CHAPTER - 1

 Introduction to Occupation therapy.  Conceptual foundation for practice.  Process of Occupation therapy

OBJECTIVES  Describe occupational functional model.  Use the language of Occupational Functional Model,the American Occupational Therapy Association’sOccupational Therapy practice and world health organization’s International Classification of Functioning interchangeably.  Organize assessment and treatment planning according to the occupational functioning model.

BASIC TERMINOLOGY Activity : The occupational therapy practice framework (AOTA) defines activity as a class of human actions that are goal directed. Activity analysis : A process used to identify the properties inherent in a given occupation or activity as well as abilities to complete it.

Adaptive therapy : Therapy that promotes a balance among a person’s goals, capabilities and environmental demands by use of assistive technology. Impairment : Any significant deviation or loss of body structures or physiological or psychological function.

 Occupation : Everyday life activity.  Occupational dysfunction : Inability to maintain one’s self, to advance oneself through work, learning and financial management.  Occupational functioning model : A conceptual model that guides occupational therapy evaluation & treatment of persons with physical dysfunction

Propositions of the model  To engage satisfactorily in a life role.  Tasks are composed of activities, which are units of behaviour.  To be able to do a given activity.  Abilities are developed from capabilities that person gains from learning.  Developed capacities depend on first level capacities that derive from person’s genetic endowment.

Occupational functioning model  OFM guides evaluation and treatment of persons with physical dysfunction leading to competence in occupational performance.  It is derived from clinical practice.The primary belief is that people who are competent in their life roles experience a sense of self-efficacy,self esteem and life satisfaction.  Competence in occupational performance contributes to development of a person’s identity.

THE OCCUPATIONAL FUNCTIONING MODEL  The goal of treatment, following the OFM,is to enable satisfactory engagement in valued roles whether by restored self performane or by directing others.  Another assumption of the OFM is that the ability to carry out one’s roles and activities of life depends on basic abilities and capacities e.g. strength, perception.

THE OCCUPATIONAL FUNCTIONING MODEL  Many capacities contribute to the development of one ability and many abilities are needed to engage successfully in an activity.  When one capacity or ability is impaired, occupational dysfunction does not automatically occur.  A person may adaptively use other capacities and abilities to allow accomplishment of the activity.

THE OCCUPATIONAL FUNCTIONING MODEL  Research is modify to clarify the multivariate relationships among lower level abilities and capacities and higher level activities, tasks and roles.  Researchers must verify whether remediation of impaired capacities and abilities results in more complete and versatile participation in the activities and tasks of importance to people’s lives than would learning specific routines of activities in an adapted way.

THE OCCUPATIONAL FUNCTIONING MODEL  Another assumption of OFM is that satisfactory occupational functioning occurs only within enabling environments and contexts particular to the individual.  True occupational functioning does not occur in vaccum or in a controlled situation such as clinic, it is successful with interaction of person with objects, situations & surroundings of their family or community.

Sense of self efficacy and self esteem  Goal of occupational therapy is the development of competence in activities and tasks of one’s role which promotes a sense of self efficacy and self esteem.  Competence refers to effective interaction with physical and social environments.

Sense of self efficacy and self esteem  To be competent means to have the skills that are sufficient or adequate to meet demands of a situation or task. It does not equate to excellence or ability to do everything.  Competence reflects people’s belief in their own control rather than being controlled by social or physical environment.

Sense of self efficacy and self esteem  OT help people achieve competence through graded engagement in occupation, vicarious engagement in occupation, developmental and instrumental learning with immediate feedback.  Self esteem is that aspect of self concept that attributes a negative or positive value to the self.

Sense of self efficacy and self esteem  Self esteem is created by individual’s analyses of their competency in socially relevant areas.  People’s level of self esteem depend on their confidence based on their experience, that they can make desired things happen and others will appreciatively recognize this competence.

Self maintenance roles  Self maintenance roles are associated with maintenance of the self and care of the family and home. This equates to the OTPF areas of occupation of ADL and IADL.

Paradigm of OFM  Organic substrate  first level capacities  developed capacities  abilities and skills  activities and habbits  competence in tasks of life roles  satisfaction with life roles  Self maintanence  Self advancement  Self enhancement Sense of efficacy and self esteem

Self advancement : roles are those that draw the person into productive activities that add to the person’s skills, possessions or other betterment. Ability : is a general trait such as muscle strength or memory that individuals bring with them to a new task.

Self advancement roles  This domain corresponds to the OTPF areas of occupation of work and education but extends to include the instrumental roles that enable work.  Self advancement roles correspond to the participation category of the ICF.

Self –Enhancement roles  Self enhancement roles contribute to the person’s sense of accomplishment and enjoyment. This corresponds to the OTPF areas of occupation of play,leisure and social participation and fits within the the ICF category of participation.

ACTIVITIES AND HABITS

Activities  Activities are smaller units of goal-directed behavior that comprise tasks. Activities bring together abilities and skills within a functional context. For example, one task of the gardener is pest control. Activities that make up this task include hanging lures, spreading granular insect killer, mixing and spraying liquids and picking insects off plants.

Activities  Each of these activities consists of even smaller units of behavior, such as opening the package and pouring the granular insect killer into a garden spreader.

Habits  Habits are chains of action sequences that are so well learned that person does not have to pay attention to do them under ordinary circumstances and in familiar contexts.  Physical dysfunction disrupts habits, requiring attention to be paid to the simplest of activities of daily living.

Process of occupational therapy The process of occupational therapy follows the universal plan for problem solving, identifying the problem, intervene and evaluate the result. The occupational therapist focuses on problems related to the person’s occupation life. The therapist can then use various occupational, adaptive and adjunctive therapies to intervene.

THE PROCESS OF OCCUPATIONAL THERAPY

1. Goal of therapy OFM  Satisfactorily engage in self identified, important life roles through which person gains a sense of self efficacy and self esteem. OTPA (AOTA)  Engagement in occupation to support participation.

2. Evaluation to identify the problems OFM  Identify roles, tasks and activities the person wants to do.  Observe & analyze the person’s performance.  Identify impaired abilities or capacities that causes impairment.  Identify environmental or contextual hindrances. OTPA (AOTA)  Do an profile to understand the client’s occupational history, patterns of living, needs & performance.  Do an analysis of occ. Performance by identify client’s problems.  Identify targeted outcomes.

3. Plan intervention OFM  Plan in collaboration with the person or family.  Establish short term goals that directly relate to the long term goal.  Select interventions that have evidence for effectiveness for the immediate goal. OTPF(AOTA 2002)  Develop plan with the client to guide action.  Base therapy on theories, frames of reference and evidence.

4.Implement the intervention OFM  Utilize therapeutic mechanisms.  Utilize adjunctive therapies to facilitate performance.  Modify contexts and environments to facilitate programs OTPF(AOTA 2002)  Act to influence and support improved client performance of targeted outcomes.  Monitor and document client’s response.  Review the progress toward targeted outcomes & intervention plan.

5. Evaluate the result OFM  Determine whether the targeted outcomes were achieved.  Determine whether the person was satisfied with his or her achievement.  Plan for future therapy or referral. OTPF (AOTA 2002)  Determine success in achieving targeted outcomes.  Plan future action with client.  Evaluate the program.