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Activity Analysis

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The process used by OT practitioners which "addresses the typical demands of an activity, the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it."

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Activity Analysis vs. Occupation Based Activity Analysis

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OT perspective not only looks at how an activity might be typically done, but how it is done and experienced by an individual, examining the internal and external influences on performance. Holistic perspective.

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Occupation

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Activities of everyday life, named, organized, and given value and meaning by the individuals and a culture. Occupation is everything people do to occupy themselves, including looking after themselves, enjoying life, and contributing to the social and economic fabric of their communities.

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4 Criteria of Occupations

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Definitive start and end points Intentionally executed and repeatable Meaningful to the person and bring meaning to who they are as a person Labeled by our culture

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Benefits of Occupations to Clients

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Achieve mastery in the environment Results in something that the client can either see or feel Help the client go farther and longer toward a goal than other methods Allow for greater transference toward the client's goals Requires a coordination of different skills and body systems Client receives immediate feedback on performance

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Information provided from Activity Analysis

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Identifies needed equipment, materials, space, and time Provides a knowledge base for instructing others by outlining each step and how it is done Gives information on how an activity might be therapeutic and for whom Helps to grade or adapt the activity to allow for greater success Gives specifics for clear documentation Assists in discovering how contexts influence performance of an occupation helps to select appropriate activities and find the "just right challenge" Identifies areas in which the client needs help and intervention

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Activity Analysis Process

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Activity Awareness Identify the Steps Required Determining the Activity Demands Analysis for Therapeutic Intervention

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Objects and their properties

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The tools, materials, and equipment used in the process of carrying out the activity.

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Space demands

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The physical environment requirements of the activity

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Social demands

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The social environment and cultural context that may be required by the activity

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Sequencing and timing

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The process used to carry out the activity (specific steps, sequence, timing requirements)

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Required actions

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The usual skills that was acquired by any performer to carry out the activity. Sensory, perceptual, motor, praxis, emotional, cognitive, communication, and social performance skills should each be considered. The performance skills demanded by an activity will be correlated with the demands of the other activity aspects (i.e., objects, space)

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Required body functions

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Physiological functions of body systems (including psychological functions) that are required to support the actions used to perform the activity

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Required body structures

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Anatomical parts of the body such as organs, limbs, and their components (that support body function) that are required to perform an activity

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When to Break a Task into Smaller Tasks

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Are there more than 10-15 Steps? Are there multiple criteria for successful completion? Are there different objects or space demands for different parts of the activity?

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Activities of daily living

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Bathing, showering, bowel and bladder management, toilet hygiene, dressing, eating and feeding, functional mobility, personal device care, personal hygiene and grooming, sexual activity

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Instrumental activities of daily living

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Care of others (including selecting and supervising caregivers), child-rearing, care of pets, communication device used, community mobility, financial management, health management and maintenance, home establishment and management, meal preparation and cleanup, religious observances, safety procedures and emergency maintenance, shopping

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Higher-Level Cognitive Functions

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Often called executive functioning, which includes complex decision making, planning and abstract thinking. Controlled by the frontal lobe Allow humans to adapt, think abstractly and plan for the future Complex in nature Abstract thinking is usually developed around 12 -15 years of age "Thinking in terms of concepts and general principles"

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Sustained Attention

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Requires maintaining concentration on one activity or stimulus for a sustained amount of time. Consider how long must a person sustain attention during the performance of the activity Consider how much focus is required Are there opportunities for breaks or continued concentration required throughout

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Selective Attention

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Focusing on one or more stimuli, while all other stimuli or information in the environment are ignored How many external extractors are typically present during the activity? Where does the activity take place? Does the activity require the person to ignore other stimuli while focusing on one or a group of stimuli? Example : Trying to study or read in a noisy room

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Divided Attention

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Utilized when a person must focus on two or more stimuli at one time. Examples are: Cooking Watching children while performing household tasks Talking on the phone and driving

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Memory

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Closely linked to other cognitive and sensory factors, in that the brain stores information on sensory experiences A person must attend to an experience before it can be encoded into memory. If a person does not experience something hearing it, seeing it or feeling it , he or she will not be able to recall it from memory.

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Short Term Memory

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Produces storage of information temporarily, for about 30 seconds. Short term memory is very limited Used for small pieces of information that are used briefly

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Working Memory

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Information that is retained while we are using it during a task Does the activity require the person to recall and utilize chunks of information temporarily? Does the activity require utilizing memories to guide actions? Does the activity require complex problem solving? When asked a question in class, students may utilize working memory to mentally think through the question.

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Long -Term Memory

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Information about past events, language, and sensory experiences that are stored for long periods of time. Memories are retained for a few hours up to years Consider if the activity requires the following: How far back the person is required to remember Do they need to remember over an hour ago? Recall how to do something done in the past? Recall personal history

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Auditory Perception

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Discrimination of Sensations Allows for the ability to discriminate between different sounds, tones, and pitches This is not what ambient noise occurs during an activity Does the ability to discriminate between sounds contribute to the ability to engage in the activity or can it be done without it Example : Listening to a concert vs. taking a shower

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Tactile Perception

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Allows us to distinguish different textures by touch Tactile discrimination is required of an activity if then person engaging in the activity must discriminate between different textures, such as smooth, or rough, sticky or smooth. May also be utilized when performing activities without sight such as buttoning, typing etc.

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Visual Perception

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The ability to perceive and interpret visual information Allows for discrimination between different shapes, objects, and colors Visual perception is the cognitive processing of what our eyes detect. Allows us to react with the environment and interact with objects and people

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Olfactory Perception

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Allows for distinguishing differences between smells Consider the following for activity analysis: Does the activity require the person to act upon certain smells? Does the activity require the person to be able to detect the presence or absence of certain aspects.. fumes, glue etc.

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Vestibular-Proprioception Perception

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The interaction between proprioception and vestibular perception influences positioning of the body in space. Allows for determining how to hold ourselves upright or in a certain position for activity. Assists with distinguishing : head position, speed of movement, position of the body in space, contributes to balance during activity Example : dancing

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Multisensory Processing Perception

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Integration of sensory information from different sources ( auditory, vestibular, touch, olfactory, proprioceptive) to better interpret when is occurring in the environment. Consider if multiple sensations are utilized to understand the aspects of an activity and/or do they occur simultaneously

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Sensory Memory Perception

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The first stage of memory, which is the processing and brief storage of sensory input. It is very short term and is specific to the type of sensation. Utilized in almost all ADL Example: Swatting at a fly that landed on your arm.

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Spatial Relationships/ visuospatial processing Perception

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The spatial relationship function if the ability to understand the position of objects in the relation to you and between different objects. Consider the following during activity performance: Is understanding distance required? Will the person be moving in relation to elements in the environment? Will the person need to distinguish top from bottom? Will the person need to recognize an object separate form a background?

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Temporal Relationships Perception

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Addresses the perception of and the passage of time Consider the following activity requirements: Does the activity require an understanding of timing, perception of the passing of time, rhythm or pacing? Examples : answering the phone, playing an instrument, crossing the street

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Thought Functions: Recognition

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Using information from the environment to understand what is occurring requires recognition Consider the following: Does the person performing the activity need to be able to recognize objects, language, sounds, aspects of an environment

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Thought Functions: Categorization

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Finding similarities and differences and putting objects or information into groups Consider if the activity requires the person to understand the similarities between two or more objects. Example: All dairy items are located in the same area when grocery shopping

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Thought Functions: Generalization

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The ability to take a strategy learned in one situation and transfer it to a new or different situation or environment. Example: When a child learns to use the toilet at home, it may take a while to learn to use the toilet in other environments. Consider: If the activity applied to a different settings, if only part is applied now and part later, are objects being used differently than the typical way

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Thought Functions: Awareness of Reality

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Distinguishing between thoughts and what is truly occurring requires an awareness or reality. Helps determine what is real and what is fiction Consider: Does the activity demand that the person understand what is feasible and realistic given the constraints of the environment? Distinguish between real and what is not?

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Thought Functions: Logical /Coherent Thought

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Reasonable thought that can be explained in words or symbols and used for reasoning. Requires factual information and understanding Examples: balancing a check book, grocery shopping, driving , choosing clothes to wear

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Thought Functions: Appropriate Thought Content

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Maintaining a stream of thoughts that relate to the activity or issue is appropriate thought content. What are the required actions of the person?.... Thinking about aspects that relate to a particular topic, such as ideas or conceptualization appropriate to the situation

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Mental Functions of Sequencing Complex Movement

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Execution of Learned Movement Patterns Executing learned movement patterns, as a cognitive function , is the process of mentally sequencing and coordinating purposeful movements. Praxis: the ability to mentally plan and control skilled movements As children grow and develop they learn how to control movements in purposeful ways as well as how to move in certain situations.

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Emotional: Coping

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Related to handling a crisis or decisive turning points in life or situations.

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Emotional: Behavioral Regulation

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addresses the affect and display of feelings

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Experience of Self and Time: Body Image

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the awareness of the physicality and image of their own body.

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Experience of Self and Time: Self - Concept

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being aware of your roles and identity in the world.

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Experience of Self and Time: Self - Esteem

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demonstrated by confidence in a person's actions and belief in themselves

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Global Mental Functions: Level of Arousal

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the ability to demonstrate alertness and respond to stimuli present in the environment

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Global Mental Functions: Level of Consciousness

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the ICF defines as " the state of awareness and alertness, including the clarity and continuity of the wakeful state"

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Global Mental Functions: Orientation to self

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having an awareness of one's own identity

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Global Mental Functions: Orientation to place

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being aware of one's own location

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Global Mental Functions: Orientation to time

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current date, month, year, week etc.

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Global Mental Functions: Orientation to others

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identifying significant people in one's life

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Global Mental Functions: Orientation to person

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orientation to self and orientation to others and is not a separate function. ( ICF)

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Global Mental Functions: Temperament and personality

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Temperament and personality Emotional Stability: "even tempered and calm", easy going Energy and Drive Motivation, Impulse control, Appetite, Sleep

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Global Mental Functions: Motivation

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internal incentive to behave in a certain way or to take action

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Global Mental Functions: Impulse control

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resisting internal urges to do or say things/ social demand

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Global Mental Functions: Appetite

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drives us toward action and required for eating, drinking, alcohol, sensory stimulating behaviors and physiological urges

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Global Mental Functions: Sleep

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"physical and mental disengagement" from the immediate environment

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Sensory Functions: Seeing and related functions

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Detection/ Registration, Modulation, Integration of Sensations from Body and Environment, Visual awareness at various distances

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Detection/ Registration

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Detecting shapes, light and color of visual stimuli is one of the basic foundations of seeing functions.

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Modulation

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the ability to regulate and organize the degree and intensity of the stimuli

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Integration of Sensations from Body and Environment

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integrating information from other senses from the body and what is occurring in the environment

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Visual awareness at various distances

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includes acuity as well as detection of objects close and far away

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Sensory Functions: Hearing Functions

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Tolerance of ambient sounds Awareness of location and distance of sounds

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Sensory Functions: Vestibular Functions

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Sensations of securely moving against gravity Allows us to move our bodies in the space around us against the forces of gravity Having a sense of direction and upright position Which way is up or down as we position our body Provides our sense of movement and understanding of gravity

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Sensory Functions: Proprioception

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Awareness of Body position and space The ability to tell where our body parts are moving and in which direction they are moving or are being held in and is controlled by sensory receptors in our muscles, tendons and joints The understanding of unconscious information from the muscles, joints, tendons and skin concerning their load or stress

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Sensory Functions

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Taste ( association of taste) Smell ( association of smell) Touch ( hyposensitive, hypersensitive) Pain ( localizing pain, identifying danger) Temperature / Pressure ( thermal awareness/ safety)

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Functions of Joints and Bones

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Joint Mobility Joint Stability/Joint postural alignment Muscle Power/ Strength Muscle Tone Muscle Endurance

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Joint Mobility

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The ease in which a joint moves through motion is termed range of motion

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Joint Stability/Joint postural alignment

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The stability of the joint is what allows for proper alignment of the joint

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Muscle Power/ Strength

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The force in which a body part must move or hold an object requires the functions of muscle power

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Muscle Tone

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Natural tension present in the muscles when at rest, creates a resistance or lack of resistance when a body part is passively moved.

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Muscle Endurance

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required when the contraction must be maintained for a prolonged period of time

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Motor Reflexes

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Stretch Reflex ATNR STNR

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Stretch Reflex

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Functions of involuntary contractions of muscles are automatically induced by stretching

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ATNR

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Present at birth, disappears in the first year or life. Protective function in infants to prevent rolling over before they are neurologically ready

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STNR

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Present at birth, disappears in the first year of life. Allows infants to get into the crawling position

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Involuntary Movement Reactions

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Righting and Supporting Automatic reactions that are designed to protect us and allow us to restore our bodies to a natural upright position

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Control of Voluntary Movement

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Eye-Hand/Foot Coordination Bilateral Coordination Crossing midline Fine motor control Gross motor control Oculomotor control Gait patterns

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Eye-Hand/Foot Coordination

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Visual motor

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Bilateral Coordination

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coordination of the right hand and left hand or the right foot and left foot

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Crossing midline

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Reaching across from one side of the body to the other

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Fine motor control

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small muscles of the hand

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Gross motor control

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larger muscles

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Oculomotor control

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eye muscles

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Gait patterns

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movements used to walk

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Cardiovascular System Function

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Blood pressure Heart rate

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Hematological system

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relates to the blood and the blood-forming tissues of the body which include the bone marrow and spleen

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Immunological system

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works to protect the body against infection and other pathological organisms and actions

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Respiratory System

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Rate of respiration Rhythm of respiration Depth of respiration Physical endurance, stamina and aerobic capacity ( the extent to which a person can exercise without getting out of breath)

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Voice and Speech Function

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Voice Functions Rhythm and Fluency Alternative Vocalization Functions

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Digestive system

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...

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Metabolic system

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...

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Endocrine system

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...

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Urinary functions

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release urine from the body

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Genital and Reproductive Functions

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...

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PLISSIT Model

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P= Permission form the client to discuss sexual activity ( practitioners are generally trained to offer an opportunity for discussion) LI = Limited information provided to client (adaptations/compensations) SS = Specific suggestions provided regarding sexual activity ( may require advanced training depending on the specificity) IT = Intensive Therapy regarding issues of sexuality ( not generally provided by OT's /OTA's without advanced training)

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Protective Functions of the skin

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...

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Repair function of the skin-wound healing

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...

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Crafts

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An occupation or trade requiring manual dexterity or artistic skill. To make or produce with care, skill, or ingenuity. Universal skills

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Women and crafts

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Crafts have traditionally been dominated by women, although men took over the metal and wood working until the industrial revolution made them obsolete.

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Benefits of crafts

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Improved problem-solving, perceptual skills, motor skills, attention to task, increased self-esteem and sense of mastery, and more ease in communication and social skills. Clients are more motivated and become absorbed by creative activities, which facilitates faster achievement of goals Easily graded Activities are associated with normal rather than unwell people Impact on brain function, able to naturally activate spatial and intuitive functions of the non-dominant side of the brain

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Research of crafts

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Creative activities integrate left brain function (verbal, analytical, detail oriented) with right brain functions (intuitive, emotional, image-linked). Occupational form activates multiple areas of the brain through associations with previously stored information Purposeful activity reduces the perception of exertion

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The making of a craft project entails:

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Rhythm and awareness of time Structure and following rules Opportunities for control and making choices Occasional resistance to efforts Periods of activity alternated with periods of waiting Trial and error, and encountering novel situations Both mental and physical engagement Expression of likes, dislikes, and individual identity A productive role Opportunity for success, failure, and learning Creation of something transformed or new

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Motor control model

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Neurologically based Positioning, normal movement patterns, proprioceptive and tactile input Weight-bearing, bilateral, postural requirements Rolling clay or dough, sawing or sanding, mixing/stirring

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Sensory integration/sensory processing model

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Neurologically based Multichannel sensory input Variation in texture, visual interest, vestibular input Papier-mâché, mixing dough with hands, leaf rubbing

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Biomechanical model

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Musculoskeletal ability to move and maintain postures Physical aspects of craft. What else can you do to meet motor goals? Strength, range of motion, endurance, position Resistance, placement to facilitate reaching for specific grasp Macramé, sawing, sanding, mosaics

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Cognitive disabilities model

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Compensatory methods- rely on modification of the task or environment or use of external aids to improve function Evaluation, task/environmental modification Structured, procedural in nature, visual cues/samples wood kits, leather kits, tile mosaics

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Cognitive retraining model

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Remedial method- assume that discrete skills such as attention or sequencing can be improved through repetitious tasks, then combined and transferred to more functional activities Adaptive method Cognitive skill building, adaptive strategies Structured, repetitious, cues or other memory aides Tile mosaic, paper crafts, kits, cooking

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Developmental model

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Humans assumed to progress in an orderly way through various growth stages and learn specific skills along the way Meeting developmental milestones Postural, grasp/dexterity, repetition Beading, paper crafts, metal tooling, wood work USED PRIMARILY WITH CHILDREN

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Occupational behavior model

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Client centered Client interest/engagement, task competence, consistency with desired roles Decision making/choice- Client chooses his or her own activity and treatment milieu Occupational adaptation model, the model of human occupation, the Canadian model of occupational performance, ecology of human performance, Pearson - environment - occupation model, Kawa Model

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Grading

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Structuring activities such that the challenge or demand will gradually increase and thereby facilitate improvement and clients function Proceeding by steps or degrees; moving, changing, or developing by fine, slight, or often imperceptible degrees To arrange or position and a scale of size, quality, or intensity Have client participate in planning or materials preparation Increase or decrease the number of steps Place/remove a time requirement Increase/decrease resistance Place objects to facilitate reach or postural changes Increase/reduce number of tools/supplies available Change the number of choices available Change the design Have client participate in cleanup

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Adaptations

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Alter the method Use enlarged or reshaped handles Reduce the number of steps/complexity Provide a stabilizing surface Provide extra lighting or magnification Use adapted tools (e.g., electric scissors)

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Woodworking

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Benefits: easy even for low functioning clients, easily graded, Kits or Handmade projects Good for strengthening, endurance, and weight-bearing Valuable for men Improved upper extremity range of motion, strength, and dexterity in the hand May help eliminate, or mediate, deficits in sensory processing, motor control, praxis, attention span, sequencing, spatial operations, and problem-solving Precautions: Power and hand tools are expensive, dangerous, and take up space- consider for clients with decreased strength, coordination, or sensation, or with compromised immune systems Supervision is a must when working with tools Splinters - clients with diminished sensation or are impulsive, decreased skin repair function Finishes can be messy and require special solvents and may have toxic fumes Ensure well ventilated area Noisy hammering disruptive for sensory Could exacerbate aggressive feelings

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Ceramics

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Benefits: offers plenty of room for creativity, self-expression, and variation of end product Graded it to accommodate diverse functional levels Safe activity and can be done without tools if necessary Vast selection of clay types, building processes, and glazes Biomechanical Strengthen or refine wrist and hand movements Strengthen upper extremities Balance, weight-bearing, posture Fine motor skills Opportunity to express mood and thought Facilitate intrinsic hand strength Structured nature - following procedures/rules and having to wait for results Precautions: cost, time, and space required Drying to the skin Clay is abrasive - careful with delicate skin or peripheral neuropathies Dust - respiratory problems wear a mask Edible versus inedible Contraindicated for those with arthritis or an open wound that may come in contact with Clay

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Needlework

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Benefits: fine motor, visual acuity and perception Tools and materials can be inexpensive Kits simplify the preparation process Easily done by bed-bound patients Little resistance - clients with arthritic pain or deformities can enjoy Reduced anxiety and depression, relief from pain, development of social contacts Decreased heart rate, blood pressure, and perspiration Requires little exertion Good for clients with depression Benefits from the repetition required of the craft Social interaction Precautions: can be difficult to adapt for poor grasp Clients with impaired visual skills may become frustrated Sewing may be viewed as more work than leisure Time - may require multiple treatment sessions Safety - needles and scissors- blood-borne pathogens Mental health setting - tool count before and after Sewing machines costly and dangerous, easily damaged Those with arthritis should be monitored Peripheral neuropathy

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