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Activities of Daily Living

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•Bathing and showering •Bowel and bladder management •Toileting hygiene •Dressing and undressing •Eating and feeding •Functional mobility •Personal device care •Community device use •Community mobility •Health management/medication routine •Meal preparation and clean-up

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Feeding and Eating Skills

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•Infant's oral area different from an adult's •Small oral cavity coupled with fat pads in cheeks, result in suckling •By 4 to 6 months, able to use a mature suck pattern •Rooting reflex •Suck-swallow reflex •Gag reflex •Phasic bite reflex •Grasp reflex

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Infant's Oral Motor Development

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•Suckles for the first several months of life •By 4 months, able to use a mature suck pattern •By 6 months, head control present with greater jaw stability •By 4 to 5 months, uses a phasic bite reflex to gum soft solids •By 7 to 8 months, diagonal jaw movements coupled with munching •By 12 months, prefers to eat with fingers and rotary chewing present •By 15 months, diagonal rotary chewing movements present •By 15 to 18 months, independent spoon feeding emerges

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Development of Feeding Skills During Early Childhood

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•By 2 years, able to eat most meats and raw vegetables •By 2 to 3 years, mature rotary chewing present •By 2 years, independent in spoon feeding and drinking from a cup •By 2 to 3 years, able to drink from a straw •By 3 years, able to pour liquids from a container into a glass and to serve own food

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Development of Feeding Skills During Early Childhood

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•By 2 years, able to eat most meats and raw vegetables •By 2 to 3 years, mature rotary chewing present •By 2 years, independent in spoon feeding and drinking from a cup •By 2 to 3 years, able to drink from a straw •By 3 years, able to pour liquids from a container into a glass and to serve own food

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Dressing and Undressing

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•Selecting clothes and accessories appropriate for weather and occasion •Putting on clothes sequentially •Fastening and adjusting clothes and shoes •Independence depends on the family's cultural expectations and type of clothing worn, opportunities for practice, and the child's motivation •By 4 to 5 years, independence in dressing and undressing •See Table 7-2.

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Infancy: Dressing and Undressing

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•Cooperation in dressing and routines •By 1 year, able to remove loose-fitting clothes (e.g. hats, mittens, socks) •By 1 year, motor skills necessary for independence in dressing and undressing present

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Early Childhood: Dressing and Undressing

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•By 2 years, able to raise arms to pull shirt over head and maintain balance •By 3 years, more aware of details •By 4 years, recognizes correct sides and able to manipulate most fasteners

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Personal Hygiene and Grooming

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•Cultural expectations and social routines affect independence •Face washing, hand washing, and hair care learned during early childhood •By 2 years, child imitates tooth brushing •By 5 to 6 years, child no longer requires supervision during tooth brushing

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Bathing and Showering

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•Involves soaping, rinsing, and drying the body •By 2 years, able to assist with washing •By 4 years, able to wash and dry with supervision •By 8 years, independent without supervision

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Toilet Hygiene

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•Involves clothing management, maintaining position, transferring to and from toilet, and cleaning the body •By 2 to 3 years, voluntary physiologic control of urination •By 2½ years, toilet training begins •By 2½ to 3 years, daytime bowel and bladder control •By 5 years, independence in daytime toileting •By 5 to 6 years, nighttime bladder control

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Instrumental Activities of Daily Living (IADLs)

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•Complex activities of daily living needed to function independently in the home, school, or community •Includes home management activities, community mobility, and care for others

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Readiness Skills

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•Necessary for successful participation in home management, community mobility, and care of others activities •Activity analysis used to determine skills necessary to perform a specific task

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Home Management Activities

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•Necessary tasks to obtain and maintain personal and household possessions •Contexts significantly affect home management activities •Chores may or may not have monetary incentive

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Community Mobility

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•Mobility outside the home •Environmental impact •Family and cultural expectations

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Care of Others

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•Physical upkeep and nurturing of pets or other human beings •Significantly influenced by performance contexts

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Educational Readiness Skills

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•Performance abilities necessary to effectively engage in educational and vocational activities •Stage of preparedness for "what comes next" •Performance contexts important to consider

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Preschool Readiness Skills

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•Independence in toileting •Independence in self-feeding •Cooperative play behavior •Understanding of rules and schedules •Beginning behavioral and emotional maturity

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Kindergarten Readiness Skills

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•Additional pre-academic and academic readiness beyond preschool •Ability to sit quietly •Adequate fine motor skills •Adequate gross motor skills •Ability to recognize numbers and letters

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Elementary Readiness Skills

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•Independence in bathroom and cafeteria •Ability to carry lunch tray and to clean the table •Can remain seated for extended periods •Can remain on task •Expectations of reading, writing, spelling, and math skills depend on grade level •Ability to participate in games and sports

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Middle School and Adolescent Readiness Skills

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•Build on competencies gained during preceding periods •Appropriate social skills and manners •Increased skill in creative thinking, problem solving, and development of ideas •Expressive writing skills emerge

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Educational Activities

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•Opportunities that facilitate learning •Formal: mandated by law •Informal: less structured

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Work/Vocational Activities

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•Monetary incentive •Formal: part-time job with a salary •Informal: mowing a neighbor's lawn

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Play and Leisure Activities

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•Play: occupation of childhood •Leisure activities: not associated with time-consuming duties and responsibilities

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Definition of Play

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•Method to release energy •Method to practice survival skills •Attitude or mood •Encompasses various skills and occupies much of a child's day •"Spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion"

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Occupational Therapy Theorists

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•Reilly ➢Exploratory behaviors, competency, and achievement •Takata ➢Play history interview format •Knox ➢Knox Preschool Play Scale (PPS): space management, material management, imitation, and participation •Bundy ➢Test of Playfulness (ToP): child's attitude and approach to play

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Infancy: Play Skill Acquisition

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•Explore the environment through the senses •Play focuses on opportunities for exploration •Encourage repetition •Encourage body awareness •Should be fun

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Early Childhood: Play Acquisition

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•Continued exploration •Development of friendships •Opportunities to negotiate, solve problems, and communicate •Develops and refines motor skills •Manipulative play, imitation, games, and social play

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Middle Childhood: Play Acquisition

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•Refinement of skills (i.e., speed, dexterity, strength, and endurance) •Enjoy games with rules and competition •Time for experimentation

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Adolescence: Play Acquisition

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•In search of independence •Enjoys activities with peers •Participates in clubs •Play can promote independence

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Social Participation

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•Activities associated with organized patterns of behavior expected in a social interaction •Need to consider child's social routines and performance contexts

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Adolescence

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•Turbulent stage of development •Distinct changes physically, emotionally, and socially •Ideally ➢Time to plan for the future ➢Develop positive attitudes ➢Make healthy, safe behavioral choices

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Stages of Adolescent Development

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•Physical development as result of biological changes; skeletal and muscular development; increased coordination and endurance •Puberty ➢Biological process of sexual reproductive maturity •Psychosocial development and body image ➢Perception of one's image •Sexual identity ➢Gender identity; sexual orientation •Early maturing versus late maturing •Gender-neutral language

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Cognitive Development

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•Evolution of mental processes ➢Higher-level thinking, construction, acquisition and use of knowledge, as well as perception, memory, and the use of symbolism and language •Piaget's formal operations for the development of logical thinking •Realization that the world is one of possibilities, imagined and real •Differences between males and females •Development of moral and social reasoning

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Psychosocial Development

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•Task of achieving a stable, multidimensional self-identity •Egocentric thinking •Peers increasingly important in consolidation

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Theoretical Stages of Identity

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•Identity diffusion •Moratorium •Identity foreclosure •Identity achievement

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Social Roles

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•Sports related •Academic related •May have social status •Infer a set of common behaviors, characteristics, and expectations for the group members

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Occupational Performance in Adolescence

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•Work ➢Paid employee or volunteer; develops life skills; occupational identity •Instrumental activities of daily living (IADLs) ➢Takes on more responsibilities and develops skills congruent with the new roles and responsibilities •Leisure an play ➢Structured and unstructured •Social participation ➢Cliques; friendships; quality adult relationships

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Adolescence with Disability

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•Fewer opportunities to engage in typical experiences •Negative self-perceptions •Lower expectations •Social isolation •Decreased social status

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OT Practitioner's Roles and Responsibilities

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•Consultation •Monitoring •Direct •Optimize each adolescent's ability to engage in daily occupations of choice

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Objectives The Occupational Therapy Process

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•Understand the occupational therapy (OT) process. ➢Family centered ➢Cultural diversity ➢Therapeutic use of self ➢Activity analysis

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Occupational Therapy Practitioner Roles

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•Registered Occupational Therapist (OTR) ➢Selects assessments ➢Interprets results ➢Develops intervention plan •Certified Occupational Therapy Assistant (COTA) ➢Gathers data under the supervision of the OTR ➢Contributes to the intervention plan ➢Provides intervention

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Models of Practice (MOPs)

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•MOPs help to organize thinking. •Types of MOPs ➢Model of Human Occupation (MOHO) ➢Person-Environment-Occupation (PEO) Model ➢Occupational Adaptation Model ➢Canadian Model of Occupational Performance

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Referral

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•Only OTRs accept referrals. •Variety of referral sources, but most frequently by a doctor or nurse practitioner

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Screening

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•The OTR or COTA performs screenings to determine if there is a need for an evaluation.

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Evaluation

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•OTR determines type and scope •COTA assists •Areas of occupations •Performance skills •Occupational profile

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Occupational Profile

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•Who is the client? •Why is the client seeking services? •What occupations and activities are successful or difficult? •Contexts and environment •Occupational history •Client's priorities and targeted outcomes

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Levels of Performance

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•Functional independence •Assisted performance •Dependent performance

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Intervention Planning

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•Parental concerns •Client's strengths and weaknesses •Client's potential •Long-term goals •Short-term objectives •Method, media, and modality •Frequency and duration

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Frames of References

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•Developmental •Sensory integration •Biomechanical •Neurodevelopmental •Motor control •Rehabilitative •Model of Human Occupation (MOHO)

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Legitimate Tools

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•Occupation •Purposeful activity •Activity analysis •Activity synthesis: adaptation and grading •Activity configuration •Therapeutic use of self

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Therapeutic Use of Self: Intentional Relationship Model (Taylor, 2007)

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•Advocating •Collaborating •Empathizing •Encouraging •Instructing •Problem solving

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Therapeutic Use of Self

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•Be aware of body language. •Read verbal and nonverbal cues. •Be caring and nonjudgmental. •Exercise cultural awareness and sensitivity.

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Long-Term Goals

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•Outcomes of intervention •More general than short-term objectives

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Short-Term Objectives

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•Steps toward long-term goals •Skills to be gained in a relatively short period •Must meet the RUMBA criteria

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RUMBA

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•R: relevant •U: understandable •M: measurable •B: behavioral •A: achievable

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Reevaluation and Discharge Planning

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•The COTA always is responsible for reporting changes to the OTR. •The reasons for discontinuation of services vary across systems of care.

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Occupation-Centered Top-Down Approach: Occupational Therapy Intervention Model (OTIPM)

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•Parental concerns •Areas of occupational performance •Play •Social participation •Habits and routines •Interpretation of the evaluation results •Establishing an intervention plan

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Occupational Therapy Practice Framework, 2nd edition

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•Body structures ➢Cells, tissues, organs, and organ systems •Body functions ➢Osmoregulation, thermoregulation, homeostasis, health, and well-being •Beliefs, values, and spirituality

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Definitions

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•Anatomy ➢Branch of biology that studies structure •Physiology ➢Branch of biology that studies function •Key biological concept ➢Form (structure) fits function •Potential impact of atypical structure or function on successful engagement in daily occupations

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Hierarchy of Living Matter

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•Atoms •Molecules •Cells •Tissues •Organs •Organ systems •Organism

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Anatomic Position

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•Standing upright •Feet slightly apart, pointing slightly outward •Arms adducted and resting at the sides of the body •Forearms supinated •Fingers adducted

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Descriptive Terminology

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•Anterior (ventral): front •Posterior (dorsal): back •Superior (cephalad): toward the head; above • Inferior (caudal): toward the tail or foot; below •Proximal: closer to the body •Distal: farther away from the body •Medial: closer to the midline or midsagittal plane •Lateral: farther from the midline or midsagittal plane

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Plane

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•Sagittal •Frontal •Horizontal

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Axis

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•Frontal •Sagittal •Vertical

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Flexion

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bending a joint, decreasing the angle

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Extension

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straightening a joint, increasing the angle

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Abduction

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movement away from the midline or midsagittal plane

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Adduction

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movement toward the midline or midsagittal plane

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Horizontal abduction:

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movement away from the midline through the horizontal plane

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Horizontal adduction:

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movement toward the midline through the horizontal plane

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Elevation

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movement toward the head

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Depression

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...

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depression

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movement toward the feet

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movement toward the feet

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•Rotation: movement about an axis •Supination: turning palms up toward the ceiling •Pronation: turning palms down toward the floor •Radial deviation: movement toward the thumb •Ulnar deviation: movement toward the little finger •Inversion: turning the foot inward •Eversion: turning the foot outward •Circumduction: sequential movements of flexion, abduction, and extension, moving the distal aspect of the extremity in a circle •Lateral flexion: bending at the waist, moving the upper body toward the lower body

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Integumentary System

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•Structures: skin (epidermis and dermis), hair, nails, and sebaceous glands •Covers external surface of the body and lines internal organs (e.g., stomach, heart) •Functions: first of nonspecific defenses to potential microbes; part of the immune system •Thermoregulation function •Typical development (e.g., embryonic, neonatal, infant) •Disorders (e.g., acne, jaundice, burns)

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Skeletal System

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•Structure: bones, cartilage, and joints •Axial and appendicular subdivisions •Function: supports and protects internal organs •With muscular systems, allows movement at joints •Degrees of freedom of movement: 1st, 2nd, and 3rd •Types of joints: ball and socket, hinge, and saddle •Synovial joints •Typical development: ossification and stabilization •Disorders that involve the skeletal system (e.g., fractures, congenital anomalies)

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Muscular System

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•Smooth muscle: found in internal organs (e.g., esophagus); functions in peristalsis in the digestive system; involuntary and not under conscious control •Cardiac muscle: found in the heart; functions in heart contraction to support pulmonary and systemic blood flow; involuntary and not under conscious control •Skeletal muscle: origin, insertions, and muscle bellies; creates movements at joints; role in thermoregulation and osmoregulation; supports and protects internal organs; contraction and relaxation voluntary and under conscious control •Typical development (e.g., strength, endurance) •Disorders of the muscular system (e.g., muscular dystrophy, sprains)

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Cardiovascular System

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•Structures: heart, blood vessels (arteries, veins, capillaries), blood , and bone marrow •Functions: transport and exchange •Pulmonary circuit: between the heart and the lungs for gas exchange; right atrium to right ventricle to pulmonary artery to alveoli of lungs to pulmonary vein to left atrium •Systemic circuit: between the heart and the rest of the body to transport oxygen and nutrients to cells and pick up waste to be distributed to the appropriate organ system for elimination to the outside of the body; left atrium to left ventricle to aorta to the upper and lower body •Typical development (e.g., blood pressure, cardiac cycle) •Disorders (e.g., sickle cell anemia, ventricular septal defect)

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Respiratory System

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•Structures: mouth and nose, pharynx, larynx, trachea, diaphragm, and lungs (bronchi, bronchioles, alveoli) •Functions in gas exchange (oxygen and carbon dioxide) and in osmoregulation •Typical development (e.g., breaths per minute), neonatal lung development •Disorders (e.g., asthma, chronic obstructive pulmonary disease)

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Digestive System

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•Structure: mouth (teeth, tongue, mandible, maxilla, muscles of mastication and facial expression), pharynx, esophagus, stomach, small intestine, large intestine, and accessory organs •Functions in the mechanical and chemical breakdown of food (macromolecules) into simple molecules (monomers) that bodies can use at the cellular level; most nutrient absorption occurs in the small intestine, and most water absorption occurs in the colon; role in osmoregulation and homeostasis •Typical development (e.g., liquids to semisolids to solids) •Disorders (e.g., anorexia nervosa, esophageal reflux)

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Nervous System

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•Structure: brain, spinal cord, peripheral nerves, and special sense organs (e.g., eyes, ears) •Central nervous system (CNS): brain and spinal cord •Peripheral nervous system (PNS): peripheral nerves and special sense organs; includes the sympathetic (flight or fight) and parasympathetic (rest and digest) •Typical development (e.g., myelin completion, nerve conduction) •Functions in rapid communication and control of body structures and functions

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Endocrine System

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•Structure: hypothalamus, endocrine and exocrine glands •Functions in communication and control through the use of chemical messengers known as hormones; primarily a negative feedback loop; significant role in homeostasis •Typical development (e.g., sleep-wake cycle, gamete production) •Disorders (e.g., dwarfism)

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Urinary System

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•Structure: kidneys, ureters, urinary bladder, urethra •Function: regulates water balance in the body; eliminates wastes through urination; role in electrolyte balance •Typical development (e.g., bladder control during the day and at night) •Disorders (e.g., incontinence due to paresis or paralysis caused by spinal cord injury or myelomeningocele, flaccid bladder)

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Lymphatic and Immune Systems

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•Lymphatic system structure: lymph, lymphatic vessels, lymphatic nodes, tonsils, spleen, appendix •Immune system structure: nonspecific lines of defense (e.g., skin, mucous membranes, phagocytes) and specific lines of defense (e.g., T cells, B cells) •Function: Fights infection, promotes healing at the injury site, and returns fluid to the circulatory system •Typical development (e.g., active and passive immunity, immunizations) •Disorders (e.g., HIV infection, juvenile rheumatoid arthritis)

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Reproductive System

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•Male structure: penis, testes, accessory glands (e.g., prostate gland) •Female structure: ovaries, oviducts (fallopian tubes), uterus, vagina •Function: produce gametes (egg and sperm) or cells that are haploid (half the number of chromosomes as the parent cell) in preparation for reproduction of the organism; gamete production is a result of puberty •Typical development, onset of puberty •Disorders (e.g., sexually transmitted diseases such as cytomegalovirus or herpesvirus infections)

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Body Structures, Body Functions, and Occupational Performance

answer

•Neuromuscular and movement functions: range of motion and strength •Cardiovascular and respiratory functions: aerobic capacity and endurance

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