Updated for 2026
OT exam prep: ADL assessment, occupational therapy models, and rehabilitation practice
The NBCOT OTR examination tests competency in occupational therapy assessment, intervention planning, and implementation across all practice settings and patient populations. Core content includes occupational performance assessment, models of practice (MOHO, CMOP-E, OA), therapeutic use of self, ADL/IADL training, sensory integration, neurological rehabilitation, and mental health OT practice.
Educational purpose: This content is for exam preparation and professional development only. It is not intended for clinical decision-making. Always follow current guidelines, institutional policies, and scope of practice.
Occupational therapy models of practice
Model of Human Occupation (MOHO): Three components of occupational participation: Volition (motivation — personal causation, values, interests), Habituation (routines and roles), Performance capacity (physical and mental abilities). Environment interacts with person to produce occupational performance. Assessment tools: OPHI-II (Occupational Performance History Interview), OSA (Occupational Self Assessment), OQ (Occupational Questionnaire).
Canadian Model of Occupational Performance and Engagement (CMOP-E): Spirituality at the core, surrounded by person (cognitive, affective, physical), occupation (self-care, productivity, leisure), and environment (cultural, institutional, physical, social). Guides client-centred occupational therapy practice. Used with COPM (Canadian Occupational Performance Measure) — rates performance and satisfaction.
Occupational Adaptation (OA) model: Focuses on the adaptive response and adaptive capacity development. Occupational challenge + press from occupational environment → occupational response. Person develops relative mastery through experience. Goal: develop internal adaptive capacity, not just specific skills.
Biomechanical model: Used for physical dysfunction — ROM, strength, endurance, and posture. Assessment: goniometry (ROM), manual muscle testing (MMT grades 0–5), dynamometry (grip strength). Applicable to orthopaedic conditions, hand therapy, burns, and post-surgical rehabilitation.
ADL/IADL assessment and rehabilitation
Functional independence measure (FIM): 18-item scale (13 motor + 5 cognitive). Each item scored 1 (total assistance) to 7 (complete independence). Total 18–126. Used for rehabilitation admission/discharge to measure functional change. Minimum detectable change varies by population.
Stroke ADL rehabilitation: Top-down approach — assess occupational performance first (what activities are impaired?), then analyse underlying skills (motor, sensory, cognitive). Task-specific training (practice of real ADL tasks) is evidence-based for stroke rehabilitation. Constraint-Induced Movement Therapy (CIMT): restraint of unaffected arm + intensive affected arm practice — significant evidence for improving upper extremity function after stroke. Neurodevelopmental technique (NDT): facilitation of normal movement patterns.
Seating and positioning: Pressure distribution, proper alignment, functional reach, and respiratory support. W-sitting in children (contraindicated due to hip and core development concerns). Tilt-in-space vs. reclining wheelchairs: tilt preferred for postural management without changing hip angle; reclining changes hip angle (may affect tone).
Mental health occupational therapy
Therapeutic use of self: The OT practitioner's intentional use of personality, insights, perceptions, and judgments as part of the therapeutic process. Intentional relationship model (Taylor): modes of therapeutic relating — advocating, collaborating, empathising, encouraging, instructing, problem-solving. Therapeutic relationship is the foundation of OT mental health practice.
OT in psychiatric settings: Assess and restore occupational functioning across all performance areas disrupted by mental illness. Key assessments: Allen Cognitive Level Screen (ACLS) — leather-lacing tasks; Allen levels 1–6 assess cognitive functioning. Role Checklist — identify valued roles and disruption. Occupational therapy focus areas: medication management, independent living skills, work skills, social participation, leisure.
Sensory processing in mental health: Sensory modulation dysfunction is common in mental illness (schizophrenia, PTSD, borderline personality disorder). Sensory diet — scheduled sensory activities to maintain optimal arousal. Sensory room/snoezelen for de-escalation. Weighted blankets and vests for proprioceptive input — calming effects.
Frequently asked questions
- How does the OT approach differ from physiotherapy in rehabilitation?
- While both occupational therapy (OT) and physiotherapy (PT) work in rehabilitation, their scope and focus differ. PT focuses primarily on movement, strength, flexibility, gait, and pain management — the body's physical components. OT focuses on occupational performance — the ability to engage in meaningful daily activities (ADLs, work, leisure) and the underlying factors that support or limit participation. In stroke rehabilitation: PT addresses gait training, balance, and lower extremity function. OT addresses upper extremity function, self-care tasks (dressing, bathing, grooming), cognitive aspects of daily life (meal preparation, home management), driving readiness, and return to work/leisure. OT uses occupation as both the means and the end of intervention — the therapeutic activity is purposeful and personally meaningful to the client. Both disciplines use evidence-based practice, and an interdisciplinary approach combining PT + OT + SLP is standard for complex rehabilitation.
Clinically reviewed by NurseNest Clinical Review Team · Last updated 2026-06-10 · For educational purposes only · Review policy