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1. 1. Psychosocial Needs Dennis explains that sometimes, grading is done based on the clients' psychosocial needs, or their emotional well-being and social interactions. For instance, a client on the autism spectrum who is very easily upset by noisy stimuli might benefit from very short exposures to sound, while someone with hearing loss who is learning to turn to where the sound is coming from might be able to do the same activity for a longer time because it is not emotionally grueling.

2. 2. Cognitive Needs Cognitive needs, or those pertaining to learning, knowledge, and memory, are also relevant to grading interventions. Dennis explains, for example, that when a client is only able to remember one letter at a time, he only makes them look at one letter and trace it for five minutes as part of pencil control work. A patient who remembers the whole alphabet can do the same activity for a longer period of time and with fewer visual support.

2.1. 3. Developmental Abilities Finally, Dennis takes developmental abilities, or capacities related to age and overall development, into consideration when grading activities. He doesn't usually expect children to do activities with the same intensity and duration as adults, for instance. At the same time, some of his elderly patients also require shorter and less intense durations for different interventions.

3. Down-grade grading: 'Down-grade' an activity (make it easier) when the client is having too much difficulty with performance.

4. Grading is the way in which the physical, cognitive and psychological characteristics of an activity can be gradually modified or progressed to meet a therapeutic goal.


6. In the school system, the term modification is often used to when in lieu of gradation, while the word accommodation is frequently used instead of the term adaption. (Note: when it comes to adapting an activity, the word grading is used in a different context than it usually is in the school setting – it doesn’t have anything to do with earning an A or a B in this context.) When a student’s IEP calls for a modification to the curriculum, the child is taught and/or tested on something different than his peers. When the IEP lists accommodations that are to be allowed for a student, the child is taught and is tested on the same material as his peers but may use alternate materials and/or strategies to take in or output information.


7.1. This can be done by starting with easy activities and than progressing to harder or more difficult one.

7.1.1. E.g. for a tetraplegic person the activity of drinking a glass of water with both hand could be easily practiced initially with or without support. But teaching the same person to perform lower limb dressing would be very difficult.

8. Up-grade grading: A general rule is to 'up-grade’ (make the activity more difficult) an activity when the client is able to accomplish the task and further progress is desired.

9. Grading of an activity

9.1. Grading of an activity can be ensured by determining patient’s abilities with activities and tasks the patient needs or wants to do (occupation-as-end) and select the most appropriate activity for remediation from those that are available and are of interest to patient (occupation-as-means).

10. A background in the historical and conceptual use of the term Adapatation in occupational therapy is beyond the scope of this book but is an important part of the student's education. A list of references is given at the end of this unit as a starting point for learning more. In one sense, the real goal of all occupational therapy is to facilitate the client's adaptive responses to promote health and wellbeing

11. Scaffolding is support provided in a creative and adaptive manner that enables the student to learn the skills at the most independent level possible. Each student has a range of skill levels from what he or she is able to do without any assistance to what he or she is able to do with maximal assistance.

12. Grading Interventions

13. Documentation of Changes: Any form of upgrading and downgrading tasks should be thoroughly documented in the daily treatment notes. If anything, downgrading tasks should be efficiently backed up with evidence to support the change. Therapists know that insurance companies like to see functional progress and maintenance of functional participation in order to justify coverage of services.