1 The core of occupational therapy: independence in action
Assessing Activities of Daily Living (ADLs) is the indispensable starting point for any occupational therapy intervention. Whether considering basic ADLs such as washing, dressing, eating, moving and personal hygiene, or more complex instrumental ADLs such as preparing meals, managing a budget, using transport and the telephone, the occupational therapist assesses the person's ability to act within their real environment.
2 The Functional Independence Measure (FIM)
The FIM is a universally recognised assessment scale comprising 18 items scored from 1, total assistance required, to 7, complete independence. It explores thirteen motor activities, including personal care, bed-to-chair transfers and locomotion, and five cognitive activities, including communication, social interaction, problem-solving and memory. The overall score objectively documents gains in independence throughout rehabilitation.
3 Ecological analysis of environmental barriers
The occupational therapist does not assess the person alone, but meticulously analyses their material and architectural environment. They identify physical obstacles at home, including dangerous steps, a slippery bath, doors too narrow for a wheelchair and inadequate lighting, which turn bodily vulnerability into actual disability.
4 The place of this approach within care
This approach leads to concrete, tailored recommendations: installing wall-mounted grab rails, providing assistive gripping devices and ergonomically reorganising kitchen cupboards. It restores the user's pride and comfort in living independently at home.
5 Ecological follow-up and involvement of family carers
The occupational therapist periodically reassesses functional independence at home to adjust equipment and relieve family carers of strenuous tasks. The environment adapts to the person, rather than the reverse, preserving comfort in everyday life.