Occupational Therapy: Introduction

• Occupational Therapy Class #2 is an introduction to occupational therapy by Josh Campbell.

Course Outline

• Theories, models, and frameworks in OT.
• OT frames of reference.
• Key concepts of occupational therapy.
• Principles of Practice

Definitions of Occupational Therapy

• Occupational therapy assesses function and adaptive behavior, treating and preventing disorders affecting these.
• The focus is on developing, maintaining, rehabilitating, or augmenting function/adaptive behavior in self-care, productivity, and leisure.

Practice Areas Preview

• Hospitals: Including ortho, neuro, cardio, acute rehab, outpatient rehab, Spinal Cord Injury (SCI), stroke, pediatrics, hand, and upper limb.
• Private Practice: Home care, community care, case management, mental health outreach, insurance claims, return-to-work planning, vocational assessment, and rehab.
• School Systems.
• Additional roles: administrative and educator

Key Concepts

• Theory
• Model
• Framework

Models

• Models are simplified explanations of complex ideas.
• Use models to organize thoughts and identify existing knowledge versus what needs to be discovered.
• Models direct assessment and treatment.
• PEO, CMOP-E, MOHO, Kawa River Model, and CanMOP are examples of OT Models.

PEO Model (Person-Environment-Occupation)

• Occupational Performance is the result of the interaction between the person, environment, and occupation.
• Person factors include abilities, skills, and physiology.
• Personal abilities can be physical, cognitive, and psycho-emotional.
• Environmental factors can be physical, cultural, institutional, and social.
• Occupation factors include timing, sequencing, space demands, objects, and activity demands.
• Successfully completing activities needs a specific sequence and correct timing.
• Space demands include size, object arrangement, surface, lighting, temperature, humidity, noise, and ventilation.
• Objects can be tools, supplies, or equipment.
• Each element involved can be a barrier or facilitator.
• Finding the best fit among person, environment, and occupation leads to optimal performance.
• Basic PEO questions:
  • What are the occupation's demands?
  • Do the client's personal abilities allow them to complete the occupation/activity?
  • Are there environmental factors impacting the occupation or person?

CMOP-E Model

• Includes spirituality, self-care, productivity, and leisure, while considering the environment, cultural, social, cognitive, and physical aspects.
• Spirituality means different things but includes a sense of meaning, purpose, and connection.
• Occupation should be engaged in, going beyond just performance, and being invested in it.

Kawa River Model

• Represents life as a river, with different elements affecting its flow.

MOHO (Model of Human Occupation)

• Components: Personal causation, values, interests, roles, routines, environment, and performance skills.
• When using a MOHO lens, questions to consider:
  • Why are people motivated to do what they do?
  • How is occupational behaviour organised and structured?
  • What are the client's values, interests and occupations?
  • What are the individual's habits or routines?
  • How well can a person complete a task or occupation they are motivated to do?

CanMOP (Canadian Model of Occupational Participation)

• A model of occupational participation with history, relationships, meaning and context.

Frameworks

• One example is the Canadian Practice Process Framework (CPPF).

CPPF (Canadian Practice Process Framework)

• Consists of:
  • Entering/initiating
  • Setting the stage
  • Assessing/evaluating
  • Agreeing on objectives and plan
  • Implementing the plan
  • Monitoring and modifying
  • Evaluating the outcome
  • Concluding/exiting

Each Stage of CPPF Includes

• Enter and Initiate: Review service referral, conduct initial client interview, gain consent, and establish action points.
  • Consider who is the client, client's needs for OT services, occupational challenges, consent to participate, and the service delivery model.
• Set the Stage: Thoroughly interview the client and gather preliminary information.
  • Client needs, perceived issues, goals, and theoretical frameworks for the process need consideration.
• Assess/Evaluate: Assess PEO factors, provide recommendations, decide on service continuation, and determine the use of standardized vs non-standardized assessments.
  • Frame(s) of reference for assessment, conduct, meaning of findings, and continuation of interaction with the client are factors for consideration.
• Agree on Objectives & Plan: Establish goals, set objectives, and decide on service continuation with the aid of a frame of reference.
  • Occupational goals, action based objectives and stakeholder involvement needs consideration.
• Implement the Plan: Doing what was agreed to do in the previous step.
  • Consider implement the plan of who, what and how the client is engaged.
• Monitor & Modify: Collecting data and making changes to the plan as needed, and monitoring the client's progress while working with the client of other stakeholders.
  • Consider is the plan going as expected, contextual factos, and making needed modifications.
• Evaluate the Outcome: Conducting a summative evaluation to see if occupational goals have been met.
  • Occupational goals and new occupational issues need consideration.
• Consider where to return to within Action point 4.
• Conclude & Exit: Concluding the practice relationship together, informing the client on re-entry, and determining referrals/community resources.
  • Consider and document whether the client agrees on conclusion, needed referrals or additional documentation.
• The CPPF can be used as a roadmap.

COTIPP

• The Canadian Occupational Therapy Inter-Relational Practice Process Framework.
• Using justice, equity, and rights based lenses, connections are made, while critical thinking is used regarding transition, context, and participation.

OT in Practice: Focus Areas

• Energy conservation and pacing
• Working with limited resources
• Symptom budgeting
• Avoidance of the activity-rest cycle
• The Four Ps of Energy Conservation:
  • Prioritize: Deciding what is important based on limitations.
  • Plan: Organizing tasks based on priorities, when energy is best, and including rest.
  • Pace: Manipulating the frequency, duration, and intensity of activities.
    • Frequency: altering the activities.
    • Duration: alter how long you do them.
    • Intensity: altering the speed or equipment.
  • Positioning: Use safe and efficient ergonomic movement.
• Energy conservation and pacing are key ideas for OT.
• It is important to avoid the activity-rest cycle.
• Energy Bucks & Budget: Imagine clients have a "budget" for energy/symptoms, with each activity costing a certain amount.
• Assistive Devices should only be use if other interventions are not able to ahieve the same level of participation.
• Ensure the best route to independence is achieved when using devices.

Biomechanics 101

• Consider muscles, body, plane and posture of center of graity
• Repetitions, Work Height and Assitive Devices are important

Assistive Devices

• Any device/system allowing an individual to perform a task that the user couldn't otherwise do.
• Available come in both low and high quality.
• Example Devices:
  • Eating and Drinking Devices: Such as nonslip mats and motorized aids.
  • Devices for Preparing Meals: Such as one-handed jar opener and accessible stations.
  • Self-Care Devices: Such as elastic clothing and dressing tools.
  • Mobility Aids: Such as canes, walkers and adapted vehicles.

Next Class

• Specific Areas of Practice
• OT Programs in Canada
• Admissions at Western
• Licence to Practice and Regulation of OTs