OT 205 Final Study Guide 2024 PDF

**OT 205** **Final Study Guide 2024** - Cole's 7 Step Process 1. Introduction - Introduce self - Introduce name of the group - Have members introduce themselves - Warm up activity often used - Setting the mood - Expectation of the group - Explain the purpose of the group...

**OT 205** **Final Study Guide 2024** - Cole's 7 Step Process 1. Introduction - Introduce self - Introduce name of the group - Have members introduce themselves - Warm up activity often used - Setting the mood - Expectation of the group - Explain the purpose of the group - Specific information on what will be happening in that session and why 2. Activity - Main activity to be completed in the group - Choosing an activity is a complex process that should - take the patients into consideration - Specific things to take into consideration: - Timing - Therapeutic Goals - Physical and Mental capacities of members - Knowledge and skill of group leader - Adaptation of an activity 3. Sharing - After the activity is completed, each member shares their work made or their experience in the group 4. Processing - Builds on sharing and involves members expressing how they feel about the activity, themselves, other members, and the leader 5. Generalizing - Leader tries to summarize what occurred in the group, what was learned, and how - Comparing responses from various group members 6. Application - Discussion of how what was learned in the group can be applied to the member's individual situation, environment, and everyday life (i.e. how the group can improve their occupational performance) 7. Summary - Verbally emphasizing and reiterating the most important aspects of what occurred in the group to make sure the members can use the information - Allen's Cognitive Disabilities Groups - Focus - Applicable for chronic and acute care settings - Presence of a need to measure and monitor the problem solving and safety of a client during performance of daily occupational activities - Groups can be: - Individuals with similar cognition - Caregiver groups - Primary features of intervention - Adaptation of contexts and task demand - Physical and social contexts - Habits and routines - Cognition - Cognitive disability defined: - "a limitation in sensorimotor actions originating in the physical or chemical structures of the brain and producing observable and assessable limitations I routine task behavior" - Examples of Cognition - Level of Arousal - Orientation - Recognition - Attention Span - Initiation - Termination - Memory - Task Analysis - Breaks activity into steps and takes into consideration culture, motivation, and situation - Defined as the method of determining the functional complexity of an activity by breaking the activity into steps and determining the cognitive and physical functional abilities required to do each step - Allen's Six Cognitive Levels - Three categories of cognitive impact on task performance - Attention - What sensory stimuli catch the person's interest - Motor Actions - Observed in the context of task performance - Conscious awareness - In respect to the surroundings - Guide behavior at each level - Lower the level the greater the impairment - Levels 1-4 have difficulty living unassisted in the community - Level 1- Automatic Actions - Usually bedridden; caretaker doing ADLs - Mostly unaware and unresponsive except to sensations in the body - Behavior is habitual and reflexive - Attention is for seconds - Treatment - Sensory stimulation - Attempts to elicit gross motor responses - Level 2- Postural Reactions - May be able to change positions and imitate gross movements - Response to proprioceptive input - Can assist caretaker in doing simple ADLs, but needs 24 hour care - May understand very basic language (i.e. body parts) - Can complete one step at a time (may or may not spontaneously repeat what was demonstrated) - May use some familiar objects - Attention for about 5-10 minutes - Treatment: - Movement or exercise group - Level 3- Manual Actions - More interested in what is going on in the environment - Can engage in: - Simple one-step repetitive tasks but not necessarily goal driven - Responds to tactile cues - Needs demonstration -- one step at a time - Attends for up to 30 minutes but is easily distracted - Can do basic ADLs but needs cues and reminders for safety, phone, cooking, and money management - Can use familiar tools but must be supervised as there may be poor safety awareness - Level 4- Goal-Directed Actions - Motivated toward achieving end product - Makes activity purposeful - Basic ADLs are intact but has difficulty dealing with new information or changes in routine - Not able to follow verbal or written directions without demonstration - Can attend for up to an hour - Can complete multi-step activities but each step must be demonstrated separately before next step is demonstrated - Typically does exact copy of the example (i.e. rote learning) - Still some safety issues; not aware of hidden dangers - Can better use simple tools with some difficulty - Level 5- Exploratory Actions/Independent Learning - Able to ask for assistance and may self-initiate - Able to use trial and error and experimenting for desired outcome; concrete thinking - Capable of new learning and prefers novelty and variation and can make choices - Can perform tasks with 2-3 familiar steps or 1 new step - Learns best with demonstration but is better able to understand verbal directions - Poor planning or anticipation of possible future problems that may occur because of their own actions - Often focuses on social awareness and accepting supervision - Can use hand tools and will experiment to get different results - Level 6- Planned Actions - Level represents absence of disability - Can plan ahead and problem solve - Abstract thinking utilized - Behavior is organized to deal with future situations - Can follow written and verbal directions without demonstration - Can follow symbolic, intangible cues and do abstract thinking - Group Dynamics - Group Norms: 1. Definition: Standards of group behavior, participation, and interaction 2. Group norms have recently also been called group "culture" 3. Evidence tells us group culture must be established by the leader right from the first group session 4. Once established, norms (culture) are exceedingly difficult to change - Explicit vs. Implicit Norms: 5. Explicit: - Content - Ground rules - Structure - Leadership expectations 6. Implicit - Process - Not verbalized - Assumptions about topics, emotional expression, other behaviors - Group Roles: 7. Definition: Behavior patterns or structured ways of behaving within the group. 8. Group roles are the result of members dividing the work of the group among themselves. 9. Benne and Sheats: Studied roles in corporate work groups. They identified three types of roles in groups: - Task roles---Help group get its work done - Group maintenance roles---Foster group communication and morale - Individual roles---Interfere with group functioning - 12 Task Roles: 10. Initiator‑contributor---Suggests new ideas, innovative solutions to problems, unique procedures and new ways to organize 11. Information seeker---Asks for clarification of suggestions, focusing on facts 12. Opinion seeker---Seeks clarification of values and attitudes presented 13. Information giver---Offers facts or generalizations automatically 14. Opinion giver---States beliefs or opinions 15. Elaborator---Spells out suggestions and gives examples 16. Coordinator---Clarifies relationships among various ideas 17. Orienter---Defines position of group with respect to its goals 18. Evaluator‑critic---Subjects accomplishments of group to some standard of group functioning 19. Energizer---Prods the group into action or decision 20. Procedural technician---Expedites group\'s movement by doing things for the group such as distributing materials, arranging seating 21. Recorder---Writes down suggestions and group decisions, acts as the group memory - Group Building and Maintenance Roles 22. Encourager---Praises, agrees with and accepts the contributions of others 23. Harmonizer---Mediates the differences between other members 24. Compromiser---Modifies his or her own position in the interest of group harmony 25. Gate‑keeper and expediter---Keeps communication channels open by regulating its flow, and facilitating participation of others 26. Standard setter---Expresses ideal standards for the group to aspire to 27. Group observer and commentator---Comments on and interprets the process of the group 28. Follower---Passively accepts ideas of others and goes along with the movement of the group - Individual Roles 29. Aggressor---Deflates the status of others, expresses disapproval of the values, acts, or feelings of others, attacks the group or group task, etc. 30. Blocker---Tends to be negativistic or stubbornly resistant, opposing beyond reason or maintaining issues the group has rejected. 31. Recognition‑seeker---Calls attention to self through boasting, acting in unusual ways or struggling to remain in the limelight 32. Self‑confessor---Uses group as an audience for expressing non‑group-oriented feelings, insights or ideologies 33. Playboy---Displays lack of involvement through joking, cynicism, or nonchalance. 34. Dominator---Monopolizes group through manipulation, flattery, giving directions authoritatively, or interrupting the contributions of others 35. Help‑seeker---Looks for sympathy from the group through unreasonable insecurity, personal confusion, or self‑depreciation. 36. Special interest pleader---Cloaks his or her own biases in the stereotypes of social causes, such as the laborer, the housewife, the homeless, or the small businessman. - Leadership Styles - Directive - Therapist determines structure, activity, and processing - Therapist takes an active role in shaping member participation - Communication groups are an example - Group goals are achieved through active leadership - Facilitative - Prioritizes empowering employees, fostering open communication, and collaboration - Encourages active participation, shared responsibility, and dialogue amongst team members - Advisory - Serves as mentors or coaches, and strategic guides to help leadership teams make informed decisions and navigate challenges - Role of Occupational Therapy Leader - Select members - Design group based on client needs - Set goals, write group protocol - Determine best leadership style based on client needs and preferences and purpose of the group - Oversee group roles, maintain therapeutic norms, support positive efforts of members - Process group according to member needs - Evaluate progress and determine group outcomes - PEO - Characteristics - Client-centered - Systems perspective - Top-down approach - Evidenced-based - Targeted outcomes - What environments are considered? - Environment includes: - Physical environment - Cultural environment - Social environment - Institutional/Organizational environments - Environment is the context within which behavior takes place - Activity vs. task vs. occupation - Activity- the basic units of a task - example: using a computer keyboard and word processing software - Task- sets of purposeful, related activities - example: typing up an assignment - Occupation- groups of self-directed, tasks and activities in which a person engages in over a lifetime (occupations change over lifespan) - Occupational Performance - Occupational Performance -- the ability to carry out activities, self-care, work, leisure - Dynamic, ever-changing experience of a person engaged in purposeful activities, tasks and occupations within an environment - PEO Four-Step Process - Process for OT Evaluation and Intervention - Narrative - Assessment/Evaluation - Intervention - Outcomes - OT Treatment Utilizing the PEO Model - Treatment attempts to - The better the fit between the - Tx can focus on eliciting change in the person, the environment, the occupation or - Tx using this model is client-centered - Goals identified by the client, not the therapist - Evals such as the Canadian Occupational Performance Measure - MOHO - Volition - The process by which an individual is motivated towards, and chooses what they do - Has 3 components: - Personal causation - Values - Interests - Volition- Personal Causation - Belief in one's own competency and ability to achieve a desired outcome - Belief in skills - Belief in efficacy - Expectancy of success or failure - Internal and external locus of control - Volition- Values - Beliefs of what is good, right, and/or important - Values are often perceived as obligatory - Individuals want to participate in activities they value - Values are typically learned from one's environment but are also balanced with innate biologic needs - Volition- Interests - Occupations and activities that one is inclined to find pleasurable - We tend to be interested in things where we anticipate a positive experience - Interests have a big impact on occupational behavior - Interests relate to and affect our performance of work, leisure, and even self-care tasks - Habituation - The process by which we organize everyday organizational behavior (actions) into patterns and routines - Involves limited conscious choice - Made up of 2 components: - Roles - Internalized beliefs about what it means to be a worker, parent, student, retiree, wife, etc. - Incorporation of societal belief - Habits - The routine and typical ways in which a person performs a task or series of tasks - Provides a sense of stability and well-being that comes from predictability - Function vs. Dysfunction - Function is defined as: - Participation, performance, and skill and sustained patterns of engagement in everyday occupations - Successful functioning involves 3 outcomes: - Occupational identity - Competence - Adaptation - Dysfunction is defined as: - A threat to occupational adaptation - Has both intrinsic and extrinsic contributors - How does it view diagnoses? - Focus of treatment is to restore order to the open system - Focused on looking at the 3 subsystems and trying to assess where there is dysfunction - Also focuses on the environment - Roles and addressing the component skills that an individual needs to return to their roles - Motivation - Developmental Approaches - Overview of thoughts on developmental theories - Life stages are a part of AOTA Framework II's temporal context, thereby playing a part in every occupational therapy intervention. - The normal developmental tasks of each stage of development over the lifespan can guide the focus of group intervention. - As an occupational therapy approach, physical, psychological, social, moral, and spiritual aspects of the self are considered together. - Mosey-refer to Appendix C and ppt - Donohue's Social Profile groups - Parallel Level Group - Three-year-olds playing separately next to each other in a sand box - Adults standing in rows next to each other doing movement to music in a movement group - Associative Level Group (Project) - Four-year-olds playing telephone for two minutes - Five-year-olds building blocks together to make a fort (five-minute interaction) - Adults engaged in a "pass the ball" game identifying names of members (15-minute interactive exercise) - Basic Cooperative Level Group (Egocentric Cooperative) - Seven-year-olds role playing in costumes with mutually designed guidelines for role interaction - Adults in an ADL group washing, cutting, mixing, serving, and eating fruit in a salad - Supportive Cooperative Level Group - Sixteen-year-olds discussing feelings about musical lyrics while making decorations for a parade float - Seniors discussing feelings about peers' illnesses, memories of the past, and process of dying - Mature Level Group - Twenty-year-old college students take turns coaching each other in a computer science course - Forty-year-old parents of children with learning disabilities coach each other on methods of intervention for their children in a parents' support group - Function vs Dysfunction - Function - Each theorist defines normal functioning at each stage somewhat differently. - Function is based on achieving the appropriate or expected developmental tasks for the current age/stage of the individual. - Developmental research is traditionally embedded in the norms within specific cultural groups. - Research based on statistical averages may not appropriately apply to individual clients. - Dysfunction - Dysfunction may occur when clients' growth and development falls below that expected for their age. - Dysfunction can be observed from multiple developmental perspectives, but most importantly, from the client's own viewpoint. - Illness or trauma may cause regression to an earlier developmental stage. - Know the FOCUS of each theorist; expect more familiarity with Erikson - Freud: Psychosexual stages - Jung: Spiritual development - Erikson: Psychosocial development - Piaget: Intellectual development - Kohlberg and Wilcox: Moral reasoning - Levinson: Life transitions - Atchley: Continuity theory - Laslett: Third Age theory - Carstensen: Socioemotional selectivity - Baltes and Baltes: Selection, Optimization, and Compensation - Levinson's Transitions - Young Adult Transition (17 to 22 Years old) - Separation from home of origin - Establishing separate identity - Establishing independence - Physical - Financial - Emotional - Tasks---A young adult must: - Form a dream - Find a mate and start a family - Choose and prepare for a career - Enter into a mentor relationship - Midlife Transition - A person at midlife must reappraise the past and resolve four polarities: - Young/old - Destruction/creation - Masculine/feminine - Attachment/separateness - According to Levinson, each polarity or conflict is resolved by exploring the opposite side from that which predominated prior to midlife transition (40 to 45 years old) - Late Life Transition - A person approaching late life must come to terms with certain realities: - Physical decline - Loss of the productive role - Coming to terms with death - This part of Levinson's theory is speculative, inaccurate, and better defined with later theories of aging. - Sensorimotor / Sensory Integration - History of SI theory - Ayres - The processing of sensory information occurs in a four-level developmental sequence: - Primary level---Vestibular, proprioceptive, tactile (auditory and visual are present but not integrated until later) - Eye movements - Posture and balance - Muscle tone - Gravitational security - Sucking and eating - Mother-infant bond, tactile comfort - Second Level---Above three basic senses are integrated into: - Body precept - Bilateral coordination - Attention span - Activity level (pace) - Emotional stability (postural security, safety) - Third Level---Auditory and visual senses begin to join the basic three to produce: - Speech and language - Eye-hand coordination - Visual perception - Purposeful activity - Fourth Level (highest level)---Produces the following end products: - Ability to concentrate - Ability to organize - Self esteem - Self-control - Self-confidence - Academic learning ability - Capacity for abstract thinking - Specialization of each side of body and brain - Lorna Jean King - Adapted the theory of Ayres for adults with chronic mental illness - Faulty proprioceptive processing produces abnormal muscle tone and posture - Adults with this syndrome do not possess spontaneous voluntary movement - Symptoms of mental illness relating to sensory processing deficits are: - Perceptual deficits (poor reality testing) - Feelings of fatigue, slow movements (psychomotor retardation) - Postural insecurity (fear of falling) - Concrete thinking - Lack of emotional response (flat affect) - Mildred Ross - Originally adapted the principles of Ayers for use with older adults with cognitive deficits - Developed the Five-Stage Group technique, using carefully selected sensory input to increase cognitive functioning and adaptive social behaviors - Ross 5 Stage Group 37. Acknowledge presence of each member 38. Provide maximum exertion of movement 39. Perceptual motor skills 40. Cognitive stimulation 41. Resolution and termination - Function, Dysfunction, Change - Dysfunction - Deficits in processing and integrating sensory inputs - Deficits in planning and producing behaviors necessary for conceptual (academic) and motor learning - Attention deficits, hyperactivity (learning disability, ADD/ADHD) - Defensive syndromes (hypersensitivity) - Difficulty with volitional action directed to the environment, a motor planning problem manifest in clumsiness (dyspraxia) - Change - Therapy always aims at remediation of the sensory integrative problem. - The goal of therapy is to improve the ability to integrate sensory information by changing the organization of the brain. - Enhanced sensory input, which occurs when a client plans and organizes adaptive behavior in a meaningful activity, improves the ability of the CNS to process and integrate sensory inputs. - Treatment; Interventions - Intervention - Sensory integrative experiences are chosen based on identification of the client\'s deficits and the model\'s explanation of the reasons for those deficits (i.e., the difficulty in processing sensory information) - Treatment - Play\* is the vehicle for therapy; environmental demands are matched to the person\'s capacity and challenge him or her to engage in new sensory-motor action - Play activities are adapted for client age level - Group treatment is most common method with adult populations - Sensory strategies are incorporated into everyday activities - Biomechanical - Goals - Prevent injury - Restore function - Compensate for lost function - Behavior - Conditioning - Habit formation - Shaping and chaining - Rehearsal and practice - ROM - Maximum motion of every joint in every possible direction - Activities used to increase and/or maintain ROM - Exercise groups beneficial for at risk populations - Consider "just right" amount of movement - Strength - Addressed when there is specific muscle weakness or risk for deformity - Ways to increase strength: - Increasing load/weight - Duration of muscle contraction - Rate and frequency of contraction - Functional Examples: - Sanding wood - Weaving on a loom - Gardening/landscaping - Cleaning/moving furniture - Stocking shelves - Endurance - Duration muscles can work before becoming fatigued - Inversely related - Can increase by: - Using moderately fatiguing activities for progressively longer periods of time - Active games and sports - Prevention, Restoration and Compensation - Prevention - Prevention/health maintenance are of particular focus in the workplace - OT practitioners as consultants - Educational Programs - Restoration - Restoration: developing client competence in performing occupational roles - Compensation - Compensation: Permanent or temporary disability present - CIMT - Specific, evidence-based biomechanical approach - Reverse effects of learned nonuse of the UE following acquired brain injury (ABI) - Involves constraint of the strong UE for several hours per day - Motor Learning - What is Motor Learning? - Framework for understanding how an individual acquires movements and modifies as needed to perform a task - Hierarchical model - OT most interested in effecting long-term memory/learning - Stages of Motor Learning - Cognitive Stage - Client attempts to understand task - Therapist discusses strategies for performing tasks and evaluating performance - Associative Stage - Practice - Autonomous Stage - Skill Is habitual - Guidelines for grading and adapting - Change the position of the person, the seating, the support, or the alignment - Change object placement, position relative to the body, or distance - Change the object characteristics, weight, size, one- versus two-handed lifting - Change temporal demands, such as using stationary versus moving objects - Telehealth- - Pros - Convenience and accessibility - Lower costs - Ability to see your doctor without leaving your home - Cons - Not suitable for all situations (emergencies, annual exams, serious injuries) - Some visits still require in-person office visits (imaging tests, blood work, hands-on diagnoses)