Lec 5 - OT 201 - OFM Intervention Approaches PDF

THE OCCUPATIONAL FUNCTIONING MODEL (OFM) & INTERVENTION APPROACHES Jordan University of Science & Technology OT 201 - Occupational Therapy Fundamentals Lecture 5 1  LEARNING OBJECTIVES Describe...

THE OCCUPATIONAL FUNCTIONING MODEL (OFM) & INTERVENTION APPROACHES Jordan University of Science & Technology OT 201 - Occupational Therapy Fundamentals Lecture 5 1  LEARNING OBJECTIVES Describe the Occupational Functioning Model (OFM). Organize assessment and treatment planning according to the Occupational Functioning Model. Describe and understand activity demands in OT. Describe OT Intervention Approaches 2  THE OCCUPATIONAL FUNCTIONING MODEL (OFM) Conceptual models of practice are meant to be used in conjunction with the American Occupational Therapy Association’s Occupational Therapy Practice Framework (OTPF). Therapists may choose from among many different conceptual models of practice in order to put the framework into practice. An occupational therapy model of practice is a way of conceptualizing the interrelatedness of the person’s characteristics and his or her environment, occupation, and quality of life to guide assessment and intervention. The Occupational Functioning Model (OFM) conceptualizes the process of occupational therapy for persons with physical dysfunction. The model reflects the philosophy of occupational therapy regarding health being a state enabling full participation in life’s activities. 3  OFM CONT. The OFM guides assessment and treatment of persons with physical dysfunction leading to competence in occupational performance and subsequent feelings of self-empowerment. The OFM was derived from clinical practice with persons with physical impairments. The primary belief is that people who are competent in their life roles experience a sense of self-efficacy, self-esteem, and life satisfaction. 4  OFM CONT. The goal of treatment, according to the OFM, is to enable competent engagement in valued roles whether by restored self-performance (personal agency) or by directing others (proxy agency). Another assumption of the OFM is that the ability to carry out one’s roles, tasks, and activities of life depends on basic abilities and capacities (e.g., strength, perception, and ability to sequence information) However, the relationship is not linear. Only part of the variance associated with function is accounted for by any one ability. 5  DOMAINS OF THE OCCUPATIONAL FUNCTIONING MODEL Competence and Satisfaction with Life Roles and Competence in the Performance of Tasks of Life Roles: Life roles and the tasks that comprise them are defined by the patient or client. Generally, roles fall into one of the following three categories: Self-maintenance roles: These roles maintain self, family, pets, and home, including all basic activities of daily living (BADL) and instrumental activities of daily living (IADL) associated with self-care; all IADL associated with care of family; and all IADL associated with care of home, and other possessions. Self-advancement roles: These roles add to the person’s skills, possessions, or other betterment. Self-enhancement roles: These roles contribute to personal accomplishment and enjoyment or sense of well-being and happiness. 6  DOMAINS OF THE OCCUPATIONAL FUNCTIONING MODEL Competence in the Performance of Activities and Habits of the Tasks of Life Roles: Activities: Smaller units of goal-directed behavior that comprise tasks. Habits: Chains of action sequences acquired by frequent repetition that can be carried out with minimal attention. Therapy aims to sustain useful habits, release useless habits, and develop new habits. 7  DOMAINS OF THE OCCUPATIONAL FUNCTIONING MODEL Abilities and Skills: Abilities and skills that are basic to interaction with objects and physical and social environments include: Motor: Adequate strength, coordination, range of motion, dexterity, and muscular endurance. Sensory: Abilities to adequately receive and interpret sensory stimuli to enable occupational performance. Cardiorespiratory: Adequate cardiac and pulmonary function to sustain performance. Visual-perception: Adequate visual acuity and ability to perceive and interpret sensory stimuli and to perceive self and objects in space to enable occupational performance. Cognitive: Abilities and skills that are basic to interaction with the environment, to organizing life tasks, and to solving occupational problems; abilities include attention, memory, problem solving. Socioemotional: Abilities and skills that enable occupational performance in a social context or environment 8  DOMAINS OF THE OCCUPATIONAL FUNCTIONING MODEL Developed Capacities: Voluntary responses that have developed from first-level capacities First-Level Capacities: The reflexive subroutines of voluntary movement and behavior. These functional foundations for movement and behavior include sensorimotor, cognitive-perceptual, and socioemotional capacities. Organic Substrate: Structural and physiological foundation for movement, cognition, perception and emotions. The substrate includes central nervous system organization and the integrity of skeleton, muscles, peripheral nerves, heart, lungs, and skin. 9  DOMAINS OF THE OCCUPATIONAL FUNCTIONING MODEL Environment and Context: Physical: Including the natural and built environments, objects and utensils, and the requirements that tools and utensils pose for use. Personal: Including age, gender, activity history, sense of competency, and spirituality. Cultural: Including norms, values, beliefs, and routines or rituals of the family, ethnic group, community, or religious group. Social: Including therapeutic interaction and relationships with family members, peers and friends, and community. Temporal: Including temporal demands of role tasks, activities and habits; balance of activity types; and balance of activity and rest Situational: Including circumstances related to the setting or surroundings at a given moment. 10  ACTIVITY DEMANDS Activity Demands refers to the specific features of an activity that influence the type and amount of effort required to perform the activity. Activity demands are specific to each activity 11  ACTIVITY DEMANDS & OFM The OFM has no comparable concept within the hierarchical model. Activity analysis is, however, a basic therapeutic process within the OFM. Three analyses: 1. Task-focused activity analysis—Deconstruction of activity itself outside of the client-specific application to build student’s or clinician’s repertoire of therapeutic occupations 2. Client-focused activity analysis—Description of the reasoning used in the therapeutic use of occupation-as-means for a particular therapeutic goal for a particular person 3. Client-environment fit analysis—Deconstruction of the specific activity-environment-person fit to determine and/or optimize the likelihood of successful performance of occupation-as-end 12  ACTIVITY DEMANDS & OTPF Activity demands include: Objects used and their properties—Tools, materials, equipment Space demands—Size, arrangement, temperature, etc. Social demands—Social environment and cultural contexts Sequence and timing—Rules, sequences Required actions and performance skills—Sensory, perceptual, motor, praxis, emotional, cognitive, communication and social performance skills Required body functions—Those physiological functions required to support the actions required of the activity Required body structures—Anatomical parts of the body that are required to perform the activity 13  THE PROCESS OF OT & OFM Goal of therapy: Satisfactorily engage in self-identified, important life roles through which the person gains a sense of self-efficacy and self-esteem. Evaluate to identify the problem(s): Identify roles, tasks, and activities the person wants to do or needs to do Observe and analyze the person’s performance, preferably within usual context Identify inadequate performance Identify impaired abilities or capacities that contribute to inadequate performance and assess level of impairment using valid, reliable assessment tools administered according to the standardized protocol Identify environmental or contextual enablers or hindrances Interpret assessment data to the patient and family and document in the patient’s record 14  THE PROCESS OF OT & OFM Plan intervention: Plan in collaboration with the person or family, after presenting the current evidence, to determine whether the person wants to engage in either remediation of impaired abilities or capacities to enhance overall performance or restoration of occupational performance through relearning and/or adaptation of method or environment. With the patient, establish short-term goals that directly relate to the long-term goal of successful role functioning identified by the patient and that can be objectively and reliably measured. Select interventions that have evidence for effectiveness for the immediate goal. 15  THE PROCESS OF OT & OFM Implement the intervention: Use therapeutic mechanisms, as appropriate: Occupation Occupation-as-end to restore occupational functioning Occupation-as-means to optimize abilities or capacities Therapeutic rapport Education—Learning or relearning Adjunctive therapies—Therapies such as orthoses, technological aids, physical agent modalities, mobility aids used to facilitate performance Contextual and environmental modification—To facilitate performance 16  THE PROCESS OF OT & OFM Evaluate the result: Assess patient outcomes Determine whether the short-term goals were achieved Determine whether achievement of the short-term goals resulted in desired occupational performance If not, reevaluate and modify the plan relative to achieving targeted outcomes If yes, determine whether the person was satisfied with his or her achievement Plan for the next level of therapy or plan for discharge and referral as appropriate 17  THE PROCESS OF OT & OFM Types of outcomes: Satisfactory occupational performance to allow expected discharge success Voiced, or otherwise indicated, sense of self-efficacy and self-esteem Prevention of further disability through education and follow-up, if necessary 18  OT INTERVENTION APPROACHES Approaches to intervention are specific strategies selected to direct the process of evaluation and intervention planning, selection, and implementation on the basis of the client’s desired outcomes, evaluation data, and evidence. Approaches inform the selection of practice models, frames of references, or treatment theories. 19  OT INTERVENTION APPROACHES Create, promote (health promotion) Establish, restore (remediation, restoration) Maintain Modify (compensation, adaptation) Prevent (disability prevention) 20 Thank You!