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Top Down or Bottom Up?

Assessment approaches in Occupational Therapy
by

Michelle Hedley

on 19 January 2013

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Transcript of Top Down or Bottom Up?

A. Top Down or Bottom Up ! Q. How do you think you should approach assessing someone? Occupational Therapy Assessment Approaches by PBL Group 1 "Take on global perspective and focus on the client's participation" (Brown & Chien 2010) in the context they live. Bottom Up Approach "They tend to examine small separate components of a client's skills, or occupational performance components" (Brown & Chien 2010). Top Down Approach Spirituality
Environment
Contextual
Personal Goals
Lifestyle Exploration Physical impairment
Evaluate specific criteria
Components causing performance issues
Dysfunction Mental Health Bottom Up Used in emergency incidences where the safety of the client, i.e. during psychotic episode, is at risk to self or others.

In contrast to the macrolevel, Christiansen and Baum (1997) describe the bottom up approach as a microlevel functional level of analysis based on data acquisition. This only addresses one aspect of occupation as a tool. Top Down Focuses on ability of client to participate in meaningful occupations. Examining motivations, routines, habits, and roles within their environment. Evaluates how the environmental demands influence occupational performance. The information gathered guides intervention (Ideishi 2003 cited by Kramer et al. 2003, p.281). Physical Learning Disabilities Top Down & Bottom Up A person with learning disabilities has a range of needs that require an holistic approach facilitating strategies for needs that continue through person's lifetime. Top down approach suits learning disabilities as this meets all needs of the person, e.g. OT's encourage those with learning disabilities to engage in meaningful occupations (COT 2011).

An example of this is in Autism. Autism affects the child's ability to perform key occupational roles. A top-down approach is ideally suited to address these kinds of issues. The therapist focuses on barriers to his/her occupational performance, and addresses issues such as the development or acquisition of skills, and compensation or task adaptation where necessary. Adapting the environment is also an important part of the top-down approach, e.g. facilitating capacity building for the child and his/her family, rather than implementing strategies that aim to reduce the characteristics of the condition as a bottom up approach tends to do. Paediatrics Top Down Addressing the child's problems in occupational performance, together with their role participation at home, school and in the community (Chen et al 2003).
Adopts an individual client centered approach focused on strategy based skill position. Bottom Up Limited as focused primarily on physical deficits not taking into account the many variables present in the child's life. Top Down The selection process involves the information gathering from notes and interview (Pearson 1999). The OT recognises areas that need to be assessed and chooses ax and goal setting approaches. MOHO which is a top down approach is a favoured model in mental health settings in due to its components, e.g. Dorset Healthcare Trust use MOHOST as a standardised assessment tool. Bottom Up Putting the impairment first and blending together knowledge of performance requirements. References
Christiansen, C.H. & Baum, C.M., 2005. Occupational Therapy Performance, Participation, and Well-Being. 3rd ed. : Slack Incorporated.
Case-Smith, J., 2005. Occupational Therapy for Children. 5th ed. Missouri: Elsevier Mosby.

Chen, H.F., Tickle-Degnen, L., & Cremack, S. A., 2003. The Treatment Effectiveness of Top-down Approaches for Children with Developmental Coordination Disorder: A Meta- Analysis in Journal of Occupational Therapy Association, R.O.C. 21, 16-28.

Hemphill-Pearson, B.J., 1999. Assessments in Occupational Therapy Mental Health: An Integrative Approach. 2nd ed. United States of America: SLACK Incorporated.

Ideishi, R.I., 2003. Influence of Occupation on Assessment and Treatment. In: Ch.10. Kramer, P., Hinojosa, J., & Royeen, C.B., 2003. Perspectives in Human Occupation: Participation in Life. United States of America: Lippincott, Williams & Wilkins.

Laver, A.J., & Baum, C.M., 1992. Areas of Occupational Therapy Assessment Related to the NCMRR Model of Dysfunction. In: Laver, A.J., 1994. The Development of the Structured Observational Test of Function (SOTOF). Unpublished Doctoral Thesis, University of Surrey, Guildford, 185 – 186, 191.

Lintern, S., 2012 . Mortality rate for mental illness is three times the population average. Health Services Journal. Available from: http://www.hsj.co.uk/news/mortality-rate-for-mental-illness-is-three-times-the-population-average/5046462.article [Accessed 12th January 2013].

National Center for Medical [[#|Rehabilitation]] Research (NCMRR), 1992. Report and Plan for Medical Rehabilitation Research to Congress. NCMRR, US Department of Health and Human Services, National Institutes of Health, Bethseda, MD.

Payne, S., Howell, C., 2005, An evaluation of the clinical use of the assessment of motor and process skills with children). In: Occupation in occupational therapy: a labour in vain? In: occupational therapy and physial dysfunction, Curtin M., Molineux M., Supyk-Mellson J., 2010, elsevier limited

Rodger, S., 2010. Occupation centred practice with children: A practical guide for occupational Therapists. Malaysia: Wiley Blackwell.

Trombly, C., 1993. Anticipating the Future: Assessment of Occupational Function. American Journal of Occupational Therapy (47): 253-257.

Turner, A., et al., 2002. 5th ed. Occupational Therapy and Physical Dysfunction: Principles, Skills and Practice. London: Churchill Livingstone.

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