (adolescent), acute care setting n hospital ex. Dementia, TBI
Limitations in IADL performance tend to increase with ____, and predict
age...and predict poor future health and functional status, comorbidity, hospitalization and mortality
Independent Living Scale (ILS) - Equipment
manual booklet and record form, stopwatch, writing paper and pencil, 6 quarters, 5 dimes, 5 pennies, 4 nickels, phone, $10 bill, phone book, envelope
AlphaFIM score of <40, 40-80, mild >80
mild >80 = community based rehab moderate 40-80 = inpatient rehab severe <40 = restorative care
How are IADLs assessed?
self-report, proxy-report or observed performance, (or a combination of methods) to collect the data
How are BADL assessed?
•BADL is assessed using observation of tasks and self-report questionnaires
Instrumental activities of daily living (IADL)
•Includes - shopping, cooking, house-keeping, banking, transportation, laundry, medication management, use of telephone. •Focus: Home and community