Top-down or bottom-up occupational therapy assessment: which way do we go?

摘要

Using either a top-down or a bottom-up approach has been introduced to occupational therapy assessment and there has been a long debate about which approach is the most appropriate for contemporary occupational therapy practice (Weinstock-Zlotnick and Hinojosa 2004). Traditionally, bottom-up assessments have been used more frequently in occupational therapy practice and fit within the medical model (Stewart 1999). Bottom-up assessments tend to examine small, separate components of a client's skills or occupational performance components. They focus primarily on the body structure and function (impairments) level of the International Classification of Functioning, Disability and Health (ICF; World Health Organisation [WHO] 2001). Moreover, bottom-up assessments are frequently administered in contrived, standardised contexts, which may not be meaningful to the client and are often isolated from relevant daily life contexts. One example is the Peabody Developmental Motor Scales, 2nd edition, which evaluates children's grasping skills by observing them performing several simulated tasks (for example, stacking blocks and placing coins in a small box).