Rehabilitation Engineering

Raymond V. Smith, John H. Leslie, Jr.

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351419208
• Edition: 1
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

The purpose of this handbook is to bring together information on the special devices and associated systems which have been developed to assist the handicapped in living and vocational pursuits and in clinical use. This unique work places emphasis on the devices and systems plus includes sufficient background information to clarify the objectives and use. The general subject matter is divided into two major areas. The first area deals primarily with the environment of the handicapped. The second section deals with devices for personal assist systems-such as for testing, evaluation, and training-and devices which provide individualized support. The information in this comprehensive handbook will assist those working directly in the broad field of rehabilitation of the handicapped and also those associated with the subject matter in a peripheral way, including counseling and vocational evaluation.

SPECIAL APPLICATIONS

Independent Living

Chapter 8

TIMBERS ASSESSMENT OF CONCEPTS OF INDEPENDENT LIVING

Harold D. Converse and Janet B. Thompson

TABLE OF CONTENTS

I.	Abstract
II.	Introduction
III.	The Development of the Tacil
IV.	Test Standardization
V.	Methodology
VI.	Results of the Reliability Study
VII.	Discussion

I. ABSTRACT

The Timbers Assessment of Concepts of Independent Living (TACIL) is a self-assessment of the concepts of independence of adults with physical or neurological disabilities. Responding to positive statements, individuals rate their awareness, organization, or management abilities relating to seven domains of adult community living. Studies have found the TACIL to be a valid self-rating with reliable correspondence between self-rating and staff rating. Not seen as a prediction, the TACIL rates the individual’s ability to manage those tasks he or she is unable to perform.

II. INTRODUCTION

TACIL was developed out of a need to identify the capability of individuals with severe physical or neurological disabilities to live independently. The Timbers is a residential facility sponsored by Cerebral Palsy Research Foundation of Kansas for adults with physical or neurological disabilities. In addition to accessible apartments, the Timbers, through the Program Services Department, offers support services such as attendant care, transportation, and independent living skill training. Assessment of the individual’s ability to live independently is a critical component of skill training; however, an adequate assessment for individuals with severe physical or neurological disabilities was not available. Indeed, the definition of “independent” was debatable. Is independence defined as being able to function without assistance? Because the residents of the Timbers are severely physically or neurologically disabled, the definition of independence needed to focus on the individual’s control of the decision-making process, not the functional skill. The Program Services Department staff identified the need for an assessment of the individual’s ability to be in control of daily living activities.

A search was initiated for such an instrument. Most of the independent living assessments found were functional assessments which penalized physically disabled individuals who could not perform the tasks. Other assessments were the “on-off” variety, i.e., the client either was fully independent or not at all. In addition, most assessments were third party; a case manager, helper, or parent assessed the ability of the disabled person to perform. The Program Services Department staff refined the paremeters of their needed assessment:

1. It must assess the disabled individual’s ability to exert control over the activities of adult daily living (ADL). How does the disabled individual perceive independence? What is the individual’s concept of independence?

2. It must be a self-assessment. No third party can truly assess an individual’s concept of independence.

3. It must identify how individuals function in different domains or areas of life at differing levels of independence. Skill acquisition is progressive and individuals living in a “learning” environment progress at individual rates and for different reasons.

III. THE DEVELOPMENT OF THE TACIL

Over a 3-year period, ideas for the assessment were collected from the Program Services Department staff and from residents of the Timbers. Items were written, tried out, and rewritten. One of the main goals was to create an assessment that the individual could complete independently. This required that it be written in a language easily understood and commonly used. The Timbers residents are, for the most part, developmentally disabled. Their educational history is varied, but many were not included in public education under Public Law (PL) 94–142, The Education for All Children Act.

In addition to being easily understood, the assessment was developed to include following premises:

1. A self-assessment, rather than a third-party assessment, would provide a truer picture of the individual’s ability to control activities.

2. The domains to be assessed should be drawn from experiences common to persons with disabilities living independently.

3. The assessment must reflect varying degrees or levels of independence to reflect changes over time and to allow for comparison of strength and needs within and between domains.

4. The assessment should be easily understood and easily administered to make it accessible for the widest possible use.

An instrument was developed which would assess the disabled individual’s concept of his or her own ability to function in five major domains: adult daily living (ADL), management of finance (MF), legal rights (LR), health and attendant care (H/AC), and lesiure time (LT). Questions were presented as “I” statements, and individuals were asked to rate their response to the statements on a scale of 1 to 4, from “not like me” to “just like me”. The statements were designed to reflect one of three levels of independence: awareness, organizational, and management. The awareness level indicates that the individual is aware that something needs to be done, but has difficulty organizing steps to accomplish the task. The organizational level indicates the individual is aware of the task and has some ability to organize the necessary steps, but is unable to provide the follow-through independently. The management level indicates assimilation and accommodation: the individual is aware of the task, can organize steps for its completion, and can manage to carry them out.

The first trial instrument was administered to ten residents at the Timbers who were picked at random. The residents were asked to rate the instrument itself, specifically the language used, the content of the statements, and their personal response to assessing their own skills. Results of this first testing, although highly informal, were extremely useful. First, there was general agreement between the self-raters’ assessment and the staffs’ opinion of their functioning. Residents’ response to the language, the content, and the testing experience prompted changes. Items were rewritten, further simplifying or clarifying the language. Statements were restated, putting them more within the context of the residents’ experience. In addition, two more domains were added, vocational (V) and mobility (M). The assessment was again administered and reviewed for corrections.

The results of this 3-year development is the TACIL. The TACIL is a 60-item assessment in which adults with disabilities respond to “I” statements related to seven domains of adult community living. These domains are ADL, MF, LR, H/AC, LT, V, and M. The TACIL is a self-assessment designed to determine whether the self-rater’s concept of his or her independence is at an awareness level, an organizational level, or a management level. The three levels relate to the categories of residential programs defined in the Kansas Rehabilitation Information System, an interagency...