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O.T.P.F. - definition

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Occupational Therapy Practice Framework: outlines the territory of OT in the realm of physical disability.

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O.T.P.F.

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"Supporting health and participation in life through engagement in occupation"

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Preoccupations - vs - Occupations

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Preoccupations: hot packs, massage, functional exercises Occupations: client does the occupation (dressing, eating) 1. RAMP 2. Requires planning

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OT practice

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Overlaps with other areas of practice (speech, PT)

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OT - Domain of Concerns

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Areas of Occupation Client Factors Performance Skills Performance Patterns Context & Environment Activity Demands

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Areas of Occupation

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1. ADL's (Activities of Daily Living) 2. IADL's (Instrumental Activities of Daily Living) 3. Rest and Sleep 4. Education 5. Work 6. Play 7. Leisure 8. Social Participation

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Client Factors

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1. Values, beliefs and spirituality 2. Body Functions 3. body Structures

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Performance Skills

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1. Motor & Praxis skills 2. Sensory - Perceptual Skills 3. Emotional Regulation Skills 4. Cognitive Skills

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Performance Patterns

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1. Habits 2. Routines 3. Roles 4. Rituals

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Context & Environment

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1. Cultural 2. Personal 3. Physical 4. Social 5. Temporal 6. Virtual

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Activity Demands

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1. Objects used & their properties 2. Space demands 3. Social demands 4. Sequencing & Timing 5. Required actions 6. Required body functions 7. Required body structures

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Theories, Models and Frames of Reference

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Provide a starting point for information gathering, treatment planning and treatment implementation.

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Model of Human Occupation

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M.O.H.O. - a systems model

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M.O.H.O. = Basic Tenet

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1. Humans have intrinsic motivation to explore, interact with and master their environment (regardless of age or cognitive state). 2. Individual cannot be separated from the environment; they interact with one another (intertwined) 3. A Holistic Model - vs - Reductionist Model

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A Holistic Model

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Looks at the person as a whole.

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A Reductionist Model

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Looks intensely at one part (i.e. muscular function).

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3 Subsystems of Human Occupation

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1. Volition (motivation) 2. Habituation 3. Performance Capacity and the Lived Body

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Volition

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aka: motivation 1. Personal Causation 2. Values 3. Interests

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Personal Causation

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1. Sense of competence (the persons beliefs about personal effectiveness. 2. Locus of Control (Internal & External)

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Values

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1. What is meaningful and important. 2. Motivate behavior

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Interests

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1. What is satisfying and interesting (attraction) 2. Energized, alive and ready to try new things.

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Habituation - definition

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Refers to activities that have been performed enough times to become routine and customary.

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Habituation

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1. Habits 2. Internalized Roles; role change or transition

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Habits

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1. Automatic routines or patterns of activity that a person seems to perform almost by reflex, without much conscious awareness. 2. Conserves energy & free up cortical space.

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Internalized roles

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1. Common roles that are personalized by the individual. 2. Consist of many different habits, routines and skills (homemaker, student)

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Role change or transition

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1. Occurs as life moves forward and the person grows. 2. Roles contract, expand, modified, abandoned, replaced.

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Performance Capacity

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1. Ability to participate in activities 2. Subjective beliefs about capabilities 3. "the ability for doing things"

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Lived Body (Kielhofner)

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1. "the experience of being and knowing the world through a particular body". 2. Perception of activities changes when body is disabled.

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M.O.H.O. - Guidelines for OT Intervention (Tenets)

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1. Client change is the focus of therapy. 2. Only clients can accomplish their own change. 3. For Occupations to be therapeutic, activity must be actual - vs - contrived. 4. Activities must be relevant, meaningful and appropriate in order to be therapeutic. 5. Therapeutic change involves alterations in the individual, the environment and their relationships. 6. The OT Practitioner guides and supports change.

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Client change is the focus of therapy

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The client must take what is presented/learned during the therapy and implement their own change.

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Only clients can accomplish their own change.

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Client must be actively involved in the therapy process; treatment is not done to an individual.

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Occupations must be actual - vs - contrived for the activity to be therapeutic.

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Maximal gain from treatment occurs during appropriate, meaningful, relevant activities; "real" to the pt.

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Activities must be relevant, meaningful and appropriate in order to be therapeutic.

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OT Practitioner must be creative with resources that are available when actual activities are not practical.

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Therapeutic change involves alterations in the individual, the environment and their relationships.

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OT Practitioner modifies task, environment for "just right challenge" for client to learn new ways of doing tasks.

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The OT Practitioner guides and supports change.

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Encourage and support; validate, analyze tasks, give feedback, provide alternatives.

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Practice Approaches/Frames of Reference

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1. Bio-mechanical Approach 2. Sensorimotor and Motor Learning Approach 3. Rehabilitation Approach

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Bio-mechanical Approach

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1. Kinetics (study of motion and forces acting on objects) 2. Physics (study of force, levers, torque) 3. Statics (study of forces acting on objects at rest) 4. ROM, Strength, Endurance, Torque, Force 5. Lever & Joint

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Bio-mechanical Approach - seeks to ...

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1. Evaluate/treat deficits in ROM, strength, task tolerance. 2. Prevent or decrease deformities (fixed or flexible)

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Bio-mechanical Approach & OT

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1. Best used with intact CNS (not stroke) 2. Utilized in ergonomics 3. Utilized in work hardening. 4. Diagnosis of RA, OA/DJD, burns, fx, jt replacement

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Ergonomics

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Evaluation and adaptation of the environment and the individual in the work setting.

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Work Hardening

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Evaluation/treatment aimed at improvements in physical & psycho-social performance skill - return to employment.

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Sensorimotor Approach

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1. Used when CNS is damaged/abnormal, resulting in limited smooth, controlled movements. 2. Utilizes neuro-physiological pathways

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Neuro-physiological pathways

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1. Provide controlled sensory stimulation 2. Normalize muscle tone 3. Elicit reflexes 4. Employ concept of Ontogeny recapitulates Phylogeny

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Ontogeny recapitulates Phylogeny

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Individual developmental stages from primitive to complex.

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Motor Learning Approach

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1. Newer approach to treatment with focus on practice, client problem solving, reflection and feedback. 2. Relies heavily on context. 3. Integrates the 3 subsystems of MOHO

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Motor Learning Approach - Pt guidelines

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1. Be able to recognize & terminate activity. 2. Be able to repeat tasks. 3. Be able to recognize and correct mistakes.

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Rehabilitation Approach

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1. Focus is on the residual capabilities of the individual 2. Assists with compensatory strategies for purposeful activities that impact quality of life. 3. Role Performance and Performance Skills are of greater focus that the structure/function of the body.

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The Continuum of Treatment with Physical Disabilities

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1. Adjunctive Methods 2. Enabling Activities 3. Purposeful Activities 4. Occupational Performanance & Occupational Roles

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Adjunctive Methods

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1. Used to prepare the patient to engage in activity. 2. Often used in acute stages of illness or injury. 3. First stage of treatment continuum.

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Adjunctive Methods - examples

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1. Exercise 2. Facilitation & Inhibition techniques 3. Positioning 4. Sensory stimulation 5. Selected physical agent modalities (hot/cold packs) 5. Devices (splints & braces)

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Enabling Activities

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1. Used for simulating purposeful (but not necessarily meaningful) activities. 2. Used to train specific sensory, motor, perceptual or cognitive functions necessary for performance skills and occupations. 3. Second stage of treatment continuum.

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Enabling Activities - examples

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1. Sanding boards 2. Stacking cones or blocks 3. Practice boards for clothing fasteners & hardware 4. Driving & work simulators

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Purposeful Activities

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1. Been the core of OT since its inception. 2. Has an inherent or autonomous goal 3. Are relevant and meaningful to the patient. 4. Are used to evaluate, facilitate, restore or maintain a persons ability to function in life roles. 5. Third stage of treatment continuum.

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Purposeful Activities - examples

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1. Hygiene, Dressing, Mobility 2. Arts,Crafts, Games, Sports 3. Work, Education, Communication

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Purposeful Activities & the OT

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The therapist is concerned with evaluating & remediating deficits in performance of skills related to occupation.

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Occupational Performanance & Occupational Roles

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1. Final stage of treatment continuum. 2. Patient resumes/assumes occupational roles in the living environment & in the community. 3. Formal OT intervention is decreased / terminated. 4. OT is concerned with transitioning needs.

Phys Dys: Chapter 1 "OT & Physical Disabilities" – Flashcards

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