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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 meaning that might be ascribed to it. 2 types: occupation based , activity based

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Activity analysis

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Allow client to achieve mastery in the environment Allow client to see & feel what they are doing Makes activity meaningful & allows them to "get lost" in the activity Allow for greater transference toward goals Requires coordination of total body Client gets immediate feedback (Our tools as well as our end goal of interventions)

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Why occupations

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Leads to: Clients achieving sense of mastery Clients feeling a result Encourage to go farther, longer Transference to other client goals The challenge to use multiple skills and body system Immediate feedback to the client on performance

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Occupations as tools

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Identify needed equipment, materials, space, and time Provide knowledge base Give specifics for documentation Assist in discovering how contexts influence performance of an occupation (environment during activity) Helps to find "just right challenge" Identifies intervention needs of the client

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Why do we analyze

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1. Activity awareness 2. Identify steps required 3. Determine activity demands 4. Analysis for the therapeutic intervention

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Activity analysis process

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What are we analyzing Establishment of what is being analyzed of the activity analysis. Activities can overlap Separate them and define success for each

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1. Activity awareness

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Break down activity into specific steps and timing of each step. Enables practitioner to identify demands of activity.

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2. Identify the steps required

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Objects and their properties Space demands Social demands Sequence and timing Required actions Required body functions Required body structures

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3. Determining the activity demands

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Step of the process where an activity and the needs of the client to find possible outcomes. Finds ways to adapt or grade an activity in order to increase or decrease the challenge for the client.

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4. Analysis for the therapeutic interventions

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Making things by hand, a profession or activity such as weaving, pottery, or wood carving, involving the skillful making of decorative or practical objects by hand. Provide a mental escape, sense of productivity, alternative to communication, restorative to physical, mental, and psychological self.

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Crafts defined

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Uniform Terminology

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1979 - AOTA

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Uniform Terminology 2nd edition

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1989

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Uniform Terminology 3rd edition

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1994

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Developed the Uniform Terminology for Occupational Therapy Model of Practice Act when really defined

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1999 - AOTA Commission on Practice

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Published International Classification of Functioning , Disability, and Health To help everyone understand what "we" are talking about.

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2001 - World Health Organization (WHO)

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First revision 2008 and 2nd edition Second revision and current 3rd edition 2014

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2002 - AOTA Occupational Therapy Practice Framework: Domain and Process

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A profession's domain includes those areas of human experience in which the practitioner of the profession offer to others. Professions area of expertise

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Domain

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Focuses on assisting people to engage in daily life activities that they find meaningful and purposeful.

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OT Domain

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Knowledge of occupation & how to break everything down. How engaging in occupations can be used to affect/effect.

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OT Expertise

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Occupation is both a means to an end..... Means = method of changing performance may include use of occupation as Tx method (how you get there) Ends = when client demonstrates improved engagement in meaningful occupation (end product)

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OT Profession

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alignment with the client's goals, values, beliefs, needs and perceived utility. EX: driving a car = independence

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Relevance and importance to client

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Tools, supplies & equipment required in the process of carrying out an activity.

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Objects and their properties

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(related to physical environment) Physical environmental requirements of the activity (size, humidity, ventilation)

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Space demands

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Elements of the social environment & virtual & cultural contexts that may be required by the activity. EX: Rules of a game

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Social demands

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Process required to carry out the activity (specific steps, sequence of steps, time required) (Body functions & structures)

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Sequencing and timing

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Actions (performance skills) required by the client that are an inherent part of the activity. EX: feeling heat of a stove

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Required actions & performance skills

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Physiological functions of the body systems required to support the actions used to perform the activity. EX: joint mobility, cognitive level

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Required body functions

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"Anatomical parts of the body, such as organs, limbs, and their components" that support body functions and are required to perform the activity. EX: # of hands or feet

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Required body structures

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Motor control & sensory integration Focus is on connection of mind and body by CNS - sensory input through nervous system to brain and out through motor. Uses positioning, normal movement patterns, sensory input through tactile and proprioceptive cues. Crafts: motor=mixing, rolling clay, sawing Sensory=mixing dough w/hands, leaf rubbing

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Neurological FOR

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(must have intact brain) Strength, endurance, ROM, edema control etc Crafts: all physical

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Biochemical FOR

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(retraining) Ability to learn/maximal functional level based on cognitive ability. Sequencing, memory, problem solving, visual scanning, mental flexibility, pattern recognition Crafts: kits w / instructions, cooking

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Cognitive Disabilities

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Mastery of stages needed to progress through orderly growth. (Consider what can be done by a given age) Crafts: coloring, cutting, beading, metal tooling, hand-writing

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Developmental / Spatiotemporal Adaptation

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MOHO, CMOP Context is central to occupational performance. Client-centered......important for client to choose their activities/occupations and should have relevance and meaning. (May or may not be a craft)

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Occupational Behavior Model

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Mentally process the steps Engage in the activity yourself Talk to your client Talk to someone who performs the activity Watch someone perform the activity

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Methods for determining key steps of an activity

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Determine what activity you will be analyzing Preparatory & clean up tasks should only be included in steps if absolutely necessary Be sure to begin with action verb Include the object or environment being acted upon (the noun) State how the action is being performed (adverb / s) Include time is needed List steps sequence Keep simple and concise Be specific with amounts Do not use R & L unless absolutely necessary Do not list the physical or mental requirements Include precautions or warnings Do not use proper nouns ******verb - noun - adverb format******

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Sequencing & timing for an activity

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Objects that help complete the activity, typically smaller objects; scissors, stapler, ruler (Reusable)

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Tools

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Items that you use to make something that will be depleted and my need to be replaced; tape, glue, writing utensils (Replenishable)

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Materials

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Objects that serve to equip someone to complete an activity, think bigger items; microwave, vacuum, workbench (Changeable)

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Equipment

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Amount of space / area needed for a particular activity. Also, equipment size

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Size - space demands

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"just right" due to space & arrangement to target goal that is to be achieved. Purposeful set-up

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Arrangement of objects - space demands

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Depends on type of activity & challenge to be sought. Can range from flat tabletop to rough pavement.

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Surface - space demands

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How much is required & what type. *Controllable

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Lighting - space demands

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Comfortable according to activity. *Controllable

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Temperature - space demands

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Determine according to activity. *Controllable

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Humidity - space demands

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Will the noise or lack of help or distract for the activity?

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Noise - space demands

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Circulation of air & the process of providing fresh air. EX: important when using chemicals

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Ventilation - space demands

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Consider client.....are they diabetic, have a food preference Texture

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Taste - space demands

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Rules are the typical norms & expectations of how one should act & communicate when involved in doing the activity and how related to culture. Social rules = rules of games, how one should act, dress codes, language w / peers as opposed to peers EX: avoidance of temper tantrums and melt downs

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Social demands of an activity

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Explain aspects of the objects used. Descriptive terms. EX: OLIVE oil, RED paint, UNLEADED gas

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Properties of an activity

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Motor / praxis Sensory-perceptual Emotional regulation Cognitive Communication and social

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Required performance skills

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Screening / evaluation Tx planning (list problems, prioritize problems, set-up LTG & STG, list activities that could help the client using FOR) Implementation of TX Re-evaluation Discharge planning (throughout all steps)

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The OT Process

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Developing a mutual partnership - active involvement of the client in the intervention plan is essential. Basis for activity analysis: assessing human & non-human components that are required to complete any activity. Activity + therapeutic purpose = intervention tool.

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Developing a meaningful plan

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Therapist imposed but no meaning to client (done to client.....EX: combs, therabands)

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Exercise Methods of intervention

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Therapist imposed but no meaning to client. Occupation based

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Contrived occupation method of intervention

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Incorporates meaning and active participation by the client (feedback from the client) Occupation based

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Therapeutic occupation method of intervention

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Focuses on improving occupational performance. Focus on client's skills Use adaptation if necessary

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Adaptive or compensatory occupation method of intervention

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****Is part systematic & part highly cognitive Scientific component Narrative component Tx environment Therapist own paradigm Client's religious and culture Maslow's hierarchy of needs

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These interactive elements of clinical reasoning should apply to all activity selections

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Includes systematic & highly cognitive, based on data, collection & hypothesis testing

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Scientific component

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Improvisational & intuitive, based on client's beliefs, values & subjective experience.

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Narrative component

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Tx environment & therapist's own paradigm Above all......the therapist should consider the client's abilities and interests, contextual factors, and characteristics of the activity itself.

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Other components

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Cost Time (EX: client LOS Space (Use of kits can eliminate some these issues)

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Pragmatic issues & practical clinical constraints for the use of crafts

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More appropriate cause ensure consistency. (Allen Diagnostic Module) Allows therapist to observe if client can read and follow written instructions, and / or provide copied example. Consider: reimbursement, cultural norms and practices, space, costs

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Kits for assessment

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Rehabilitation Changing the complexity of what is to be performed...to increase or decrease the activity demands on the person while they are performing an activity. Done incrementally to provide "just right challenge" and allow the person to develop the skills needed, while still assuring success at completing the activity.

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Grading

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Structure and activity so that the challenge / demand will gradually increase and facilitate improvement in a client's function. Identify performance skills or client factors that need improved then grade activity to level of challenge. Used when goal is remediation (correcting deficit)

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Grading during OT

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Challenge the Pt's ability by progressively changing the process, tools, materials, or environment of a given activity to gradually increase/decrease performance demands. Provide opportunity for gradual development of skill & related therapeutic benefits.

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Grading according to AOTA

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Field of study using applied science to specifically adapt equipment and the surrounding work environment to maximize human productivity.

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Ergonomics

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Any item, piece of equipment, or product system, whether acquired commercially or off the shelf, modified or customized that is used to increase, maintain, or improve functional capability of individuals with disability.

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Assistive technology

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Modifying or substituting objects used in performing the activity. (How they are always going to do the activity or use a tool) Ex: apply velcro fastener on a purse, color code files for quick ref., wear a walkman/ipod to drown out background noise.

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Activity adaptation

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The design and/or restructuring of the physical environment to assist self-care, work, and play/leisure performance. Used when goal is compensation.

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Therapeutic adaptations

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Select, obtain, fit, and fabricate equipment, and instruct client, family and/or staff in proper use and care of equipment. (raised toilet seat, weighted mug) Minor repair and modification for correct fit, position, or use (bending handle of a spoon). Do not change outcome of an activity!!! Should be meaningful, purposeful, while matching goals of intervention. Commercial products vs fabricating a product. Adjust and fit modalities

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Adaptations during OT

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1. To teach clients how to participate in life tasks when they have lost skills due to illness or injury. 2. To teach clients new or adapted ways to use to participate in life tasks when they have lost skills to illness or injury. 3. To teach new skills that are required to use adapted techniques or equipment necessary to participate in life. 4. To teach activities or therapeutic modalities used in therapy to provide "just right challenge" & improve client factors/performance skills for improved ability to participate in occupation. 5. To teach families how to enhance client independence or safety in daily occupations.

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5 Reasons OTs use teaching techniques

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Cognitive Associative Autonomous

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3 stages of motor learning

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Guide movement, talk & think through steps

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Cognitive learning

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Make connections to previous experiences

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Associative learning

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Learner no longer thinks consciously about the movements but can perform them quickly & efficiently & adjust to changes.

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Autonomous learning

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Mastering movements or techniques. Processing & steps of how movements are performed. Practitioners include demonstration followed by practice & feedback sessions.

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Procedural motor learning

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Depends more on memory & other analytic skills & refers to the descriptive sequencing of events. Can be related to a story, mental rehearsal. Need cognitive ability!!! NOTE ..... Tasks 1st learned in declarative way & later become procedural.

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Declarative motor learning

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Looking at individuals abilities & focusing learning specific motor functions. Ex: ROM, increase strength

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Individual in motor learning

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Uses purposeful activities important to client to motivate & increase success.

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Task in motor learning

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Therapist manipulates the environment to increase success of activity.

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Environment in motor learning

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Enables individual to perform similar tasks in a new context by drawing on past experience. EX: Toileting in nursing home....can they properly take task home with them.

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Transfer of learning

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Help client to see desired action Do 1st

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Modeling or demonstration feedback

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Brief highlight main cues, & be carefully timed. Do 2nd

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Verbal instruction feedback

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Arises from sensory stimulation to tactile receptors, proprioceptors, & visual & vestibular systems while performing task. Feeling it

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Intrinsic feedback

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Performance from outside source such as OT practitioner or a mechanical device. Knowledge of performance Knowledge of results Seeing results of action

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Extrinsic feedback

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Verbal Visual Rewards

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Reinforcement

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Factors in learning environment that increase the difficulty of initial learning. Can be manipulated by therapist to provide "just right challenge". !!!! If there is high contextual interference then learner must rely on intrinsic feedback & learning tends to be better!!!!!!! EX: Use environment noise during an exam

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Contextual skill interference

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Blocked practice: low, practice 1 task until you master it, quicker acquisition of skill but lower long-term retention. EX: give client verbal feedback during task --- declarative ("raise your arm a little higher). Give client feedback about outcome --- procedural ("the shirt is put on correctly, it looks neat, & each button is lined up with buttonhole)

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Types of contextual interference

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HIGH contextual interference Attempt multiple tasks & variations before master any one of them. Slower acquisition of skill but better long-term retention. EX: ROM activities in variety of ways

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Random practice

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Practice the task as a whole providing assistance as needed and removing the assistance gradually. HIGH contextual interference Slower acquisition of skill but better long-term retention

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Whole task practice

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Simulated Impoverished feedback Transfer of learning is poor

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Practice in simulated environment

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Variable contexts Enriched, natural environment provides real feedback and information Transfer of learning is better

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Practice of real environment

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Deciding what type of style will work best for client.

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Teaching/learning assessment

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What interventions are going to work best for the client. EX: use activity analysis, & what we learned from forms

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Design of teaching plan

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Structuring the instruction & the practice so that learners can progress at their own speed, & that they can handle.

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Pacing & grading instruction

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How did the intervention go? Did the client succeed? What went well? What could have gone better? Were Tx objectives achieved? What was the extent or quality of achievement of specific objectives?

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Questions to ask self after each Tx session

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Preparation --- pre-instruction phase before intervention. Demonstration --- instruction begins Return demonstration --- after demonstration then the client asked to perform skill. Follow-up

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4 part instruction phase

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Active participation Occupationally embedded instruction Intrinsic feedback Contextual interference Random practice schedules Naturalistic context Whole-task practice Strategy development (Box 7-2 in Pedretti pg 107)

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Factors that support transfer of learning

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