Occupational Therapy: Areas, Concepts & Dimensions

Week 1

• Areas of occupation include paid work, education, play, leisure, self-care, household and life maintenance, and sleep, according to the Occupational Therapy Practice Framework (OTPF).
• Organizer, foundations, and perspectives are key concepts in defining occupation.
• Occupations allow humans to be economically self-sufficient and act as primary organizers of time and resources.
• Rules dictate engagement in occupations while habits are automatic and repetitive patterns of behavior.
• Skills reflect choice, intensity, time use, and outcomes in occupations.
• Occupations have a meaning that is variable and has different dimensions.
• Everyone has a personal narrative that occupations define and change over time and circumstances.

Dimensions of Occupation

• Biological: Needs, drives, abilities, and limitations at the physiological level providing mechanisms for survival.
• Temporal-spatial: Sense of past, present, and future with timing, season, pace, and duration, and the space in which occupation takes place.
• Socio-cultural: Values, trends, traditions, rules and regulations that influence choice of occupations.
• Psychological: Emotional and cognitive aspects, that include happiness, joy, anger, sadness, and jealousy.
• Spiritual: Essence of a person expressed in daily actions, values, belief systems, and sociocultural backgrounds; acceptance of a greater reality, remaining intact and growing by the end of life.

Background and Benefits of Occupation

• Healthcare is currently dominated by medical science.
• The human need for occupation includes biological and sociocultural determinants that affect health and occupation.
• Benefits include; promoting learning, providing a role identity, involving the use of the hands, challenging and changes the internal organism to promote adaptive responses, providing structure and integration to a person's “wholeness", balance and meaning, reducing awareness of physical or psychological symptoms and promoting recovery from illness.

Week 2

• Occupations provide a bridge to health through survival by fulfilling biological needs, diversion from negative aspects, leading to "flow".
• Diversion allows individuals to transcend the fixed realities of time and space to find satisfaction from difficulties in their lives
• Mastery provides control and turns situations to an advantage, acquiring, practicing, and learning when to apply skills.
• Habits can promote health, increase occupational skills, decrease fatigue, free attention, and protect against the stressful effects of difficult situations.
• Support involves the value of being a helper or participating as a volunteer, and a sense of belonging associated with health and wellness.
• Occupations reinforce identity and grounds individuals.
• Spiritual connection is achieved, through occupation, connecting the self, others, the natural world, and a supreme power; being occupied provides the sense of not being alone.

Key Concepts

• Human evolution shows humans are occupational beings who define and identify themselves by occupations.
• Humans make decisions and have a need for occupation
• Human capacity indicates they have the capacity to make decisions and need to engage in occupations for health and survival, upright walking, hand dexterity, stereoscopic vision, language, and social nature.
• Occupation is activities people do everyday that give their life meaning, can be done alone or with others, are performed in a variety of environments, help shape identities, and influence health and well-being.
• Activity denotes a form of action that is objective and not related to a specific client's engagement and development of skills; can be selected by a practitioner to enhance occupational engagement and the development of skills (e.g., chopping veggies to improve fine motor skills).

Domains of Occupation

• ADLs are activities oriented toward taking care of one’s own body and completed on a routine basis; this includes showering, toileting, dressing, eating, mobility, hygiene, and sexual activity.
• IADLs are activities to support daily life within the home and community involving caregiving, child care, driving, financial management, meal prep, shopping, and safety.
• Health management involves activities related to developing, managing, and maintaining health and wellness routines.
• Rest and sleep involves activities to obtain restorative rest and sleep to support healthy, active engagement.
• Education involves the activities needed for learning and participating in the educational environment.
• Work involves labor or exertion related to development, production, delivery, or management of objects or services, that may be financial or non-financial.
• Play involves activities that are intrinsically motivated, internally controlled, and freely chosen and that may include suspension of reality.
• Leisure is nonobligatory activity that is intrinsically motivated and engaged in during discretionary time; time not committed to obligatory occupations.
• Social participation involves activities that involve social interaction with others that support social interdependence.

Week 3

• Health, according to the World Health Organization (WHO), is a state of complete physical, social, and mental well-being, not merely the absence of disease or infirmity, and varies according to culture, spiritual beliefs, philosophies, economy, and technology.
• Socially accepted models of health include medical, social, biopsychosocial, and disablement models.
• The International Classification of Functioning, Disability and Health (ICF) purposes, define health and some health-related components of well-being for all people, and classifies function and disability.
• Participation is a person's actual performance of occupation in their own environment, including problems due to barriers.
• Activity limitation is a person's capacity to execute occupations; what a person could do in an environment without barriers.
• Body functions and structure refer to impairments, i.e. breathing/lungs; blood pressure/heart
• Health is distinct from disease, disorder, or condition.

SAMHSA's 8 Dimensions of Wellness

• Physical: Internal need to make use of physical capacities, growing awareness of mind-body connections, and alternative medicine.
• Emotional: Prerequisite for overall well-being, associated with a balance of occupations, and reflective of coping skills.
• Intellectual: Keeping the brain active through learning, diverse perspectives, reading, and mental challenges.
• Social: Associated with satisfying interpersonal relationships, the ability to interact with other people in cultural and social parameters without fear, dependent on social well-being.
• Financial: Understanding financial processes and resources and satisfaction with one's financial situation and future prospects.
• Spiritual: Represents beliefs and values and involves having meaning, purpose, and a sense of belonging, balance, and peace.
• Environmental: Values a person's safety and considers the physical environment, access to clean water/food, and positive wellbeing places.
• Occupational: Engaging in meaningful activities that reflect personal values, beliefs, and interests.

Needs and Sociocultural Influences

• Needs: help to maintain our stability and health is a three-way role in health.
• "Needs" as a "warn of problem" use negative perception "my stomach is growling, I must be hungry”.
• "Needs" as a "protect and prevent" use neutral perception "I need to take a walk and get a breath of fresh air after studying for the past 4 hours".
• "Needs" as a "prompt and reward" use positive perception "I worked so hard for so long, and today I will finally get my degree".
• Sociocultural influences on health include occupational norms where a certain activity is executed in a certain culture (e.g., dressing in Halloween costumes) and occupational circumstance (e.g., swimming in a backyard pool vs. at the Olympic trials).

Holism, Occupational Risk Factors, Context

• Holism associated with belief that the tendency of nature is to produce novel and irreproducible wholes and living systems are more than the sum of their parts.
• Occupational risk factors are actions or lack of actions that lead to pre-clinical health conditions.
• Imbalance: Overabundance, incompatibility, limit in occupational opportunity, infrequency of occupation due to lack of participation or motivation, role overload, and role strain.
• Deprivation: Prolonged preclusion form engagement in occupation, outside of the control of the individual, extrinsic; Occupational disruption is temporary (different than deprivation).
• Alienation: When an individual or population is NOT ABLE to engage in meaningful activities and instead engage in tasks whose requirements do not reflect their full capacities, also, a Prolonged experience of disconnectedness, isolation, emptiness, lack of sense of identity, and sense of meaningless.
• Injustice: Occurs when participation in occupation is barred, confined, restricted, segregated, prohibited, underdeveloped, disrupted, alienated, marginalized, exploited, excluded or otherwise restricted.
• Context encompasses the circumstance, situation, or environment within which an occupation is performed, including geographic, economic, sociocultural, political, and regulatory contextual factors as well as environmental and personal factors.

Environmental Press and Historical Perspectives on Development

• Environmental press: Any environmental condition that works in combination with an individual’s need, to influence behavior and recognize individuals have varying levels of competency, require the environment to be adjusted.
• Preformationist perspective posits children as miniature adults.
• Maturationist perspective views children as growing organisms, education passively supporting growth, and development being dictated by genes.
• Environmentalist perspective emphasizes the environment alone impacts development.
• Interactionist perspective highlights reciprocal interactive relationship and environment and influenced by heredity.
• The interactionist perspective is most closely linked to occupational development theory.

Continuity, Determinicity, Patternicity and Determinants

• Continuity: means development is a lifelong process that beginning at conception and continuing to death; occupations mirror developmental stages.
• Multiple determinicity: means no single factor determines development.
• Person factors: heredity, learning, and active participation.
• Environmental factors: physical, social, historical, and cultural.
• Multiple patternicity: means is two patterns are Multiple variations and Changing mastery.
• Development determinants: Heredity, environment, and age-normative events, typical events for age/gender, history-normative events, and events influenced by world events, and non-normative events.
• Non-normative events: Events influenced by personal situations that are not “typical" of development; trauma or rare illnesses.

The Effect of Inactivity/Disuse in Early Development

• Play allows for social development through interaction with peers, emotional development, energy expenditure, and improvement in physical abilities by enhancing strength, endurance, and skills teaching that CHILDREN LEARN THROUGH PLAY AND DOING.
• Play and its link to cognitive process (e.g. Types of problem solving).
• Negative consequences from lack of play opportunity include failure to thrive/ organic or nonorganic, psychological deprivation, poor stimulation, lack of routine, lack of attention, lack of skill opportunities, and lack of problem-solving.
• Convergent problem solving means there are problems that have a single correct solution.
• Divergent problem solving means there are problems that have multiple solutions.

Frailty, Context and Effects of Function

• Frailty: A state of reduced physiological reserve that is associated with an increased susceptibility to physical disability, unintentional weight loss, muscle weakness, slow walking speed, \exhaustion, and low physical activity.
• Context impact on older adult's occupations: Older adults living in the community have greatest opportunity for engagement in meaningful activity and increased care leads to decreased engagement in community.
• Changes associated with immobility/disuse include: cardiovascular changes such as cardiovasulcar deconditioning/ increased risk for tachycardia, orthostatic, hypotension, venous stasis, and deep vein thrombosis formation and respiratory changes.
• Decreased respiratory movement, pulmonary stasis, disturbed CO2-02 balance, pulmonary embolism formation, respiratory acidosis, confusion and fatigue.
• Gastrointestinal system is at an increased risk of acid reflux, development of ulcers, constipation, and gastritis.
• Motor dysfunction includes reduced ROM, contractures, swelling and edema, muscle atrophy, reduced strength and endurance, and sarcopenia (age related muscle loss).
• Skeletal system is indicated with Osteoporosis, increased risk for bone fractures, and increased pain.
• Integumentary system: Significant risk for pressure injury.
• Metabolic decline: Tissue wasting, bone demineralization, fluid/electrolyte imbalance.
• Urinary system: Urinary retention→ UTIs and renal stones→ confusion and delirium.

Week 5

• Signs and symptoms of disease can impact how and when to engage in occupations.
• It is important to consider the whole person when providing interventions and setting functional goals.
• Prognosis/outcomes can be dependent on willingness to engage in treatment process, safety awareness, social supports, and physical ability/capacity.
• Spinal cord injury primarily affects young adults with majority of injuries are male- 4:1 ratio (78%), which is caused by car accidents, falls, violence (primarily gunshot wounds), and sports/recreation activities; life expectancy is increasing because of new medical technology but still below the expectancy of persons without SCI.
• The symptoms of Schizophrenia fall into three main categories: positive (hallucinations, delusions), negative (loss of motivation, isolation, difficulty engaging in ADLs and IADLs), and cognitive (difficulty with memory, attention, concentration); first episode can occur in young adulthood and it is one of the top 15 leading causes of disability with risk factors.
• Factors include genetics, the environment, and brain structure and function; life expectancy is an average of 28.5 years lost, with co-occurring medical conditions and 4.9% die by suicide.
• CVA/ stroke impacts cause: two primary types of stroke i.e. hemorrhagic vs. ischemic, spontaneous recovery accounts for most gains in the first 30-90 days due to neuroplasticity.
• Right side CVA: left side weakness, spatial-perceptual ability loss, balance difficulty, left neglect, poor motor planning, and impulsiveness.
• Left side CVA: right side weakness, swallowing difficulty, aphasia, slow and cautious movements, balance difficulty, and difficulty learning new things.
• Parkinson’s disease is caused by cell loss in the substantia riga, depletes dopamine with strong correlation with depression and cognitive impairments, tremors, rigidity, akinesia, and postural instability.
• Alzheimer's disease is a progressive degenerative disease and type of dementia, impacting executive functioning and short-term memory first.
• Other functional impairments caused by AD include Sequencing problems, reduced or low vision, changes in balance/gait, and agitation.
• Arthritis, most common being osteoarthritis, that impacts activities involving bending of the joints or weight-bearing activities.
• Multiple sclerosis, also a inflammatory disease of the central nervous system is expressed with: fatigue, weakness, spasticity, balance problems, bowel/bladder problems, numbness, vision loss, tremors, and depression; comes in four different types
• Autism spectrum disorder, the fastest growing developmental disorder in the USA, impacts development in the following areas such as social interactions, and communication skills; Autism varies greatly from person to person.

Week 6

• Culture is real, shared, malleable, and dynamic, is learned and invisible (especially to the carrier).
• Culture is not static, fixed, immutable, inherited, or a race/ethnicity synonym.
• Culture impacts include values, family and gender roles, role of the elderly, religion, health status, and health beliefs and practices.
• Cultural aspects shape interactions, work habits, communication, problem-solving, negotiation, and relationship-building.
• Values are ideas of beliefs that are important to self or others that contain a psychological component that influences engagement in occupation and reflection of personal choices/ consideration.
• Perspectives of time organizes of lives enables us to appreciate the rhythm of rest and activity, excess time completing occupation are often signs of dysfunction.
• Linear time is unidirectional and has no going back.
• February 29, 2024 as leap year example of linear time.
• Cyclical time is rational and February 14 occurs every 12 months as an example of cyclical time
• Biological time is related to the traditional sense of time.
• Psychological time reflects the sense of “timing” in regard to communication and human interaction.
• Necessary time denotes basic physiological and self-maintenance needs.
• Contracted time denotes paid productivity or format education.
• Committed time denotes work or productive character but without pay or specific time frames.
• Spirituality is related to understanding one's “place" in the universe, making "meaning” through purposeful activity, the essential principle influencing a person, and is expressed in daily actions as influenced by values, belief systems, and socio-cultural backgrounds.
• Common characteristics of spirituality are strengthening self-identity and sense of control, enhances coping with adversity, focuses on "making" rather than just "doing", key to self-other relationships, accepts a greater reality, and influences meaningful activities.

Week 7

• Any occupation can be spiritual and based from style and context.
• The goals of "continuum of intervention" are meant to be: Adjunctive (least meaningful) o Preparatory: Done by the therapist TO the client to prepare them for more engaging therapy activities and is passive for the client. • Enabling: o Client is now active participant, stimulates just one part of task or activity, no meaning, except that it is done. • Purposeful: Client is an active participant, a true activity in that it has goal and result, but therapist-chosen and not in proper context. • Occupation-based (Most meaningful): Client is active participant, performed in the right context.

Intervention Approaches

• Restoration seeks to improve levels of occupational engagement through restoration of associated skills, implying we are restoring 100% and that they can handle all obstacles.
• Compensation acknowledges residual limitations. maximizing functional gains with environmental modifications, implying active client engagement/ limitations.
• Adaptation focuses on improving client function by modifying the environment and/or providing caregiver training, acknowledging chronic conditions and being passive performance.
• Important to prioritize occupations valued to client with just right challenge, ensure pt is challenged not frustrated.
• Important to consider: time constraints. as it relates to functional abilities and prognosis

Disability, Participation and the Evolution of Work

• Clients accept disability and learn to modify methods for self-care tasks and to use adaptive equipment.
• Clients can use modifications and equipment, while unsatisfied with the changes.
• Clients use modifications and equipment in rehab, abandoning them at home.
• Clients can devise their own methods.
• Pre-modern work was Seasonal, everyday, Religious influences.
• The industrial revolution began with work and leisure, separate environmental space and opposites.

Work, Education, ADLs, IADL and Context

• Work influences way of life, friend groups, attitudes and values, area where we live, how we spend leisure/dress, grants status, and is established in childhood and traits.
• Job conditions not congruent with personality: occupational risk factors.
• Components of Work is Employment and employment as it relates to performance, prep, adjustment, and meaningful occupations.
• Education components are: formal, exploration, and informal.
• ADLs have to be the activities oriented towards taking care of one's own body, and ADLS are activities towards one's personal body.
• How stress from work is related to the design of tasks, styles, concerns and relationships, environmental condition.
• Consider context and environment and how this relates to our occupations.
• Caregiving and is it important to understand it for what we are doing.
• Caregiving that leads to stress and burn out long and short term: long typically results in higher burn out rate
• Place is important because occupation is influenced by place.
• The sense of place has a special meaning if a place has a special relationship.

Sleeping, Wellbeing and Leisure

• OTPT 4 sleeping, rest, play and how do we get them all?
• We gear them all for restorative rest.
• Play includes activities/exploration for appropriate activities.
• Activities include if we are engaging with play.
• Sleep affects emotions.
• Health problems happen if we don't sleep.
• Sleep Hygiene has positive routines.
• Play has to be something throughout the day or life time.
• Cognitive allows someone to grow or see new ways what we feel through ourselves and our identity.
• Ways to help leisure, and our needs can be fulfilled, and thinking of this and helps people be warned of things through positive rewards and prevents those.

Universal Design

• Universal Design is enabling occupation for all people by products and designs.
• Universal design is to simplify things for people and is at little to no cost.
• Top Down: You're looking at the whole person; a “bottom-up” approach is one thing related to something like rehab.
• A bottom-up approach might be one thing that is generated from the referral of our customers for our treatment.
• Consider others with conditions.
• Each member is working on their own goals; do not seek to collaborate and work together; singular and narrow view of profess and success.
• Interdisciplinary: Team works together to meet the client's goals. Each individual service may have their own goals but coordinate with each other discipline's goals for one outcome.
• Benefits of OT (Occupational Therapy): to people who are injured, illness, help them with what happens to them.

Therapies

• Benefits of therapies are physical injury or illness, can be developmental problems and ageing and there are people to help along with it.
• Primary goal, enable more dependant, or safe and performance that's adequate.
• We want our medical team to work together to solve/collab issues as a whole.
• A Healthcare proffesion with services and individuals all ages whose lines have been disrupted.
• Help you do tasks and move so the functional tasks are for things.

Speech and Music Therapy

• For people with speech this helps people to communicate.
• Music is great for lifespan and commnication with wellbeing
• Art- increase awareness, art is shown to enhance your cognitive.
• OT- and how does the fit here; the goal is the building blocked is and for engagement.
• Working together as a team is important to create it.
• The music therapy is a great impact on those individuals to help them through certain issues such as anxiety and stress.