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OT 425 Session 6B-C 2017
- 1. Session 6B/C
- 2. of the OTPFand OT LingoReview
- 3. Concepts - ideas (or mental pictures) that describe the regularity or relationship within a group of things, often in generalized terms Constructs – abstract, subjective ideas that are often guided by interpretation “OT think”
- 4. Principle (aka postulate) - describes the relationship between two or more concepts, two or more constructs, or a combination of constructs and concepts “OT think”
- 5. Theory – a broad and overarching set of assumptions, concepts, and definitions used to help explain and/or link concepts or constructs “OT think” Image retrieved from http://www.indianlink.com.au/celebrating-100-years-of-relativity/
- 6. Model of Practice (MoP) – takes the philosophical base of the profession and organizes the concepts for practice helps OTs organize thinking around “OT think”
- 7. Frame of reference (FoR) - describes the anticipated process for change in the client and the principles for moving a client along the continuum from dysfunction to function generally selected based on population, diagnosis, and other client factors as well as setting “OT think” Helps to determine … • Theory regarding change/outcome goals • Concepts of function - - dysfunction • Principles of intervention • Role of the practitioner • Evaluation instruments
- 8. “OT think”
- 10. • Aids in problem identification and problem-solving • Validates and guides practice • Justifies reimbursement • Clarifies specialization issues • Professional growth and direction • Education “OT think” Learning about & Using Theory in OT Practice
- 11. Image retrieved from https://www.pinterest.com/otlassie/moho-model-of-human-occupation/
- 12. MOHO Lingo • Volition – one’s motivation, interests, values, and belief in skill • Habituation – one’s daily patterns of behaviors, roles, and routines • Performance – motor, cognitive, and emotional aspects required to act in a given situation • Environment – the physical, social, and societal surrounds in which one is involved “OT think” >20 assessment tools developed for use with this MoP
- 13. MOHO in Action: John’s Story
- 14. MOHO in Motion: The Story of Ramona
- 15. Resources to Explore • #Otalk on Twitter - http://otalk.co.uk/otalk-focus-on-models/ • ADVANCE for OT practitioners • Pinterest • Instructables • YouTube • Case study (O&H p. 137)
- 17. To gain an understanding of the demands, therapeutic potential, skills required, and meaning of a particular activity Why Do We Learn to Analyze Activities and Occupations? It provides insight into what is needed in order to perform an activity and to instruct others in how to complete an activity, and it allows for planning and preparation of the necessary elements (staff, materials, costs, space, time, etc.). Recommended blog: “Cooking Mamas” - https://cookingmamasuk.wordpress.com Review
- 18. • Activity analysis is essential to OT practice. • Occupations are the focus of our profession. • The OTPF (3rd ed.) is used as a basis on which to analyze occupations and activities. Activity Analysis Activity Analysis Occupation- based Activity Analysis Review
- 19. Activity Analysis Baking as an Occupation Review
- 20. "Whatever you can do or dream you can do, begin it. Boldness has genius, power and magic in it.” ~Scottish mountaineer W. H. Murray, quoted by Charles Christiansen in Gary Kielhofner’s eulogy
- 21. Review
- 22. Review
- 23. Occupational Performance Model Canadian Model of Occupational Performance (CMOP) Canadian Model of Occupational Performance and Engagement (CMOP-E) Polatajko, Townsend, and Craik Spirituality – “anything that motivates or inspires a person” (O&H, p. 136)
- 24. The Canadian Model of Occupational Performance and Engagement (CMOP-E)
- 25. Main Key Term Spirituality - essence of self and the place where determination and meaning are drawn Retrieved from http://thewayofmantra.com/?attachment_id=540
- 26. Use of the CMOP-E in Clinical Practice • Canadian Occupational Performance Measure - standardized semi-structured interview that is used for individual, client-centered outcome measurements • Used with all ages and conditions and in multi-cultural settings • Can be used with other standardized or non-standardized assessment tools
- 27. Canadian Occupational Performance Measure (COPM)
- 28. Canadian Occupational Performance Measure (COPM)
- 29. The Life Balance Model (LBM) Using Mindfulness to Create Life Balance: http://scholarworks.wmich.edu/ojot/vol4/
- 30. Occupational patterns should enable people to meet important needs such as – • Supporting biological health and physical safety • Contributing to positive relationships • Feeling engaged and challenged • Creating a positive personal identity The Life Balance Model (LBM) • Satisfaction • Meaning • Stress
- 31. What are the characteristics of a habit? • Useful – supports occupational performance • Impoverished – has not been established/needs to be improved • Dominating – interferes with daily life Review of Occupational Therapy Lingo
- 32. The Life Balance Inventory (LBI) http://minerva.stkate.edu/LBI.nsf
Editor's Notes
- Define theory, model of practice, and frame of reference as they relate to OT. Discuss the importance of using a model of practice and frame of reference in OT practice. Identify the components of a FoR. Provide an overview of the Model of Human Occupation (MOHO). Explain the purpose of activity analysis and describe its application to occupation.
- OT Lingo: Performance Patterns: habits, routines, roles, and rituals used in the process of engaging in occupations or activities Environment: Physical – Natural or man-made surroundings in which daily life occupations occur Social – Relationships with and expectations of persons, groups, and populations with whom a client has contact Context: Elements within and surrounding a client that are often less tangible than environments but still have a strong influence on performance OTPF song - https://www.youtube.com/watch?v=s9xwTMTLpg4
- “Doublethink” – term from George Orwell’s book 1984. Related to hypocrisy but more in line with cognitive dissonance, as in when a person thinks conflicting things. “OTthink” – a way of thinking that develops in OT practitioners that involves an understanding of historical contexts, theoretical knowledge, empathy, servant leadership, ethics, drive, clinical reasoning Concepts: Also defined as “ideas that represent something in the mind of the indiv., ranging from simple/concrete to complex/abstract, expressed thru use of symbols and language Examples - a table and ball go together for ping pong (think about word associations in psychology); picturing a tree when the concept is brought up in conversation Constructs: intangible, often guided by societal/group or individual interpretation Examples – Time, history, quality of life, health, mastery, “the fullest” as in “living life to the fullest” Advancements in our field is less about tangible innovation (as in medicine, transplants, medicines, implants) and more about concepts and principles and theory. In that way, it’s like science and art.
- “OT Theories” Handout by Rachel – OT theory and practices have developed from concepts and constructs Example: Once the concept of colors is learned, a child comes to understand that mixing two or more colors produces yet a different color TO DO: Return to the concept of occupational imbalance Group questions: How do you know when your own life is occ. Balanced? How do you recognize when you don’t have occ bal Etc.
- An overarching theory that helps to explain a large set of findings or observations A plausible or scientifically acceptable general principles or body of principles offered to explain phenomena “The analysis of a set of facts in their relation to one another” (O&H p. 136) Example: theory of relativity (Einsten’s 4-D space-time continuum) Four basic criteria of a theory: Fit – reflects the everyday reality of the phenomenon it is designed to represent Understanding – rationale, logic, and sense of the theory Generality – comprehensive with sufficient variation that it can be applied in diverse contexts Control – a degree of control over phenomenon
- Provides OTs with terms to describe practice, an overall view of the profession, tools for eval, and a guide for intervention (O&H p. 137) In OT431, defined as serving as a guide in the field of OT to “define scope and boundaries, define its fundamental principles, and guide practitioners in eval and intervention”
- A FoR tells the OT practitioner what to do and how to evaluate and intervene with clients. Also, FoR have research to support the principles guiding eval and intervention. Thus, using a FoR to guide one’s practice is essential to EBP. COMPONENTS description of the population, theory regarding change, function and dysfunction, principles of intervention, role of the practitioner, and evaluation instruments.
- MODEL OF PRACTICE = TOOLBOX FRAME OF REFERENCE = TOOLS IN THE TOOLBOX OT practitioners will typically use more than one toolbox and tool to complete the OT process. If I call for a repairman and one comes to my house, the person will likely have some idea of what the issue (reason for the call for assistance) is so that he can bring the correct materials inside. (Broken light fixture – diff tools than clogged toilet)
- Students to think – pair – share
- May be broad in scope and address many aspects of OT – or narrow and concern only a small portion of the field. Help us to predict and/or explain what we as OTs are doing – NOT APPLYING THEORY to practice is like taking a road trip w/o a map Theory is a key element in problem setting and problem solving. It is a tool that enables the practitioner to ‘name it and frame it’” – meaning both language and logic are needed to ID a problem (name it) and to figure out how to address it (frame it). Tips for learning about theory – Put your “big picture” cap on Memorize the core principles and key terms Practice explaining how an intervention will be accomplished using the theory or several theories together Observe and ask questions in clinical situations (why?)
- MOHO – Best researched model of practice in OT. Kielhofner – born in Oran, Missouri, in 1949 to a farming family. Preferred reading over outside work and had an affinity for the spiritual side of life. GM had a LE amputation after a traffic accident and refused a prosthesis, as a result spent her life in a w/c. A visionary devoted to community service. Died in 2010. He once caught one of his wife Renee’s employees using her office as a lunchroom, with feet up on her desk. Gary felt Renee was perhaps letting those she was in charge of get away with too much. He gave her a little statuette of an antelope - "the consummate prey animal," as she later described it - to remind her not to make herself a victim. She had a right, by virtue of her accomplishments and her title, to expect respect and ask for it. First published in 1980 – this MoP views occ perf in terms of volition, habituation, performance, & environment. Within MOHO, humans are conceptualized as being made up of 3 inter-related components – volition, habituation, and performance capacity. Seeks to provide an explanation of how these factors interact to influence what people do in their everyday lives and to explain why problems can arise in the face of illness and impairments and when environmental factors interrupt occupation http://occupational-therapy.advanceweb.com/Features/Articles/A-Tribute-to-Gary-Kielhofner.aspx
- An NBCOT survey of entry-level OTs (2004) showed MOHO as the most used occupation-based theory. Other popular FoR were biomechanical, neurodev’al, and SI. Updated and collectively shaped by OTs globally (theoretical refinement) Seeks to explain how occupation is motivated, patterned, and performed – with an intent of providing a broad and integrative view of diverse human occupations Emphasizes that to understand human occupation, we must understand the physical and social environments in which it takes place.
- Students to pay attn to the visual aid used in this video as it is helpful in organizing one’s thoughts about how to apply the MOHO in working with a client.
- The process of breaking down an activity into steps and detailed subparts and examining its components. With each activity being evaluated carefully to determine its therapeutic potential (Creek, 2003) Any activity can be broken down into performance components to analyze the perf skills required as a way to understand the client’s ability to complete the task or activity OR to identify areas where the activity can be adapted (Mosey, 1986) Determine the relevance and importance to the client Identify the steps required Determine the objects and properties, space and social demands Determine the required body functions & body structures Determine required performance skills Analyze for therapeutic intervention—occupation-based activity analysis
- OT practitioners must be able to select approp activities by assessing the demands of an activity on many levels, integrating the info with knowledge of the client’s needs and abilities, and grading and adapting activities as needed. Heavily reliant on clinical reasoning in eval and intervention Identifies needed materials and equipment Allows for instruction of others Gives information regarding therapeutic value Helps to grade and adapt activities Gives specifics for documentation Discovers how contexts play a role Helps in selecting intervention activities Identifies areas in which the client may need help It also helps the practitioner to see when, where, for whom, and under what circumstances the use of the activity would be therapeutic.
- OT practitioners have a unique view of what comprises daily activities and what contributes to a person’s engagement in an activity. Methods of approaching the activity analysis: Frame of Reference OTPF Develop a plan to target components of the activity that are challenging for the client Two types of AA – Standard – analyzing an activity as it’s typically done Occupation-based AA – individualized to a particular client, looks at meaning and context for that person In the practice of occupational therapy, there are many ways of analyzing and adjusting activities. Activity analysis that occurs during the process of intervention planning can be used along with the patient profile to determine the appropriateness of grading or adapting the task to enhance its value as a therapeutic tool (Trombly & Scott, 1977, p. 243).
- Students to work in small groups to find a video on MOHO and use the diagram to take notes.
- Effort to explain and organize a particular phenomenon or process It is a tool that enables the practitioner to ‘name it and frame it’ – meaning both language and logic are needed to ID a problem (name it) and to figure out how to address it (frame it). Often develops in response to an observation or experience that cannot be accounted for using existing explanations. Validates and guides practice Evolves over time. Help us to predict and/or explain what we as OTs are doing – NOT APPLYING THEORY to practice is like taking a road trip w/o a map FoR – Tools in the Toolbox - describes the anticipated process for change in the client and the principles for moving a client along the continuum from dysfunction to function generally selected based on population, diagnosis, and other client factors as well as setting. A FoR tells the OT practitioner what to do and how to evaluate and intervene with clients. Also, FoR have research to support the principles guiding eval and intervention. Thus, using a FoR to guide one’s practice is essential to EBP. COMPONENTS description of the population, theory regarding change, function and dysfunction, principles of intervention, role of the practitioner, and evaluation instruments. MoP – Toolbox - takes the philosophical base of the profession and organizes the concepts for practice helps OTs organize thinking around occupation. Provides OTs with terms to describe practice, an overall view of the profession, tools for eval, and a guide for intervention (O&H p. 137) HANDOUT
- Effort to explain and organize a particular phenomenon or process It is a tool that enables the practitioner to ‘name it and frame it’ – meaning both language and logic are needed to ID a problem (name it) and to figure out how to address it (frame it). Often develops in response to an observation or experience that cannot be accounted for using existing explanations. Validates and guides practice Evolves over time. Help us to predict and/or explain what we as OTs are doing – NOT APPLYING THEORY to practice is like taking a road trip w/o a map FoR – Tools in the Toolbox - describes the anticipated process for change in the client and the principles for moving a client along the continuum from dysfunction to function generally selected based on population, diagnosis, and other client factors as well as setting. A FoR tells the OT practitioner what to do and how to evaluate and intervene with clients. Also, FoR have research to support the principles guiding eval and intervention. Thus, using a FoR to guide one’s practice is essential to EBP. COMPONENTS description of the population, theory regarding change, function and dysfunction, principles of intervention, role of the practitioner, and evaluation instruments. MoP – Toolbox - takes the philosophical base of the profession and organizes the concepts for practice helps OTs organize thinking around occupation. Provides OTs with terms to describe practice, an overall view of the profession, tools for eval, and a guide for intervention (O&H p. 137) HANDOUT
- Occupational Performance Model (OMP) established by Canadian Assoc of OT (CAOT) Updated in 1997 to the Canadian Model of Occ Perf (CMOP) Updated again in 2007 a COPM-E by Polatajko, Townsend, and Craik At the heart of the CMOP-E is spirituality, and, as was brought up in a Discussion Board post (thanks, Saniya!): “A person’s spirituality is important to consider in terms of occupational therapy because spirituality will directly affect a person’s desires and motivations, and, in turn, what occupations a person wishes to return to as a result of therapy.” Well said!
- Focus – OT values are essential – client-centered, occupation-centered, and EB This is considered to be a recovery-oriented model
- Key Postulates: Occupations are determined and influenced by context/environment and human development. Health, well-being and occupational justice are attainable through occupation. Occupational performance and engagement is the outcome of the interdependent and dynamic interaction between Person, Environment, & Occupation. Occupation shapes and expresses spirituality. People can use religion to explore their spirituality, but that is not required. If there is a change or shift in one component then it will influence all of the components, possibly causing occupational dysfunction or occupational impairments. Function can only occur when there is harmony between the interdependent components of person, occupation, and environment. Theoretical underpinnings – humanistic theory/models; developmental and learning theories.
- https://youtu.be/yHWATieGSzk Extensive research of the Canadian Occupational Performance Measure (COPM). Strong validity and reliability. Published in over 100 peer-reviewed journals. Takes 20-30 minutes to administer. A client-centered outcome measure Designed to detect change in a self-perception of occupational performance over time. Authors include Mary Law, Sue Baptiste, Anne Carswell, Mary Ann McColl, Helene Polatajko and Nancy Pollock.
- COPM - Takes 20-30 minutes to administer. Designed to detect change in a self-perception of occupational performance over time. Application/CASE STUDY #1 - In my work with younger, school-aged children, I use the COPM during the initial interview. It helps me get to know the concerns of a parent or teacher, and guides me in setting priorities for intervention. It is also an excellent medium to explain occupational therapy and the services that I can offer. At critical points in the service delivery process, I will use the COPM to stop and reflect with a parent and/or teacher about a child’s occupational performance. Many parents say that the COPM helps them to focus on what is really important. When the COPM is completed by both parent and teacher, it can serve as a means of opening communication between them and identifying mutually agreed-upon goals. I view the COPM as both an outcome measure and as a framework for my interviews. It allows me the freedom to write the concerns of parents and teachers in words that we all understand. My intervention outcomes are occupation-based and meaningful to the child and family. In the following case, I used the COPM to identify a mother’s perceptions of her son’s occupational performance at a critical point in the intervention process. Chad is a nine-year-old boy who lives with his parents and one older sibling. His diagnosis is spina bifida (lumbosacral myelomeningolcele) and hydrocephalus. He walks independently when bilateral ankle foot orthoses are worn. Chad has been receiving occupational therapy services from an outpatient children’s treatment centre since his family moved to the area one year ago. Services are now provided primarily in the school environment. Chad is currently in grade three, fully integrated in a class of 19 students with a teacher and part-time teaching assistant. During the occupational therapist’s most recent visit, some concerns were expressed by the teacher and teaching assistant about Chad’s behaviour and problems with the self-catheterization routine at school. The occupational therapist contacted Chad’s mother and decided to use the COPM to identify her perceptions. The interview was held at home as this was considered to be the most comfortable environment for Mrs. T. to openly discuss her concerns. She identified three main problems: Chad needed to be more careful about keeping clean during self-catheterization; Chad was having difficulty attending to school tasks on his own, as he didn’t listen to the teacher’s instructions; Chad did not always play safely in the schoolyard, especially during the winter months. The occupational therapist reviewed the results with Mrs. T., discussed the concerns of the school staff and together they established a plan of action. The results of this COPM were then discussed with school staff and it was agreed to focus efforts on these three areas. Once these issues were addressed, new problem areas in Chad’s occupational performance were then identified by Mrs. T. using the COPM. http://www.thecopm.ca/casestudy/copm-as-framework/
- W&S p. 168-171 Kathleen Matuska (OT Journal of Research, 2012) Developed from concept that practiced a balanced rhythm between work, play, and rest/sleep leads to wholesome living (Meyer, 1977) Supports preventative and restorative philosophies of practice Links to perf patterns and occupational balance – perception that one’s patterns of everyday occupations are satisfactory and include a range of meaningful occupations Life balance – “a satisfying pattern of daily activity that is healthful, meaningful, and sustainable to an individual within the context of his/her current life circumstances” (Matuska & Christiansen, 2008, p. 11) Oval A – represents activity config congruence – match b/w desired and actual time spent engaged in valued activities Oval B – equavilence of satisfaction across four need-based dimensions in LBM (health, relationship, challenge, and identity) Overlap of these ovals shows LB Application to OT: as challenging as most feel it is to achieve LB, it can be much moreso for those w/ disabilities or chronic illness (MS, parents of a child with autism) GROUP QUESTIONS
- Prezi: http://prezi.com/3webb0yjl_b3/?utm_campaign=share&utm_medium=copy&rc=ex0share The LBM depicts the relationship between occupational patterns, life outcomes, and the environment The extent one is able to engage in patterns of occ that address all of the above needs determines how they perceive their life – Satisfying Less stressful More meaningful – balanced Life balance requires the skill to create match b/w amount of time one desires to engage in activities and actually engages in those that meet important needs Possibility – environmental constraints can make it difficulty to engage in a satisfactory LB
- Habits – specific, automatic behaviors, performed repeatedly, relatively automatically, and with little variation. Perfor details depend on context Examples of each type? Useful – brushing teeth before bed. Putting keys on table, writing appointment on calendar When barriers arise (stranded at airport), loss is noticed but not incapacitating Save time, energy, and brain power (cognitive energy) Increase skill in action Application to intervention: help client with SCI develop habit of setting clothes by bed at night to save time in morning routine Impoverished – Result from dysfxn’al internal state interfering with learning new useful habits or adapt existing ones to meet needs of situation Application: May occur with Alzheimer’s, depression, ADD. OT works with caregiver to support dev’ment of habit of putting materials out for client Dominating – need to smoke while driving or consuming junk food while watching TV Consistently performed even if they interfere with optimal perf. Often create stress or anxiety if they cannot be performed Include addiction and/or other habits that affect one’s health negatively Can be very difficult to change and are sometimes managed with medication Application – OT helps individual to identify/create alt. habits that are less harmful. In OCD, autism, or other mental health conditions
- The Life Balance Inventory (LBI) – pp. 170-171 in W&S (read to learn more) This 53-item assessment tool measures perceived balance across the four need-based dimensions In the LBM and was designed to allow unique configurations of daily occupations for each person within each of those dimensions. Scoring is based on the idea that imbalance could result from spending too little or too much time in any activity. Available free online at http://minerva.stkate.edu/LBI.nsf Output consists of an overall life balance score and balance scores in each subscale. Another assessment tool often used by OT under this MoP is a daily log, which allows the OT to examine occ patterns. Can be a 24-hour record divded into 30 min. intervals with the client asked to fill it out for 3 consecutive 24-hour periods. OR client could record what he/she is doing every 30 mins., or contextual info such as “what I was doing, where it occurred, who I was with, and how I felt.” This helps the client to be more aware of how time is spent and can be a step towards estab healthy lifestyle changes when life imbalance is present.