AMPS (Assessment of Motor and Process Skills) Begin with the idea that the AMPS is an occupational therapy evaluation, and it reflects the unique focus of OT (occupational performance, the doing)

AMPS Een ergotherapeutisch observatie instrument Meet de kwaliteit van het dagelijks handelen Gestandaardiseerd bij 50.571 cliënten wereldwijd The AMPS is an observational assessment, used to evaluate people in the context of familiar and relevant tasks. The AMPS is used to measure the quality of those task performances. The AMPS is a standardized assessment that can be used with clients aged three or older, with any diagnosis or disability. It is currently in use in Europe, North and South America, Asia, Nordic Countries, Australia, New Zealand, Israel, the United Kingdom, and South Africa.

Een AMPS onderzoek Begint met een cliënt-gericht interview waarin vastgesteld wordt welke taken relevant en bekend zijn Observeren van twee of drie zelfgekozen adl taken (zelfzorg of huishouden) Er zijn 83 taken gestandaardiseerd, varieërend van makkelijk tot moeilijk. A core concept in the AMPS is the importance of client choice, as engagement in chosen and meaningful activities at the core of occupational therapy. Client motivation and performance is believed to be best when he or she can choose the activity. An AMPS assessment begins, therefore, with an interview of the client so that the therapist can determine which tasks that are standardized in the AMPS are familiar and relevant to the client. For an AMPS assessment, the client chooses 2 or 3 tasks to perform from a subset of tasks offered by the therapist. The therapist must also ensure that the tasks offered as choices are hard enough to offer a “just right” challenge to the person – not too easy and not too hard. There are 83 tasks standardized in the 4th edition of the AMPS Manual, 74 domestic ADL tasks and 9 personal ADL tasks.

Standaardisering van taken Elke taak bevat: Specifieke criteria waaraan voldaan moet worden om standaardisatie te behouden Keuze mogelijkheden waardoor variaties en persoonlijke wensen in het handelen mogelijk zijn The standardized challenge of the tasks is maintained by establishing essential criteria that all clients who do this particular task must complete. Within these standardized guidelines, however, each task also is flexible enough to allow a the client some choice and variety in the tools and materials he or she uses in completing the task.

Taak A-3. Pot koffie of thee - één of twee personen Essentie van de taak: Een pot koffie of thee zetten Koffie of thee in kopjes schenken Serveren met melk of room op het aanrecht of op tafel It is often helpful to show an example of a task. Task A-3 is a good one, because it has a variety of tools that can be used (electric kettle, drip coffee maker, stovetop percolator, etc.) as well as a variety of options of ingredients such as coffee, tea, and sugar. The “essential task” is a description of the basic steps of the task.

Taak A-3. Pot koffie of thee – één of twee personen Specifieke criteria: De koffie of thee moet worden ingeschonken Er moet een kannetje melk of room bij geserveerd worden Specific criteria are things that must be done in order to maintain the standardized challenge of the task.

Taak A-3. Pot koffie of thee – één of twee personen Keuzemogelijkheden Koffie of thee Koffie kan gezet worden door water te koken, met koffiezetapparaat, perculator of French press Water voor de thee kan verwarmd worden in waterkoker, op het fornuis of in de magnetron Suiker of zoetjes zijn naar keuze Within the structure of the essential task and the specific criteria are options that allow for choice and for the client to be able to use tools and materials that are preferred and culturally relevant. In this task, tea is commonly the more popular option in Canada, United Kingdom, and Asia; coffee is commonly more popular in America, Europe, and Nordic Countries. Boiled coffee is more popular than brewed coffee in Sweden, Alaska, and parts of New Zealand (see page 6 in Volume 1 of the 4th Edition of the AMPS Manual for more detail). Each of the 83 AMPS tasks has been standardized in this manner.

Conceptuele model Because of copyright restrictions, the AMPS Conceptual model is not reproduced here. For an inservice, however, you could legally make one (1) overhead copy of the conceptual model (page 21 of Volume 1, 4th Edition of the AMPS Manual). Because of copyright restrictions, the AMPS Conceptual model is not reproduced here. For an inservice, however, you could legally make one (1) overhead copy of the conceptual model (page 21 of Volume 1, 4th Edition of the AMPS Manual). When discussing the conceptual model, stress the following points: When the AMPS is given, the focus is on the quality of the task performance and the quality of the individual motor and process skills. Characteristics of the person, the environment, and the task the person does will impact the skill of the task performance we observe. In OT practice, it has been common to start evaluation at the level of the person (e.g., ROM, strength, perception, memory, etc.) and to assume or infer relationships between impairments of the mind-brain-body capacities and global performance (bottom-up approach) In an AMPS assessment, we are not evaluating the person (motivation, impairments, etc.) nor are we evaluating the environment. We use the AMPS in a top-down manner, beginning with an client interview and progressing to observing the quality of his or her performance of chosen and meaningful tasks. We then assess the quality of the person’s motor and process skills – which are individual units of performance. Lastly, we consider the impact of environmental features and capacities of the mind- brain-body on the quality of performance we observed. You might also want to use Figure 2-2 (p. 26 in Volume 1 of the 4th Edition of the AMPS Manual) to discuss the AMPS in relation to the WHO/ICIDH-2 classifications of body functions, activities, and participation. If you do, feel free to make one overhead of Figure 2-2 to use in your presentation. Refer to section 2.4, (p. 25) of Volume 1 of the 4th Edition of the AMPS Manual for more information on AMPS and WHO/ICIDH-2. The AMPS motor and process skills are individual units of goal-directed action, scored at the WHO/ICIDH-2 level of activity. The interpretation of the AMPS scores takes into account the impact of elements of the person and the environment on the observed performance, and so is made at the WHO level of participation.

Vaardigheden Bestaan uit: Geven zicht op: praktische activiteiten doelgerichte handelingen Geven zicht op: de behendigheid, bedrevenheid en het zelfvertrouwen Zijn te zien: bij een persoon die een taak uitvoert in de context van een specifieke omgeving (Connolly & Dalgleish, 1989) A common source of confusion is the difference between skills and impairments/capacities/performance components. Stress the idea that skills are goal- directed actions (e.g., reaching for this glass from this cupboard) not the person’s reaching capacity (e.g., the person’s maximal degrees of humeral flexion).

Motorische vaardigheden: Doelgerichte handelingen om zichzelf of voorwerpen te verplaatsen tijdens het uitvoeren van een taak. What are motor skills? Note that they are goal-directed actions. They are not physical capacities.

Motorische vaardigheden (16) Stabiliseren Oprichten Positioneren Lopen Reiken Buigen Coördineren Manipuleren Vloeiend bewegen Bewegen Transporteren Tillen Doseren Grijpen Tempo houden Uithoudingsvermogen Depending on the amount of time you have, you may or may not want to give a brief definition of the skills. Sometimes it is enough to give two or three definitions as examples.

Proces vaardigheden Doelgerichte handelingen die nodig zijn om bij het uitvoeren van een taak: De juiste materialen en gereedschap te kunnen kiezen en gebruiken Het handelen te organiseren in de tijd Het handelen te kunnen aanpassen wanneer er zich problemen voordoen Process skills are also goal-directed actions! They are not cognitive capacities such as problem solving or memory. Adaptation is a critical feature of the AMPS. When the person experiences a problem, we consider what he or she does about it. Do problems happen? If so, does he or she prevent the problem from recurring?

Proces vaardigheden (20) Tempo houden Aandacht schenken Kiezen Gebruiken Hanteren Doelgerichtheid Informeren Initiatief nemen Continueren Volgorde aanbrengen Beëindigen Zoeken / Lokaliseren Verzamelen Organiseren Opruimen Navigeren Depending on the amount of time you have, you may or may not want to give a brief definition of the skills. Sometimes it is enough to give two or three definitions as examples.

Procesvaardigheden - Adaptatie Opmerken / Reageren Accommoderen Adjusteren Baat hebben These are the skills that deal with adaptation – the person’s skill at doing something to prevent motor or process problems from happening or recurring during the task performance.

Vaardigheden zijn géén functies! Een koffiepot vastpakken en optillen Reiken naar een kraan Opmerken dat de kan vol is en reageren door de kraan dicht te draaien Functies Grijpen en kracht van biceps Bewegingen in de schouder Vermogen om probleem op te lossen Just to make the point again. . . Use examples from client populations that are relevant to your audience and/or practice setting. Also be sure use examples from whatever task (e.g., Pot of coffee) that you used earlier in the inservice.

Iedere vaardigheid wordt gescoord op een vier punt schaal 4 = competente uitvoering 3 = twijfelachtige uitvoering 2 = ineffectieve uitvoering 1 = onacceptabele uitvoering Once you’ve presented the skill items, begin to talk about how the AMPS is scored on a 4-point scale. The scale is criterion-referenced (as opposed to being norm-referenced) with the criteria being competent performance. On many norm-referenced tests, “normal” people would get perfect scores. Because the AMPS is criterion referenced, even “normal” people will get some scores of 2 if they are doing a task that is hard enough. None of us perform with perfect competence all of the time – we all occasionally do things like drop an egg, trip, or discontinue actions for no apparent reason. Competent (4) = no problems observed with this skill in this task Questionable (3) = the therapist questions whether or not there was a problem Ineffective (2) = some increased effort or inefficiency noted – could be slight or more pronounced Unacceptable (1) = an unacceptable amount of effort or inefficiency, imminent safety risk, or need for assistance was noted

De scores worden per taak in de computer ingevoerd Het computerprogramma verrekent de ruwe scores voor: De persoonlijke strengheid van de onderzoeker De taak zwaarte De zwaarte van de vaardigheid Computer scoring is what makes the AMPS such a sensitive tool. Through computer scoring, AMPS raw scores are adjusted for: The severity of the rater (this is why each person who gives the AMPS must be trained at an AMPS workshop and be calibrated) The challenge of the tasks that the person did (this is why the specific criteria of each task must be standardized) The difficulty of each motor and process skill item – lower scores on harder items are less of a big deal than lower scores on easier items. You might want to mention that the computer program is based on many- faceted Rasch measurement, which allows for this sort of complexity.

AMPS Computer rapporten Samenvattend rapport Rapport van de ruwe scores Grafisch rapport It is nice to show samples of each of these. If you are using a case study, make copies of these reports for the case. AMPS Summary Report: Communicates an overall picture of the quality of the person’s ADL task performance. Generally put in the client’s chart as a summary of the results of the AMPS. AMPS Raw Scores Report: Shows patterns in the client’s skills across different tasks. While it is not usually placed in the chart, it is helpful to assist therapist reasoning in the intervention planning phase. AMPS Graphic Report: The quantitative aspect of the AMPS (more detail on next slide)

AMPS Grafisch rapport Kwantitatieve metingen van de cliënt’s algehele motorische and proces vaardigheden Verrekend door het programma voor: de zwaarte van de taak de strengheid van de onderzoeker de moeilijkheid van de vaardigheden Zeer bruikbaar om na verloop van tijd veranderingen te meten The person’s place on the lines of motor and process ability is calculated by the computer; and is adjusted for the challenge of the task, the severity of the rater, and the individual difficulty of each item. This report is useful to use in pre- and post- testing to show change over time. This is the report that is most interesting to third party payers. Cut off indicators Motor 2.0: Persons below this cutoff experience increased effort during task performance. Older adults who are just beginning to have increased difficulty doing tasks (e.g., stiffness when bending down, some stiffness of fingers) should be near 2.0 on the motor scale. Process 1.0: 93% of persons below this cutoff need assistance to live in the community. (see section 7.13, Volume 1 of the 4th Edition of the AMPS Manual, (pp. 226- 229 for more information on the development of the cut off indicators)

Case study Introductie van de cliënt AMPS resultaten Interpretatie AMPS Doelen Plannen van interventie It is often very useful to include a case study in your inservice. Make a videotape of the client, if possible. Give the participants a copy of scored responses with comments as to why you gave the scores you did. Also share with them some of the computer-generated reports for the client. Discuss how you interpreted the results of the AMPS, and how you used this information to develop goals and plan intervention.

Discussie en vragen As time allows, encourage questions and discussion.