Learning Objectives of this School Aged Therapy presentation:
- Describe how to determine which instruments are the best match for my measurement needs
- Describe validity and how validity is determined
- Describe reliability and ways to improve reliability
- Describe broad categories of measurement tools based on the International Classification of Functioning, Disability and Health (ICF)
- Locate resources of appraised reviews of relevant measurement instruments
- Identify at least 2-3 new measurement tools to further explore
Biofeedback machines commonly used in the physiotherapy practice are described along with available evidences for clinical use.
Most of the feedback modalities are described along with its use and the mechanism behind it.
22- Force platform- is the device used to measure the ground reaction forces in steady and/or in moving phase. Sensors in the force platform give visual feedback on the screen attached to therapist as well as patient about the weight distribution and other parameters of gait can also be measured.
33- Mirror -used as visual feedback to treat the pain as well as disability in different conditions. It healps to activate the mirror neuron in the brain. Mirrior therapy proposed by Ramchandran et al has been found most beneficial treatment in the phantom limb pain treatment
This is a power point presentation of Lower cross syndrome for medical/physical therapy purpose created by Dr Harshad Morasiya. Including contains are pathophysiology, causes, signs and symptoms, diagnostic and treatment method as well as recent evidences with references.
Biofeedback machines commonly used in the physiotherapy practice are described along with available evidences for clinical use.
Most of the feedback modalities are described along with its use and the mechanism behind it.
22- Force platform- is the device used to measure the ground reaction forces in steady and/or in moving phase. Sensors in the force platform give visual feedback on the screen attached to therapist as well as patient about the weight distribution and other parameters of gait can also be measured.
33- Mirror -used as visual feedback to treat the pain as well as disability in different conditions. It healps to activate the mirror neuron in the brain. Mirrior therapy proposed by Ramchandran et al has been found most beneficial treatment in the phantom limb pain treatment
This is a power point presentation of Lower cross syndrome for medical/physical therapy purpose created by Dr Harshad Morasiya. Including contains are pathophysiology, causes, signs and symptoms, diagnostic and treatment method as well as recent evidences with references.
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
PPT that made a short and crisp description on physiotherapy role in women's health at a glimpse.
Physical therapist plays a over all role in all stages of a women.Physiotherapist or a pelvicfloor physicall therapist plays a all arounder in childbirth educator, as a labour doula, as lactation expert , as a postpartum doula, as a pelvicrehab practitioner etc.. So all you need to understand is a WOMEN'S HEALTH/ PELVICFLOOR PT is a person who benifits women at all the stages.
Stress and it's physiotherapy Management.pptxAvaniAkbari
Stress, often manifested as tension and strain, can have profound effects on both the mind and body. Physiotherapy plays a crucial role in managing stress-related symptoms by addressing the physical manifestations of tension. Therapeutic techniques such as massage, stretching exercises, and relaxation training are employed to release muscular tension and promote overall relaxation. Physiotherapists also focus on breathing exercises and mindfulness techniques into physiotherapy sessions helps individuals develop coping mechanisms to better manage stress on a holistic level. By combining physical interventions with stress management strategies, physiotherapy contributes to the overall well-being of individuals experiencing stress, fostering a balanced and healthier lifestyle
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Remove or Replace Header Is Not Doc TitleGuiding Questions.docxlillie234567
Remove or Replace: Header Is Not Doc Title
Guiding Questions
Quality Improvement Initiative Evaluation
This document is designed to give you questions to consider and additional guidance to help you successfully complete the Quality Improvement Initiative Evaluation assessment. You may find it useful to use this document as a prewriting exercise, an outlining tool, or a final check to ensure you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment.
Do not turn in this document as your assessment submission.
Remember, you are analyzing a current QI initiative that is already in place. You are not creating a new QI initiative (Assessment 3).
Analyze a current quality improvement initiative in a health care setting.
· What prompted the implementation of the quality improvement initiative?
· What problems were not addressed?
· What problems arose from the initiative?
Evaluate the success of a current quality initiative through recognized benchmarks and outcome measures.
· What benchmarks or outcome measures were used to evaluate success? Consider requirements for national, state, or accreditation standards.
· What was most successful?
Incorporate interprofessional perspectives related to initiative functionality and outcomes.
· How does the interprofessional team contribute to the success of the QI initiative?
· What are the perspectives of interprofessional team members involved in the initiative?
· Who did you talk to? From what other professions? How did their input impact your analysis?
Recommend additional indicators and protocols to improve and expand outcomes of a current quality initiative.
· What process or protocol changes would you recommend?
· What added technologies would improve quality outcomes?
· What outcome measures are missing, or could be added?
Convey purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.
· Is your analysis logically structured?
· Is your analysis 5–7 double-spaced pages (not including title page and reference list)?
· Is your writing clear and free from errors?
· Does your analysis include both a title page and reference list?
· Did you use a minimum of four sources? Were they published within the last five years?
· Are they cited in current APA format throughout the analysis?
1
image1.png
1
Quality Improvement Initiative Evaluation
Student’s Name:
Course Name:
Course Number:
Instructor’s Name:
This study source was downloaded by 100000855641916 from CourseHero.com on 12-20-2022 05:43:38 GMT -06:00
https://www.coursehero.com/file/176043112/Revised-QIIE-1edited-2editeddocx/
https://www.coursehero.com/file/176043112/Revised-QIIE-1edited-2editeddocx/
2
Introduction
In healthcare settings, plans for process-specific quality improvement are frequently
reactive and focused on act.
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
PPT that made a short and crisp description on physiotherapy role in women's health at a glimpse.
Physical therapist plays a over all role in all stages of a women.Physiotherapist or a pelvicfloor physicall therapist plays a all arounder in childbirth educator, as a labour doula, as lactation expert , as a postpartum doula, as a pelvicrehab practitioner etc.. So all you need to understand is a WOMEN'S HEALTH/ PELVICFLOOR PT is a person who benifits women at all the stages.
Stress and it's physiotherapy Management.pptxAvaniAkbari
Stress, often manifested as tension and strain, can have profound effects on both the mind and body. Physiotherapy plays a crucial role in managing stress-related symptoms by addressing the physical manifestations of tension. Therapeutic techniques such as massage, stretching exercises, and relaxation training are employed to release muscular tension and promote overall relaxation. Physiotherapists also focus on breathing exercises and mindfulness techniques into physiotherapy sessions helps individuals develop coping mechanisms to better manage stress on a holistic level. By combining physical interventions with stress management strategies, physiotherapy contributes to the overall well-being of individuals experiencing stress, fostering a balanced and healthier lifestyle
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Remove or Replace Header Is Not Doc TitleGuiding Questions.docxlillie234567
Remove or Replace: Header Is Not Doc Title
Guiding Questions
Quality Improvement Initiative Evaluation
This document is designed to give you questions to consider and additional guidance to help you successfully complete the Quality Improvement Initiative Evaluation assessment. You may find it useful to use this document as a prewriting exercise, an outlining tool, or a final check to ensure you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment.
Do not turn in this document as your assessment submission.
Remember, you are analyzing a current QI initiative that is already in place. You are not creating a new QI initiative (Assessment 3).
Analyze a current quality improvement initiative in a health care setting.
· What prompted the implementation of the quality improvement initiative?
· What problems were not addressed?
· What problems arose from the initiative?
Evaluate the success of a current quality initiative through recognized benchmarks and outcome measures.
· What benchmarks or outcome measures were used to evaluate success? Consider requirements for national, state, or accreditation standards.
· What was most successful?
Incorporate interprofessional perspectives related to initiative functionality and outcomes.
· How does the interprofessional team contribute to the success of the QI initiative?
· What are the perspectives of interprofessional team members involved in the initiative?
· Who did you talk to? From what other professions? How did their input impact your analysis?
Recommend additional indicators and protocols to improve and expand outcomes of a current quality initiative.
· What process or protocol changes would you recommend?
· What added technologies would improve quality outcomes?
· What outcome measures are missing, or could be added?
Convey purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.
· Is your analysis logically structured?
· Is your analysis 5–7 double-spaced pages (not including title page and reference list)?
· Is your writing clear and free from errors?
· Does your analysis include both a title page and reference list?
· Did you use a minimum of four sources? Were they published within the last five years?
· Are they cited in current APA format throughout the analysis?
1
image1.png
1
Quality Improvement Initiative Evaluation
Student’s Name:
Course Name:
Course Number:
Instructor’s Name:
This study source was downloaded by 100000855641916 from CourseHero.com on 12-20-2022 05:43:38 GMT -06:00
https://www.coursehero.com/file/176043112/Revised-QIIE-1edited-2editeddocx/
https://www.coursehero.com/file/176043112/Revised-QIIE-1edited-2editeddocx/
2
Introduction
In healthcare settings, plans for process-specific quality improvement are frequently
reactive and focused on act.
Competency Validation: An Advisory Board ApproachAPI Healthcare
Over the past decade competency has gone from buzzword to requirement in healthcare. The Joint Commission, along with federal and state regulatory agencies, has increasingly focused on staff competency with each coming year. Why this focus on competency?
QI PLAN PART 22QI PLAN PART 25Running head QI.docxamrit47
QI PLAN PART 2 2
QI PLAN PART 2 5
Running head: QI PLAN PART 2 1
QI Plan Part 2
This methodology is chosen because in performance improvement it entails satisfactory of the patients, the process of delivery and improvement of the processes. The quality improvement (QI) is identified to focus on bringing out the gap in between the current levels of quality and the expected quality levels. The Quality Improvement uses the tools for managing quality together with the principles towards understanding and address systems deficiencies hence improving or re-designing efficiently the effective healthcare processes (Scales, 2014). Moreover, setting up a Quality Improvement process is termed to be an easy task but in order to integrate these processes in day to day activities, there have to be effective implementation via the leadership dedication, empowering of the employees, the healthy culture of business and the effectiveness of strategic planning that management has been embraced along with the desired performances.
The information technology applications include the Hospital Admission Risk Prediction (HARP) and the Episheet. In terms of improving the performance area, the HARP aims in predicting the future events, creating the intervention mechanism to the health care providers and generating the information regarding patient risk within future framework (Scales, 2014). The other application tool named Episheet is a qualitative tool which is applied in epidemiologic data analysis. It will help improve the performance area through gathering of the information and ensuring the priority of the healthcare organization.
In order to meet the performance improvement plan, innovation technology has to be considered in all applications. The IT applications are applied in an object oriented technology as well as in a computerized patient records systems and might also be used in the specific components of IT. Certainly, the object oriented technology would ensure that all different systems within the organization are connected and proper management (Hermann, 2005). The information technology entails the management of the patient’s records through computerization in order to prevent loss or from being accessed by the illegitimate persons. Furthermore, this aspect explores that for the use of the specific IT components, it is quite easy to monitor an organizational quality performance because the organization does not need change from the component directly to the other when delivering its services.
The quality indicators are identified as the guide to evaluation of the appropriate performance of an organization. The reason is that the performance is always evaluated continuously and at last at the end of the projects in a way that the organization carries out the process. Therefore, the benchmarks are termed as the programs as well as the operations which are set in order to make assessment of organizational performances. It is ideally ach ...
A textbook must provide, first and foremost, information to assist the reader in better understanding the topic. Second, it ought to provide the information in a way that can be easily accessed and digested, and it needs to be credible. Textbooks
that have gone through multiple editions continue to improve as a result of reviewers’ comments and readers’ feedback, and this one is no exception. Looking back over the efforts associated with this Fifth Edition, the old wedding custom of “something old, something new, something borrowed, something blue” comes to
mind. We have built upon the solid foundation of previous editions, but then added “something new.” It almost goes without saying that we have “borrowed” from others in that we both cite and quote examples of program evaluation studies
from the literature. “Something blue” . . . well, we’re not sure about that. Those who have used the Fourth Edition might be interested in knowing what has changed in this new edition. Based on reviewers’ comments we have:
• Created a new chapter to explain sampling.
• Incorporated new material on designing questionnaires.
• Overhauled the chapter on qualitative evaluation. It is now “Qualitative and Mixed Methods in Evaluation.”
• Reworked the “Formative and Process Evaluation” chapter with expanded coverage on developing logic models.
• Added new studies and references; new Internet sources of information.
• Included new examples of measurement instruments (scales) with a macro
focus.
• Inserted new checklists and guides (such as ways to minimize and monitor for potential fidelity problems—Chapter 13).
• Revised the chapter “Writing Evaluation Proposals, Reports, and Journal Articles” to give it less of an academic slant. There’s new material on writing
executive summaries and considerations in planning and writing evaluation
reports for agencies.
• Deleted the chapter on Goal Attainment Scalin
SOCW 6530 wk 7 peer responses Respond to the blog posts of t.docxrronald3
SOCW 6530 wk 7 peer responses
Respond to the blog posts of three colleagues in one or more of the following ways:
Share an insight from having read your colleague’s posting.
Make a suggestion to your colleague’s post.
MUST RESPOND TO EACH ONE SEPARATELY CITE EVERYTHING AND FULL REFERENCES
PEER 1 Alicia Simpkin
Evaluation of How You Have Addressed Evaluation or How You Might Address Evaluation
Evaluation of a service is beneficial in determining how a program/service is being run and whether or not it is working the way it is supposed to. When someone evaluates a service, they gather information related to how the program is being run, such as whether it has worked properly, or whether things need to be changed (i.e. implemented or removed). Evaluation may be done through surveys or other measurements to determine the validity of such. This information gathered may be utilized as ‘evidence’ when defending the use of the service or program in practice. According to the text, when considering the use of evidence in practice, “practitioners generally first consider the proximal similarity of information and the trustworthiness of the source before directly translating research into their clinical practice” (Wharton & Bolland, 2012). Practitioners will determine whether the research can be trusted before moving forward with incorporating such into their future practice.
In my field placement, services are typically evaluated through client satisfaction surveys upon discharge, or one can determine how a program is being run through client progress. If the program is running the way it should, then client progress will reflect such. For example, sessions with clients often have a purpose, whether that is to identify their triggers and work through them, or offer resources and other information and encouragement that allows them to work towards achieving their goals, etc. If client notes reflect progress in their recovery and progress towards achieving their goals, then one is able to understand that the tools offered in the program are beneficial in client recovery. I would also address evaluation of the program through client satisfaction surveys, which would allow clients to address all concerns and share what has worked for them and what has not worked well.
References
Wharton, T. C., & Bolland, K. A. (2012). Practitioner Perspectives of Evidence-Based Practice. Families in Society: The Journal of Contemporary Social Services.
PEER 2
LaTiona Washington
An explanation of how you have addressed evaluation or how you might address evaluation in your field education experience
The evaluation focuses on the patient’s progress, goals, and if they need to be reevaluated (Scarnato, 2019). At Rolling Hills Hospitals (RHH), the term “Hospital” informs how the intent is to stabilize and discharge. Initially, it was difficult to determine evaluation at my agency. We assist the patient in creating long-term and short-term goals. Due to our se.
This is a presentation from the 2013 American Academy of Pediatrics National Conference and Exhibition that discusses Maintenance of Certification, Quality Improvement and Electronic Health Records
Discussion ( 150 words and sources and References) ( this is wha.docxlynettearnold46882
Discussion ( 150 words and sources and References) ( this is what need to be done)
Reflect on your research intentions and a variable which may be potentially of interest to you. Please describe this variable and how you may measure it (e.g., which sample will you approach). Then explain whether you expect it to be normally distributed and the logic for your assumption. If you expect a deviation from normality, please explain how you may deal with it. You may search external sources for addressing the last point.
The followings are the resources for the discussion.
NOTE FOR THIS Discussion
Discussion
Learning Outcomes
· Develop critical thinking regarding variables and their distributions.
Module Overview
In this module we use the language and knowledge we acquired in the previous module and start talking about basic statistical measures, which allow us to understand the data we collect. Before we run inferential analyses, we need to be able to describe the data and understand its qualities. For these purposes, we will discuss the concepts and applications of frequency distribution, shapes of distributions, skewness and kurtosis measures, and measures of central tendency (mean, mode, median), measures of dispersion (standard deviation, variance and range). We will then discuss when to use which measure and emphasize the advantages of using well-validated existing scales when they exist. Finally, we will discuss one of the most important distributions in management research, namely the normal distribution which is the basis for most statistical techniques we will in this course and beyond. In this context, we will also discuss z-scores, probability distribution and percentiles.
Required Reading
On measures of central tendency:
1. Dietz, D., Barr, C. D., & Çetinkaya-Rundel, M. (2016). OpenIntro statistics, 3rd ed.
(The textbook is available under a Creative Commons license. Visit openintro.org for a free PDF, to download the textbook’s sources, or for more information about the license.)
https://www.openintro.org/stat/textbook.php?stat_book=os
Chapters 2, 3, and 4.
2. http://www.rci.rutgers.edu/~japhill/ho3s04.pdf
3. Watch: http://www.youtube.com/watch?v=E4HAYd0QnRc
4. Watch: http://www.youtube.com/watch?v=RAekTsenqPI
On the Normal distribution
1. https://www3.nd.edu/~rwilliam/stats1/x21.pdf
2. http://www.youtube.com/watch?v=mai23vW8uFM
3. http://www.dummies.com/how-to/content/understanding-the-statistical-properties-of-the-no.html
4. http://www.dummies.com/how-to/content/how-to-find-a-percentile-for-a-normal-distribution.html
Optional Reading: http://www.youtube.com/watch?v=uanvaJCYY_8
My Previous Disuccion) (I add to the instruction my previous discussion in order to stay in the same direction in the field of Business management and Organizational.)
HERE IS MY PRVIOUS MODULE DISCUSION FOR YOUR KNOWLEDGE ( IF NEED FOR WHAT WAS).
What I do know when reflecting on my experience as a Chief Executive Officer in my privat.
I probably should have titled this section Who Ensures that Digita.docxsalmonpybus
I probably should have titled this section Who Ensures that Digital Health Tools are Safe?. The Food and Drug Administration (FDA) is largely tasked with ensuring the safety and oversight of "traditional" medical devices. Consumer oriented technologies and many of the digital health tools available today present a more unique challenge for federal regulators. For example, software which reads digital mammograms is clearly a medical device intended to diagnose cancer. However, a mobile application which a user/consumer/patient leverages to track daily blood glucose levels is a very different approach. The mobile application is not making a diagnosis. There is limited risk of harm or change in medical management resulting from use. To address many of these nuances the FDA has created a
digital health resource page. The FDA often issues regulatory guidance documents in the event there is a question surrounding the legal authority provide oversight on a specific tool, device, or software component of a device.
FDA Approach to Risk
The FDA continues to evaluate technologies in the context of risk and classifies technologies in one of three tiers. It is important to note that any mobile app; regardless of if FDA approval is needed or not; may be submitted to the FDA for review. At times a vendor will submit to the FDA for review to increase the marketability of service or solution. The device itself is not required to be evaluated but the vendor chooses to do so anyway. The classes fall into one of the three following categories:
Class I - Low-risk where general reporting of adverse events occurs
Class II - Medium-risk where the FDA must provide review and clearance before marketing of the solution occurs. Review period takes between 60 to 90 days.
Class III - High risk where clearance before marketing must be obtained and the clearance must involve clinical studies showing that the product is safe and effective.
Mobile Medical Applications
The FDA has done a good job of clarifying the types of mobile apps that will not, will, and may be regulated by providing guidance documents. The FDA calls this document
Mobile Medical Applications Guidance. The aim of the guidance document is to clarify where the agency intends to enforce oversight and where the agency will continue to monitor developments. While the guidance document and website is extensive, there are a few key items worth mentioning. 1. The FDA defines what mobile medical applications
ARE. They can be Apps or accessory devices which meet the definition of a medical device (somewhat abridged and abbreviated for simplicity)- recognized by the National Formulary (ie Pharmaceuticals), intended for the use in the diagnosis of disease, cure, mitigation, treatment, or prevention of disease; or affect the structure or function of the body of man or other animals. 2. Consumers can use both medical apps and mobile apps to manage their o.
Closing the Loop on Clinical Competency Based AssessmentsExamSoft
Presented by Karen Bobak, DC, EdD, Dean of Chiropractic, and Wendy Maneri, MS, DC, Associate Dean of Chiropractic Clinical Education and Health Centers, of New York Chiropractic College, discussed ways to effectively assessing student competency in a clinical setting is an essential element in professional healthcare education.
Effectively assessing student competency in a clinical setting is an essential element in professional healthcare education. Moreover, the use of assessment data to improve student learning is essential in order to meet program goals, professional standards, and provide quality patient care. Examples of strategies used to develop and implement a process of assessment / analysis / communication and change will be shared. Participants will be encouraged to develop a process framework while considering the challenges and opportunities that exist within their programs.
Similar to Measurement Tools for School Aged Therapy 2015 ppt (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Measurement Tools for School Aged Therapy 2015 ppt
1. New or Recently Developed
Measurement Tools for Occupational Therapists
and Physiotherapists Working with School-Aged
Children with Motor Impairments
IVONNE MONTGOMERY, OCCUPATIONAL THERAPIST
SUNNY HILL HEALTH CENTER FOR CHILDREN
COQUITLAM SCHOOL DISTRICT CONTRACT
MAY 5, 2015
2. Learning Objectives:
Describe how to determine which instruments are the best match for my
measurement needs
Describe validity and how validity is determined
Describe reliability and ways to improve reliability
Describe broad categories of measurement tools based on the International
Classification of Functioning, Disability and Health (ICF)
Locate resources of appraised reviews of relevant measurement instruments
Identify at least 2-3 new measurement tools to further explore
4. Why do we need to measure?
To inform treatment plans and areas in which to intervene
To help identify optimum techniques for the best clinical outcomes
Help demonstrate treatment effects
Useful in comparing different interventions
To show children, families and schools benefits of therapy
To encourage reflective practice: “ Has my intervention worked?”
To demonstrate outcomes for potential funding
To promote a common language
10. Original study with
CP sample –
Manualized
ASD Sample
Study -
Preschooler
ASD Sample
Study –School
Age
Validation Process:
Step by step
Ongoing
Different types of validation evidence
11. Appraisal process for valid use of an instrument :
Face Validity
Content
Construct
Criterion
12. Bottom Line:
Degree of confidence in interpreting results is dictated by your
interpretation of the how closely your population, practice setting
and purpose match the sample.
How to convey or document this?
18. Strategies to Optimize Reliability:
Restriction
Training and standardization
Averaging repeated measures
19. Bottom Line:
Your degree of confidence in interpreting results is dictated by how
reliable the measure is for your population and purpose
How to convey or document this?
20. Summary :
Validity: “Measures what it is intended to measure”
Reliability: “Measures same information over different situations”
Bottom Line:
Together this affects your degree of confidence in interpreting results
21. Clinician Rated vs Patient Reported
Clinician Rated
Examples – ?
Patient Reported
Examples - ?
Bottom Line :
There are benefits of incorporating both clinician-rated and patient-reported
instruments to measure overall performance
24. New or Recently Developed Measures:
Reviewed in the following 4 categories:
Body Function and Structure
Activity
Participation
Quality of Life
28. Spinal Alignment and Range of Motion
Measure (SAROMM)
Area of Assessment:
Posture and flexibility
Diagnosis/Age: (includes)
Children with CP
How to access: (free download)
http://www.canchild.ca/en/measures/saromm.asp
29. Selective Control Assessment of the Lower
Extremity (SCALE)
Area of Assessment:
Voluntary selective motor control of lower limb joints (hip, knee, ankle).
Diagnosis/Age:
Children with CP aged 4 to 18 years
How to access: (free download)
http://www.uclaccp.org/images/ResearchPapers/SCALE%20reliability%20and%2
0validity_DMCN%20Aug2009.pdf
30. The Chronic Pain Assessment Toolbox for
Children with Disabilities
Area of Assessment:
Chronic pain in pediatric disability clinical practice – 8 pain measures are
included
Diagnosis/Age:
Measures cover various populations of children and adolescents including:
CP, MD, RA, SB
How to access: (free download)
http://hollandbloorview.ca/TeachingLearning/EvidencetoCare/PainToolbox
33. Assisting Hand Assessment (AHA)*
Area of Assessment:
Hand function: Measures and describes how children with a unilateral
upper limb disability use their affected hand (assisting hand)
collaboratively with the non-affected hand in bimanual play.
Diagnosis/Age:
Children with a unilateral disability ( hemiplegia or obstetric brachial
plexus palsy) 18 months - 12 years
How to access: ( $ )
http://www.ahanetwork.se/aha.php ( includes psychometric properties)
34. Quality of Upper Extremity Skills Test (QUEST)*
Area of Assessment:
Quality of upper extremity function in four domains: dissociated movement,
grasp, protective extension, and weight bearing.
Diagnosis/Age:
Children with CP aged 18 months - 8 years
How to access: ( $ )
https://www.canchild.ca/en/measures/quest.asp
35. The Melbourne Assessment 2 (MA2)*
Area of Assessment:
Unilateral upper limb function and quality of upper limb movement
Diagnosis/Age:
Children with neurological conditions aged 2.5 - 15 years
How to access: ( $ )
http://www.rch.org.au/melbourneassessment/ (includes a long reference
section with +++ evaluative validity evidence)
36. School Version of the AMPS
(School AMPS)
Area of Assessment:
Student’s quality of schoolwork task performance (e.g., cutting, pasting, writing,
drawing, computing)
Diagnosis/Age:
Students 3 - 15 years experiencing challenges with schoolwork task performance
How to access: ( $ )
http://www.innovativeotsolutions.com/content/school-amps/
*http://www.innovativeotsolutions.com/content/wp-
content/uploads/2014/01/SchoolAMPSReportSupplement.pdf – see page 2
37. Gross Motor Function Measure (GMFM)*
Area of Assessment:
Evaluate change in gross motor function
Two versions: original 88-item measure (GMFM-88) and more recent 66-item
GMFM (GMFM-66)
Diagnosis/Age:
GMFM-66 version is ONLY valid for use with children with CP (5 m - 16 years)
GMFM-88 version also valid for use with children with Down Syndrome
How to access: ( $ for manual but the score sheets are free )
http://motorgrowth.canchild.ca/en/gmfm/overview.asp
38. Quality FM (GMPM)*
Area of Assessment:
Quality of movement related to ambulatory skills
To evaluate change over time in specific qualitative features, or attributes, of
gross motor behaviour
Diagnosis/Age:
It is a new version of the GMPM that is specifically designed for use with children
with CP, ages 4 and up, who are in GMFCS Levels I, II and III
How to access: ( $ )
http://motorgrowth.canchild.ca/en/GMPMQualityFM/qualityfm.asp?_mid_=2531
39. Handwriting Assessments ( $ )
The McMaster Handwriting Assessment Protocol - 2nd edition (Pollock et al., 2009)
Minnesota Handwriting Assessment (MHA) (Reisman, 1999)
Evaluation Tool of Children’s Handwriting (ETCH) (Amundson, 1995)
Children’s Handwriting Evaluation Scale (CHES) (Phelps & Stempel,1982, 1985)
Print Tool (Olsen, 2006)
Scale of Children’s Readiness for PrinTing (SCRIPT) (Weil & Amundson, 1994)
Test of Handwriting Skills-Revised (Milone, 2007)
41. Pediatric Evaluation of Disability Inventory –
Computer Adaptive Test (PEDI-CAT) *
Area of Assessment:
Abilities in the three functional domains of Daily Activities, Mobility and
Social/Cognitive plus a Responsibility domain
Diagnosis/Age:
Children and youth (birth through 20 years of age) with a variety of physical
and/or behavioral conditions
How to access: ( $ )
http://pedicat.com/category/home/
43. Canadian Occupational Performance
Measure (COPM)*
Area of Assessment:
Assesses an individual’s perceived occupational performance in the areas of
self-care, productivity, and leisure.
Diagnosis/Age:
Designed for use with all clients regardless of diagnosis (Law et al, 2004)
Validated with clients including : CP, Traumatic BI and Pediatrics
How to access: ( $ )
http://www.thecopm.ca/
44. Goal Attainment Scale (GAS) *
Area of Assessment:
Client’s occupational goal(s) achievement
Diagnosis/Age:
Children with developmental, physical, and communication needs (McDougall &
King , 2007)
How to access: (free download)
http://canchild.ca/elearning/dcd_pt_workshop/assets/planning-interventions-
goals/goal-attainment-scaling.pdf
45. Goal Attainment Scale (GAS)*
Scoring:
-2 = Much less than expected (Worst clinically plausible condition)
-1 = Somewhat less than expected
0 = Expected level
+1 = Somewhat better than expected
+2 = Much better than expected
46. Perceived Efficacy and Goal Setting (PEGS)
Area of Assessment:
A measure that uses children's self-reported performance on everyday tasks
to establish and prioritize occupational therapy interventions.
Diagnosis/Age:
For children who are chronologically or developmentally at a 6 – 9 year-old
level. It can be used with children of all type of disabilities and severity, as long
as they can formulate a response
How to Access: ( $ )
http://participation-
environment.canchild.ca/en/perceived_efficacy_goal_setting_pegs.asp
47. The WeeFIM II® System*
Area of Assessment:
Functional performance in three domains: self-care, mobility, and cognition
Diagnosis/Age:
Children and adolescents with acquired or congenital disease
How to access: ($$$$)
http://www.udsmr.org/WebModules/WeeFIM/Wee_About.aspx
48. School Function Assessment (SFA)
Area of Assessment:
Three parts:
1. Participation in school-related activities
2. Task supports
3. Activity performance of specific school-related functional activities
Diagnosis/Age:
Used for elementary students (K-6) with disabilities
How to Access: ( $ )
www.peasronassessments.com
*http://images.pearsonclinical.com/images/assets/SFA/SFAOverview.pdf
49. Physical Tasks:
Travel, Up/down stairs, Maintaining and changing positions and
Recreational movement
Manipulation with movement, Using materials and Setup and cleanup
Eating and drinking, Hygiene and Clothing management
Written work, Computer and Equipment use
50. Cognitive/behavioural Tasks:
Memory and understanding
Functional communication
Following social conventions
Compliance with adult directives and school rules
Task behaviour/completion
Positive interaction
Behaviour regulation
Personal care awareness
Safety
53. The Participation and Environment
Measure for Children and Youth (PEM-CY)
Area of Assessment:
Parent-report measure that asks about participation in the home, school and
community, along with environmental factors within each of these settings.
Diagnosis/Age:
Children and youth, with and with out disabilities, ages 5 - 17.
How to access: ( $ )
http://participation-
environment.canchild.ca/en/participation_environment_measure_children_youth.asp
54. The Child and Adolescent Scale of
Participation (CASP)
Area of Assessment:
Measures the extent to which children participate in home, school, and
community activities as reported by family caregivers.
Diagnosis/Age:
For children with traumatic and other acquired brain injuries (ABI). A youth
report version is also available.
How to Access: (free download)
The CASP is provided with open access for download from :
Click here
55. Child Occupational Self Assessment (COSA)
Area of Assessment:
Children's and youth's perceptions regarding their own sense of occupational
competence and the importance of everyday activities
Diagnosis/Age:
Children and youth's with disabilities
How to Access: ( $ )
http://www.cade.uic.edu/moho/productDetails.aspx?aid=3
57. Caregiver Priorities and Child Health Index
of Life with Disabilities (CPCHILD)
Areas of Assessment:
Caregivers perceptions of their child’s health status and well-being
Diagnosis/Age:
Children aged 5-12y with severe CP
How to Access: (free download)
http://www.sickkids.ca/pdfs/Research/CPChild/6573-CPCHILD_manual.pdf
58. The Cerebral Palsy Quality of Life
Questionnaires (CP QOL-Child & Teen)
Areas of Assessment:
Quality of Life ( QOL)
Diagnosis/Age:
Children with cerebral palsy aged 4-12 years & adolescents aged 13-18 years
How to Access: (free download)
http://www.cpqol.org.au/questionnaires_manuals.html
59. Neuro QOL
Areas of Assessment:
Health-related quality of life
Diagnosis/Age:
Children with neurological disorders:
Epilepsy
Muscular Dystrophies
How to Access: ( free download)
http://www.neuroqol.org/Pages/default.aspx
60. Summary
Reviewed :
20 + measurement instruments
4 broad categories:
Body Function and Structure
Activity
Participation
Quality of Life
61. Classification Systems (CP)
Gross Motor Function Classification System (GMFCS)
Manual Ability Classification System (MACS)
Eating and Drinking Ability Classification System (EDACS)
Communication Function Classification System (CFCS)
62. Resources (links):
Can be downloaded for free at:
GMFCS: http://motorgrowth.canchild.ca/en/gmfcs/resources/gmfcs-er.pdf
MACS: www.macs.nu
EDACS: http://www.sussexcommunity.nhs.uk/get-involved/eating_drinking_classification.htm
CFCS: http://cfcs.us
63. Gross Motor Function Classification System
(GMFCS)
5 level classification system
Describes gross motor function
self-initiated movement (emphasis on sitting, walking, and wheeled mobility)
Children and youth with CP
Click on the links below for further information:
GMFCS - Original Version (1997)
GMFCS - Expanded and Revised Version (2007)
64. GMFCS – E & R
Gross Motor Function Classification System
ExpandedandRevised
LEVEL I - Walks without Limitations
LEVEL II - Walks with Limitations
LEVEL III - Walks Using a Hand-Held Mobility Device
LEVEL IV - Self-Mobility with Limitations; May Use Powered Mobility
LEVEL V - Transported in a Manual Wheelchair
65. Manual Ability Classification System for Children
with Cerebral Palsy 4-18 years ( MACS)
I. Handles objects easily and successfully.
II. Handles most objects but with somewhat reduced quality and/or speed of
achievement.
III. Handles objects with difficulty; needs help to prepare and/or modify activities.
IV. Handles a limited selection of easily managed objects in adapted situations
V. Does not handle objects and has severely limited ability to perform even simple
actions.
68. Communication Function Classification System
(CFCS) for Individuals with Cerebral Palsy
Level I - Effective Sender and Receiver with unfamiliar and familiar partners.
Level II - Effective but slower paced Sender and/or Receiver with unfamiliar
and/or familiar partners.
Level III - Effective Sender and Receiver with familiar partners.
Level IV - Inconsistent Sender and/or Receiver with familiar partners.
Level V - Seldom Effective Sender and Receiver even with familiar partners.
71. Student Summary of Functional Abilities and School Therapy Goals
Name: Date(s):
School: Category Designation:
Diagnosis:
Fine Motor or MACS (CP): Gross Motor or GMFCS (CP):
Eating and Drinking or EDACS (CP): Communication or Communication Function
Classification System (CFCS):
Vision Hearing:
Psych Ed: Technology:
Goals:
Equipment:
72. Key Messages
Simple clinical classification systems are available to describe gross motor,
manual ability, eating and communication function of young people with
cerebral palsy.
These systems are complementary to traditional biomedical descriptions of
disorders and disabilities.
The systems are free, easily accessible, usable by, and acceptable to parents
and school staff
Help with communication amongst interprofessional team members
73. Resources of Appraised Reviews of
Measurement Instruments
WHERE TO FIND INFO REGARDING MEASUREMENT INSTRUMENTS
74. Resources of Appraised Reviews of
Measurement Instruments
Rehabilitation Measures Database
McMaster website
Child Development & Rehabilitation website
TherapyBC website
The Children's Trust ( BI)
COMBI (BI)
75. Resources of Appraised Reviews of
Measurement Instruments
Spinal Cord Injury Rehab Evidence ( SCIRE)
Stroke Engine
Archives of Physical Medicine
HaPI – Health and Psychosocial Instruments
Cosmin
90. About CP – Assessments and Outcome Measures
https://www.cerebralpalsy.org.au/about-cerebral-palsy/assessments-and-
outcome-measures/
91. A few more resources:
The Center for Outcome Measurement in Brain Injury ( COMBI)
http://www.tbims.org/combi/
Spinal Cord Injury Rehab Evidence (SCIRE) Common Measures used in SCI
Clinical Practice are available for download here:
http://www.scireproject.com/outcome-measures
Stroke Engine - Common Assessments used in Stroke Clinical Practice
http://www.strokengine.ca/assess/
92. A few more resources:
Archives of Physical Medicine has a section on measurement tools
http://www.archives-pmr.org/content/measurementtools
HaPI – Health and Psychosocial Instruments
http://www.bmdshapi.com/index.html
Systematic Reviews of Measurement Instruments – COSMIN
http://www.cosmin.nl/Ssystematic-reviews-of-measurement-properties.html
95. References:
Amundson, S.J. (1995). Evaluation Tool of Children’s Handwriting. Homer, AK: OT Kids
Bartlett, D., & Purdie, B. (2005). Testing of the Spinal Alignment and Range of Motion Measure:
a discriminative measure of posture and flexibility for children with cerebral palsy.
Developmental Medicine & Child Neurology, 47(11), 739-743.
Bower, E. (2013), Using the Assisting Hand Assessment and the Mini-AHA for clinical evaluation
and further research and development. Developmental Medicine & Child Neurology, 55: 977–
978. doi: 10.1111/dmcn.12229
DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1993). The reliability
and validity of Quality of Upper Extremity Skills Test. Physical and Occupational Therapy in
Pediatrics 13(2), 1-18.
de Vet, H. C. W., Terwee, C. B., Mokkink, L. B., & Knol, D. L. (2011). Measurement in medicine.
New York, NY: Cambridge University Press.505 class notes
96. Fowler, E. G., Staudt, L. A., Greenberg, M. B., & Oppenheim, W. L. (2009). Selective Control
Assessment of the Lower Extremity (SCALE): development, validation, and interrater reliability of
a clinical tool for patients with cerebral palsy. Developmental Medicine & Child Neurology, 51(8),
607-614.
Kozlowski, A. (2014, January). Measurement in Assessment , Planning and Evaluation. RHSC 505.
Lecture notes from University of British Columbia, Vancouver, BC
Krumlinde‐Sundholm, L., Holmefur, M., Kottorp, A., & Eliasson, A. C. (2007). The Assisting Hand
Assessment: current evidence of validity, reliability, and responsiveness to change.
Developmental Medicine & Child Neurology, 49(4), 259-264.
Mayson, T. ( 2007) Outcome Measures: A Primer Sunny Hill Health Centre for Children
97. Milone, M. (2007). Test of Handwriting Skills-Revised. Novato, CA: Academic Therapy
Publications
Olsen, J., & Knapton, E. (2006). The Print Tool (2nd ed.). Cabin John, MD: Handwriting Without
Tears.
Phelps, J., & Stempel, L. (1987). The Children’s Handwriting Evaluation Scale for (Cursive,
Manuscript) Writing. Dallas, TX: Texas Scottish Rite Hospital for Crippled Children (Available thru
SoftDesign)
Pollack, N., Lockhart, J., Flowers, B., Sample, K., Webster, M., Farhat, L., Jacobson, J., Bradley, J. &
Barnetti, S. (2009). Handwriting Assessment Protocol- 2nd ed. McMaster University CanChild
www.canchild.ca/en/measures/handwritingassessment.asp
Reisman, J. (1999). Minnesota Handwriting Assessment: San Antonio, TX: Pearson
98. Saether, R., Helbostad, J. L., Riphagen, I. I., & Vik, T. (2013). Clinical tools to assess balance in
children and adults with cerebral palsy: a systematic review. Developmental Medicine & Child
Neurology, 55(11), 988-999.
Weil, Marsha, & Amundson, Susan. (1994). Relationship between visuomotor and handwriting
skills of children in kindergarten. American Journal of Occupational Therapy, 48(11), 982-988.
Wright, F. V., & Majnemer, A. (2014). The Concept of a Toolbox of Outcome Measures for
Children With Cerebral Palsy Why, What, and How to Use?. Journal of child neurology, 29(8),
1055-1065.
World Health Organization (Ed.). (2007). International Classification of Functioning, Disability,
and Health: Children & Youth Version: ICF-CY. World Health Organization.
Editor's Notes
Following this session, it is my hope that you will be able to meet these learning objectives.
Describe how to determine which measurement instruments are the best match for my measurement needs
Describe validity and how validity is determined
Describe reliability and ways to improve reliability
Describe broad categories of measurement tools based on the International Classification of Functioning, Disability and Health (ICF)
Locate resources of appraised reviews of relevant measurement instruments
Identify at least 2-3 new measurement tools to further explore
As we are both OTs and PTs, I will mainly focus on measurement instruments for children with major motor impairments, however I will also be touching on some handwriting measurement instruments, as this is an area of interest for me.
Also – to clarify – I will not be going into much detail, AT ALL, regarding each measure. Mainly the title and some very basic information – just enough to allow you to decide if you would like to further evaluate this measure for use in your setting, for your population and purpose.
So at this point, I thought we could incorporate a little bit of measurement. If you could all please fill out the pre-inservice questionnaire :
Please rate your opinion (by circling numbers) of the importance of the below skills as they relate to your work, as well as rating your performance and satisfaction with your current knowledge and skill level:
1 = Not important, not able, not satisfied …………...up to 10 = extremely important, able to do extremely well and extremely satisfied
Just to clarify – there are many different terms used in measurement . These include “Measurement tools” or “Measurement instruments” “Assessments” “Standardized assessments” “Tests” “Questionnaires” and “Outcome measures”.
In regards specifically to “outcome measures” - Some researchers and authors use “outcome measures” as a broad, umbrella term whereas others use it to mean only an evaluative tool - which is used for measuring change over time. I know we will be discussing this further in the second half of our time today so we can leave this discussion for then.
It is my hope that highlighting this will help to bring some clarity to this topic in general.
To inform treatment plans and areas in which to intervene
To help identify optimum techniques for the best clinical outcomes
Help demonstrate treatment effects
Useful in comparing different interventions
To show children, families and schools benefits of therapy
To encourage reflective practice: “ Has my intervention worked?”
To demonstrate outcomes for potential funding
To promote a common language
Add in somewhere that this is important because we know so much of our tx is yellow –also read the Data Driven article again by Schaaf – in this folder
Determining validity is a process and hence the term - The “Validation process” .
A good place to start when you are interested in measurement is to determine “What is the purpose of my measurement”?
Is everyone familiar with these different purposes?
Quick review:
To discriminate i.e. is child able to do age appropriate activities - WHAT ARE SOME EXAMPLES OF DISCRIMINATIVE MEASURES ? Peabody, BO, VMI. -- Testing helps us to describe the extent and nature of impairment and activity limitations.
To predict i.e. how the child will do in future - WHAT ARE SOME EXAMPLES OF PREDICTIVE MEASURES?? VMI – predictive of printing readiness. Screening measures can also be predictive.
To evaluate i.e. measure change over time -WHAT ARE SOME EXAMPLES OF EVALUATIVE MEASURES?? GMFM, QUEST, MHA, COPM
To plan i.e. assess present skills and make plans on how to proceed and progress - many measures help in this regard.
Next we want to think about the child or in other words – “What is the population we are looking at?”
In terms of terminology – just to clarify – the children we work with are considered to be part of “the population” that we are looking at. In a research study/article the children in the study are referred to as “a sample” . So in essence they are “a sample of a population”. So if I work with school aged children with CP – that would be my population of interest. In a study for example, there might be 20 school-aged children with CP – and that would be the sample.
We need to define our “population of interest” – in general we look at 3 areas:
Age
Suspected or known diagnosis ( population)
Presenting challenges
Next we need to have a clear definition of the construct or issue or problem or concern to be measured.
Just to keep it simple I am going to be referring this as “a construct” for this presentation - so construct means issue to be measured.
The construct needs to be meaningful and valuable ! For example – “printing legibility”
So to bring what we have been talking about together, an example might be – “Discriminative evaluation of printing legibility of an Elementary-aged child with autism” or “Evaluative measurement of walking speed in an Elementary-aged child with CP”. In these example – purpose, child and construct are clearly defined.
We will look to the next slide to help us categorize constructs into different areas ……………..
We can use the International Classification of Functioning, Disability and Health (ICF) to classify outcomes to promote a common language.
Is everyone familiar with the ICF??
Ask - What are some examples of constructs?
- Body Function and Structure for e.g.: Vision or Strength or Sensation or Tone ( Impairment, )
- Activity - for e.g.: Fine motor skills or Gross motor skills or Visual perceptual skills (Limitation)
- Participation - for e.g.: being on a sports team, going to a birthday party (Restriction)
- Quality of Life – social interactions, health etc.
Does this make sense to everyone?
Once you have defined your purpose, the child, and the construct that you would like to measure …..then you begin searching for an appropriate measurement tool. Bottom line is that we often need to look or search in more than one area ( not just the test manual) ……….. as validation is a step by step and ongoing process and you may not find all the information you need in the test manual. It is best to look at the research literature for this.
To clarify - a measurement tool is typically developed for a specific purpose in a specific sample of the population of interest. Then it is often used in other research, possibly with other, different samples. What we need to do as clinicians, is to integrate different types of validation evidence to come to a conclusion about the degree of validity of the instrument for our specific purpose and population. This allows us to know how confident we can be in the results.
So we should not think of a measurement instrument as being valid in and of itself………………….but that an measurement instrument is valid for my purpose and population. Its really about validating the tool’s use with our population & purpose in order to determine our confidence with the interpretation of test scores.
This is what the dots on the slide show……..the original study lead to an MI being published ( with a sample of the CP population). However later it was also used in studies with different sample (eg ASD – preschooler and school aged). You would now know that the test had been validated in these populations.
What we need to ask ourselves is : “ how closely the study clinically relates to my practice.“
Occasionally you will find studies with sample characteristics that match your clinical population. But more often the characteristics will differ.
So why does this matter to your practice?
Because as the sample and population characteristics differ more, you might have less confidence in applying the results to your clients. However, we often have no directly relevant evidence to support the use of a specific instrument with a specific client, so we use the best evidence available, and adjust our interpretation of results to reflect the evidence gap and our confidence.
Reference: 505
Once you have the manual and other research studies in front of you - you would appraise them. Again you are looking to see if the MI is a good match for your specific client and for your specific purpose.
You would also look at psychometric properties of the MI – starting with validity.
As we know, there are various types of validity, including face, content, criterion and construct validity
Is everyone familiar with the basic types of validity? If not - you can refer to the handout titled : “Outcome Measures: A Primer” for more information. Pg. 4 and 5
So to summarize - Validation focuses on the scores produced by a measurement instrument and not on the instrument itself. Thus, as clinicians, it cannot be stated that a measurement instrument is valid, only that is provides valid scores in the specific situation in which has been used.
So we need to be aware that measurement instruments have been validated in a specific situation or for a specific purpose and that if they are applied in another target population or form of administration that this should be considered to be a new situation and would affect validity and therefore our interpretation of the scores.
Your degree of confidence in interpreting results is dictated by how closely your population and purpose match the sample or samples in studies that do show good validity.
Does this make sense ? ( This is objective 1 – understanding this process of how validity is determined and then applied in clinical practice)
Ask: How do you document your confidence ?? So how would you interpret and communicate scores from adapted testing situations, when you feel the validity of the scores is in question?
Answer: document test adaptations or document that the sample is not the same as your population and then note in the clinical record that scores need to be interpreted with caution. There are other points consider but I am not able to cover them all today.
GIVE AN EXAMPLE – So for example I note that the handwriting assessment that I often use– the MHA – has not been normed for children with autism – I write this in the appendix of my reports and I say the score needs to be interpreted with caution .
TEST DESCRIPTION AND RESULTS
As is always the case with developmental tests, current scores reflect performance within this setting at this time. It should be noted that the normative data for this test was derived from a sample not specific to current diagnostic category. Therefore results should be interpreted with caution. Please refer to report for interpretation of test results.
It is important to also know about the reliability of the instrument you are considering for use in your practice setting.
Is the MI reliable? - Reliability refers to whether a measure is giving the same information over different situations.
Is everyone familiar with the basic types of reliability? If not - you can refer to the handout again - titled : “Outcome Measures: A Primer” for more information. Pg. 3 and 4
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This site gives values for how to rate reliability : ie - excellent/adequate/poor reliability as well as validity information .
Ranges of reliability co-efficients
What is considered EXCELLENT vs ADEQUATE vs POOR for each type of reliability.
What can constrain or affect measurement?
Environment/Materials –
- NB to be able to use quiet, distraction-free spaces, of the correct size and configuration for the intended test purposes. Interruptions, distractions, noise and crowding can be problems.
- Missing or poorly calibrated test materials can further affect clinical utility…...
Staff:
Best to have the same person conducting the pre and post testing.
Time: Time of assessment within the day can vary and for some children this can affect results. Also certain lengthy tests also can potentially affect the outcome.
Reference is (de Vet et al., 2011).
Strategies to optimize reliability incorporate restriction, training/standardization and averaging of repeated measures
Restriction (means - avoiding variation) includes ensuring that instruments are in good working order, measuring the child at the same time of day, and ensuring that the circumstances of the test environment are as similar as possible to those described in the manual ( such as avoiding environmental distractions). Avoid cueing and coaching as appropriate..
Training and standardization encompasses detailed and thorough initial and ongoing training in administration and scoring, use of scripts, and consistent use of the manual in scoring (rather than scoring from memory).
Averaging repeated measures, especially when doing research.
In general if you are concerned about the validity and reliability of a test or measure for your use, you may want to combine it with use of another measure and of course never rely solely on the results of one test as our interpretation requires use of our clinical judgement and reasoning when making decisions and interpretations.
There are other factors to consider such as floor and ceiling effects, SEM, but I am not able to cover this all today. Should be aware of these concepts for the measures that you use or would like to use as again this will affect your interpretation of the test results. Please refer to the same handout for more information.
Reference is (de Vet et al., 2011).
Your degree of confidence in interpreting results is dictated by how closely your population and purpose match the samples in studies that did show good reliability.
Does this make sense ? This is objective 2 – understanding how reliability is determined and then applied in clinical practice.
Ask??: How would you interpret and communicate scores from adapted testing situations, when you feel the reliability of the scores is in question? ( for example you know the test has poor reliability or you tested the child at different times of the days pre and post and you feel this affected reliability ?)
Answer: documenting test adaptations or concerns and note, in the clinical record, that scores need to be interpreted with caution.
So in summary :
Validity: “Measures what it is intended to measure”
- Validity is a ongoing process
- A test is not valid – instead we need to determine if it produced valid scores for our purpose and population
- Evidence of validity - how well it matches our purpose and population - affects our confidence
Reliability: “Measures same information over different situations”
Use strategies to optimize reliability
Bottom Line:
Together, evidence of validity and reliability for your purpose and population affects your degree of confidence in interpreting results
Before we move on - I would like to point out that it is also useful to think about whether a measurement instrument is Clinician Rated or Patient Reported ?
Clinician Rated
What are some Examples - ??? Goal Attainment Scale (GAS) or the Beery (VMI) or the MBAC
Patient Reported
What are some Examples - ??? - Canadian Occupational Performance Measure (COPM) or The Participation and Environment Measure for Children and Youth (PEM-CY)
Which type do you think we mainly use?
Bottom Line :
There are benefits of incorporating both clinician-rated and patient-reported instruments to measure our clients’ overall performance – such as more confidence in our results and findings. Also with use of a PR measure we can better identify the main priorities and needs of the family and child.
So in this next section I will be covering various measurement instruments.
So just a few disclaimers or things to note:
I have only included those that cover the “school aged population” and that are new or newish ( last 10-15 years of so)
I will be focusing on measures that are suitable mainly for children with major motor impairments.
Again, as I mentioned before, I will not be going into a lot of detail due to time restrictions but I hope to give you enough information so that you would know if a test or measure might hold promise for you and your caseload or team. Lastly, to clarify ….I am not personally familiar with most of these….
I will be using the International Classification of Functioning, Disability and Health (ICF) to classify outcomes
The constructs that we previously reviewed would fit under each domain.
Does anyone have any questions about the ICF before I move onto the next section?
The measures I will be reviewing are meant to spark interest and lead to further review and investigation.
Maybe in the future, small groups in each district would like to further review a certain measure to look at it in more detail and then bring back to this group to share???
Measurement instruments will be reviewed in the following 4 categories:
3 ICF categories plus a few Q of L measures.
Body Function and Structure
Activity
Participation
Quality of Life
This is an excellent article that I would encourage you to read. Many other measures are covered in detail in this very recent article.
If anyone is familiar with a measure – esp. the newer ones --- please lift your hand up – I have tags made up that say “ I have an opinion on the X measure”. If you feel comfortable you can wear this tag and during the break others will know they can come talk to you if they have any thing they would like to discuss – does this sound ok?
Just another “General Disclaimer”: there may be other diagnoses that each test has been validated for….I have only listed the ones I think are relevant to us.
Body Structure and Function: I will not cover older measures such as the Ashworth Scale and Tardieu Scale
The links for “How to Access” may actually be links to the measure for “free download” or they may be links to ordering and other information. I have indicated if free or not.
Spinal Alignment and Range of Motion Measure (SAROMM)
A discriminative measure of “posture and flexibility” for children with cerebral palsy
FREE
Is anyone familiar with this measure?
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Reference : Reliability and validity testing conducted for children with cerebral palsy is reported in Developmental Medicine and Child Neurology (Bartlett & Purdie,2005)
http://www.canchild.ca/en/measures/saromm.asp
Bartlett, D., & Purdie, B. (2005). Testing of the spinal alignment and range of motion measure: A discriminative measure of posture and flexibility for children with cerebral palsy. Developmental Medicine & Child Neurology, 47(11), 739-743.
Selective Control Assessment of the Lower Extremity (SCALE)
Measures - Ability to move each LE joint selectively as well as a rating of ability to reciprocate movement, speed and generation of force
Children with CP aged 4 to 18 years
FREE
Is anyone familiar with this measure?
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From Wright tool box article
(guidelines provided in Fowler et al, 2009)
The Chronic Pain Assessment Toolbox for Children with Disabilities
A compendium of resources - many chronic pain measures are included
Diagnosis/Age:
Measures cover various populations of children and adolescents including: CP, MD, RA, SB
FREE
Is anyone familiar with this toolbox ?
Activity Measures
Activity Measures
* EVALUATIVE - I have used a * ( ASTERISK) to denote if designed or if there is some evidence of use to measure change over time.
The AHA is a criterion-referenced scale for *evaluating change over time. This is not a norm-referenced scales and was not developed to discriminate children from the norm.
Area of Assessment:
Hand function: Measures and describes how children with a unilateral upper limb disability use their affected hand (assisting hand) collaboratively with the non-affected hand in bimanual play.
Diagnosis/Age:
Children with a unilateral disability ( hemiplegia or obstetric brachial plexus palsy) 18 months - 12 years
Not free ( $ )
Who can use the AHA?
To become a certified AHA-rater a 3-day training course and the completion of a number of calibration cases is required.
Is anyone familiar with this measure??
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http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12229/full
GOOD ONE TO OPEN hyperlink
Area of Assessment:
Quality of upper extremity function in four domains in Children with CP aged 18 months - 8 years
Not free ( $ )
A license is required to use the QUEST.
CAN BE USED TO MEASURE CHANGE OVER TIME – Evaluative*
Is anyone familiar with this measure???
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DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1993). The reliability and validity of Quality of Upper Extremity Skills Test. Physical and Occupational Therapy in Pediatrics 13(2), 1-18.
--- “QUEST was responsive to changes in quality of movement after upper extremity casting in a study of 72 children with cerebral palsy”.
Area of Assessment:
Unilateral upper limb function and quality of upper limb movement
Diagnosis/Age:
Children with neurological conditions aged 2.5 - 15 years
Not free ( $ )
Each child's test performance is video recorded for subsequent scoring
Has been validated for the purpose of evaluation of change over time.
Is anyone familiar with this measure???
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http://www.rch.org.au/melbourneassessment/about_ma2/Psychometrics_of_the_MA_and_MA2/
http://www.rch.org.au/melbourneassessment/about_ma2/References/
LONG LIST
Area of Assessment:
Student’s quality of schoolwork task performance (e.g., cutting, pasting, writing, drawing, computing)
Diagnosis/Age:
Students 3 - 15 years experiencing challenges with schoolwork task performance
Not free ( $ )
The School AMPS is used to:
Test a student in his or her usual classroom setting, as he or she is performing schoolwork tasks (27 standardized schoolwork tasks can be observed)
Measure the quality of performance.
Need to attend a specialized training course in the standardized School AMPS administration procedure and be calibrated as a valid and reliable School AMPS rater
Is anyone familiar with this measure??
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http://www.innovativeotsolutions.com/content/wp-content/uploads/2014/01/SchoolAMPSReportSupplement.pdf – see page 2
Long reference list : http://www.innovativeotsolutions.com/content/wp-content/uploads/2012/11/Schoolrefbyauthor.pdf
Are most of you familiar with this measure?
Area of Assessment:
Evaluate change in gross motor function
Two versions: original 88-item measure (GMFM-88) and more recent 66-item GMFM (GMFM-66)
Diagnosis/Age:
GMFM-66 version is ONLY valid for use with children with CP (5 m - 16 years)
GMFM-88 version also valid for use with children with Down Syndrome
Not free( $ )
This MI is designed to measure change over time – EVALUATIVE
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http://motorgrowth.canchild.ca/en/gmfm/overview.asp
Are most of you familiar with this measure?
Area of Assessment:
Quality of movement related to ambulatory skills
To evaluate change over time in specific qualitative features of gross motor behaviour
Diagnosis/Age:
It is a new version of the GMPM that is specifically designed for use with children with CP, ages 4 and up, who are in GMFCS Levels I, II and III
This MI is designed to measure change over time – EVALUATIVE
It is an Observational instrument
The Quality FM is rated from a video of the child's performance of the Stand and Walk/Run/Jump items of the GMFM.
Not free( $ )
Certification training is required prior to use of the Quality FM. Need to attend a course.
Here is a list of some common handwriting assessment tools. All must be purchased. None are free – the latest version of the McMaster is no longer free.
Handwriting assessment and handwriting in general could be a in-service session in itself ( if there is the interest) – therefore I will not be covering in detail due to time
Also – I did review the MHA for my 505 measurement class and I have written a critical appraisal of it - that describes the MHA in great detail. I have a couple copies available here - if any one would like to see it - and also it will soon be available on our CDR website.
Are most of you familiar with this measure?
The Pediatric Evaluation of Disability Inventory (PEDI), originally published in 1992, has been revised as a “computer adaptive test” (CAT)-the PEDI-CAT.
PEDI manual version ( paper version ) was only validated from 6 months to 7 years but the PEDI CAT goes to 20 yrs. of age
Measures abilities in the three functional domains of Daily Activities, Mobility and Social/Cognitive - WHICH I WILL REVIEW ON THE NEXT SLIDE plus a Responsibility domain measures the extent to which the caregiver or child takes responsibility for managing complex, multi-step life tasks.
Can be administered by professional judgment of clinicians or educators who are familiar with the child or………….. by parent report
COST: Ordering Information and Cost
PEDICAT costs $89.00 for a one-year license and can be purchased for Windows and iPad.
Daily Activities: Getting Dressed, Keeping Clean, Home Tasks, and Eating & Mealtime
Mobility: Basic Movement & Transfers, Standing & Walking, Steps & Inclines, Running & Playing and Wheelchair
Social/Cognitive: Interaction, Communication, Everyday Cognition, and Self Management
Responsibility: Organization & Planning, Taking Care of Daily Needs, Health Management, and Staying Safe
This MI is designed to measure change over time – EVALUATIVE
Are most of you familiar with this measure?
Area of Assessment:
Assesses an individual’s perceived occupational performance in the areas of self-care, productivity, and leisure.
Diagnosis/Age:
Designed for use with all clients regardless of diagnosis (Law et al, 2004)
Validated with clients including : CP, BI and Pediatrics
Not free ( $ )
The COPM Web App -You can now administer the measure on your computer, tablet or smartphone with a web-based application. Safe, secure and convenient.
This MI is designed to measure change over time – EVALUATIVE
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Reference: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=928&Source=http%3A%2F%2Fwww.rehabmeasures.org%2Frehabweb%2Fallmeasures.aspx%3FPageView%3DShared
Are most of you familiar with this measure?
Area of Assessment:
Client’s occupational goal achievement - therefore - designed to measure change over time – EVALUATIVE
Diagnosis/Age:
Originally designed for mental health but has been modified and applied in many areas including several studies of the effects of pediatric therapy services for children with developmental, physical, and communication needs
Free
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King
http://canchild.ca/elearning/dcd_pt_workshop/assets/planning-interventions-goals/goal-attainment-scaling.pdf
Administration: Professionally administered semi-structured interview. Goals set w/ family & client.
GAS is conducted on a 5-pt measure with the degree of attainment captured for each goal area.
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Pros:
1. encourages communication and collaboration w multidisciplinary team members for goal setting and scoring 2. encourages patient involvement and communication 3. good measures of outcome b/c it avoids probs of standardized measures (floor/ceiling effects, lack of sensitivity to change, disjuncture between patient's main concerns and the domains of standardized measures 4. user-friendly
Cons:
1. Requires knowledge and experience to predict outcomes 2. Requires patient's ability to achieve goals 3. some clinician's find it too flexible and not easy to measure 4. 'weighting' for 'difficulty' can lead
This is another tool to help with goal setting --- Is anyone familiar w/ this measure?
Area of Assessment:
A measure that uses children's self-reported performance on everyday tasks to establish and prioritize occupational therapy interventions.
Diagnosis/Age:
For children who are chronologically or developmentally at a 6 – 9 year-old level. It can be used with children of all type of disabilities and severity, as long as they can formulate a response
Not free( $ )
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http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CCwQFjAD&url=http%3A%2F%2Fwww.childdevelopment.ca%2FLibraries%2FCollaborative_Goal_Setting%2FOverview_of_Goal_Setting_Tools_GAS_COPM_PEGS.sflb.ashx&ei=YddGVdf2D9broASD1IDQCg&usg=AFQjCNEecjryxamFDELudMDGs2ZOA5B4PQ&sig2=_DvUYLDqNGF9tiKmbRZF8w&bvm=bv.92291466,d.cGU
Assessment focus:
Measures child’s progress towards self-identified, individual goals
ICF: activity and participation; also could be used for body function/structure
Area of Assessment:
Functional performance in three domains: self-care, mobility, and cognition
Diagnosis/Age:
Children and adolescents with acquired or congenital disease
The WeeFIM® instrument was developed to measure the need for assistance and the severity of disability in children between the ages of 6 months and 7 years. But it can be used with children above the age of 7 years as long as their functional abilities, are below those expected of children aged 7 who do not have disabilities
Training or certification requirements: To use the WeeFIM assessors need to attend training and pass an online exam to become credentialed. Once an assessor has passed the exam, credentialing remains valid for two years, after which time the exam must be sat again. $4100 (in/outpatient)
Is anyone familiar with this measure???
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Is anyone familiar with this measure???
Area of Assessment:
Three parts:
Participation in school-related activities
Task supports
Activity performance of specific school-related functional activities
Diagnosis/Age:
Used for elementary students (K-6) with disabilities
( $ ) Pricing: $222.50
See attached handout and there is one on the Therapy BC website.
This assessment helps the practitioner set-up school based goals for the child. This assessment uses a collaborative effort to help your team to establish interventions for the child. This assessment could possibly be used during a quarterly evaluation to see the child is really progressing to meet his IEP goals. The SFA was designed to assist in the initial assessment of student needs and to evaluate the outcomes of services provided.
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Reference: http://otforchildrenassessmentportfolio.blogspot.ca/2013/04/school-function-assessment-sfa.html
Physical Tasks:
Travel, Up/down stairs, Maintaining and changing positions and Recreational movement
Manipulation with movement, Using materials and Setup and cleanup
Eating and drinking, Hygiene and Clothing management
Written work, Computer and Equipment use
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Cognitive/behavioural Tasks:
Memory and understanding
Functional communication
Following social conventions
Compliance with adult directives and school rules
Task behaviour/completion
Positive interaction
Behaviour regulation
Personal care awareness
Safety
A couple other measures that I would just like to mention are:
The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire for 3-16 year olds.
The Questionnaire of Young People’s Participation (QYPP): a new measure of participation frequency for disabled young people that includes education and school questions.
If you would like additional information about either one of these please email me.
Participation: Involvement in home life, involvement in Education, Community events and organizations, Social relationships
In case anyone asks : I am not reviewing - Children's Assessment of Participation and Enjoyment (CAPE) & Preferences for Activities of Children (PAC) – Measures outside of school so I am not reviewing
Is anyone familiar with this measure???
Area of Assessment:
Parent-report measure that asks about participation in the home, school and community, along with environmental factors within each of these settings.
Assesses participation and environmental factors at the same time
Designed to help parents, service providers and researchers better understand the participation of children and youth, ages 5 to 17.
Not free ( $ )
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Reference: http://participation-environment.canchild.ca/en/participation_environment_measure_children_youth.asp
Is anyone familiar with this measure???
CASP
Area of Assessment:
Measures the extent to which children participate in home, school, and community activities as reported by family caregivers.
Diagnosis/Age:
For children with traumatic and other acquired brain injuries (ABI). A youth report version is also available.
How to Access: (free download)
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http://participation-environment.canchild.ca/en/child_adolescent_scale_participation_casp.asp
Is anyone familiar with this measure???
COSA -
Area of Assessment:
Children's and youth's perceptions regarding their own sense of occupational competence and the importance of everyday activities
Diagnosis/Age:
Children and youth's with disabilities
How to Access: ( $ )
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Version 2 – 2014 update
Client directed assessment tool and an outcome measure
Using the instrument in therapy provides a young client with an opportunity to identify and address their participation in important and meaningful occupations
Its self-rating design allows the client to document his/her understanding of occupational competence and values using familiar visual symbols and simple language..
Quality of life (QOL) refers to an individual's perception of their wellbeing across various domains of life.
Social and emotional well-being, Participation and physical health, Pain and impact of disability, and Access to services
Is anyone familiar with this measure?
CPCHILD
Areas of Assessment:
A disease-specific measure of health status and well-being of children with severe cerebral palsy (CP).
Caregivers perceptions of their child’s health status and well-being
Diagnosis/Age:
Children aged 5-12y with severe CP
(free download)
Areas include:
1) Personal care
2) Positioning, transferring & mobility
3) Comfort emotions and behaviour
4) Communication and social interaction
5) Health
6) Overall quality of life
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Is anyone familiar with this measure?
CP QOL-Child & Teen
These instruments are useful for evaluating interventions designed to improve the lives of children and adolescents. The CP QOL - Child was first designed to assess the QOL of children with cerebral palsy aged 4-12 years and an adolescent version, the CP QOL – Teen has recently been developed for adolescents aged 13-18 years.
Self-report: 53 items. Parent Proxy: 66 items
How to Access: (free download)
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http://www.cpqol.org.au/
Can download questionnaires and manuals for free:
http://www.cpqol.org.au/questionnaires_manuals.html
Reference: http://www.biomedcentral.com/1471-2431/10/81/table/T3
Is anyone familiar with this measure?
Neuro-QoL is a set of self-report measures that assesses the health-related quality of life of children with neurological disorders.
Diagnosis/Age:
Children with neurological disorders:
Epilepsy
Muscular Dystrophies
free download
Summary --
Reviewed :
20 + measurement instruments
4 broad categories:
Are any of the measure I just reviewed of interest ? Would everyone be able to note 1-2 that they think might be relevant and worth further thinking about ( Objective 5) ?
Does use of the ICF make sense to everyone as a way to classify measures ?
I think by use of the ICF it helps to better define what construct or constructs we are looking at.
Also provides us with a common language.
Next I would like to briefly share some classification systems as these also help us use a common language.
These are all designed for children with CP
They are all free open access
How familiar is everyone with these classification systems ? Who is familiar with all 4 ?
Can all be downloaded for free.
Is everyone familiar with the GMFCS ?
5 level classification system
Describes gross motor function
Children and youth with CP
Distinctions between levels are based on functional abilities, the need for assistive technology, including hand-held mobility devices (walkers, crutches, or canes) or wheeled mobility, and to a much lesser extent, quality of movement.
All 4 of these classification systems are rated on a scale of 1-5 – with 1 being typical and 5 being the furthest from typical. This works well for consistency when you are using the measures together.
I. Handles objects easily and successfully.
II. Handles most objects but with somewhat reduced quality and/or speed of achievement.
III. Handles objects with difficulty; needs help to prepare and/or modify activities.
IV. Handles a limited selection of easily managed objects in adapted situations
V. Does not handle objects and has severely limited ability to perform even simple actions. Requires total assistance.
EDACS was developed as there was no agreement about how to rate the severity of someone’s eating and drinking ability.
The words “severe”, “moderate”, and “mild” are all used without an agreed definition.
(EDACS) offers an alternative to these subjective terms using five distinct descriptions of different levels of ability.
A few benefits:
EDACS enables clear and efficient communication about a child’s eating and drinking skills between professionals and between professionals and parents.
EDACS provides a method by which limited resources can be directed (e.g. dietitian’s time) to those children with the most severe difficulties, highest risk of malnutrition and therefore the greatest need.
EDACS contributes to the identification of treatment needs of children with CP (alternative feeding methods etc.)
I think that these benefits could be generalized to all 4 measures…………………
Algorithm
CFCS
Algorithm
Why would use of this type of summary sheet be helpful?
Interprofessional communication
When clients are transitioning between therapists
Use for teaching with OT students
I have included this in your handout – at the end
Where to find info regarding Measurement instruments
There are very few MI’s that we use on this site however relevant examples:
Ashworth Scale / Modified Ashworth Scale
Braden Scale (Pressure Ulcer)
COPM
Motor-free Visual Perception Test
TVPS
293 total
COPM –
For each instrument – it reviews purpose, ICF domain, PRO vs CRO etc
Review time to administer, cost, age range, populations tested etc.
SEM and Minimal Detectable Change
Reliability data ( co-efficients)
Reliability info
Validity
Various types of validity
Various types of validity
I have the Mc Master handout it you would like to see it…………..
Each link takes you to the abstract of each study
Child Development & Rehabilitation website
Clinical Measures and Goal Setting Resources
TherapyBC also has a good listing of measurement tools http://www.therapybc.ca/eLibrary/resources.php
The Children's Trust (Brain Injury Measures)
Not only does this new site called About CP look at MI but there is also a page on “Interventions and Therapies” – with ++ information regarding each therapy listed including effectiveness of research findings as per the traffic light evidence system. I would highly recommend checking this page out.
This About CP resource outlines the costs and effectiveness of interventions, as well as providing information on the applicability of the intervention for children with CP by:
Age, Type of CP Motor ability (GMFCS) Arm Ability (MACS) Communication Ability (CFCS) and Intellectual Ability.
Currently only the AHA
COMBI – OM in brain injury and SCIRE and Stroke engine are mainly adult but there are some measures covered that would be appropriate for use with all ages or esp for older teenagers with spinal cord injuries or strokes
There are also a couple of databases to search for measures specifically. Archives of Physical medicine and HaPI are two examples.
Lastly - COSMIN - A complete list of all systematic reviews of measurement properties of health status or QOL measurement instruments, published in PubMed or Embase
Updated regularly – 572
Pass around – I have 3 copies
For example I found on COSMIN a review of MI to measure bimanual performance in young children with hemiplegic cerebral palsy: a systematic review” (Greaves, Imms, Dodd, & Krumlinde-Sundholm, 2010)
RESULTS:
1435 papers retrieved, 15 were eligible for inclusion, and 11 assessments of bimanual performance were identified.
Ten assessments had inadequate evidence for reliability and validity.
Only the Assisting Hand Assessment had evidence for reliability and validity for its intended purposes.
If each group wants to review a measure here are 2 critical appraisal forms to use:
So at this point. If you could all please fill out the post-inservice questionnaire :
Please rate your opinion (by circling numbers) of the importance of the below skills as they relate to your work, as well as rating your performance and satisfaction with your current knowledge and skill level:
1 = Not important, not able, not satisfied …………...up to 10 = extremely important, able to do extremely well and extremely satisfied
Also – the general evaluation form – so that I can have some feedback about this session.
Thank you
Move to the next slide!