Monday, April 18, 2011

OT A to Z Challenge: O and P are for Occupational Performance

It seemed fitting to do double duty and combine "O" and "P" as occupational performance reflects that which is truly OT!

Occupational performance is the completion of an occupation or an activity that requires the interaction of the person, the context, and the activity. Many things - including things we have addressed in our OT A to Z Challenge - may support or hinder a person's occupational performance. For instance, a person's habits may improve occupational performance by enabling him or her to more proficient at an activity. Conversely, features in a specific context may hinder a person's occupational performance.

What are examples of occupational performance? Much of what a person needs or wants to do throughout the day constitutes occupational performance - a person getting up and getting ready fro the day, a young child engaged in play behaviors that are necessary to acquire developmental skills, a person participating in a leisure activity or hobby, a student participating in a classroom setting, a person socially interacting with his or her peers to maintain social relationships, a father preparing a meal fro his family, a person balancing his or her bank account in order to manage their finances, a person taking care of a pet...and the list would be nearly endless.

How does an OT address occupational performance? As part of an evaluation, an OT will assess the client’s occupational performance needs and goals, strengths, and problems areas. Occupational performance is often observed in context to identify what supports performance and what hinders performance. Then, the OT will address with the client specific performance skills (sensory, motor, cognitive, etc.), performance patterns (habits, roles, routines), context, and activity demands.

There is probably no other profession that views activities in the way OTs do - as an interdependence between the person, the activity, and the context!

Friday, April 15, 2011

OT A to Z: N is for Neuroplasticity

Neuroplasticity - while not a concept unique to OT - holds tremendous application for neurorehabilitation provided by OTs. Neuroplasticity refers to the brain's ability to adapt and change over the course of one's life - not just in the period of development. This is particularly important when considering rehabilitation following a neurological event such as a stroke.

When I was in OT school in the early 1990s, the accepted thought was that a person with a stroke would see maximum recovery within 6 months following the stroke. Consequently, if a person was seeking therapy several years post-stroke, it was thought that the person had limited rehabilitation potential and it was often difficult to receive approval to provide services. With the improved understanding of neuroplasticity that has occurred in more recent years, it is now accepted that the brain has the ability to modify itself even years after a stroke. More specifically, following a neurological event such as a stroke, it has been demonstrated that the brain has the ability to "rewire" itself.

This understanding has provided the explanation as to why interventions such as constraint induced movement therapy provides such notable results. In this approach, "forcing" the use of the affected upper extremity appears to unmask neural pathways that reorganized or sprouted following the stroke. However, the person learned not to use the affected upper extremity based on their unsuccessful attempts initially following the stroke.

OT A to Z: M is for Model

Thanks to the suggestions of of @pinkypanda, the OT "M" is for model. Models provide a conceptual tool to assist in translating our theories into practice. Models are not prescriptive with regard to intervention activities, but rather provide a set of guidelines or principles which OTs can apply in developing their approach to working with clients. Fortunately, research surrounding several OT models has been robust which has facilitated the development of associated standardized assessment measures.

Two widely known models in OT practice are The Model of Human Occupation (MOHO) and the Canadian Measure of Occupational Performance and Engagement (CMOP-E). Although each is unique in it s approach, both models seek to explain the process through which humans engage in occupations. MOHO has several assessment tools associated with it and the CMOP-E provides the foundations for the Canadian Occupational Performance Measure (COPM).
Due to the overarching principles addressed through models, they can applied to a variety of client populations and OT settings.

A newer conceptual model in OT is the Kawa Model. This interesting conceptual model uses a river as a metaphor for life and enables a person to consider the rocks or challenges they have encountered.

If you are an OT student, how has learning and understanding supported your understanding of OT?

If you are a practitioner, has your view or understanding of a specific model changed over time?

Wednesday, April 13, 2011

OT A to Z: L is for Leisure

"L" is the OT alphabet represents leisure. Leisure is defined as a" non-obligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep” (Parham & Fazio, 1997, p. 250). Akin to interests, leisure activities are those pursuits that we engage in because we enjoy the activity. Leisure activities are those things we look forward to doing and fulfill us in a way that other things that we are required to do often do not. Since it is not something we are obligated to do, very few of us would spend the time and energy engaging in a leisure activity that we did not like.

From a perspective of occupational balance, we would agree that everyone needs to have the opportunity to engage in leisure activities for optimal health and well-being. However, most of us can readily identify barriers to pursuing leisure activities. Do OTs have a role in addressing leisure participation at the community level? If so, what could that look like?

We all probably have leisure activities that we would be interested in pursing if it weren't for time and money (sailing in the Caribbean would be high on my dream list of leisure activities!). Whereas we may not get the opportunity to pursue all leisure activities that appeal to us, is the opportunity to participate in some form of leisure activities a fundamental right? If this is the case, when populations have limited opportunities - perhaps due to socioeconomic conditions or limited accessibility - is this an issue of occupational justice? If so, what is the OT's role in addressing leisure participation for disenfranchised groups?

Tuesday, April 12, 2011

OT A to Z: K is for Kielhofner

What else could "K" be today but Kielhofner?

Any OT - and OT student - knows of Gary Kielhofner. Dr. Kielhofner was a passionate OT, a groundbreaking theorist, an educator and researcher, and a mentor to countless OTs in the US and abroad. He developed the Model of Human Occupation, more commonly know as MOHO, which is used internationally by OTs. The OT community was truly saddened by his passing in September 2010 at only 61 years of age. One must wonder what else he would have accomplished in years to come.

I never had the honor of meeting Dr. Kielhofner in person. I did attend several of his presentations at AOTA conferences over the years and was struck by how approachable and affable he was, despite all of his accomplishments. I am also on the MOHO listserv and similarly was always impressed at the lengthy and thoughtful responses he provided on the listserv, regardless of whether the person was a notable international colleague or an OT student grasping the concepts of MOHO for the first time. In addition to his intellect and creativity, graciousness was clearly a strong part of his character.

If you missed some of the many tributes for Dr, Kilefhofner, I have provided some links:

OT A to Z: J is for (Occupational) Justice

Occupational justice is a concept that has arisen in the field of occupational therapy in recent years. Occupational justice refers to the humanistic principle that all members of a society have a right to equally participate in in their occupations. Conversely, occupational injustice occurs “…when participation in occupations is barred, confined, restricted, segregated, prohibited, underdeveloped, disrupted, alienated, marginalized, exploited, excluded, or otherwise restricted,” (Kronenberg & Pollard, 2005, p. 66). Typically, the people most at risk for occupational injustice are those who lack resources, are refugees, imprisoned, or ill.

Since the role of occupational therapists is to engage people so that they
may participate in occupations, considering issues of occupational justice seems a natural extension of our role. Activities related to occupational justice may occur at the societal level and include such activities as assisting those experiencing injustice to advocate for their rights or address policy issues. Forerunners in the area of occupational justice have often addressed in the context of international needs. For instance, the Occupational Therapy International Outreach Network (OTION), established in 1999 by a group of Australian OTs, is an organization focused on addressing the occupational needs of those in under-served countries.

While it is is easy to imagine the occupational deprivation that may occur in developing countries, where there are often limited resources including employment, healthcare, and education, as well as the often ongoing potential for political instability, how often do we think of occupational injustices that exist in our communities? What could - or should - our role as OTs be in own communities to bring awareness to situations that consciously or unconsciously limit the participation in occupations to ALL of those in our communities?

Note: Photo retrieved from the National Council of Independent Living


Kronenberg, F. & Pollard, N. (2005). Overcoming occupational apartheid: A preliminary
exploration of the political nature of occupational therapy. In F. Kronenberg (Ed.), Occupational Therapy without Borders: Learning from the Spirits of Survivors (pp. 58-86). London: Elsevier Churchill Livingstone.

Monday, April 11, 2011

OT A to Z: I is for Interests

Our OT "I" word is interests! As children, interests tend to convey things they are attracted to doing. One only has to spend time with an enthusiastic kid, and hear him or her talk about how they "want to" play a certain sport, or dance, or fly an airplane, or take care of animals. As adults, our interests may reflect our skills, or they may be ways we continue to develop new skills. Interests are often the things we are excited about doing, the things we look most forward to doing in our days, the things that are meaningful to us. Most of us have no shortage of interests, but the ability to pursue our interests - especially as adults - tend to be limited by our resources such as time.

As OTs, interests are something that are considered in the assessment process, as part of the occupational profile. Understanding the interests of a client can help help determine goals of a client, things that may motivate the client, or activities to use in order to achieve a therapeutic goal.

In thinking about interests...
  • Have your interests remained stable over the course of your life, or have they changed?
  • What barriers exist in the pursuit of your interests?
  • If time (or money) weren't a consideration, is there something that interests you that you would like to pursue?