Occupational therapy is a health profession that promotes people’s health and well-being

through engagement in occupation. Occupations refer to everyday activities that people need to,
want to, and are expected to do within their relevant environments, to occupy time and bring
meaning and purpose to their lives. Occupational therapy has a primary goal of enabling people
to participate in their daily occupations or activities that are meaningful and valued to them.

Model of neuro-occupation, intention, meaning and perception

This model aims to describe the symbiotic relationship between occupation and the brain, as a
chaotic, self-organized, and complex system. It assumes that changes in human condition do not
follow a linear path. The model views occupational therapy as a complex intervention and a
result of dynamic integration of several factors and unpredictable outcomes. The concept of
neuro-occupation is complex and holistic, and aims to help occupational therapists to apply the
non-linearity principles. Cognition is a process with dynamic relationships between the three
levels of Intention, Meaning, and Perception that are operated in a circular feedback loop, which
are for adaptation of occupational performance. The three levels are:
1. Intention: a state of readiness that enables one to select and define goal-directed action(s) to
fulfil the need and desire.
2. Meaning: the actions that have meaning accumulated from experiences and maintained
through one’s history of goal development and goal-directed actions and choices.

3. Perception: Attitudes and Beliefs are shaped, which change perception and awareness of the
person about his or her own conditions.

The process begins with hypothesis formulation at the intention level, then the meaning level
(hypothesis will be tested by trial and error actions in the environment), then eventually at the
perception level (information will be created from the trial and error to modify or form new
perceptions). This explains how humans regulate behavior and adapt successfully to challenging
environmental conditions and, by creating meaning through engagement in occupations, execute
complex occupational performance. Perturbance is any condition that causes circular causality to
happen as a response. A person may respond to an internal (i.e. neurological event) or external
Perturbance (i.e. significant person or perceived important situation). Perturbance causes a
person to move from a steady state of homeostasis to the edge of chaos, where dynamical change
and adaptation occurs. It is where creativity occurs, and these constraints facilitate new action
formation and choice based on circumstances. Several factors, such as experiences, genetics,
environment, arousal state, intention state, affect the recognition of Perturbance. Occupational
therapists use personal creativity and accumulated knowledge of the client, pose an effective
Perturbance that challenges, motivates, and directs personal goal formation to client, and may
influence the client’s perception. An intervention based on what is meaningful to the client may
be taken as a Perturbance for restoring hope and motivation.

COMMUNITY BASED REHABILITATION (CBR)

Community Based Rehabilitation (CBR) is a community development strategy that aims at
enhancing the lives of persons with disabilities (PWDs) within their community. Community-
based rehabilitation (CBR) was initiated by WHO following the Declaration of Alma-Ata in
1978 in an effort to enhance the quality of life for people with disabilities and their families;
meet their basic needs; and ensure their inclusion and participation. While initially a strategy to
increase access to rehabilitation services in resource-constrained settings, CBR is now a multi-
sectorial approach working to improve the equalization of opportunities and social inclusion of
people with disabilities while combating the perpetual cycle of poverty and disability. CBR is
implemented through the combined efforts of people with disabilities, their families and
communities, and relevant government and non-government health, education, vocational, social
and other services(WHO).

It emphasizes utilization of locally available resources including beneficiaries, the families of

PWDs and the community. According to the UN Convention on the Rights of Persons with
Disabilities, comprehensive rehabilitation services focusing on health, employment, education
and social services are needed to enable PWDs/CWDs attain and maintain maximum
independence, full physical, mental, social and vocational ability, and full inclusion and
participation in all aspects of life (UN, 2006).

MOHO (Model of Human Occupation) is a theoretical framework used in occupational therapy

to understand how individuals engage in occupations. Several assessment tools are used within
the MOHO framework to assess different aspects of a person’s occupational functioning. Some
common assessment tools used in MOHO include:
1. **Occupational Self-Assessment (OSA):** A self-report questionnaire that evaluates an
individual’s perceptions of their own occupational competence, values, interests, and
choices.
2. **Role Checklist:** This checklist assesses the individual’s participation in various roles,
such as worker, student, friend, etc., and evaluates the importance and satisfaction
associated with each role.
3. **Volitional Questionnaire (VQ):** This questionnaire assesses an individual’s
motivation, interests, and values related to engaging in occupations.
4. **Routine Task Inventory (RTI):** A structured interview or questionnaire that assesses
an individual’s daily routines, habits, and roles to understand how these factors influence
occupational engagement.
5. **Interest Checklist:** This tool assesses an individual’s interests across various
domains, such as work, leisure, and social activities.
6. **Environment Measure of Participation, Home Version (EMP-H):** This assessment
tool evaluates the physical and social environment of the home, including accessibility,
safety, and support available for occupational engagement.
7. **Occupational Performance History Interview (OPHI-II):** An interview-based
assessment that explores an individual’s occupational history, including past roles,
experiences, and significant life events.

These assessment tools help occupational therapists gather information about an individual’s
occupational profile, including their interests, values, roles, routines, and environmental factors.
This information guides intervention planning within the MOHO framework to promote
meaningful occupational engagement and participation.
The CMOP (Canadian Model of Occupational Performance) is another occupational therapy
framework that focuses on occupational performance, which encompasses the interaction
between the person, their occupations, and the environment. Assessment tools used within the
CMOP framework aim to evaluate these aspects of occupational performance. Some common
assessment tools used in CMOP include:

1. **Canadian Occupational Performance Measure (COPM):** This client-centered

assessment tool enables individuals to identify their own occupational performance issues
and prioritize areas for intervention. It assesses self-perception of occupational
performance in areas such as self-care, productivity, and leisure.
2. **Occupational Performance History Interview (OPHI-II):** Similar to the assessment
tool used in the MOHO framework, the OPHI-II is an interview-based assessment that
explores a person’s occupational history, including past roles, experiences, and significant
life events.
3. **Assessment of Motor and Process Skills (AMPS):** This standardized assessment
evaluates an individual’s quality of performance in activities of daily living (ADLs) and
instrumental activities of daily living (IADLs). It provides objective measures of motor
and process skills required for occupational performance.
4. **Canadian Occupational Performance Measure – Visual Analog Scale (COPM-VAS):**
A variation of the COPM, this tool uses a visual analog scale to assess an individual’s
self-perception of occupational performance in various areas.
5. **Occupational Performance Questionnaire (OPQ):** This questionnaire assesses an
individual’s perceived competence and satisfaction with their occupational performance
in different areas of life.
6. **The Role Checklist:** Similar to the Role Checklist used in the MOHO framework,
this tool assesses an individual’s participation in various roles and the importance and
satisfaction associated with each role.

These assessment tools help occupational therapists gather information about a person’s
occupational performance, including their perceived competence, satisfaction, priorities, and
environmental influences. This information guides intervention planning within the CMOP
framework to promote meaningful engagement in occupations.
For evaluations focused specifically on dexterity, occupational therapists often use assessment
tools that target fine motor skills, coordination, and hand function. Here are some commonly
used evaluation tools for assessing dexterity:

1. **Nine-Hole Peg Test (NHPT):** This test assesses fine motor dexterity and
coordination by timing how long it takes for an individual to pick up and place nine pegs
into a pegboard and then remove them.
 2. **Minnesota Manual Dexterity Test (MMDT):** The MMDT evaluates manual dexterity
and hand-eye coordination through tasks that involve placing, turning, and manipulating
small objects within a time limit.
3. **Purdue Pegboard Test:** This test measures both gross and fine motor dexterity by
assessing the speed and accuracy of placing pegs into a pegboard using one or both
hands.

4. **Box and Block Test:** This assessment evaluates manual dexterity and gross motor
coordination by measuring the number of blocks a person can transfer from one
compartment of a box to another within a set time.

5. **Jebsen-Taylor Hand Function Test:** This test assesses various hand functions,
including writing, turning over cards, picking up small objects, and simulated feeding
tasks, to evaluate dexterity and coordination.

6. **Functional Dexterity Test (FDT):** The FDT evaluates dexterity and hand function by
assessing an individual’s ability to manipulate everyday objects commonly encountered
in activities of daily living.

7. **O’Connor Finger Dexterity Test:** This test assesses finger dexterity and coordination
by measuring the speed and accuracy of placing small pins into a pegboard using one
hand.

These evaluation tools provide quantitative and qualitative measures of dexterity, helping
occupational therapists assess an individual’s hand function and fine motor skills to inform
intervention planning and monitor progress over time.