In Analysis of Occupational Performance, bottom-up is contrasted with top-down. Which is bottom-up most closely associated with?

• A. Focusing on underlying skills and client factors
• B. Starting with daily activities and roles
• C. Limiting assessment to motor skills
• D. Requiring that only OTR can accept referrals

Answer: (A)

Bottom-up approaches focus on the building blocks that support what a person can do. It looks at the client’s underlying abilities and factors—body functions and structures, motor and processing skills, perception, cognition, sensation, memory, motivation, and habits—because these foundations explain why a person performs the way they do in daily life. In this view, you start by evaluating and improving these underlying components before addressing the activities themselves. That’s why bottom-up is most closely associated with focusing on underlying skills and client factors.

Starting with daily activities and roles is top-down because it begins with what the person wants or needs to do and then looks for deficits in performance to trace back to underlying causes. Limiting assessment to motor skills is too narrow, since bottom-up encompasses a range of client factors beyond just motor abilities. Requiring that only OTRs can accept referrals isn’t related to the bottom-up/top-down distinction.