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Performance Patterns

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the habits, routines, roles, and rituals used in the process of engaging in occupations or activities that can support or hinder occupational performance

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Routines

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are established sequences of occupations or activities that provide a structure for daily life; they can promote or damage health

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Roles

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sets of behaviors expected by society and shaped by culture and context; they may be further conceptualized and defined by a client (person, group, or population)

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Rituals

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symbolic actions with spiritual, cultural, or social meaning. They contribute to a client's identity and reinforce the client's values and beliefs

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Habits

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specific, automatic behaviors; they may be useful, dominating, or impoverished

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Environment and context

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often used interchangeable. Both terms reflect the importance of considering the wide array of interrelated variables that influence performance.

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physical environment

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natural and built surroundings in wh/ daily life occupations occur includes geographic terrain, plants, animals, as well as the sensory qualities of the surroundings. The built environment includes buildings, furniture, tools, and devices. ex. a individual's house or apartment, a group's office building or factory, a population's transportation system

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social environment

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consists of the presence of, relationships with, and expectations of persons, groups, and populations with whom clients have contact. It includes availability and expectations of significant individuals like spouse, friends, and caregivers; relationships w/ groups, populations, and relationships with systems (political, legal, economic, institutional,) that influence norms, role expectations, and social routines. ex. friends, colleagues, group - occupational therapy students conducting a class together. population - people influenced by a city government.

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context

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refers to elements within and surrounding a client that are often less tangible than physical and social environments, but exert a strong influence on performance. In Framework contexts are described as cultural, personal, temporal, and virtual. In Thomas contexts include the physical environment, the tools and materials that the person uses, and the social complexities and demands of the occupation.

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cultural context

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includes customs, beliefs, activity patterns, behavioral standards, and expectations, accepted by the society of which a client is a member

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personal context

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refers to demographic features of the individual such as age, gender, socioeconomic status, and educational level that are not part of a health condition

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virtual context

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refers to interactions that occur in simulated, real-time, or near-time situations absent of physical contact

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occupational justice

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"a justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences

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temporal

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The experience of time as shaped by engagement in occupations; the temporal aspects of occupation that "contribute to the patterns of daily occupations include rhythm, tempo, synchronization, duration, and sequence. The temporal context includes stage of life, time of day or year, duration and rhythm of activity, and hx. ex person-retired from work for 10 years; group - a community organization's annual fundraising campaign; population- people celebrating Independence day on July 4.

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Occupational Therapy Practice Framework: Domain and Process, 3rd Edition

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Official document of the American Occupational Therapy Association(AOTA). Intended for OT practitioners, students, other health care providers, educators, researchers, payers, and consumers.

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occupational therapy

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the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, and routines in home, school, workplace, community, and other settings.

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occupational therapy practitioner

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OTs and OTAs

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The Framework

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Intended for internal and external audiences, it is an ever-evolving document. As an official AOTA document it is reviewed on a 5-year cycle. (2002, 2008, 2014). It is divided into 2 major sections: 1) domain which outlines the profession's scope and areas in which its members have an established body of knowledge and expertise. 2)process - which describes the actions practitioners take when providing services that are client centered and focused on engagement in occupations. Domain and process are described separately but are linked inextricably in a transactional relationship. The 2014 version includes performance skills and who is considered a client of OT.

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occupational therapy's domain

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achieving health, well-being, and participation in life through engagement in occupation to encompass both domain and process.

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clients

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persons, groups, populations

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Health

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state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.

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Well-being

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general term encompassing the total universe of human life domains, including physical, mental, and social aspects.

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participation

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involvement in a life situation

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engagement in occupation

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performance of occupations as the result of choice, motivation, and meaning within a supportive context and environment.

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Contexts and environments include

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cultural, personal, physical, social, temporal, virtual

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Performance patterns include

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habits, routines, rituals, roles

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Performance skills include

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goal-directed actions that are observable as small units of engagement in daily life occupations. They are learned and developed over time and are situated in specific contexts and environments. - motor skills, process skills, social interaction skills. They are the client's demonstrated abilities.

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occupations include

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ADLs, Instrumental activities of daily living (IADLs), rest and sleep, education, work, play, leisure, social participation

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client factors include

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Specific capacities, characteristics, or beliefs that reside within the person and that influence performance in occupations; values, beliefs, spirituality, body functions, and body structures. They are affected by the presence or absence of illness, disease, deprivation, disability, and life experiences.

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occupation

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the daily life activities in which people engage. In the Framework, the term occupation denotes life engagements that are constructed of multiple activities.

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values

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principles, standards, or qualities considered worthwhile by the client who holds them.

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Belief

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cognitive content held as true

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Spirituality

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aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, self, to others, to nature, and to the significant or sacred.

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Body functions and body structures

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physiological function of body systems (including psychological functions) and anatomical parts of the body such as organs, limbs and their components. Body functions and structures are interrelated.

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Activity analysis and Occupational Analysis

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the process used by PT practitioners that "address of 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." Occupation-based activity analysis takes into account a specific person's interests, goals, abilities and contexts in addition to the demands itself.

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Activities of daily living (ADLs)

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activities oriented toward taking care of one's own body.

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Adaptation

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OT practitioners enable participation by modifying a task, the method of accomplishing the task, and the environment to promote engagement in occupation.

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assessments

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specific tools or instruments that are used during the evaluation process.

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client-centered care (practice)

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Approach to service that incorporates respect for and partnership with clients as active participants in the therapy process. This approach emphasizes clients' knowledge and experience, strengths, capacity for choice and overall autonomy.

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Goals of AOTA

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1) Assure quality of OT services 2) Improve consumer access to health care 3) Promote professional development of members

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AOTA Vision 2025

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Occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living.

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Domain

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The profession's purview or areas in which practitioners have an established body of knowledge and expertise. "Everything we know".

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Process

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How we do it! - The actions that practitioners take when providing services to clients that are client-centered and focused on engagement in occupations. 1) Evaluation 2) Intervention 3) Targeting of outcomes.

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Direct services vs. Indirect services

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working with clients directly in hospitals, clinics, schools, homes, community, etc. Indirect example is consultation or advocacy.

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Clinical Reasoning

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Professional reasoning or therapeutic reasoning. Cognitive process used to plan, direct, perform, and reflect on services. Guided by our use of theories/models, knowledge and experiences, and available evidence. Ensures accuracy throughout the OT process. Enhances/promotes client outcomes.

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Therapeutic use of self

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developing and managing the therapeutic relationship w/ clients. Utilizing various styles when necessary like empathy, encouraging, instructing, problem-solving, advocacy, and collaboration. Recognizing and responding to various client interpersonal characteristics. Responding to challenges that arise.

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Evaluation Process

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Close to a clients hx but focuses on occupations. Identifying outcome measures. Select and use assessments to identify and measure performance skills, performance patterns, contexts and environments, activity demands, and client factors. Use tools then analyze and interpret results. Hypothesize what are underlying factors that need to be addressed. Write goals. Figure out intervention plan.

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Intervention Process

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1) Intervention Plan 2) Intervention Implementation 3) Intervention Review

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Intervention Plan

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1) Develop plan, w/ objective measurable goals and related time frames 2) Consider potential discharge needs and plans like "what do they need to demonstrate in order to not need your services anymore". 3) Recommend or refer to other professionals if needed

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Intervention Implementation

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1)Determine and carry out OT intervention 2) Monitor client response through ongoing evaluation and reevaluation

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Intervention Review

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1) Reevaluate the plan and implementation relative to achieving outcomes 2) Modify as needed 3) Determine the need for continuation or discontinuation of OT services and for referral

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Targeting of Outcomes

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1) Select outcomes and measures. Outcome measures should be valid, reliable, sensitive to change, consistent with outcomes, congruent w/ client goals, and based on their actual or purported ability to predict future outcomes. 2) Use outcomes to measure progress and adjust goals and interventions

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activities

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components of occupations. Actions that are typically performed without a client in mind.

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Engaging in occupations allows clients to:

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1) Achieve mastery in their environment and feel they have some sense of control. 2) Experience results they can see/feel and achieve a sense of accomplishment 3) engage in a meaningful activity that will often help the client go farther and longer toward a goal than other methods. 4) allow for greater transference toward the client's goals 5) coordinate different skills and body systems 6) receive immediate feedback on performance

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ADL - Personal Device Care example

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Using, cleaning, and maintaining personal care items, such as hearing aids, contact lenses, glasses, orthotics, prosthetics, adaptive equip, glucometers, and contraceptive and sexual devices.

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Instrumental Activities of Daily Living

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Activities to support daily life w/in the home and community often require more complex interactions than self-care ADLs. examples, Care of Others, Child Rearing, Care of Pets, Communication Management, Driving and Community Mobility, Financial Management, Health Management and Maintenance, Home Establishment and Management, Meal Prep and Cleanup, Religious and Spiritual Activities and Expression, Safey and Emergency Maintenance, Shopping

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ADL examples

answer

Activities that are oriented toward taking care of one's own body. Bathing and Showering, Toileting and Toilet hygiene, Dressing, Swallowing/Eating, Feeding, Funcitional Mobility (personal basis), Personal Device Care, Personal Hygiene and Grooming, Sexual Activity

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Habilitation

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Health care services that help you keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn't walking or talking at the expected age.

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Work ADL

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Includes interview, doing job, scheduling, responding to emails, planning, interaction of coworkers. Volunteer is considered part of work. 1) Employment Interests and Pursuits 2) Employment Seeking and Acquisition 3) Job Performance 4) Retirement Preparation and Adjustment 5) Volunteer Exploration 6) Volunteer Participation

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Occupational Therapy Domain

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Occupations, Client Factors (beliefs, values, spirituality, body functions, body structures), Performance Skills, Performance Patterns, Context and Environment

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Motor Skills

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Occupational performance skills observed as the person interacts with and moves task objects and self around the task environment. Aligns, Stabilizes, Positions, Reaches, Bends, Grips, Manipulates, Coordinates, Moves, Lifts, Walks, Transports, Calibrates, Flows, Endures, Paces

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Performance Skills

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Goal-directed actions that are observable. Smallest observable actions or units. 3 categories. 1) Motor Skills, 2) Process Skills, 3) Social Interaction Skills

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Aligns

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motor skill - interacts with task objects without evidence of persistent propping or persistent leaning.

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Stabilizes

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motor skill - (Does not have to be standing.) Moves through task environment and interacts with task objects without momentary propping or loss of balance. Someone w/ problems with stabilizing would be a person with cane or someone taking a trip or misstep.

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Positions

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motor skill - Positions self an effective distance from task objects and without evidence of awkward body positions. ex use this when driving, sitting at desk, getting ready in mirror in morning, positioning in shower so don't get basted by water, putting gas in car.

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Reaches

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motor skill - Effectively extends the arm and when appropriate, bends the trunk to effectively grasp or place task objects that are out of reach. ex of problems w/ reaches would have to make extra effort to reach.

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Bends

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motor skill - Flexes or rotates the trunk as appropriate to the task to grasp or place task objects out of reach or when sitting down. Ex of problem with bends would be someone slow to bend.

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Grips

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motor skill - Effectively pinches or grasps task objects such that the objects don't slip (from fingers or teeth). ex. Anything that slips out would be a problem with grips.

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Manipulates

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motor skill - Uses dexterous finger movements w/o evidence of fumbling when manipulating task objects. Problem with manipulates - ex fumbling (dropping ) toothbrush

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Coordinates

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motor skill - Uses 2 or more body parts together to manipulate, hold, and or stabilize task objects w/o evidence of fumbling task objects or slipping from one's grasp. Problem w/ this. Any time you fumble when using 2 body parts.

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Moves

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motor skill - Effectively pushes or pulls task objects along a supporting surface, pulls to open or pushes to close doors and drawers, or pushes on wheels to propel a wheelchair, pull chairs in underneath us, move pedals of a bike by pushing them along their access. More ex. pulling socks, pushing up sleeves. propelling wheelchair, opening or closing drawers. (Brushing or painting is not moves, pulling a block is not moves)

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Lifts

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motor skill - Effectively raises or lifts task objects without evidence of increased effort. ex of problem w/ lifts is when someone struggles to lift b/c it is too heavy.

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Walks

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motor skill - During task performance, ambulates on level surfaces w/o shuffling the feet, becoming unstable, propping, or using assistive devices. ex of prob w/ walks is losing your balance & having to prop. if have to prop then it is also a problem with stabilizes.

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Transports

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motor skill - Carries task objects from one place to another while walking or moving in a wheelchair. For ex when feeding a dog you carry the food dish, or when doing laundry.

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Calibrates

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motor skill - Uses movements of appropriate force, speed, or extent when interacting with task objects. ex. not crushing objects, cracking eggs, pouring, opening and closing doors. Problem w/ calibrates would be breaking egg, pouring too fast/slow, opening/closing doors w/ too much/little force.

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Play

answer

any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion. 1) Play exploration 2) Play participation

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Leisure

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a nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is time not committed to obligatory occupations such as work, self-care, or sleep. 1) Leisure Exploration 2) Leisure Participation

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Social Participation

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Interweaving of occupations to support desired engagement in community and family activities as well as those involving peers and friends. 1) Community 2) Family 3) Peer, friend

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Flows

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motor skill - uses smooth and fluid arm and wrist movements when interacting with task objects. ex of prob of flows is if you have tremors when pouring something

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Endures

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motor skill - Persists and completes the task without showing obvious evidence of physical fatigue, pausing to rest, or stopping to catch one's breath.

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Paces

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motor skill - Maintains a consistent and effective rate or tempo of performance throughout the entire task.

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Process Skills

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Occupational performance skills observed as a person 1) Selects, interacts with, and uses task tools and materials 2) carries out individual actions and steps 3) modifies performance when problems are encountered. Paces, attends, heeds, chooses, uses, handles, inquires, initiates, continues, sequences, terminates, searches, gathers, organizes, restores, navigates, notices/responds, adjusts, accommodates, benefits

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Paces for process skills

answer

process skill - maintains consistent and effective rate or tempo of performance throughout the entire task.

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Attends

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process skill - Does not look away from what he or she is doing, interrupting the ongoing task progression.

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Heeds

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process skill - carries out and completes the task originally agreed on or specified by another. Ex of prob of heeds is if you say you are going to clean your room and your room is still a mess.

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Chooses

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process skill - Selects necessary and appropriate type and number of tools and materials for the task, including the tools and materials that the person was directed to use or specified he or she would use.

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Uses

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process skill - Applies tools and materials as they are intended (ex. uses a pencil sharpener to sharpen a pencil but not to sharpen a crayon) and in a hygienic fashion. Ex of prob of uses is when someone uses a spoon to comb their hair.

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Handles

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process skill - Supports or stabilizes tools and materials in an appropriate manner, protecting them from being damaged, slipping, moving and falling. Ex of prob of handles is putting cup on edge of desk so it falls.

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Inquires

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process skill - 1) Seeks needed verbal or written information by asking questions or reading directions or labels and 2) Does not ask for information when he or she was fully oriented to the task and environment and had immediate prior awareness of the answer.

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Initiates

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process skill - starts or begins the next action or step w/o hesitation

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Continues

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process skill - performs single actions or steps without interruptions such that one an action or task is initiated, the person continues without pauses or delays until the action or step is completed. Prob with continues is stirring and then stopping

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sequences

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process skill- performs steps in an effective or logical order and with absence of 1)randomness or lack of logic in the order and 2) inappropriate repetition of steps

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terminates

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process skill - brings to completion single actions or single steps without inappropriate persistence or premature cessation. ex. pours milk to top of bowl

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searches/locates

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process skill - looks for and locates tools and materials in a logical manner, both within and beyond the immediate environment. Ex of prob with locates is when you have to go through every drawer to find something.

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Gathers

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process skill - collects related tools and materials into the same work space and regathers tools or materials that have spilled, fallen or been misplaced. Ex of Prob with gathers is when something drops on floor and you don't pick it up.

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Organizes

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Logically positions or spatially arranges tools and materials in an orderly fashion within a single work space and b/w multiple appropriate work spaces such that the work space is not too spread out or too crowded.

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restores

answer

process skill - puts away tools and materials in appropriate places and ensures that the immediate work space is restored to its original condition. Ex of prob w/ restores is if you put something in the wrong place.

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Navigates

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process skill - moves the arm, body, or wheelchair without bumping into obstacles when moving in the task environment or interacting with task objectives. ex is navigating shopping cart thru store.

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Notices/responds

answer

process skill - responds appropriately to 1) nonverbal task - related cues (eg heat, movement) 2) the spatial arrangement and alignment of task objects to one another and 3) cupboard doors and drawers that have been left open during task performance. ex noticing a rolling pencil and grabbing it b4 it hits ground.

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Adjusts

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process skill - effectively 1) goes to new work spaces 2)moves tools and materials out of the current work space and 3 adjusts knobs, dials, or water taps to overcome problems with ongoing task performance. ex if I spill water, I move glass to clean the table. If pot starts to boil over, move it to another burner that is turned off.

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Accommodates

answer

process skill - prevents ineffective task performance. ex if one has problem with motor skills then you didn't accommodate. So any time there is a problem then there's a problem with accommodate.

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Benefits

answer

process skill - prevents problems with task performance from recurring or persisting.

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Social Interactions Skills

answer

approaches/starts, concludes/disengages, produces speech gesticulates, speaks fluently, turns toward, looks, places self, touches, regulates, questions, replies, discloses, expresses emotion, disagrees, thanks, transitions, times response, times duration, takes turns, matches language, clarifies, acknowledges and encourages, empathizes, heeds, accommodates, benefits

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Approaches/starts

answer

approaches or initiates interaction with the social partner in a manner that is socially appropriate.

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Concludes/disengages

answer

SIS(social interaction skills) -effectively terminates the conversation or social interactions, brings to closure the topic under discussion, and disengages or says good-bye.

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Produces speech

answer

Social interaction skill - produces spoken, signed, or augmentative (ie computer generated) messages that are audible and clearly articulated. (doesn't need to be spoken. could use a device)

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Gesticulates

answer

Social interaction skill-uses socially appropriate gestures to communicate or support a message.

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Speaks Fluently

answer

Social interaction skill-• Speaks in a fluent and continuous manner, with an even pace (not too fast, not too slow) and without pauses or delays during the message being sent

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Turns toward

answer

social interaction skill - • Actively positions or turns the body and face toward the social partner or person who is speaking

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looks

answer

social interaction skill-Makes eye contact with the social partner

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Places self

answer

social interaction skill -Positions self at an appropriate distance from the social partner during the social interaction

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Touches

answer

social interaction skill - Responds to and uses touch or bodily contact with the social partner in a manner that is socially appropriate

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Regulates

answer

social interaction skill - Does not demonstrate irrelevant, repetitive, or impulsive behaviors that are not part of social interaction

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Questions

answer

social interaction skill - Requests relevant facts and information and asks questions that support the intended purpose of the social interaction

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Replies

answer

social interaction skill that shapes content of social interaction - Keeps conversation going by replying appropriately to questions and comments

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Discloses

answer

social interaction skill that shapes content of social interaction - Reveals opinions, feelings, and private information about self or others in a manner that is socially appropriate

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Expresses emotion

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social interaction skill that shapes content of social interaction - Displays affect and emotions in a way that is socially appropriate

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disagrees

answer

social interaction skill that shapes content of social interaction - Expresses differences of opinion in a socially appropriate manner

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Thanks

answer

social interaction skill that shapes content of social interaction - Uses appropriate words and gestures to acknowledge receipt of services, gifts, or compliments

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Transitions

answer

social interaction skill that maintains flow of interaction-Handles transitions in the conversation smoothly or changes the topic without disrupting the ongoing conversation

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Times Response

answer

social interaction skill that maintains flow of interaction-Replies to social messages without delay or hesitation and without interrupting the social partner

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Times Duration

answer

social interaction skill that maintains flow of interaction-Speaks for reasonable periods given the complexity of the message sent

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Takes Turns

answer

social interaction skill that maintains flow of interaction-Takes his or her turn and gives the social partner the freedom to take his or her turn

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Matches Language

answer

social interaction skill that verbally supports interaction-• Uses a tone of voice, dialect, and level of language that are socially appropriate and matched to the social partner's abilities and level of understanding

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Clarifies

answer

social interaction skill that verbally supports interaction-Responds to gestures or verbal messages signaling that the social partner does not comprehend or understand a message and ensures that the social partner is following the conversation

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Acknowledges and Encourages

answer

social interaction skill that verbally supports interaction-Acknowledges receipt of messages, encourages the social partner to continue interaction, and encourages all social partners to participate in social interaction

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Empathizes

answer

social interaction skill that verbally supports interaction-• Expresses a supportive attitude toward the social partner by agreeing with, empathizing with, or expressing understanding of the social partner's feelings and experiences

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heeds

answer

social interaction skill that adapts social interaction - Uses goal-directed social interactions focused on carrying out and completing the intended purpose of the social interaction

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accommodates

answer

social interaction skill that adapts social interaction - Prevents ineffective or socially inappropriate social interaction

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Benefits

answer

social interaction skill that adapts social interaction - • Prevents problems with ineffective or socially inappropriate social interaction from recurring or persisting

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