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 à 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
Husband
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
Strengths
Personal
Committed to therapy
Familiar with rehab process
Good motor control
Physically capable
Cooperative
Strengths
Environmental
Support of family
Close relationship with AA sponsor
Support of church community
Strengths
Occupational
AA meetings
Rewarding job
Works for accommodating company
Variety of leisure interests
Limitations
Personal
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
Limitations
Environmental
Financially supports 2 of 3 children
Mother with Alzheimer’s lives at home
Lives in rural area
Limitations
Occupational
Inadequate recreational and leisure opportunities
Needs a lot of assistance/guidance to complete tasks à 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)
Constructs/Variables
Instrumental Activities
(24 Items)
Low Physical Demand Leisure Activities
(27 items)
High Physical Demand Leisure Activities
(15items)
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
Safety
Format Non-threatening & Easily Understood
Chance of Emotional Distress
Reliability
Test-Retest = 0.897
Current studies being conducted
-
Baum, C. & Edwards D. (2001)
Validity
Content
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
Construct
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)
Practicality
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)
Utility
Sort categories are flexible & reflect the questions being posed by the evaluator
Scoring compares scores only with in the patient, not other patients.
Unbiased
Q-sort (Rank Order Procedure)
- Baum, C. & Edwards D. (2001)
References
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 http://www.aota.org.featured/area2/links/link16ga.asp
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 http://www.aota.org.featured/area2/links/link16ga.asp
Baum, C. & Edwards D. (2001). Activity Card Sort. St. Louis, Missouri:
Washington University School of Medicine.
