This document discusses the importance of assessing personal context when conducting occupational therapy assessments. It provides examples of factors within a client's personal context that can influence functioning, such as age, symptoms like pain and fatigue, coping strategies, mental health, spirituality, and beliefs. The document also emphasizes that a therapist must be aware of how their own personal context and biases could influence the client interaction and assessment. It provides suggestions for questionnaires and topics therapists can explore with clients to better understand their personal context, values, and experiences with disability or illness.

1. Assessing Context
Personal Values, Belief and Spirituality
Durga Sankar Suar
Assistant Professor
College of Occupational Therapy
SRMIST, Tiruchirappalli Campus

2. Importance of Context to Assessment
• Paying attention to contextual factors is central to occupational therapy
assessment for three key reasons.
• It provides the therapist with a more complete picture of the client, which in
turn guides selection of assessments and interpretation of results.
• Experience prior to assessment that illustrates the importance of considering
contextual factors in planning the occupational therapy assessment.
• Paying attention to contextual factors may impact the outcome of
occupational therapy services by informing the focus of intervention.

3. Looking in the Mirror: Therapist as
Contextually Influenced Being
• Appreciating the influence of context on function requires that therapists acquire a
complex combination of knowledge, attitudes, and skills.
• Rather than focusing on how a client fits into the therapist’s world (via assumptions,
schedule, and conventions), the therapist examines how he or she can understand and fit
into the client’s world (St. Clair & McKenry, 1999).
• To accomplish this shift, therapists must acknowledge and inventory the contextual factors
that influence their own function. As I become aware of my own beliefs and biases, social
background, and culturally based expectations, I will be able to appreciate their influence
on collaborations with patients and coworkers (Odawara, 2005).

4. Personal Context
• “Life is suddenly reduced to a one dimension picture, known as
physical function, and continually referred to as ‘ outcome.’
• The typical outcome process ignores . . . emotional and
interpersonal needs and skills.
• Within those parameters lies the answer to true recovery . . . I
refuse to have an ‘ outcome.’ I do have a life !” (Cannon, 1994, p. 3)

5. Personal Context
• Personal context refers to the intrapersonal environment that shapes an individual’s
experience.
• These factors play a role in determining the client’s unique response to the onset of
illness or impairment and contribute to his or her ability to adapt (National Center for
Medical Rehabilitation and Research, 1993).
• Some aspects of a person’s internal environment, such as age and long-standing beliefs,
are stable; others, such as pain, mood, and adaptation to illness or injury (see Chapter
30), may be constantly in fl ux.

6. Age
• The age of a person can impact their rehabilitation outcomes and occupational functioning in various
ways.
• Age-related changes in capacities and abilities, developmental shifts in goals and priorities, and
generational worldviews all play a role.
• Elderly people may have longer stays and poorer outcomes in rehabilitation.
• Different generational groups have unique attitudes and beliefs that can influence their participation in
occupational therapy.
• However, therapists should be cautious of age-related biases and understand that catastrophic loss of
function is an individual experience that occurs alongside other age-related changes and

7. Symptoms: Pain and Fatigue
• A patient’s intrapersonal environment is also shaped by his or her ongoing
experience with symptoms such as pain and fatigue that influence both
assessment and functioning.
• Occupational therapists try to understand the extent to which these symptoms
contribute to the patient’s performance during assessment.

8. Pain
• Pain is a common problem experienced by many people receiving occupational therapy
services, particularly those with spinal cord injury or stroke.
• Pain can interfere with occupational function and quality of life, and is also linked to
depression, inefficiencies in information processing, and coping strategies.
• Many people with disabilities may be reluctant to mention their concerns about pain to
therapists, so therapists take responsibility to routinely ask and/or assess pain using tools
such as the Numeric Pain Rating Scale (NPRS).

9. Pain
• a brief self-report questionnaire in which patients rate their pain
intensity using an 11-point scale.
• The NPRS used to understand a patient’s overall pain experience
or how pain changes during an activity.

10. Fatigue
• Fatigue is a subjective feeling of insufficient physical or mental energy to carry out
desired activities.
• It is commonly experienced by individuals with disabilities or chronic health
conditions, such as stroke, multiple sclerosis, and brain injury, and can be
influenced by personality characteristics, depression, and the nature of the
neurological impairment itself.
• To quantify or characterize the level of fatigue, occupational therapists may use
fatigue visual analog scales or standardized questionnaires, such as the Fatigue
Severity Scale.

11. Fatigue
• Pain and fatigue management may become the focus of occupational
therapy intervention, and assessments with good psychometric
properties and known responsiveness to change, such as the Numeric
Pain Rating Scale and Fatigue Severity Scale, may be utilized.
• However, these measures should be accompanied by in-depth
conversations with clients to explore their experience with pain and
fatigue, and identify strategies to manage them effectively.

12. Coping and Beliefs
• Occupational therapists take into account a person's coping strategies,
mental health, and spirituality when assessing their response to sudden-
onset disability and loss.
• They may refer patients to specialists and work to engage with them in ways
that promote adaptation and wholeness.
• While people with disabilities may be at risk for anxiety and depression,
most are able to adjust and maintain a happy, relatively normal life.

13. Coping and Beliefs
• Resilience, defined as maintaining relatively stable, healthy psychological
and social functioning despite a severe injury, is influenced by a person's
mood and coping strategies, which are modifiable.
• Identifying emotional distress and maladaptive coping early in the recovery
period is important, as they are unlikely to resolve over time without
treatment.

14. Identifying Emotional Distress
• Early identification and treatment of mood disorders is important, as depression and anxiety
appear to interfere with attention and concentration during assessment (Eysenck & Keane,
1990) and negatively influence outcome of intervention (Lai et al., 2002).
• Although occupational therapists do not diagnose mood disorders, they have numerous
opportunities to observe behavior.
• According to Scherer and Cushman (1997), certain patterns of behavior may indicate
psychological distress and warrant referral to a psychologist or psychiatrist for further
assessment and treatment.

15. Depression
• The signs of normal grief or transitory sadness may resemble those of depression, but
they differ in terms of their persistence and effect on self-esteem.
• Symptoms of clinical depression include significant declines in functioning lasting more
than two weeks, feelings of worthlessness or inadequacy, diminished interest in
activities, a depressed or irritable mood, vegetative disturbances, poor concentration,
withdrawal from social interaction, and recurrent thoughts of death or suicide.
• It is important to distinguish between normal grief and clinical depression in order to
provide appropriate treatment.

16. Depression
Signs and symptoms of Depression
• Significant declines in functioning lasting 2 weeks or more.
• Feelings of worthlessness, inadequacy, or self-doubt.
• Diminished interest in virtually all activities, even formerly enjoyable
activities
• Depressed or irritable mood most of the time.

17. Depression
Vegetative disturbances:
• lethargy, insomnia or excessive sleep
• change of appetite with weight change of more than 5%
• periods of excessive activity or slowness almost every day
• Very poor concentration
• Withdrawal from social interaction
• Recurrent thoughts of death or suicide

18. Anxiety
• Anxiety is a subjective feeling of impending danger, which is experienced both psychologically and
physiologically.
• Anxiety is different from fear. Anxiety is characterized by a diffuse feeling of dread, whereas fear is
a reaction to a specific temporary external danger.
• Occupational therapists may have difficulty recognizing anxiety disorders, so its advised to use
standardized screening tools to identify patients in need of psychological or psychiatric services.
• The Hospital Anxiety and Depression Scale and the Beck Depression Index-FastScreen for Medical
Patients are good examples.

19. Anxiety
• Some signs of possible anxiety disorder that may prompt referral to a
psychiatrist or psychologist:
• Panic attack (choking feeling, nausea, dizziness, palpitations or chest pain, fear of
dying, or losing control)
• Distorted, unrealistic fears or perceptions of a situation or object
• Disruption of normal routines or daily activities associated with irrational fears

20. Spirituality
• Spirituality can be an important aspect of a person's coping and occupational
function, it is not necessarily a requirement for occupational therapy
intervention.
• Therapists should always respect a patient's beliefs and values, and tailor their
interventions accordingly.
• Additionally, therapists should be aware of their own beliefs and biases and
ensure they do not impose them on their patients.
• The key is to create a safe and supportive environment where patients can
explore their own spirituality if they choose to do so.

21. Assessing Patients’ Coping, Spiritual
Beliefs, and Meaning Systems
• People typically share personal information with those they trust.
• Therefore, to explore patients’ beliefs and meaning systems, therapists invest in establishing
therapeutic rapport.
• Without the rapport that comes with time and consistency of care providers, patients may perceive
questions about their spirituality, for example, as intrusive or offensive.
• Therapists who are aware of their own coping strategies and belief systems will be best able to
comfortably discuss these issues with their patients.
• In general, discussions of these very personal and potentially sensitive matters begin at a superficial
level and progress to deeper, more personal levels as dictated by the patient and therapist’s comfort
with each other and the subject matter. Here are examples of this progression.

22. Questionnaire to Follow
• Ask the client to provide an hour-by-hour account of a typical day prior to the injury or onset
of illness (Radomski, 1995). How a person is used to spending his or her time richly defines his
or her valued activities and priorities.
• Take a brief life history, asking the patient to give you an overview of his or her life course,
including past goals and obstacles (Kleinman, 1988). People often use stories or narratives to
make connections and meaning attributions between a series of life events (Mattingly, 1991).
• What are some ways to incorporate spirituality into occupational therapy practice and how can
therapists address their clients' spiritual beliefs and experiences of suffering?

23. Questionnaire for assessing Spirituality
• What gives your life meaning? What is your greatest hope?
• When you are discouraged and feeling despondent, what keeps you going?
• What comforts or encourages you? Where have you found strength in the past?
• What have you done in the past when you have lost someone or something
important?
• What do you think the message in this is for you?

24. FICA acronym for spiritual assessment
• F: Faith - What things do you believe in that give meaning to your
life?
• I : Importance And Influence - How have your beliefs influenced
your behavior during this illness? What roles do your beliefs play in
regaining your health?
• C :Community - Are you a part of a spiritual or religious
community? Is this a support to you and how?
• A : Address - How would you like me, your health care provider, to
address these issues in your health care?

25. Reference
• Occupational Therapy for Physical Dysfunction_Mary Vining
Radomski, Catherine A. Trombly Latham_ 7th edition