Intro to OT

Semester 1

Quantitative

Observable, measurable facts that can be discovered to explain and predict phenomena

Qualitive

Subjective experiences, socially constructed, complex, constantly changing

Discipline Paradigms

• A discipline is a group of like-minded individuals concerned with understanding particular phenomena 

• Each discipline has a way of knowing and viewing the world 

• Individual lens 

• Paradigms change & evolve as understanding increases 

 

Occupation & Meaning

• Meaning is important 

• Linked to OT in regards to participation/engagement 

• Meaning is subjective and individual 

Habits & Routines

Habits = relatively automatic things a person thinks or does repeatedly  

Routines = the patterns we follow regularly. Type of higher order habit that involves sequencing & combining processes, procedures, steps and occupations. 

• Structures our time  

• Helps us organise our lives (efficiency, confidence, speed, experience) 

• Certain habits & routines are necessary for wellbeing 

• Loss of routine – increased risk of physical or emotional disturbances 

Occupational Analysis

• Process of examining and occupation and identifying all constituent parts 

• Fundamental to OT 

• Various OT frameworks to guide this 

• Different terminology used 

T - COP

T - Cop (Occupation)

• Activities performed with some consistency & regularity & create structure 

• Given value and meaning by individuals and culture 

• Occupations should be ending in 'ing' 

• At any given time we must be doing something that can be considered our PRIMARY occupation 

• Activities and occupations can be performed simultaneously = embedded or secondary occupation 

T-COP (Activity)

Numerous tasks make up activity

T-COP (Tasks)

• Self-contained stage in an activity 

• A combination of actions sharing some purposes as recognised by the task performer, related to the accomplishment of specific goals 

 

Hierarchy of Occupation

Classifying Occupations

Self-Care: everything people do to take care of themselves

Productivity - everything people do to contribute to the social and economic fabric of communities

Leisure - everything people do to enjoy life

Rest - the purposeful pursuit of non-activity

Occupational Performance

The ability to perceive, desire, recall, plan and carry out roles, routines, tasks and subtasks for purpose of self-maintenance, productivity, leisure and rest in response to demands of the internal 
and/or external environment. 

Defining Context

• The 'where' 

• 'context and environment' - interchangeable 

• Both physical and social elements 

• Social context – further divided 

Understanding Context

• Transactional nature – we shape and are shaped by the world around us 

• The person and their environment are intertwined and co-constitutive 

• Constantly influencing each other 

Physical Context

• Natural – all living and non-living things occurring naturally in the world 

• Built – buildings, products, technology 

• Space in between

Social Context

• The complexities of our relationships, connections and influence of others in our world 

• Includes – relationships, attitudes and expectations of each other, social events and connections 

Understanding Social Context

• Holistically 

• By layers: social systems and structures – social groups in relation to access to resources and power – micro, meso and macro elements 

Institutional Context

• Usually macro-level 

• "institutions" organise society socially, economically, politically, legally 

• Informal + formal structures for order and governing society 

• Highly complex + reflect societal values, power and resources 

• Has a profound effect on human occupation  

• The impact of human institutions is embedded in day-to-day life & is hard to identify 

• Institutional elements control policies that influence access to resources and services 

Temporal Context

• Our lives and the world we live in are not static 

• Temporal refers to time 

• Two main elements – cyclical and linear time 

• Cyclical – the routines and patterns in life – daily, weekly, yearly outcomes 

• Linear – past, present and future – influence of history and the experiences throughout the lifespan 

Cultural Awareness

Understanding of the similarities & differences in attitudes, values, beliefs & customs between themselves & people from other countries or other backgrounds 

Cultural Responsiveness

• refers to the ability and willingness to recognise, respect and effectively respond to the diverse 
  cultural backgrounds, values, beliefs, and practices of individuals or communities. 

Cultural Safety

“An environment, which is safe for people; where there is no assault, challenge or denial of their identity, of who they are and what, they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning together with dignity, and truly listening”

Aspects of the Person - Physical

• Physical traits 

• Physical function/performance/skills 

• Biological systems 

• Movement 

• Strength 

• Coordination 

• Balance 

• Sensation 

• Pain  

• Appearance 

• Illness/injury of body systems or structures 

Aspects of the Person - Cognitive

• 'cognition' 

• 'thinking' 

• 'the mental process involved in knowing, learning, and understanding things 

• Acquiring knowledge 

• Memory 

• Orientation 

• Concentration  

• Insight 

• Judgement 

• General knowledge 

• Problem solving 

Aspects of Person - Psychological

• 'affective' 

• 'mental health' 

• 'psychological and emotional well-being' 

• 'intrapersonal' 

Aspects of the Person - Intellectual

• Ability to understand things and think in a logical way 

• This is important to consider when working with people with disability 

• Mood 

• Affects 

• Emotional regulation 

• Resilience 

• Confidence 

• Motivation 

Influencing Factors - Intrinsic

• Personality /temperament 

• Preferences 

• Skills, abilities, knowledge 

• Basic needs 

• Health/ illness/ disability 

• Biological rhythms 

• Age, gender, socio-economic status 

• Values, attitudes, meanings (spirituality)

Influencing Factors - Extrinsic

• Physical, social, cultural, institutional contexts 

• Resources 

• Circumstance 

• Time 

• Space 

Occupational Roles

• Determined by each unique person-context- performance relationships 

• Established through need and/or choice 

• Roles are modified with age, ability, experience, circumstance and time 

• Roles are nouns 
  ∙ I am a … 

• Roles may be: 
  ∙ Short term 
  ∙ Long term 

•  Roles can overlap, be congruent or conflict – 
  affecting life balance and stress levels 

• Influence behaviour 

• Chosen or assigned 

• Dynamic 

• ‘Cultural norms’ influence 

• Variability – characteristics, circumstance & context 

PEO - Person, Occupation, Environment

PEO Model- Examines relationship among person, environment and occupation and how this contributes to occupational performance 

• How this contributes to occupational performance is called PEO-fit 

• PEO-fit changes over time and with different circumstances 

• Transactive rather than interactive 

Health & Wellbeing

• Health is the state of being free from illness and injury 

• The condition of being sound in body, mind or spirit 

• A balance between four bodily fluids – black bile, yellow bile, phlegm, and blood 

• Harmonious functioning of the organs

The ‘Negative’ View of Health

• Health is seen as the absence of illness 

• Health is defined by reference to ill health 

• Health is defined by what it is NOT:  

• Not experiencing symptoms, not suffering any serious sickness/pain, not being ill 

The ‘Positive’ View of Health

• a state of being 

• Describing what you have that constitutes health 

• Example – being fit/functional, having energy, having healthy habits 

• An organism that is working well as a whole 

• A state of equilibrium or wellness 

Social Determinants

• Non-medical factors that influence health outcomes 

• The conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life 

 

Determinants Include: 

• Income and social protection 

• Education 

• Working for life conditions 

• Food insecurity 

• Structural conflict 

• Early childhood development 

• United Nations adds that self-determination, collective rights, crucial to indigenous health 

Health Promotion

the process of enabling people to increase control over, and to improve their health 

• Central document in world health policy 

• Bio-pyscho-social view of health 

• Health is a positive concept – requiring personal & social resources and the ability to cope with the environment 

• Calls for health services & societies to act beyond the medical treatment of disease 

Biopsychosocial Model

Health Promotion

The process of enabling people to increase control over, and to improve their health knowing that lifestyle & occupational choices influence both physical and psychological wellbeing 

Saluto Genesis

• The study of the origins of health and focuses on factors that support human health and wellbeing, rather than on factors that causes disease  

• What creates health 

• What supports health vs what causes disease 

Occupational Balance

• A state of equilibrium or equipoise; equal distribution 

• Happiness is not a matter of intensity but of balance and order and rhythm and harmony 

• Humans have many roles and occupations 

• Complementary/competing 

• Fluidity in balance 

• Includes 6 factors; individual, subjective, experienced, changes over time, does not mean equal distribution, no 'ideal' distribution 

 

Occupational Imbalance

• Lack of congruence across occupations or between occupations and one's core values 

• Can be due to over occupation or under occupation  

 

PEO Elements - Person

• Dynamic, motivated and ever-developing being 

• Constantly interacting with the environment 

• People change over time – this may stem from changes to the environment, circumstances or development 

 

PEO Elements - Environment

• Conceptualised as inseparable from the person 

• Model processes that the environment both shapes and is shaped by people 

• Five aspects – cultural, socioeconomic, institutional, physical, social  

• Context/environment shapes/influences occupational performance 

PEO Elements - Occupation

• What people do in the environment 

• Three aspects of occupation – task, activity, occupation 

• 'nestled within each other’

PEO Elements - Occupational Performance

• "The dynamic results of the transaction between the person, environment and occupation is known as occupational performance" 

• Measured both subjectively and objectively

PEO-fit

• Based on the premise that the person, environment and occupation interact regularly over time and space 

• The better the fit or compatibility between the person, environment and occupation, then the greater the occupational performance  

CMOP - E Historical Developments

• A group of OT, medical and medical sociology colleagues work on a project to articulate the conceptual foundations of OT in Canada 

1. Guidelines for client-centred practice for OT 

2. Intervention guidelines for client-centred practice of OT 

3. Toward outcomes measures in OT 

• The Occupational Performance Model 

CMOP

• Presented in 1997 as a new version of the OPM 

• Three dimensional 

• Emphasises the dynamic nature of the interaction of the PEO 

• Occupational performance if embedded within the model

CMOP - E (Key Elements - Person)

• Spirituality is a separate component situated at the core of the entire model 

• Spirituality is infused within the person 

• The CAOT (1997) characterizes spirituality as ‘a pervasive life force, 
  manifestation of a higher self, source of will and self-determination, and a sense of meaning, purpose and connectedness that people experience within the context of their environment’ 

CMOP - E (Key Elements - Environment)

Physical – all natural & built aspects of the environment 

Social – people in the environment, relationships, networks and assistance 

Cultural – includes personal & family rituals, expectations & attitudes of broader culture 

Institutional – government & organisational structure, education, unemployment race 

CMOP - E: Concept of Occupation

• Occupational performance is only one aspect of a person's potential engagement in occupation 

• People have many occupations 

CMOP - E (Occupational Repertoire)

• Presents an idea of a person's occupational life 

• Broadens scope to consider occupational balance/imbalance, marginalisation and deprivation

CMOP - E (Performance)

• Captures what a person has capacity, skills & knowledge to do 

• Observable act of 'doing' 

• Embedded in the model where occupation bridges person & environment 

• Taxonomic Code of Occupational Performance (TCOP) offers a way of understanding the observable acts of doing 

CMOP - E (Engagement)

• This is a distinct important outcome for OT 

• There needs to be involvement in the 'doing' 

• Broadens scope to include social participation in occupation  

Key Assumptions regarding Occupation

• Occupation affects health and well-being 

• Occupation organises time ad brings structure to living 

• Occupation brings meaning to life 

• Occupations are idiosyncratic 

Summary: CMOP - E

• The CMOP – E as developed over time to reflect concepts central and core to occupational therapy practice 

• Key elements of the person, occupation and the environment are considered 

• The core domain of OT is visualised in the model 

• Occupational engagement has broadened the scope of OT to go beyond just the 'doing', and to consider the subjective experience and motivations of occupation 

• There are many guiding frameworks and resources to compliment CMOP – E and occupation therapy practice  

Model of Human Occupation - History of MOHO

• One of the first published OT models of practice 

• Developed by Dr Gary Kielhofner 

• First published in 1980 with adaptations  

• Very important model, one of the most influential theoretical contributions to OT 

• Understanding human occupation requires the application of systems theory and demands the application of research the biological, psychological and social sciences 

• MOHO seeks to explain occupational behaviour, it helps in understanding how occupation is motivated, patterned and performed 

Key Elements of MOHO

• Three interrelated components of the person 

  • Volition 

  • Habituation 

  • Performance capacity  

• Environmental context 

• Three dimensions of doing 

  • Occupational skill 

  • Occupational performance 

  • Occupational participation 

• Occupational adaptation 

  • Occupational identity 

  • Occupational competence  

Volition - MOHO

• A pattern of thoughts and feelings about oneself as an actor in one's world which occurs as one anticipates, chooses, experiences, and interprets what one does 

• Subcomponents 

  • Personal causation 

  • Values 

  • Interest  

Habituation - MOHO

• Subsystem responsible for organising behaviour into routines or patterns 

• Subcomponents 

  • Habits 

  • Roles 

Performance Capacity - MOHO

• The ability to do things 

• Subcomponents  

  • Objective components (physical and mental abilities) 

  • Subjective components (the lived body)  

Environment - MOHO

• The particular physical and social, cultural, economic and political features of one's contexts that impact upon the motivation, organisation and performance of occupation 

• Subcomponents 

  • Spaces 

  • Objects 

  • Social groups 

  • Occupational forms 

  • Cultural, political and economic context  

Three Dimensions of Doing

Occupational participation – engaging in work, play or activities of daily living that are part of one's sociocultural context and that are desired and/or necessary to one's wellbeing 

Occupational performance – the doing of an occupation 

Occupational skill: the skills required to perform the occupation 

• Motor – moving self or objects 

• Process – sequencing actions 

• Communication and interaction - (communicating needs and intentions + engaging with others) 

KAWA Model History & Overview

• The Kawa Model is a therapeutic method developed in Japan 

• Kawa is the Japanese word for 'river' 

• Uses the natural metaphor of a river to depict one's life journey 

• Quality and character of its flow will vary from place to place, from instance to instance 

• Can be used as a conceptual model of practice, frame of reference, assessment tool and modality 

KAWA Model

(I) life flow and overall occupations (river) 

(ii) environments/contexts, social and physical (river banks) 

(iii) circumstances that block life flow and cause dysfunction/disability (rocks) 

(iv) personal resources that can be assets or liabilities (driftwood) 

Elements of KAWA Model

River 

• the past, present and future occupational needs of the client 

• The flow of a person's life 

 

River banks: 

• Natural contexts, including social and physical environments 

• A person exists and interacts with others 

 

Rocks: 

• Barriers to function and life flow 

• Life issues that are usually deep-rooted and can impact water flowing through river 

 

Driftwood 

• Assets and resources that promote function and happiness 

• What people use to their advantage  

History of OPM(A)

• First published 1986 – Sydney, Australia 

• Founded on the Occupational Performance Model, the focus of OT movement in the 70s and 80s 

• By the 1990s – sent it on a broader and more deeply contextualised notion of occupational performance 

Key Assumptions of OPM(A)

1. OT -> occupational needs 

2. Satisfaction with occupational experience 

3. Strategies to enhance occupational performance 

4. Occupational performance - "the ability to perform, including doing knowing and being dimensions" 

5. Occupations are those activities and tasks that a person: 

• Wants to do 

• Needs to do 

• Capable of doing 

Key Elements OPM(A) - Occupational Role

• Determined by individual person-environment-performance relationships 

• Established through need and/or choice 

• Modified with age, ability, experience, circumstance and time 

• Roles connect the internal and external environments 

3 dimensions:

1. Doing – how we carry out these roles 

2. Knowing – understanding desired or expected roles 

3. Being - the satisfaction or fulfilment that a person might obtain from them 

Key Elements OPM(A) - Performance Areas

Patterns of occupational behaviour are grouped into performance areas 

• Productivity – occupations/routines that enable a person to provide support for self, family or community through the production of goods or provision of services 

• Self-maintenance: occupations to preserve a person's health and well-being in the environment  

• Leisure: entertainment, creativity and celebration 

• Rest: the purposeful pursuit of non-activity 

Key Elements OPM(A) - Performance Components

Attributes of the performer as well as the components of the occupation 

• Biomechanical: operation/interaction between physical structures of the body, or the biomechanical attributes of the task 

• Sensory-motor: operation/interaction between sensory input and motor responses of the body, or the sensory aspects of the task 

• Cognitive: operation/interaction between mental processes, the cognitive dimensions of the task (simplicity or complexity) 

• Intrapersonal: interaction between internal psychological processes (emotions, mood, self-esteem) 

• Interpersonal: the continuing and changing interaction between a person and others 

Key Elements OPM(A) - Core elements

'Core elements of human existence'   

• Body: all of the tangible physical components of human structure 

• Mind: core of our conscious and unconscious intellect that forms the basis of our ability to understand and reason 

• Spirit: sense of harmony within self and between self, nature, others and in some cases an ultimate other 

Key Elements OPM(A) - Environment

Both internal and external; below are external 

• Physical: the natural and constructed surroundings 

• Sensory: the sensory surroundings of a person 

• Cultural: an organised structure composed of a systems of vales, beliefs, ideals and customs which contribute to the behavioural boundaries of a person or group of people 

• Social: an organised structure created by the patterns of relationships between people who function in a group which in turn to establishing the boundaries of behaviour 

 

Environment Cont. 

• Physical 

• Sensory 

• Cultura 

• Social 

• Economic 

• Political