Peds ch 1

develops a person's ability to engage in the "occupations" of work, play, and self-care activities

developing and implementing a plan of purposeful activity, or occupation, to overcome obstacles and perform competently.

designed to assist in the development of underlying performance components (prerequisite skills) enable the child to function in the educational settings

an official document of the OTA

"The framework was developed to articulate occupational therapy's contribution to promoting the health and participation of people, organizations and populations through engagement in occupations

outlines the profession's purview and the areas in which its members have an established body of knowledge and expertise

related to the delivery of occupational therapy services

performance in areas of occupation

• ADL
• IADL
• education
• rest and sleep
• work
• play/leisure
• social praticipation

• bathing/showering
• feeding/eating
• bowel/bladder management
• dressing
• grooming
• hygeine
• functional mobility
• toliet hygeine

• more complex
• involes others

• care of others
• care of pets
• communication device use
• communicating mobility-bus, subway
• health maangement/maintenance
• safety procedures/emergency responses
• shopping

formal education participation

seeking out and participating

informal personal education participation-needs or interests exploration ex. boy scouts, play sport

activities related to obtaining restorative rest and sleep that supports healthy active engagement in other areas of occupation

tasks performed by the ehild that involve "work"

• school
• home

chores-use chores for home therapy

initial focus on social skills, health and sensorimotor development

later, mastery of reading, writing, math and higher problem solving

skills and performance of intrinsically motiviating activities, spontateous enjoyment, or self-expression

early childhood

play involves exploration of objects and the environment, initiating others and repetitive activites

childhood

play becomes more social and involves games with groups of children

play skills evolve from swimple play iinteractions of touch and sounds in infancy to sophisticated construction and art activities in adolescence

• remediation
• improving the related impairments

adaptation-spina bifada-scooter

compensation-ex. raise garden table

which aspects of the performance can be remediated

employ strategies to improve performance

how can the activity be adapted

organized patterns of behavior that are characteristic and expected of an individual or a given position within a social system

• community
• family
• peers

the abilities clients demonstrate in the ations they perform

motor:

actions or behaviors a client uses to move and physically interact with tasks, objects, contexts, and invironments. includes planning, sequencing and executing new and novel movements

praxis(motor planning):

skilled purposeful movements. ability to carry through learned motor acitivity. motor planning

ex. riding a bike

driving your car comnpared to driving a rental

gross motor skills- large movement, walk, run, jump

fine motor-writing, play instrument, eye movement

oral motor skills-

sensory and perceptual processing

neuromuscular abilities ex. adjust shower for warmth, clothes and how they feel

• positioning of the body-
• where is our body in space
• how we know we are upright

the childs ability to attend to and learn from the environment

color blue-find something like this

actions or behaviors used to plan and manage the performance of an activity

thinking. problem solving, planing things

actions or behaviors used to identify, manage and express feelings while engaging in activities or interacting with others

childs ability to interact with others

to cope with new or difficult situations

to manage their behaviors in socially appropriate way

actions or bnehaviors a person uses to communicate and interadt with others

• eye contact
• non verbal communication
• personal space
• verbal interaction

values, beliefs and spirituality

body functions

body structures

• objects and their properties
• space demands-ex. kitchen, floor
• social demands-talk to others
• sequencew and timing
• required actions and performance skills
• required body structures

habits-automatic behaviors. ex. biting nails

routines-patterns of behavior ex. getting up in the morning, bed time. an order that keeps you organized

rituals-symbolic actions with meaning ex. light candles, jewish tradition

roles-set of expected behaviors ex. as a parent, PTA president

related to functioning of an indivudual, organization and population

how the child's performance is influenced by and influences the environment

interrelated conditions within and surrounding the client that influence performance

what factors are critical to the child's performance

• cultural
• physical
• social
• personal
• spiritual
• temperal
• virtual

• evaluation
• occupational profile
• analysis of occupational performance

• intervention
• intervention plan
• intervention implementation
• intervention review

• outcomes
• how well the child does

done by OT

pocuses on what the client wants and needs to do

formal and informal evaluation

• consists of:
• occupational profile
• analysis of occupational performance

includes information about the clientand the client's needs, problems and concernsabout performance in the areas of accupaation

summary of information that describes poccupational history and experiences, patterns of daily livingk, interests, values and needs

who is the client?

why is the client seeking servies and what are his'her concerns relative to performance in areas of occupation?

what areas ofoccupation are successful and what are causing problems?

what contesxts and environmentswsupport or inhibit participation?

what are the client's priorities and desired outcomes?

• gather essential and comprehensive information
• strengths and weaknesses

liimitations in underlying performance skills, performance in areas of occupation, performance patterns, context, activity demands and client factors

relate to the child's occupational performance

what the child is able to do

the range of human occupations and activities that make up peopleslivesw

quantity and quality of skills and performance

structured and non-structured iobservation, interviews

who is the child

how does the childs occupation relate to his or her identity

in what areas of occupation is the child successful

what areas of occupation are problematic

what are the childs occupational priorities and desired outcomes

what is the child unable to do

how does the current occupational situation affect ongoing developoment

whi is affected by the childs challenges

how do the occupations of key person hinder or support the client

how might key person provide better support to the child

what actions are required to complete the occupation successfully

where can the occupation be observed

when and how oftewn coan it be observed

what is the quality of the childs performance

what will phappen as a result of performingthe occupation

what contexts are supporting/inhibiting engagment in the occupation

the OT interprets how assts and limitations and the environment influence "occupational performance"

a plan that is developed based on the results of the evaluation process

describes selected OT approaches and types of interventions to reach the clients identified targety outcomes

developed collaboratively with the client family significan others

the design of the intervention plan is directed by:

• the clients goals, values, beliefs and occupational needs
• the health and well-being of the client

the cleints performance skills and performance patternsas they are influenced by the interaction of the context, activity demands and client factors

the setting or circumstances in which the intervention is provided (context)

best available evidence

develop the plan

the OT develops the plan and the OTA can contribute to the plan

the olan includes:

objective and measurable goals with time framemechansims for service delivery

consider potential discharge needs and plans

select outcomes measures

make recommendationsor referrals to others as needed

intervention approach

• STG-relate to performance components
• ex. button shirt, etc. whill change

LTG-relate to performance of functional areas of daily living, play and school activities. ex. totally dress-does not change

putting the plan into action

defined as the skilled process of effecting change in the clients occupational performance

leads to engagement in occupations or activities

primary goals:

improve performance components

enhance performance of functional activites

modifuling the performance context

• preventing disability and socail role dysfunction
• . the earlier the better to work with them
• increasing self esteem and self-actualization

promoting positive interactions and relationships

1. determine and carry out the type of OT intervention used

• therapeutic use of self
• occupational-based interventions

purposeful activity

preparitory methods

consultation process

education process

advocacy

• 2. monitoring client
• s response to intervention

the intervention process always involves reassessment

leads to refining and adjusting goals and srategies

formal or informal

occurs regularly via observation

may require objective criteria

should always be related back to the childs ability to function in the everyday environment

reevaluate the plan and how it is carried out with the client relative to achieving targeted outcomes

modify the plan as needed

determine the need for continuation, discontinuation, or referral

important dimensions of health, attributed to intervention but include the ability to function, health perceptions and satiswfaction with care

the end-result of the occupational therapy process

describes what OT intervention can achieve with clients

• occupational performance
• adaptation
• health and wellness
• participation
• prevention
• quality of life
• role competence
• self-advocacy
• occupational justice

neonatal intensive care unit

pediatric units of heneral hospitals

childrens hospitals

rehabilitation centers

outpatient facilities

early intervention programs-1-2

preschool 2-5

public schools (regular/spec. ed)

classrooms

private schools

earlyintervention programs

private practice

homes

child care centers

job sites and work settings

residential settings

what is theory?

a set of ideas or concepts that people use to guide their actions

a theory reflects an image or explanation of why or how a phenomenon occurs

general guide to the profession

provide frameworks that delimits the professionss range of interests and fous attention on those aspects of human functioning that are of greatest concern to OT practitioners

refers to the application of theory to occupational therapy practice

models of practice are not interventions protocols but serve a means to view occupation through the lens of theorywith the focus on the clients occupational performance

• MOHO
• incorporates a systems view of the human being that emphasizes two main points:

• behavior is dynami and context dependent
• occupation is essential to self-organization

a persons inner characteristics interat with the environment to create a network of conditions that influence a persons motivation, actions and performance

• peoples characteristics reflect what they havce done in the past. This model views therapy as a process by which:
• -people are helped to do things in order to shape their abilities, self-concepts, and identities
• -MOHO envisions OT as engaging people in occupation, which helps maintain, restore and reorganize their occupational lives

volition-will, do by choice

habituation

performance capacity (mind, brain, body performance)

Volitional system

• personal causation
• self-sknowledge
• values
• interests
• choices
• thoughts and feelings

hubituation system

• habits and learned roles that give peoople stability
• can perform an action without thinking though the action

performed capacity

• reflects what the client has done
• allows an individual to perform an actrion/occupation
• links physical status with mental/cognitive abilities
• brings concepts of the mind and body together

cause and effect are important

• aninteractive model
• context is central of occupational
• environmental interaction is the essence of human occupation
• client must choose activity and needs to participate

client centered model

EHP framework is a model for considering context on OT practice

EHP framework is that ecology or the interaction between a person and the context, affects human behavior and task performance

human performance is a transactional process through which the person, the context and the task performance affect each other

each transaction influences a persons future performance range and options

therapeutic intervension from an EHP perspective occurs as collaboration among the person, the family and the OT practitioner

it is designed to facilitate occupational perfoormance through changing the variables

the PEO model was developed to facilitate the occupational therapists understanding of the dynamic nature of occupational performance

• the model has 3 interactricting elements:
• person
• environment
• occupation

occupational performance isthe outcome of a transactional relationship that exissts among people, their occupations, and the envieironments in whcih they live, work, and play

occupational performance is changing constatly over a lifetime

• Frame of reference:
• link theory to intervention strategies

to apply clinical reasoning to the chosen intervention methods

tends to be a more narrow view compared to models of practice

Rehabilitative Frame of Reference

embraces the philosophy of rehabilitation: to enable a person with physical or mental disability or chronic illness to achieve maximum function in the performance of his or her daily activities

emphasizes an individuals abilities

OT uses this the most, can't change what is wrong with the client. Use devices

focuses on compensatory methods, assistive devices and environmental modification theindividual needs to function

OT practitioners using this model assume that the client's impairment is stabilized and cannot be altered by therapeutic interventions

theclients capacity to function in daily activities, can be changed through the use of compensatory methods and adaptive equipment

teaching learning process is a mojor part of OT interests

teach the client compensatory methjods to perform ADL, ADL, and ways to apply these new techniques to daily activities and participation in life situations

successful outcomes depends heavily on client commitment and participation in the teaching-learning process

linked closely with the medical model

most closely associated with physical disabilities

used to treat individuals with activity limitations due to impairments in biomechanical body structures and functions, including structural instability, decreased strength, limited ROM and poor endurance

the main tenet of the biomechanical approah is that occupational performance dcn be regained through addressing underlying impairments that limit performance of activities

treatment focuses on preventing or decreasing impairments through the use o activity and exercise, which may be purposeful or rote

treatment modalities may not be inherently meaning ful to the client, but focus on the ultimate fgoal of restoring the clinets capability to engage in occupation

treatment is aimed at reducing biomechanical impairments, however goals must reflect expected improvement in occuaptional performance

treatment techniques utilized:

• static splints
• dynamic splints
• compressive wraps
• active exercise
• specialized massage
• muscle endurance
• cardiovascular endurance

the OT practitioner is trained to see the connection between the biomechanical impairments and occupational performance deficits

when using this approach, it is important to explain the purpose of the treatment activities in relationshipl to the occupational performance

approaches share a common foundation of viewing a client who has sustained a central nervous system insult

various approaches are utilized to promote reorganization of the sensory and motor cortices of the brain

specific techniques included in the frame of reference

PNF-Proprioceptive Neuromuscular facilatation

• NDT-Neuro developmental treatment
• Rood
• Sensory integration

• Developmental
• reflects current understanding of sensory and motor development

used to remediate neurologic and developmental motor dysfunction

decrease influence of abnormal postural tone and reactions

promote functional movement patterns

prevent contractures and deformities

sensory integration is the process of organizing sensory information in the brain to make an adaptive response

adaptive responses are necessary to meet the challenges within our environment

adaptive responses are believed to be the foundation of purposeful activity

used when sensory processing deficits make it difficult for a child to produce an approprioate adaptive

the therapist uses controlled sensory input to facilitate adaptive motor responses

an overarching framework for this model is the pattern of assumptions about what a cleint can do, will do, and may do

the OT practioner works with the client and uses meaningful activities to access and change cognitions and appraisals that are detrimental to the clients dcompetencies

the combination of CT and occupational therapy allows therapist the opportunity to examine meaning associated with functional acivities

the focus of the clients cognitive appraisal process leads th the individualization fo each clients intervention ploans and the developoment of specific objectives

the pracrtioner identifies the underlying mental structures of a given activity to predict similar performancew in other activities

Allen Cognitive Levels-assesment tool

a collection of ideas from the movement sciences used to explain the acquisition and modification ofmovement

the act of motor learning includes more than simple motor processes-it involves learning new strategies for sensing and perceiving movement

• motor learning is:
• the process of acquiring the capability for skilled action
• results from experiennce or practive
• inferred based on behavior and not measured dierectly
• produces permanent changes in behavior

• behaviorism
• cognitive therapy
• cognitive disability FOR
• multicontext treatment approach

• classical conditioning
• stimulus=response relationship

• operant conditioning
• behaviors develoop as a result of their effect on the environment
• reinforcement/punishment

• vicarious learning/obervational-copying those around you
• learned behaviors from observing another

• behavioral interventions may be used by occupational therapy practritioners
• behavioral-management interventions
• skill building interventions

intended to increase pro-social and health -promoting behaviors and decrease anti-social and health-threatening behaviors

evolved because behavior therapy could not address many important mental health problems

CT recognizes the importance of the clients appraisal of events in the development and continuation of mental disorders

irrational beliefs-paranoia

what a cleint can do is based on biological factors

what a client will do is influenced by psychological factors such as motivation, fears, or meaningfulness of the activity being performed

what a client may do is a reflection of how much support he or she receives fronm the social systems, including family, friends, andcaregivers

addresses the issue of generalization in cognitive rehabilitation

utilized with clients with brain injury and psychiatric disabilities

views learning as an interaction between internal (person) and external (activity demands and context) variables

problems in proessing information and learning are understood by analyzing the dynamic interaction between the person, the activity and the context

when activity demands or context changes, the type of cognitive streategies and self-monitoring skills required for efficient performance change as well

intervention focuses on increasing efficiency and effectiveness of processing strategies and self-monitoring techniques within purposeful and occupation-based activities

it combines adaptation of the activity and context with a focus on changing the persons processing strategies and self-awareness skills across a wide range of situations