1. Activity: ✓ Activity Analysis Form CATEGORY Activities of daily living Instrumental activities of daily living Health management Rest and sleep Education Work Play Leisure Social participation 2. Relevance and importance: - 1- SUBCATEGORY From Thomas H. Occupational and Activity Analysis, Third Edition. SLACK Incorporated; 3. Objects used and their properties: Tools: Supplies: Equipment: Resources: 4. Space demands: 5. Social demands: 6. Sequencing and timing demands: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Activity Analysis From Thomas H. Occupational and Activity Analysis, Third Edition. SLACK Incorporated; 2 7. Body functions required: FUNCTIONS Specific Mental Functions Higher level cognitive: Judgment, concept formation, metacognition, executive func- tions, praxis, cognitive flexibility, insight Attention: Sustained shifting and divided attention, concentration, distractibility Memory: Short-term, long- term, and working memory Perception: Discrimination of sensations (e.g., auditory, tactile, visual, olfactory, gustatory, vestibular, proprioceptive) Thought: Control and content of thought, awareness of reality vs. delusions, logical and coherent thought Mental functions of sequencing complex movement: Regulating speed, response, quality, and time of motor production Emotional: Regulation and range of emotions; appropriateness of emotions Experience of self and time: Awareness of one's identity (including gender identity), body, and position in the reality of one's environment and time NONE Activity Analysis MINIMALLY MODERATELY GREATLY CHALLENGED CHALLENGED CHALLENGED From Thomas H. Occupational and Activity Analysis, Third Edition. SLACK Incorporated; 3 HOW IT IS USED (continued) FUNCTIONS Global Mental Functions Consciousness: State of awareness and alertness, including the clarity and continuity of the wakeful state Orientation: Orientation to person, place, time, self, and others Psychosocial: Integration of mental functions to form personal and interpersonal skills to esestablisheciprocal social interactions Temperament and personality: Extroversion, introversion, agreeableness, conscientiousness, emotional stability, openness to experience self-control, self-expression, confidence, motivation, impulse control, appetite Energy: Energy level, motivation, appetite, craving, impulse control Sleep: Physiological process, quality of sleep Sensory Functions Visual functions: Quality of vision, visual acuity, visual stability, visual field Hearing functions: Sound detection and discrimination; aware- ness of location and distance of sounds NONE Activity Analysis MINIMALLY MODERATELY GREATLY CHALLENGED CHALLENGED CHALLENGED From Thomas H. Occupational and Activity Analysis, Third Edition. SLACK Incorporated; HOW IT IS USED (continued) FUNCTIONS Vestibular functions: Sensation related to position, balance, and secure movement against gravity Taste functions: Association of taste qualities of bitterness, sweetness, sourness, and saltiness Smell functions: Sensing of odors and smells Proprioceptive functions: Awareness of body position and space Touch functions: Feeling of being touched, touching various textures Interoception: Internal detection of changes in one's internal organs Pain: Localized and generalized pain Sensitivity to temperature and pressure: Thermal awareness (hot and cold), sense of force applied to the skin (thermoreception) Neuromusculoskeletal and Movement-Related Functions Functions of Joints and Bones Joint mobility: Joint range of motion Joint stability: Structural integrity of joints, physiologi- cal stability of joints related to structural integrity Muscle Functions Muscle power: Strength Muscle tone: Degree of muscle tension Activity Analysis NONE MINIMALLY MODERATELY GREATLY CHALLENGED CHALLENGED CHALLENGED From Thomas H. Occupational and Activity Analysis, Third Edition. SLACK Incorporated; 5 HOW IT IS USED (continued)

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1. Activity: ✓ Activity Analysis Form CATEGORY Activities of daily living Instrumental activities of daily living Health management Rest and sleep Education Work Play Leisure Social participation 2. Relevance and importance: - 1- SUBCATEGORY From Thomas H. Occupational and Activity Analysis, Third Edition. SLACK Incor