Male and female performance on the assessment of motor and process skills

Establishing the Predictive Validity of the Assessment of Motor and Process Skills for Driving Performance Outcomes

IMPORTANCE

Although the Assessment of Motor and Process Skills (AMPS) is an excellent tool for evaluating the functional performance of instrumental activities of daily living (IADLs), a limited number of studies have used the AMPS for decisions regarding the IADL of fitness to drive and community mobility.

OBJECTIVE

To determine the specificity and sensitivity of the AMPS as a tool for determining a person's fitness to drive.

DESIGN

Cross-sectional observational design.

SETTING

Three driving rehabilitation programs in three states.

PARTICIPANTS

Participants were 388 community-living adults (M age = 68.74 yr, SD = 11.53); 196 adults were recruited before completing a comprehensive driving evaluation, and 192 were recruited in two other studies of older drivers.

OUTCOME AND MEASURES

AMPS and results of comprehensive driving evaluation or on-road assessment.

RESULTS

Using a logistical regression, AMPS Motor and Process Skills scores yielded a sensitivity of 84.6% and a specificity of 88.8%. The odds ratio of the AMPS Motor Skills score was .347; for the AMPS Process Skills score, it was .014. Using cross-validations, the model with AMPS Motor and Process scores produced a cross-validation area under the curve of .918, with sensitivity and specificity of 84.6% and 88.4%, respectively, and a probability greater than .334 was used for predicting a fail or drive-with-restriction evaluation.

CONCLUSIONS AND RELEVANCE

The AMPS Motor and Process Skills scores revealed significant differences between those who failed or had driving restrictions and with those who passed the driving evaluation, which supported the AMPS as an effective tool for predicting fitness to drive. Plain-Language Summary: This study demonstrates how the Assessment of Motor and Process Skills (AMPS), as a top-down occupational therapy assessment tool, can be used to differentiate between medically at-risk drivers who are likely to pass a comprehensive driving evaluation and those who are likely to fail or need restrictions. AMPS will assist occupational therapy practitioners in determining who is most appropriate to receive driving rehabilitation services and/or when to refer a person for a comprehensive driving evaluation.

Agreement between self-reported and observed functioning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia, and the influence of pain and fatigue: a cross-sectional study

Objective: To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue.Method: Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman's rho correlation and regression modelling were applied.Results: Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA.Conclusion: Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.

Comparing Component-Based and Occupation-Based Interventions of a Person with Visual Deficits' Performance

This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.

How do assessments of activities of daily living address executive functions: A scoping review

Executive functions (EF) allow persons to adapt to situations arising in daily life and can be affected following acquired brain injury (ABI). Measuring the impact of EF impairments on the accomplishment of activities of daily living (ADL) requires specific assessment tools, but choosing the right tool may be difficult.

PURPOSE

To conduct a scoping review on how assessments of ADL address EF and EF impairments in persons with ABI.

METHOD

A scoping review of literature (peer-reviewed and grey literature) published until August 2014 was conducted. Using a systematic procedure, literature was selected, results were charted, and tools were analysed with respect to their goals, underlying models, psychometric properties and applicability. The analysis also included how tools considered components of EF according to Lezak's model.

RESULTS

12 tools, developed either to assess EF in ADL, independence in ADL considering EF or ADL capacities, were identified and analysed according to multiple criteria.

CONCLUSIONS

This review provides important information about existing tools to assist in tool selection and clinical decision-making related to ABI and EF.

Implementing the Assessment of Motor and Process Skills (AMPS) in the Workplace: A Comparison of the Experiences of Occupational Therapists and New Graduates

Learning to use new skills through continuing professional education courses is an important part of continuing professional development, contributing towards the evidence of competence to practise. Few studies have examined how such new learning is used in professional practice.

This study investigated the experiences of occupational therapists when learning to use the Assessment of Motor and Process Skills (AMPS) and whether years of experience or clinical area affected how the AMPS was used in practice. Twenty-three occupational therapists who undertook a 5-day AMPS course completed three questionnaires over a 10-month period. Thirteen were senior level occupational therapists and 10 were new graduates about to commence employment in their first post.

Significant differences between the two groups were found in three areas: the new graduates experienced more difficulties when starting to use the AMPS, completed fewer assessments and found workplace difficulties more time consuming. The two groups shared many difficulties when learning to use a new skill and implementing it within workplace teams, but the analysis of the ranking of these difficulties using the Mann-Whitney U test demonstrated no overall difference between the two groups. Successful implementation of the AMPS for all the participants depended on having sufficient time for new learning to take place and on support from managers so that they could change elements of practice to accommodate the use of new skills.

Cross-Cultural Validation of the Assessment of Motor and Process Skills (AMPS)

The purpose of this study was to verify the assertion that underlying motor and process skill items and tasks defined in the Assessment of Motor and Process Skills (AMPS) are cross-culturally free from bias between North America, Scandinavia and the United Kingdom. Using many-faceted Rasch analysis, the hierarchical order of AMPS motor and process skill items and culture-general tasks were compared in order to test the assertion of bias-free assessment across regions. The unidimensionality of the AMPS motor and process skills and tasks through evaluation of their goodness-of-fit to the Rasch model was also investigated.

The results revealed that the hierarchical order of all the AMPS motor and process skill items and culture-general tasks remained stable among the three regions examined, verifying cross-cultural freedom from bias of the skill items and tasks between these regions. All items in North America met the criteria for goodness-of-fit on both the motor and the process scales of the AMPS, while only 4% of the items failed to meet these expectations in Scandinavia and the United Kingdom. It was concluded that the AMPS motor and process scales and tasks are unidimensional, demonstrating internal scale validity.

Occupational Performance of People Diagnosed with Schizophrenia in Supported Housing and Outreach Programmes in Australia

This study compared the occupational performance in activities of daily living (ADL) of people diagnosed with schizophrenia in two settings: 25 people in residential rehabilitation facilities and 18 people receiving intensive outreach support in their homes in urban Australia. All participants were assessed with structured interviews, the Assessment of Motor and Process Skills (a performance-based measure of ADL ability) and the Life Skills Profile (an informant-report measure of disability).

Hypothesised differences in ADL performance between the two settings were not supported. Mean ADL process ability, based on the AMPS process skills subscale, indicated that the majority (58%) of the 43 participants needed some assistance in community living, irrespective of where they lived and the types of support received. Many participants (42%) performed ADL tasks with relative ease, efficiency, safety and independence as measured by AMPS, indicating that they could live in housing arrangements with outreach support. However, the ADL process ability measures for two-thirds of these participants indicated that they would struggle in community living in the absence of outreach support.

Given these findings, the eligibility criteria and screening for residential and outreach support services need re-examination and performance-based assessments of ADL ability could improve the identification of housing-related support needs. Occupational therapists have expertise in this area to develop individualised supports that enable a greater choice of living arrangements for people diagnosed with schizophrenia.

Differences in Activities of Daily Living Process Skills of Persons with and without Alzheimer's Disease

The purpose of this study was to determine if persons with dementia of the Alzheimer type (DAT) differed from nondisabled older controls in the actual, experienced difficulty of specific process skills that affect performance of activities of daily living (ADL). A two-group comparison was performed and all participants were evaluated in either clinical or home environments to which they had been familiarized. Participants (341 persons with DAT and 287 controls) were selected from the standardization sample of the Assessment of Motor and Process Skills (AMPS) computer-scoring software. The demographic characteristics of the two groups were comparable. The AMPS was used to evaluate the effort, efficiency, safety, and independence of 20 ADL process skills that are compiled to enact performance of familiar ADL tasks. The raw data for each sample was subjected to many-faceted Rasch analysis to determine item difficulty calibrations of the ADL process skill items for each group. Actual item difficulty calibrations of 19 ADL process skills differed meaningfully between the two groups. The results indicated that it is possible to identify specific ADL process skills that are actually easier or more difficult for each group. In addition, the results supported earlier research that has demonstrated that the underlying cognitive and physical impairments demonstrated by persons with DAT do manifest as ADL disability, negatively impacting their ability to perform ADL tasks.

Test-Retest Reliability of the Assessment of Motor and Process Skills in Elderly Adults

We examined the test-retest reliability of the Assessment of Motor and Process Skills (AMPS) in a heterogeneous sample of 55 elderly adults. Subjects were reassessed within 1 to 10 days (M=4.0, SD=2.7 days). The subjects' Time 1 and Time 2 ability measures were highly correlated (Motor: r(55)=.88, P<.001; Process: r(55)=.86, P<.001). Measures were stable in 92% of the subjects. Significant variability occurred in only 8% (N=9) of the subjects' ability measures. Measurement error was a concern less than 2% of the time; 6% of the subjects' measures differed as a reflection of real changes in their task performances. Although some variability was attributed to fluctuations in subjects' medical conditions or motivation to adhere to the task requirements, not all of it could be attributed to a specific factor. These data provide support for the reliability of the AMPS, and serve as a reminder that not all test—retest differences represent measurement error.

Relationships between Cognitive Abilities and the Process Scale and Skills of the Assessment of Motor and Process Skills (AMPS) in Patients with Stroke

The purpose of this study was: 1) to determine the strength of the relationships between cognitive components at the body function/impairment level to the assessment of motor and process skills (AMPS) at the occupational performance/activities level in persons following stroke; and 2) to examine which cognitive components best explain the variance of the AMPS score. Stroke is a major cause of disability in older age that can result in motor and/or cognitive impairments leading to functional disability. The assessment of AMPS is an activity of daily living (ADL) and instrument activity of daily living (IADL) evaluation that measures two aspects enabling occupational performance and motor and process skills. Subjects included 30 hospitalized patients 4 to 5 weeks following stroke. Among them were 17 men and 13 women with a mean age of 71.33 (SD = 8.39) who had been independent in ADL prior to the event. Instruments included the AMPS IADL tasks, Thinking Operations from the LOTCA, Contextual Memory Test, Rey Complex Figure-copy, Star cancellation from the BIT, and COGNISTAT. The study supports the existence of moderate relationships between cognitive components and the AMPS' process scale and skills, and the results add information about relationships between cognitive impairments and occupational performance that can help in treatment planning.

Ability in daily activities after early supported discharge models of stroke rehabilitation

More knowledge is needed about how different rehabilitation models in the municipality influence stroke survivors' ability in activities of daily living (ADL).

OBJECTIVES

To compare three models of outpatient rehabilitation; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke.

METHODS

A group comparison study was designed within a randomized controlled trial. Included participants were tested with the Assessment of Motor and Process Skills (AMPS) at baseline and discharged directly home. Primary and secondary outcomes were the AMPS and the modified Rankin Scale (mRS).

RESULTS AND CONCLUSIONS

Included were 154 participants (57% men, median age 73 years), and 103 participants completed the study. There were no significant group differences in pre-post changed ADL ability measured by the AMPS. To find the best rehabilitation model to improve the quality of stroke survivors' motor and process skills needs further research. Patients participating in the ESD rehabilitation models were, compared with traditional treatment, significantly associated with improved ADL ability measured by the mRS when controlling for confounding factors, indicating that patients with social needs and physical impairment after stroke may benefit from ESD rehabilitation models.

Analyse Critique D'instruments de Mesure Des AVQ en Pédiatrie: Déficits Exécutifs et Indépendance

Description. Bien que l'évaluation des activités de la vie quotidienne (AVQ) par analyse de tâches soit au cœur du rôle de l'ergothérapeute œuvrant auprès d'enfants ayant un traumatisme craniocérébral (TCC), aucune étude visant l'analyse des instruments utilisés à cet effet selon leur potentiel de mettre en évidence des déficits liés aux fonctions exécutives (ex: formuler un but, planifier) n'a été recensée.

But. Déterminer s'il existe des outils de mesure des AVQ qui considèrent les fonctions exécutives, validés auprès d'enfants de 10 à 15 ans ayant un TCC.

Méthodologie. Quatre outils, le «Assessment of Motor and Process Skills», le «Children's Kitchen Task Assessment», la «tâche du gâteau au chocolat» et le «Profil des AVQ» ont été analysés selon des critères tels que: 1) complexité des tâches, 2) approche d'évaluation non-structurée, et 3) qualités psychométriques adéquates pour la clientèle cible.

Résultats. Ces outils ne sont que partiellement conformes aux critères recherchés.

Conclusion. La poursuite des études sur ces outils serait primordiale pour mieux répondre aux besoins de cette clientèle.

Older Adults' Experiences and Perceptions of Dual Tasking

There is no consensus on which dual task (DT) test best assesses mobility or balance deficits in older adults. This study aimed to explore older adults' experiences and perceptions of dual tasking to identify DTs relevant to their everyday life and that they perceive as difficult or risky.

Two gender-specific focus groups were conducted. Six males and nine females, aged 70 years or above, participated. The topics posed to the groups included structured and open questions designed to explore experiences of combining two activities and the consequences of that for balance. The results were subjected to content analysis to identify DT examples, task difficulty levels and balance-threatening tasks.

Most participants were able to identify DT examples and some identified a concurrent impact on balance. There were gender differences in the examples: the females focused more on household tasks and the males more on outdoor activities. Many tasks that were considered difficult or risky by the participants do not feature sufficiently in the literature, such as stair negotiation and avoiding moving obstacles accompanied by secondary tasks.

The views of older adults should be taken into consideration to help to develop tests that are more sensitive and have face validity.

Group Constraint-Induced Movement Therapy: Motor and Functional Outcomes in Individuals with Stroke

Background

Strokes frequently cause limitations of the upper extremity and in performance of activities of daily living (ADL). Constraint-induced movement therapy (CIMT) is designed to enhance the use of the hemiplegic arm.

Purpose

To assess the effects of group CIMT on upper-extremity motor function and performance level of motor and process skills for instrumental activities in daily living (IADL) in community-dwelling individuals whose stroke occurred at least six months earlier.

Methods

Eight adults with stroke participated in this study. Group-based CIMT was administered for two weeks, five times per week, with two-hour intensive daily training.

Findings

The Fugl-Meyer Assessment (FMA) score and the Assessment of Motor and Process Skills (AMPS) scores improved after intervention.

Implications

The results of this study suggest that relatively brief group-based CIMT may be an effective intervention for improving motor function of the affected upper-limb and the level of IADL in individuals who have had stroke.

Using an IADL Assessment to Identify Older Adults Who Need a Behind-the-Wheel Driving Evaluation

Occupational therapists need to routinely assess driving ability in hospital and/or rehabilitation settings. The purpose of this study is to determine if the Assessment of Motor and Process Skills (AMPS), an observational tool of instrumental activities of daily living, could discriminate between older adult drivers who pass, pass with restrictions, or fail a behind-the-wheel (BTW) evaluation. Forty-six participants were evaluated with a BTW driving assessment and the AMPS. Two one-way ANOVAs found significant differences for both the motor and process scores suggesting the AMPS can be used as a screening tool for driving. Results also showed no significant difference in age between those participants who passed, failed, or needed restrictions supporting the concept that driving abilities are related more to function, not age. Exploration of minimum scores is discussed.

Performance of activities of daily living in multiple sclerosis

PURPOSE

To assess the performance of activities of daily living (ADL) in individuals with moderate to severe multiple sclerosis (MS).

METHOD

A total of 12 men and 32 women with MS (Expanded Disability Status Scale, EDSS, 6.0-8.5) were studied. The performance of personal ADL (P-ADL) and instrumental ADL (I-ADL) was assessed with the Functional Independence Measure (FIM) and the Assessment of Motor and Process Skills (AMPS).

RESULTS

Twenty-four of the 44 individuals were rated dependent in P-ADL by the FIM motor score, mainly due to limitations in some areas of self-care and in transfers and locomotion. Only three individuals were rated dependent by the FIM cognitive score, indicating no or little cognitive disability. Two thirds of the individuals who were rated independent/modified independent in P-ADL by the FIM were rated dependent in I-ADL by the AMPS. Only the FIM motor score was significantly related to the EDSS score, indicating that ADL performance and disease severity is weakly related.

CONCLUSIONS

Moderate to severe MS reduces the ability to perform both P-ADL and I-ADL. An individual with MS can be independent in P-ADL but still unable to perform I-ADL satisfactorily. Assessments of both P-ADL and I-ADL are advocated to evaluate ADL performance in order to implement appropriate management strategies for individuals with MS.

Using the assessment of motor and process skills to measure functional change in adults with severe traumatic brain injury: A pilot study

AIM

To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS).

METHODS

This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation.

RESULTS

Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation (z = -2.70, p = 0.01; z = -2.81, P = 0.01, respectively).

CONCLUSIONS

The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.

Differences in Schoolwork Performance between Typically Developing Students and Students with Mild Disabilities

The purpose of this study was to examine whether students with mild disabilities differed from typically developing students in their ability to perform schoolwork tasks. The participants, selected from the School Assessment of Motor and Process Skills (School AMPS) database, comprised 175 students in each group. Their data were subjected to many-faceted Rasch analyses and then analyzed for statistically significant differences in mean school motor and school process abilities between groups. The relative and actual item difficulty calibration values were then compared to identify meaningful differences between groups. The results revealed a statistically significant mean difference in school motor and school process ability between groups (large effect sizes), essentially stable relative skill item hierarchies between groups, and actual hierarchies that differed such that some school motor and almost all school process skill items (occupational performance skills) were more difficult to perform for the mild disabilities group. The results of this study also provided evidence of validity for the use of the School AMPS measures to assist in identifying lower than expected schoolwork performance of students with mild disabilities.

Measures of physical functioning predict self-reported performance in self-care, mobility, and domestic life in ambulatory persons with multiple sclerosis

OBJECTIVE

To determine the associations between clinically measured physical functioning variables and self-reported performance in mobility, self-care, and domestic life in ambulatory persons with multiple sclerosis (MS), using the International Classification of Functioning, Disability and Health (ICF) as a framework.

DESIGN

Survey study.

SETTING

Community setting in Finland.

PARTICIPANTS

A population-based sample of 120 ambulatory persons with MS (30 men, 90 women) with mean age 45.0+/-10.8 years (range, 20-71 y), mean disease duration from symptom onset 12.3+/-8.8 years (range, 1-39 y), and mean Expanded Disability Status Scale 2.8+/-2.0 (range, 0-6.5).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary dependent variables were self-reported performance in self-care, mobility, and domestic life from the Functional Status Questionnaire. The physical functioning variables were drawn from the ICF activities (n=9) and body functions (n=14) categories. Age- and sex-adjusted odds ratios from multinomial logistic regression were estimated for the physical functioning variables associated with activities of daily living (ADL) performance.

RESULTS

Overall, of this cohort 31% reported difficulties or dependence in self-care, 52% in mobility, and 68% in domestic life. The most significant predictors of perceived difficulties or dependence in ADL performance were: (1) lower scores in the Box and Block Test; (2) lower Berg Balance Scale scores; (3) greater velocity moment when standing with eyes open; (4) slower ten-meter walk test times and shorter stride length at normal speed; and (5) shorter distance in the six-minute walk test.

CONCLUSIONS

Perceived difficulties and dependence were most prominent in domestic life. In particular, measures of activities predicted difficulties in ADL performance. Monitoring of physical functioning should be extended to those independent MS persons reporting difficulties in ADL performance.

[Characteristics of instrumental activities of daily living and everyday memory in elderly women--method for assessment of abilities in early dementia]

AIM

To demonstrate the characteristics of the Instrumental Activities of Daily Living (IADL), assessed by the Assessment of Motor and Process Skills (AMPS), and everyday memory functions (memory necessary function for daily life) assessed by the Rivermead Behavioral Memory Test (RBMT) in elderly people with dementia. To compare the ability and the function between them and community-dwelling normal subjects.

METHODS

We divided the RBMT result into three categories: prospective memory, retrospective memory, and prospective memory+retrospective memory. The study was performed in102 women (68-92 years old) with dementia who lived in a healthcare facility or three group homes (n=52) and cognitively normal subjects who lived in their own homes (n=50).

RESULTS

There were no associations between AMPS motor and prospective memory, retrospective memory, and prospective memory+retrospective memory in both groups. There were associations between the AMPS process and retrospective memory in both groups, but no associations between the AMPS process and prospective memory in either groups and a scatter chart revealed some subjects with a prospective memory deficit even though they had a normal IADL performance ability level. From those results, we found that IADL performance ability and everyday memory were not simultaneously damaged.

CONCLUSION

When assessing elderly people, it is necessary to assess both IADL performance and everyday memory, including prospective memory. According to these methods, mild cognitive impairment may be screened more accurately.

Stepnicka's modification of the brace test: an investigation of dimensionality

Stepnicka's modification of the Brace Test is used to assess body coordination of athletes in the Czech Republic. This test has 10 tasks and indicates physical proficiencies, i.e., flexibility, balance, and kinesthetic perception. The purpose of this study was to examine the structure of Stepnicka's modifications of the Brace Test through Rasch analysis. The structure of physical proficiency was investigated as well. Volunteers included 62 men and 42 women (19 to 24 years old) who were undergraduate students in physical education and sport science. For Rasch analysis, the dichotomous model was employed. Analysis confirmed unidimensionality of the test, and this dimension was named Neuromuscular Ability. On the basis of this Rasch analysis, changes to Stepnicka's modification of the Brace Test were suggested.

Gender differences in the performance of activities of daily living11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To verify that the activities of daily living (ADL) motor and process skill items and tasks in the Assessment of Motor and Process Skills (AMPS) are free from gender bias, and to compare mean differences in ADL motor and process ability between men and women.

DESIGN

Descriptive comparison; convenience sample.

SETTING

Existing data from the AMPS database.

PARTICIPANTS

Potential participants included nonwell persons (age range, 18-99y) matched within 3 age groups, first by functional level and then by diagnostic category. The resulting sample included 9250 men and 9250 women.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The AMPS, a standardized observational assessment of the quality of ADL task performance.

RESULTS

None of the AMPS task calibrations and 1 motor skill item calibration (Lifts) demonstrated an observable difference between men and women. Men had higher ADL motor ability (F(1,18494)=11.58, P<.01) and women had higher ADL process ability (F(1,18494)=76.18, P<.01).

CONCLUSION

The results suggest that the AMPS is free of gender bias. Although differences were found between men and women in mean ADL motor and process ability, they were not considered clinically detectable differences.

[Effect of a multi-strategic group program on performance of the activities of daily living for elderly people with mild cognitive deficits

OBJECTIVE

The goal of this study was to determine the impact of a group activity program on the level of functioning of a person in instrumental activities of daily living (IADL). This program was specifically designed for people with mild cognitive deficiencies living at home and attending a day centre.

METHOD

Using a single subject design of AB type, eleven persons were assigned randomly to a experimental group (n = 7) and to a control group (n = 4). Their cognitive functioning was found to be between the 5th and the 25th percentile on the Modified Mini-Mental State Examination (3MS), which corresponds to stage 3 on the Reisberg Scale. The 18 week long multi-strategic program consisted of two weekly meetings of one and a half hours each. This program included physical exercises, psychomusical techniques, cognitive games and tasks related to IADL. The level of functioning of the subjects in their IADL was measured six times at home using the Assessment of Motor and Process Skills (AMPS), before, during and after the program.

FINDINGS

The data derived from each subject were presented as a graphical analysis. Following the application of the program, more of the participants, as compared to the control subjects, improved their functioning in terms of IADL.

CONCLUSION

The findings of this study suggest that it would be possible to use coping strategies in the early stages of cognitive deficits.

Promoting the mental health of elderly African Americans: a case illustration

Promoting mental health in an illness-oriented health care delivery system is challenging. Health promotion from a holistic perspective requires that mental health be viewed as important as physical health. The mental health needs of the elderly are numerous and often not addressed during routine visits for primary health care. Research consistently reports that elderly African Americans are not equal participants in the formal health care system. Consequently, promoting mental health in the African American elderly is a challenge made even more complicated because of this group's limited access to and use of mental health care services. Promoting the health of African Americans confronts many traditional values and practices of health care institutions and mental health practice. Therefore, health care providers must be innovative and creative to facilitate mental health promotion in this population of clients. The authors suggest that the Revised Health Promotion Model can serve as a framework for guiding the mental health care of elderly African Americans. Aspects of the model are particularly relevant for this population. The case of an elderly Black woman is presented as an illustration of ways in which the model may be applied with many cultural nuances.

Environment effect of functional task performance in adults with acquired brain injuries: use of the assessment of motor and process skills

OBJECTIVE

To examine household task performance in both familiar (home) and unfamiliar (clinic) environments in adults with acquired brain injuries.

DESIGN

The research performed was a comparison study examining the effect of the environment on functional task performance. Individuals were evaluated using the Assessment of Motor and Process Skills both in their homes and in an unfamiliar clinic setting.

PARTICIPANTS

Twenty individuals with acquired brain injuries living in the community.

MAIN OUTCOME MEASURES

The Assessment of Motor and Process Skills, an observational, standardized, occupational therapy assessment tool, was used to evaluate household task performance.

RESULTS

Paired one-tailed t tests indicated a significant difference between home and clinic performance measures in process ability (t=-4.28, p=.00), but no significant difference in motor ability performance measures (t=-1.84, p=.410). Scatter plot analyses showed that performance scores of 6 of the 20 subjects differed in a clinically meaningful way, and that instrumental activities of daily living motor performance scores for 3 of the 20 differed in a clinically meaningful way.

CONCLUSIONS

Individuals with acquired brain injuries may be influenced by their environment when performing household tasks, although further study is necessary to determine the extent of the environmental effect.