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Activity Card Sort

Sondra Munves

Gina Ligori

Case Scenario - "Mr. Smith"

59 year old Caucasian male from Deep South

Recovering alcoholic

Fell down stairs that resulted in TBI

Referred to OT because of functional limitations with memory, organization, word finding, LOC, following instructions, complex problem solving, multi-tasking, and supervising others

About TBI

Causes life-long impairments in physical, cognitive, behavioral, and social function

Cognitive, behavioral, and personality deficits are usually more disabling than the residual physical deficits

Recovery from TBI can continue for at least 5 years after injury

Social burden of TBI is significant family education and counseling, and support of patient and caretakers, is important

- Khan, F., Baguley I., & Cameron I. (2003)

Rehabilitation and TBI

Interdisciplinary approach is effective

Rehab focus is placed on issues such as retraining in activities of daily living, pain management, cognitive and behavioral therapies, and pharmacological management

- Khan, F., Baguley I., & Cameron I. (2003)

Occupational Profile


Father of three children (ages 25, 21, and 16 with only the youngest child living at home)

Caretaker for mother

Devoted Church member (Southern Baptist)

Occupational Profile

Enjoys hunting, fishing, golfing, playing cards, reading novels, and walking the dog

Regularly attends AA meetings

Executive and trainer with a national charity organization

Client’s Goals

Participate in leisure activities

Support family

Return to old job

Continue attending AA meetings

Still be active in church

Clinical Goals

Mr. Smith will attend occupational therapy in an outpatient rehab clinic 3 times a week for at least 2 weeks

Mr. Smith will begin participating in simple card games one week from when he starts therapy.

Mr. Smith will be able to read 10 pages of a novel of his choice each night



Committed to therapy

Familiar with rehab process

Good motor control

Physically capable




Support of family

Close relationship with AA sponsor

Support of church community



AA meetings

Rewarding job

Works for accommodating company

Variety of leisure interests



Many cognitive deficits with reduced awareness of such deficits

Too demanding of self with regards to returning to work in order to support family

Low frustration tolerance (esp. with memory)

Behavioral changes

Reduced self-esteem



Financially supports 2 of 3 children

Mother with Alzheimer’s lives at home

Lives in rural area



Inadequate recreational and leisure opportunities

Needs a lot of assistance/guidance to complete tasks loss of independence

Can’t go to work because of cognitive problems and inability to multi-task and follow instructions

Frames of Reference

Occupational Behavioral

Independent Living Skills View of Humans

Humans are biological, psychosocial, and cultural beings

Humans have an occupational nature; they invest time and energy into ILS tasks and events that are meaningful to them

Humans have an innate and spontaneous tendency to explore and master their environment

State of Function or Dysfunction

Occupational Behavioral
Focus of Intervention

Identify skills, habits, and sources of volition which prevent ILS role fulfillment

Identify habits and routines which impact on mastery of performance skills

Promote exploration to develop ILS skills

Promote habits and routines to develop skill competence

Promote integration of skills, habits, values, ADLs, and ILS role fulfillment

Occupational Behavioral FOR
applied to Mr. Smith

State of Dysfunction

Unable to act on valued goals and interests due to environmental constraints

Unable to demonstrate personal effectiveness in ILS tasks

Unable to fulfill ILS role requirements

Actions for Mr. Smith

According to Occupational Behavioral FOR

Design "success" activities

Develop goals

Develop interests

Develop ILS role identity

Redevelop ability to follow routines

Redevelop basic skills

Short-terms goals may be applied to clinical setting

Variables to be Measured

P = Identify Impairments that are producing limitations for Mr. Smith

E = Determine how Mr. Smith’s cognitive impairments are affecting his safety at home

O = Determine % of activities retained (post injury/illness)

Current activity

Previous activity

% retained = current activity / previous activity

Individualized Evaluation Plan

P Factors: Functional Impairment Profile

Assess how his cognitive impairments producing limitation.

The FIP has been used in research with older adults residing in the community and with people after having a stroke.

provides clinicians with tools to identify impairments that may limit the person's capacity so he or she can bring these impairments to the attention of the physician for management and to the team for further assessment and intervention planning.

- Letts, L., Baum, C., & Perlmutter M. (n.d.)

IEP (ctd)

E factors: SAFER Tool

Designed to help therapists asses client’s ability to safely carry out functional activities at home

It can be used with adults with cognitive impairments, mental health problems, physical disabilities, and complex needs.

Includes 97 items in 14 areas of concern including: mobility, kitchen use, fire hazards, wandering, communication, & so forth.

- Letts, L., Baum, C., & Perlmutter M. (n.d.)


IEP (ctd)

O Factors: Activity Card Sort

Assesses activities that were done prior to injury

Allows client to describe the role that activities play in his life and the impact that the disability has had on his activities.

The ACS reflects the % of activities retained by an individual as an indicator of occupational engagement.

- Baum, C. & Edwards D. (2001)

Purpose of Test

"The ACS is a flexible and useful measure of occupation. The ACS allows the practitioner to help clients describe their instrumental, leisure, and social activities… The information obtained by administering the ACS will provide the therapist with an occupational history and the information to help the client build routines of activities that are meaningful and healthful."

- Baum, C. & Edwards D. (2001)


Instrumental Activities

(24 Items)

Low Physical Demand Leisure Activities

(27 items)

High Physical Demand Leisure Activities


Social Activities

(14 items)

For specific variables, see handout.

Operational Definitions

Instrumental Activities – Activities necessary to maintain self and property

Low Physical Demand Leisure Activities – Activities that do not demand high physical strength or endurance

High Physical Demand Leisure Activities – Activities that require physical endurance

Social Activities – Activities that involve the individual interacting with other people, or activities that occur in an environment with other people

- Baum, C. & Edwards D. (2001)

Target Population

"Originally designed to facilitate the assessment of occupational performance in individuals with cognitive loss. It has also been used with many different adult populations."

Child’s version under development

- Connolly, K. & Law, M. (2001)

Safety & Reliability


Format Non-threatening & Easily Understood

Chance of Emotional Distress


Test-Retest = 0.897

Current studies being conducted

- Baum, C. & Edwards D. (2001)



30 older adults identified activities they performed within the course of a week = 65 activities

Older Adults Service & Information System (OASIS) suggested 15 more = 80 total activities


Care giver burden "Individuals that stay active in occupations demonstrated fewer disturbing behaviors and required less help with basic self-care."

Predicting Quality of Life & community reintegration in 70 persons with stroke was a better predictor quality of life than the FIM

- Baum, C. & Edwards D. (2001)


20 minutes

Easy to administer – Any certified OT or COTA

Can be applied to a wide population

Family member can perform test if client is severely cognitively impaired or too ill.

Cost: $125 + $20 for shipping

- Baum, C. & Edwards D. (2001)


Sort categories are flexible & reflect the questions being posed by the evaluator

Scoring compares scores only with in the patient, not other patients.


Q-sort (Rank Order Procedure)

- Baum, C. & Edwards D. (2001)


Connolly, K. & Law, M. (2001). "Measuring Leisure Performance." Measuring Occupational Performance: Supporting Best Practice in

Occupational Therapy. 183-193. Khan, F., Baguley I., & Cameron I. (2003). Rehabilitation after traumatic

brain injury. Medical Journal of Australia 178 (6). 290-295.

Letts, L., Baum, C., & Perlmutter M. (n.d.) Person-Environment-

Occupation Assessment with Older Adults. Retrieved November 16,

2004, from

Baum, C. & Edwards D. (2001). Activity Card Sort. St. Louis, Missouri:

Washington University School of Medicine.

Occupational Therapy. 183-193.

Khan, F., Baguley I., & Cameron I. (2003). Rehabilitation after traumatic

brain injury. Medical Journal of Australia 178 (6). 290-295.

Letts, L., Baum, C., & Perlmutter M. (n.d.) Person-Environment-

Occupation Assessment with Older Adults. Retrieved November 16,

2004, from

Baum, C. & Edwards D. (2001). Activity Card Sort. St. Louis, Missouri:

Washington University School of Medicine.