Techniques midterm

Adjunctive Methods

Preliminary steps used to prepare the client for purposeful activity.

Enabling Activities

Simulated or non-purposeful tasks that train specific body functions.

Purposeful Activities

Goal-directed tasks that have an inherent core meaning or end product.

Occupational Performance & Roles

The final stage where the client resumes their actual life roles in their context.

How does this fit into intervention planning?

dictates the flow of a treatment session or a long-term plan.

start with adjunctive methods to prepare the body

move to enabling activities to practice the movement

transition to purposeful activities to build functional stamina

conclude with occupational performance to solidify real-world independence.

MOHO (Model of Human Occupation)

Focuses on Volition (motivation), Habituation (routines/habits), and Performance Capacity (mind-body skills) within an environment.

PEO-P (Person-Environment-Occupation-Performance)

Occupational performance is the outcome of a dynamic interaction between the Person, their Environment, and their chosen Occupations.

Occupational Therapy Practice Models (Frames of Reference)

: Biomechanical Approach

Clients with intact central nervous systems but structural deficits (orthopedic issues, burns, fractures, arthritis).

Occupational Therapy Practice Models (Frames of Reference)

: Sensorimotor & Motor Learning Approaches

Clients with central nervous system damage (Stroke, TBI, CP, Parkinson's).

Occupational Therapy Practice Models (Frames of Reference)

: Rehabilitative Approach

Clients with permanent, chronic, or progressive deficits (SCI, advanced MS, amputations).

Service Competency

• Definition: The process of ensuring that two distinct individuals (usually an OTR and a COTA) can perform the same procedure, assessment, or intervention and achieve the exact same results.

Significance: It ensures clinical safety and guarantees that the OTA is competent to deliver specific standardized treatments under supervision.

Steps of the OT Process: • 1. Evaluation:

Gathering occupational profiles and analysis of occupational performance.

Steps of the OT Process: 2. Intervention

Creating the plan, implementing the therapy sessions, and reviewing progress.

Steps of the OT Process: 3. Outcomes

Measuring the success of the interventions and determining future steps or discharge.

Assessment Type : Standardized

Strict, prescribed protocols for administration and scoring. Norm- or criterion-referenced.

Cons: Rigid, lacks context FIM, Barthel Index, Box and Blocks test.

Assessment Type: Non-Standardized

Lacks a rigid protocol. Relies on clinical observation, interviews, and checklists.

Cons: Subjective, cannot easily compare scores.

Intervention Planning: Definition

The collaborative process of developing a strategy with the client to address targeted outcomes based on evaluation data.

Intervention Planning: Approaches: Create / Promote

Provide enriched contextual experiences to enhance performance for all people.

Intervention Planning: Approaches: Establish / Restore

Change client variables to develop a skill or ability that has not yet been developed or was lost.

Intervention Planning: Approaches: Maintain

Provide supports that allow the client to preserve their current performance capabilities.

Intervention Planning: Approaches: Modify (Compensate/Adapt)

Alter the environment or activity demands to support performance.

Intervention Planning: Approaches: Prevent

Address clients at risk for occupational performance problems to stop barriers from forming.

Manual Muscle Testing (MMT)

• Purpose: To measure the maximum contraction force of a muscle or muscle group.

• Basic Process Parameter (Proximal Support): You must stabilize the proximal joint segment to isolate the target muscle and prevent compensatory movements (cheating).

MMT Grading/ Label

Normal (N) 5/5

Good (G) 4/5

Fair Plus (F+) 3+/5

Fair (F) 3/5

Fair Minus (F-) 3-/5

Poor Plus (P+) 2+/5

Poor (P) 2/5

Poor Minus (P-) 2-/5

Trace (T) 1/5

Zero (0) 0/5

Contraindications for MMT

• Bone fractures that are unhealed or unstable.

• Advanced, unhealed cardiopulmonary conditions or recent open-heart surgeries.

• Severe pain or severe inflammation.

Goniometry & Range of Motion (ROM)

• Implications (Why Use?):

To establish baseline joint mobility, track objective clinical progress, and assess structural limitations hindering occupations.

ROM Type: Active ROM (AROM)

Movement produced entirely by the client’s own muscle power.

ROM Type: Passive ROM (PROM)

Movement produced entirely by an external force (the therapist) while the client relaxes.

• Rule of Thumb for ROM:.

If PROM is greater than AROM, the issue is likely muscle weakness. If PROM and AROM are equally limited, the issue is likely a joint capsule or tissue contracture

• FIM (Functional Independence Measure) / Section GG: OT Assessments

Measures the burden of care and level of independence during ADLs. Used to satisfy reimbursement and track progress.

• Barthel Index: OT Assessments

Measures performance in basic ADLs (mobility and self-care) for neuromuscular or musculoskeletal disorders.

• Jebsen-Taylor Hand Function Test: OT Assessments

Measures broad, objective hand functionality and manual dexterity using timed everyday tasks.

• 9-Hole Peg Test: OT Assessments

Measures finger dexterity and fine motor coordination quickly.

Preparatory

Methods that target client factors to prepare them for purposeful activity.

Therapeutic Exercise

Structured, repetitive physical movements designed to address specific physical targets.

PAMs

Modalities utilizing physical properties to alter tissue temperature, soundwaves, or electricity.

ADLs

Direct training in basic everyday self-care tasks.

• Adapting (Modifying):

Changing the task components or environment permanently so the client can perform it immediately. Goal = Independence. (e.g., Giving a built-up spoon to someone with poor grip).

• Grading:

Incrementally making a task harder or easier to challenge the client’s capabilities over time. Goal = Remediation/Growth. (e.g., Starting with a 1 lb weight, then moving to 2 lbs next week).

• Simulating Activity:

Fabricating a scenario without the real objects (e.g., driving with a plastic toy wheel).

• Enabling Activity:

Non-purposeful mechanical components (e.g., stacking blocks to improve reach).

• Adjunctive Modalities:

Pre-activity interventions applied by the therapist (e.g., applying an ice pack).

Physical Agent Modalities (PAMs): Modality Type: Superficial Thermal

Hot packs, Paraffin, Fluidotherapy.

Physical Agent Modalities (PAMs): Modality Type: Cryotherapy

Cold packs, Ice massage.

Physical Agent Modalities (PAMs): Modality Type: Deep Thermal

Ultrasound.

Physical Agent Modalities (PAMs): Modality Type: Electrotherapeutic

NMES, TENS.

Physical Agent Modalities (PAMs): Modality Type: TENS

Manages pain signals; Pacemakers, directly over the carotid sinus, active seizures.

ADL and IADL Considerations

• ADLs (Activities of Daily Living): Care of one's own body (bathing, toileting, dressing, feeding, functional mobility).

• IADLs (Instrumental ADLs): More complex tasks supporting home and community life (meal prep, money management, driving, pet care, shopping).

•ADL and IADL Key Considerations

: Cognition, safety awareness, physical endurance, structural environment, and necessary durable medical equipment (DME).

Phases of Swallowing: 1 Oral Preparatory Phase:

Chewing food and mixing it with saliva to form a manageable ball (bolus).

Phases of Swallowing: 2 Oral Phase

The tongue pushes the bolus backward toward the throat.

Phases of Swallowing: 3 Pharyngeal Phase:

The swallow reflex triggers. The airway closes (epiglottis drops) to prevent food from entering the lungs.

Phases of Swallowing: 4 Esophageal Phase

Involuntary contractions push the food down into the stomach.

Dysphagia

difficulty swallowing safely.

Intervention Strategies for Safe Mealtime

• Positioning: Sit at a 90-degree upright angle with a slight chin tuck to protect the airway.

• Diet Modifications: Modify food textures (e.g., pureed, minced) and fluid viscosities (e.g., nectar-thick or honey-thick liquids).

• Environment: Keep things calm and quiet to reduce distractions that cause choking.

OT and Sexuality

Sexuality is an ADL. OTs address the physical, emotional, and mechanical aspects of sexual performance.

Common Physical Symptoms of Dysfunction

Male: Erectile dysfunction, difficulty ejaculating, hypertonicity/spasms.

• Female: Lubrication loss, dyspareunia (pain), vaginal spasms.

• P (Permission): The PLISSIT Model

Giving the client validation and a safe opening to voice concerns about intimacy.

• LI (Limited Information): The PLISSIT Model

Providing targeted factual data (e.g., stating that joint pain during intimacy is common with arthritis).

• SS (Specific Suggestions): The PLISSIT Model

Giving direct therapeutic tips (e.g., suggesting specific pillows for joint positioning or scheduling intimacy after pain medications).

• IT (Intensive Therapy): The PLISSIT Model

Referring the client to a specialized sex therapist or medical doctor for complex psychiatric or physical issues.