Monday, April 18, 2011
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
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
"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
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:
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
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.
- 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?
Friday, April 8, 2011
OTs consider habits as specific, automatic behaviors that may support - or hinder - occupational performance. The key to habits is that they are automatic so that we don't even really think about these behaviors when we do them. Examples may include the way we brush out teeth, the order in which we get dressed, how we groom our hair, or the way we place our keys in the same place upon arriving home (well - I have hear some people do that!).
What purpose do habits serve? In OT terms, effective habits enable us increase the efficiency of our occupational performance because the behaviors are automatic. For instance, how long would our morning self-care routine be if we actually had to stop and think about performing each step of brushing our teeth, getting dressed, or grooming our hair? It would take us HOURS to get ready - everyday!! But because our habits enable us to do large portions of our daily tasks efficiently, our occupational performance is improved.
But what happens when an injury or illness occurs and we are no longer able to utilize our existing habits? As OTs we work with clients to find new ways to do things, or adapt an activity, but do we use the term "habits" when working together?
Wallenbert, I., & Jonsson, H. (2005). Waiting to get better: A dilemma regarding habits in daily occupations after stroke. American Journal of Occupational Therapy, 59, 218–224.
Thursday, April 7, 2011
G proved a little tougher to select a word! Thanks to @kirstyes and @clissa89 for their suggestions of goals, goal attainment scaling, and groups. But I opted to use @clissa89's suggestions of "grading" as the word to represent the OT "G," as grading is a concept that is truly inherent in OT practice regardless of the client population or setting.
What is grading? Grading is the modification of an activity to support the client's performance. Grading of activities occurs in the therapeutic process when a client is working toward a specific goal. Therefore, activities may be modified - or graded - for the purpose of making them easier or more difficult, depending on the goal. Activities can be graded in a variety of ways. A few examples include increasing or decreasing the complexity or difficulty of a task by changing the amount of steps required to complete it, the amount of time given to complete a task may be altered, or the amount of cues or assistance given to the person may be changed. Grading of activities is done for therapeutic purposes and can only be done with consideration of the client's abilities.
However, the precursor to grading of an activity is a process termed activity analysis. Activity analysis is when an OT analyzes all of the complexity inherent in an activity in order to know how and in what ways to grade it. This would include things such as space requirements, the objects that must be used to complete the activity, the social or cultural requirements of the activity, the required actions to complete the activity, and the body structures and functions needed for the activity.
To illustrate this, let's think about the seemingly simple activity of making a peanut butter sandwich. As part of activity analysis we would consider demands or the requirements of the activity. This will include things like:
- Formulate a plan to make the sandwich
- Sequence the activity
- The properties of the objects needed to make the sandwich such as the supplies (bread which is pliable, peanut butter which offers resistance, the knife which requires grasp)
- Physically gather the supplies
- Manipulate the objects - open the jar lid, open the bag of bread, hold the knife
- Position the objects for performance of the task
- Complete each step of the process including: get the bread out of the bag, open the jar, use the knife to get an appropriate amount of peanut butter out of the jar, put the peanut butter on the bread, spread the peanut butter on the bread without tearing the bread, put the bread together with appropriate pressure, place the sandwich on a plate, close the peanut butter jar, close the bread, wash the knife, clean the work area
So how would an OT grade this activity? Depending on the goals being addressed, the OT may choose to have the supplies out already or may have the person retrieve everything from the cabinet. The OT may provide minimal or maximum cues for the planning and sequencing of the task. The OT may choose to add more items to the sandwich, or make a deli sandwich with vegetables and spread that will require numerous additional steps to complete.
In other examples of grading, if a person is having difficulty completing their morning self-care routine due to debilitation, the OT may select portions of the activity for the person to complete so they are able to do as much as possible. For instance, rather than having a person retrieve their dressing and grooming items in the room, the OT may "set-up" the activity so his or her available energy may be utilized in performing the dressing and grooming activity. As the person's endurance and safety improve, the OT may choose to grade the activity to make it more challenging, by having the person retrieve the needed items prior to dressing.
Another example of grading may be when a person is working on cognitive skills such as problem solving by developing a budget for a trip to the grocery store. To grade the activity, the number of items may be increased or decreased, the quantities of items may be changed to increase or decrease the complexity of calculations, coupons may be applied, etc.
The possibilities of grading an activity are multi-faceted, but it must be done with regard to the client's goals. OTs, because of their education and experience, have the expertise to assess the ability of the client as well as the requirements of the activity in order to achieve a therapeutic outcome.
Wednesday, April 6, 2011
Today...F is for Function!! Function is a word that is near and dear to the heart of OTs. My intuition would say that OTs probably use the word function even more often than they use the word occupation. But, as I learned in preparing this post, function seems to be one of those concepts that we know what it means but is a bit hard to actually articulate.
I fumbled with a few definitions on my own, then consulted some standard documents and texts. Interestingly, the word function readily appears - function, functional activity, functional performance - but an actual definition was elusive. After retrieving dictionary entries of function, this one seemed the most applicable:
The purpose for which something is designed or exists.
I think this really gets to the heart of how we think as OTs...we - as humans - are designed to do. Our ability to do - or to function in our environment - supports our health and is also affected by our health. So when we address function, we are focusing on ways to support a person's ability to do what they need or want to in the context of their daily lives.
So, how do you define function?
Tuesday, April 5, 2011
- What is your reaction to the parent's post?
- What are barriers you experience in identifying and utilizing evidence in your practice?
- How do you work to incorporate best evidence into your practice - despite the challenges in doing so?
Grol, R. & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patents’ care. Lancet, 362(9391), 1225–1230.
Gutman, S. (2010). AJOT publication priorities. American Journal of Occupational Therapy, 64(5), 679–681.
Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence based medicine: How to practice and teach EBM (2nd ed.). London: Churchill Livingstone.
- Activities of daily living - basic activities such as self-care, instrumental activities such as home management and driving, but also work, play leisure, education, and social participation
- Client factors - values and beliefs of our clients, but also body structures and function
- Performance skills - motor and praxis skills, cognitive skills, sensory processing skills, communication and social skills
- Performance patterns - roles, habits, routines, and rituals
- Context (our post from yesterday!) and environment - physical, social, cultural, personal, temporal, and virtual
- Activity demands - objects used, activity requirements, sequencing, timing, body structures and functions required to complete the activity
Monday, April 4, 2011
The letter "C" seemed to offer many opportunities to explore, such as the array of topics suggested by @clissa89: cognition, creativity, client-centered, children, culture, and context! Whereas other professions also address many of these areas, I think context is something uniquely considered by OTs. So, today, C is for Context!!
The concepts for environment and context are often considered together and these terms may even be used interchangeably. Context is defined in the Occupational Therapy Practice Framework (AOTA, 2008) as interrelated conditions that surround the client and are within the client. These include cultural, temporal, personal, and virtual. Context is distinguished from environment in that environment refers to the external situations that surround the client to include the physical and social environments. In general, OTs emphasize occupational performance at the intersection of the client, the context and environment, and the activity.
The cultural context is includes the customs, beliefs, activity patterns, and behavioral expectations accepted by the society of which the person is a member. The temporal context is the experience of time as shaped by occupational participation and includes aspects such as time of day, duration of activity, rhythm, tempo, and stage of life. The personal context considers aspects of the individual that are not part of the health condition and includes things such as age, gender, as well as socioeconomic and educational status. Finally, the virtual context is when communication occurs in the absence of physical contact and may be real-time or asynchronous.
The aspect of context that I have spent the most time thinking about recently is that of cultural context. I am fortunate to co-teach a service learning course in Belize for OT students and we spend a lot of time considering the cultural context of the adult and pediatric clients we serve while we there. Immersion in another culture is such a profound way to experience cultural aspects of occupational performance - everything from the value of various occupations to the manner of engaging in occupations. It is a powerful learning experience as we strive to better understand the cultural context and, perhaps most importantly, not relay on or emphasize aspects of our cultural context.
In thinking about context, do you
- tend to specifically address aspects of context in your assessment and intervention, or are they aspects you consider as part for of the whole picture when working with your clients and families?
- emphasize one of the aspects of context more frequently that others?
Saturday, April 2, 2011
- Do OTs have a role in addressing the occupational balance in a public forum? If so, how might this be accomplished?
- What about in working with clients - do you address the occupational balance of their caregivers?
- How do you strive to achieve occupational balance in your own life?
survivors: an interpretative phenomenological analysis. Disability and Rehabilitation, 26 (16), 1000- 1011.
Friday, April 1, 2011
- So how do we as OTs understand and facilitate adaptation?
- Since OT is surely not the only profession to consider adaptation, how do our views of adaptation differ from those in psychology or other health professions?
- Is adaptation a process or an outcome - or both?
- How does adaptation differ among clients and in different cultures?