Carolina Bottari, Él - Canadian Association of Occupational Therapists

Choosing the most appropriate environment
to evaluate independence in everyday activities: Home or clinic?
Carolina Bottari, Élisabeth Dutil, Clément Dassa and Constant Rainville
Australian Occupational Therapy Journal (2006), 53 (2), 98-106.
Interpreting Activity of Daily Living Errors for Treatment and Discharge
Planning:
The Perception of Occupational Therapists
Carolina Bottari, Bonnie Swaine and Élisabeth Dutil
J Head Tauma Rehabil Vol. 22, No. 1, p. 52-56
Conference abstracts
Bottari, C., Dutil, E., & Vanier, M. (2004). Structuring the therapist not the
client: The ADL Profile approach to the measurement of independence in ADL
based on executive functions. Proceedings of the Toronto ABI Network
Conference, Toronto.
It is widely accepted that the principal cause of impaired independence in
everyday activities for individuals living with the effects of brain injury (BI) is
the range of complex behavioural and cognitive disturbances associated with
executive functions (frequently associated to frontal lobe functioning).
However, few activities of daily living (ADL) assessments permit an accurate
appraisal of the effect of related deficits (e.g. task initiation, planning, selfmonitoring, and error-correction) on independence because they are overly
structured. An assessment, the ADL Profile (Dutil et al., 2003), was thus
developed to provide a measure of independence in everyday activities
(personal and instrumental ADL) based on the specific needs of individuals
living with the effects of a BI. The purpose of this workshop will be to teach
participants, with the use of videos, the skill of administering the ADL Profile
assessment
approach.
This
performance-based
assessment
(ideally
administered in the home and community environment) includes specific
scenarios for the observation of 17 tasks. Instructions given to the patient are
kept to a bare minimum (non-structured approach) to allow for the observation
of behaviours related to executive functions. Scores obtained using the ADL
Profile have been shown to be reliable and valid. Mastery of this evaluation
approach should lead to more accurate recommendations (e.g. ability to live
independently versus need to live with family members, home safety) and more
optimal intervention strategies.
Bottari, C., Dutil, E., Robitaille, M., & Touré, M. (2005). Calling for bus
schedules: A necessary adjunct to assessments of everyday activities. CAOT
Conference 2005, Canadian Journal of Occupational Therapy- Conference
Program Supplement, p.27
Calling for information, though rarely evaluated, is required for independent
living. A pilot study using the ADL Profile with patients with cerebral
impairments and control subjects revealed atypical behaviours in the study
group. This task may contribute to estimating the consequences of the injury
on independence in everyday activities.
Bottari, C. & Dutil, E. (2005). He left the stove on: Can he be discharged
home? CAOT Conference 2005, Canadian Journal of Occupational TherapyConference Program Supplement, Vancouver, p.51
Occupational therapists (OTs) are frequently required to provide
recommendations regarding their clients’ ability to return home safely based
on ADL assessments. A determining factor is the correct analysis of errors of
performance. Objective: To explore which ADL behaviours OTs identify as
having been obtained from a normal group (NG) versus from individuals with
frontal lobe lesions (FLL). Method and analysis: A list of 26 ADL errors was
compiled and submitted to 47 OTs asked to identify the likely source
population. A descriptive analysis of the data (percentages) was completed.
Results: Only half the errors were related to the correct source population by
over 50% of the respondents. Ten errors obtained from the NG were related to
individuals with FLL by over 50% of respondents. Conclusion: OTs may over or
underestimate the importance of certain ADL errors if they do not consider the
frequency of errors and ability for self-correction.
Dutil, E., Bottari, C. (2005). The ADL Profile : a multifaceted analysis of
independence. Actes de congrès de la journée de recherche clinique du Centre
de réadaptation en déficience physique: Le Bouclier, Mirabel.
An assessment of independence in everyday activities must consider a
multitude of interrelated variables. Though it is becoming more widely
accepted that ADL independence is dependent upon both physical and cognitive
functioning, few evaluations extend their analysis to include executive
functioning, previous life habits, perception of subject and significant other
and environmental factors. The purpose of this paper is to present an
evaluation tool, called the ADL Profile, that guides the occupational therapist
through this multifaceted analysis of independence. This comprehensive tool
includes multiple task observations and semi-structured interviews for both the
subject and significant other. The originality of this evaluation is its high
ecological validity (real world setting) and its non-structured approach which
permits direct observation of behaviours related to executive functions such as
task initiation, planning, self-monitoring, and correction. Mastery of this multifaceted analysis of independence should lead to more optimal intervention
strategies for occupational therapists and their clients.
Bottari, C., Dutil, E., Robitaille, M., & Touré, M. (2005). Il est incapable
d’élaborer une séquence d’actions pour téléphoner : Est-ce attribuable à une
atteinte cérébrale? Actes du Congrès québécois de réadaptation en
traumatologie, Montréal.
Bien que téléphoner pour obtenir une information soit une tâche très
importante pour exercer de façon indépendante ses différents rôles, cette
tâche est rarement considérée dans les évaluations reliées aux activités de la
vie quotidienne (AVQ). Le Profil des AVQ, inclut cette tâche pour dresser le
profil d’indépendance dans les AVQ des personnes avec atteinte cérébrale. Une
méthode d’analyse des comportements observés lors de la réalisation de cette
tâche a été développée afin de mettre en évidence les erreurs reliées aux
processus exécutifs. OBJECTIF : Analyser les erreurs observées lors de la tâche
«téléphoner pour obtenir une information». MÉTHODOLOGIE: Cette tâche a été
administrée et filmée auprès de deux patients ayant une atteinte cérébrale
(traumatisme crânien et démence) pairés à quatre sujets contrôles. L’analyse
des erreurs a été faite par deux ergothérapeutes entraînés à l’outil avec une
méthode d’analyse reposant sur les fondements du modèle de Luria et un score
d’indépendance à la tâche a été établi en se basant sur l’échelle de cotation
du Profil des AVQ. RÉSULTATS : Les erreurs observées dans cette tâche
distinguent les patients des sujets contrôles (ex. :manque de stratégie pour
rechercher l’information demandée, difficulté à être centré sur la tâche,
absence d’auto-correction). CONCLUSION ET PERTINENCE: Cette tâche, très
brève à administrer et peu coûteuse, pourrait aider l’équipe à formuler des
hypothèses en regard des erreurs observées avec cette méthode d’analyse et à
mieux justifier les interventions pour maximiser le retour à l’indépendance des
personnes avec atteinte cérébrale.
Guillemette, M., Dutil, E., Bottari, C., & Bachand, N. (2006). Une étude
normative sur une tâche de gestion financière. CAOT Conference 2006,
Canadian Journal of Occupational Therapy- Conference Program Supplement
Introduction : Les personnes ayant subi un traumatisme crânien peuvent
éprouver des difficultés au plan de la gestion financière. Cependant, en
l’absence de comparaison avec des sujets normaux, il est difficile lors de
l’évaluation en ergothérapie de discriminer les erreurs normales des erreurs
associées au traumatisme crânien. Objectif : Déterminer les erreurs faites par
des sujets normaux dans un tâche de gestion financière. Méthode : La tâche
« Faire un budget » du Profil des AVQ-Révisé a été administrée et filmée
auprès de sujets normaux (14 hommes, 5 femmes; 20-58 ans). L’analyse des
erreurs s’est faite avec une grille basée sur les processus exécutifs
(planification, exécution, autocorrection, atteinte du but). Résultats : Les
résultats préliminaires illustrent : 1) plusieurs sujets sont indépendants dans la
tâche; 2) un certain nombre fait des erreurs (ex. : planification et exécution).
Celles-ci pourraient s’expliquer par différents facteurs comme par exemple la
clarté des consignes données au sujet, l’expérience des sujets avec cette tâche
et le niveau d’éducation. Conclusion : Comme des erreurs peuvent s’observer
auprès d’une population normale, il s’avère important pour l’ergothérapeute
d’avoir des points de comparaison avec la population « normale » afin de
minimiser les erreurs d’interprétation lors de l’évaluation.
Bachand, N., Dutil, E., Bottari, C., Guillemette, M. (2006). Une population sans
atteinte cérébrale réussit-elle à obtenir une information sans erreur? Actes du
congrès de la recherche de 1er cycle de la Faculté de médecine, Université de
Montréal, Montréal.
Introduction : La tâche obtenir une information représente une activité
intéressante pour évaluer l’indépendance des personnes ayant subi un
traumatisme crânien (TC) dans la réalisation des AVQ. Peu d’études normatives
existent auprès d’une population sans atteinte cérébrale pour cette tâche. Sans
ces normes, des erreurs d’interprétation des résultats pourraient être
préjudiciables pour les sujets TC. Objectif : Cette étude vise à recueillir les
résultats d’un groupe contrôle pour la tâche obtenir une information du Profil des
AVQ-révisé. Méthodologie : 19 sujets contrôle furent appariés par couple selon
l’âge, le sexe et la scolarité à un groupe de patients TC évalués à l’aide du Profil
des AVQ-révisé. La tâche obtenir une information fut administrée au domicile des
sujets et filmée. Le cadre d’analyse des erreurs est basé sur le modèle de Luria.
Résultats et discussion : Certaines erreurs reliées à la planification et
particulièrement à l’exécution ont été notées. Le groupe contrôle démontre une
bonne capacité d’auto-correction et une grande variabilité de temps d’exécution.
La fréquence de pratique et les consignes données aux sujets semblent avoir
influencées les scores. Conclusion : Une meilleure compréhension des erreurs
d’une population contrôle devrait permettre aux ergothérapeutes de mieux
distinguer les difficultés réelles des sujets TC.
Gaudreault, C., Bottari, C., Beaulieu, N., Dutil, E., & Émilie Lemay-Brault
(2006). Extreme ecological approach: working with socially atypical TBI clients
(2006). CAOT Conference 2006, Canadian Journal of Occupational TherapyConference Program Supplement
Several studies support the use of an ecological approach for the evaluation
and treatment of traumatic brain injury (TBI) clients (Lee et al., 2001).
However, the current application of this approach to treatment within the
context of inpatient rehabilitation units is far from optimal, particularly for
socially atypical TBI clients. Objective : To present the case study of a
homeless TBI client reflective of a broader understanding of an ecological
approach. Methods: The subject was evaluated with the ADL Profile (Dutil et
al., 2005), filmed during the performance of everyday activities within his realworld environment and interviewed to obtain his perception of the real-world
interventions he received. Results: Certain apparently aberrant ADL behaviours
require an assessment within the real world environment to be appropriately
interpreted. Moreover, targeted treatment interventions must aim to enhance
the individual’s chances of surviving on the street. However, attaining even the
simplest of goals with this clientele requires that clients accept to stay within
rehabilitation units. Conclusions: Working with this clientele obliges
rehabilitation teams to develop a much broader openness to the everyday
reality of socially atypical individuals. Also, teams may need to re-examine
ways of rendering their interventions more ecological within their own
rehabilitation units.
Touré, M., Fortier, P., Dutil, E., & Bottari, C. (2006). Un outil à connaître pour
les schizophrènes : Profil des AVQ. CAOT Conference 2006, Canadian Journal of
Occupational Therapy- Conference Program Supplement
Introduction: Les troubles des fonctions exécutives (FE) accompagnent
fréquemment la schizophrénie, mais leurs impacts dans la réalisation des
activités de la vie quotidienne (AVQ) demeurent peu documentés. Malgré
l’intérêt du Profil des AVQ (Dutil et al., 2005), un outil développé pour mesurer
l’indépendance dans les AVQ en considérant les FE, cet outil n’a pas encore été
validé auprès des schizophrènes. Objectif: Explorer l’utilisation du Profil des
AVQ chez de jeunes schizophrènes pour évaluer leurs capacités à la vie
autonome. Méthode: Une analyse de la performance dans les AVQ a été
effectuée selon la grille d’analyse du Profil des AVQ auprès de deux
schizophrènes. Résultats: Les résultats illustrent la présence de difficultés
liées à la planification dans des tâches non familières (ex.: gérer ses finances)
et documentent également les répercussions de l’anxiété sur la capacité à
formuler un but et/ou à initier la tâche : les tâches impliquant une
performance dans un contexte d’interactions sociales (ex.: faire les courses)
entraînent des comportements d’évitement et d’abandon. Conclusion: Cette
étude pilote a permis de dégager la pertinence du Profil des AVQ auprès de
jeunes schizophrènes et de cibler des interventions en ergothérapie visant
l’acquisition d’habiletés sociales essentielles pour la vie autonome.
Bottari, C., Dutil, E., Dassa, C., Rainville, C. (2007). International experts
judge content validity of the ADL Profile-Revised. CAOT Conference 2007,
Canadian Journal of Occupational Therapy- Conference Program Supplement
Introduction: In order to better estimate independence in activities of daily
living (ADL) for individuals with a traumatic brain injury (TBI), the ADL Profile –
Revised was developed. The ADL Profile-Revised, a measure of ADL
independence developed to consider the important contribution of executive
functions (EF), consists of nine ADL tasks (ex: shopping for groceries, preparing
a hot meal, making a budget) administered in the person’s home environment.
Goal: The goal of this study was to document the content validity of the ADL
Profile-Revised. Method: An international multidisciplinary group of experts
(n= 8) was asked to judge the pertinence and clarity of the following aspects of
the tool using a four point rating scale: task definitions, instructions, definition
of operations, underlying task analysis and rating scale. Analysis: A descriptive
analysis (percentages) was completed. Results: All experts judged the majority
of aspects of the tool as pertinent and clear. Instructions to the client were
judged as more or less clear by 49% of the experts. A new version of the tool
incorporating the experts’ recommendations was completed. Conclusions:
Obtaining the perception of a multidisciplinary group of experts on the content
validity of a multifaceted occupational therapy assessment enhances the
psychometric quality of the tool and adds credibility to its use.
Funded by FRSQ, SAAQ, AERDPQ, AHQ
Bottari, C., Dutil, E., Dassa, C., & Rainville, C. (2008). Relationship of
traumatic brain injury severity and socio-demographic characteristics to
independence in everyday activities. Proceedings of the Seventh World
Congress on Brain Injury, Lisbon, Portugal.
Issue: To date, investigations of the determinants of independence in
instrumental activities of daily living (IADL) in traumatic brain injury (TBI) have
suggested that reduced IADL independence may be associated to such variables
as injury severity and age. However, few studies have used analytic
observation-based IADL measurement instruments based in individuals’ home
and community environments. This is a major flaw as real-world assessments
are considered to more optimally document the interplay between individuals’
neuropsychological deficits and the requirements of their daily lives. Hence,
there exists an urgent need to establish the extent to which scores obtained on
a new observation-based measure of IADL independence, the IADL Profile
(Bottari et al., 2004), are influenced by socio-demographic characteristics and
TBI severity.
Objective: To investigate the criterion related validity of the IADL Profile with
indices of TBI severity and socio-demographic characteristics.
Method: One hundred adults (78.0% males, mean age = 37.0 ± 13.7 years, mean
years of education 11.6 ± 3.4, 69% severe and 31% moderate TBI, mean
duration of post-traumatic amnesia = 34,0 ± 50.3 days, mean time post injury =
14.2 ± 13.6 months) participated. Subjects were oriented (≥ 66 on Galveston
Orientation and Amnesia Test), sufficiently mobile (≥ 4 on transfer item of the
Measure of Functional Independence, MIF) and able to comprehend and speak
French (≥ 5 on communication item of MIF). Subjects were evaluated in their
home and community environment with the IADL Profile by a trained
occupational therapist familiar with the tool. The IADL Profile documents IADL
independence and the repercussions of executive function deficits on eight
IADL, six of which are linked to the ultimate goal of preparing a hot meal
(dressing to go outdoors, going to grocery store, shopping for food, preparing
hot meal, having meal with guests, cleaning up after meal) and two which are
complex single tasks (obtaining information, making budget).
Results: Age was significantly correlated with going to the grocery store and
shopping for food (r = -0.23). Education was significantly correlated with seven
IADL Profile scores (r = 0.22 to 0.41). Education was most highly correlated to
obtaining information (r = 0.41) and making a budget (r = 0.34). No significant
correlations were observed between gender and IADL Profile scores. Post
traumatic amnesia was the measure of injury severity that was correlated with
the largest number of IADL Profile scores (r = -0.30 to -0.53).
Conclusions: This study provides evidence for the criterion related validity of
the IADL Profile with relation to TBI injury severity, education and age. Results
of this study add credibility to the IADL Profile’s ability to measure IADL
independence subsequent to moderate or severe TBI. Moreover, the overall
modest correlations between indices of injury severity and IADL independence
suggest caution when predicting outcome post TBI.
Bottari, C., Dutil, E., Dassa, C., & Rainville, C. (2008). The influence of
executive function deficits on independence in instrumental activities of daily
living. Proceedings of the Seventh World Congress on Brain Injury, Lisbon,
Portugal.
Issue: Executive function (EF) deficits are thought to directly impact
independence in instrumental activities of daily living (IADL) in persons with
traumatic brain injury (TBI). However, most ecological studies of executive
deficits using everyday tasks have typically failed to use observation-based
IADL measurement instruments with demonstrated psychometric properties,
increasing the probability of associated measurement error. Earlier work on an
analytic observation-based measure of ADL independence, the ADL Profile, has
highlighted the potential contribution of this tool to this area of study as it was
specifically developed to document the repercussions of EF deficits on
independence. An alternate version of this tool, the IADL Profile (Bottari et al.,
2004), was recently developed to consider recent advances in the field of EF
particularly in the area of ecological assessment. However, an urgent need
exists to establish the extent to which the IADL Profile captures the
repercussions of related deficits in EF in consideration of environmental
demands. Objective: To investigate the criterion related validity of the IADL
Profile with measures of EF.
Method: One hundred adults (78.0% males, mean age = 37.0 ± 13.7 years, mean
years of education 11.6 ± 3.4, 69% severe and 31% moderate TBI, mean time
post injury = 14.2 ± 13.6 months) participated. Subjects were evaluated by
trained examiners with three measures of EF: Tower of London (ToL), Stroop
and the Working Memory Index (WMI) of the Wechsler Memory Scale III.
Individuals were then administered the IADL Profile in their home and
community environment by a trained occupational therapist familiar with the
tool. The IADL Profile consists of eight tasks with moderate to high task
complexity (i.e. sequence of six tasks linked to the goal of preparing a hot
meal, obtaining information, making a budget), consideration of the complex
interactions between environmental demands and the person’s abilities, task
definitions that consider components of EF, and explicitly defined operations
that underlie task analysis related to EF.
Results: Mean scores on measures of EF were ToL 8.1 ± 2.1, Stroop Interference
scores based on raw data 3.2 ± 8.0, WMI 97.1 ± 14.8. All IADL Profile scores
showed weak to moderate significant correlations with measures of planning
(ToL) (r = .22 to r = .40) and working memory (WMI) (r = .20 to r = .43). No
significant correlations were noted with a recognized measure of inhibition
(Stroop).
Conclusions: This study supports the premise that the IADL Profile considers EF
deficits related to planning and working memory when documenting IADL
independence. Use of this tool should provide both a better understanding of
the repercussions of EF deficits on IADL independence in the person’s home and
community environment and a better estimate of IADL independence.