Occupational Therapy Practice Framework: Domain and Process (OTPF-4)

Vocabulary practice flashcards covering the core concepts, domains, intervention approaches, FIM levels, and processes described in the Occupational Therapy Practice Framework: Domain and Process (OTPF-4).

Occupational Therapy Practice Framework (OTPF)

A foundational document developed by the American Occupational Therapy Association (AOTA)—currently in its 4th edition (AOTA, 2020), which replaced the 3rd edition (2014)—that establishes the language and constructs of occupation to describe the profession and therapy process for persons, groups, and populations.

Occupation

Everyday activities that bring meaning and purpose to life, which occupational therapists help clients engage in across categories including ADLs, IADLs, health management, rest and sleep, education, work, play, leisure, and social participation.

Activities of Daily Living (ADLs)

Activities oriented toward taking care of one's own body, including bathing, dressing, personal hygiene, grooming, toileting, and toilet hygiene.

Instrumental Activities of Daily Living (IADLs)

Activities that support daily life within the home and community, often involving complex multi-step processes, such as care of others, care of pets, child rearing, communication management, driving, financial management, home establishment and management, meal preparation and cleanup, religious and spiritual expression, safety maintenance, and shopping.

Health Management

A distinct occupation introduced in the OTPF-4 (separated out from IADLs) focused on developing, managing, and maintaining health and wellness routines, including medication management, symptom and condition management, communication with the healthcare system, physical activity, nutrition management, and social-emotional health promotion.

Rest and Sleep

Restorative occupations that support healthy, active engagement in other occupations; includes rest (quiet, effortless time away from demanding activity), sleep preparation (grooming, undressing, readying routines/environment), and sleep participation (sustaining sleep and caring for others' sleep needs).

Education

Occupational domain involving participation in formal academic environments (such as a child in school) and informal learning pursuits.

Work

Labor or employment-related pursuits, whether paid or volunteer, including employment interests and pursuits, job seeking and acquisition, job performance, retirement preparation and adjustment, and volunteer exploration and adjustment.

Play

Any spontaneous or organized activity that provides enjoyment, entertainment, amusement, or diversion.

Leisure

A nonobligatory activity that is intrinsically motivated and engaged in during discretionary time; provides diversion, amusement, and interest, contributing to one's quality of life.

Social Participation

Activities that involve social interaction and engagement with others, specifically within community, family, and peer contexts.

FIM Level 7 (Complete Independence)

The client performs all tasks making up the activity safely, without modifications, assistive devices, or aids, and within a reasonable amount of time.

FIM Level 6 (Modified Independence)

The client requires an assistive device, requires more than reasonable time, or presents safety (risk) considerations during task performance.

FIM Level 5 (Supervision or Setup)

The client requires standby assistance, cuing, or coaxing without physical contact, or requires a helper to set up necessary items or apply orthoses.

FIM Level 4 (Minimal Contact Assistance)

The client requires physical contact assistance no greater than touching/steadying and expends $75\%$ or more of the effort.

FIM Level 3 (Moderate Assistance)

The client requires more help than touching and expends half ($50\%$) or more (up to $75\%$) of the effort.

FIM Level 2 (Maximal Assistance)

The client expends less than $50\%$ of the effort, but at least $25\%$.

FIM Level 1 (Total Assistance)

The client expends less than $25\%$ of the effort required to complete the activity.

Top-Down Approach

An evaluation approach emphasized in the OTPF where the occupational therapist first evaluates the meaningful occupations the client wants and needs to engage in, followed by an analysis of the specific performance skills and client factors interfering with occupational performance.

Performance Skills

Observable, goal-directed actions consisting of motor skills, process skills, and social interaction skills used to engage in occupations.

Client Factors

Specific capacities, characteristics, or beliefs residing within the person that influence occupational performance, including values, beliefs, spirituality, body functions, and body structures.

Body Functions

The physiological functions of body systems (including psychological functions), such as vision, vestibular function, cognition, endurance, and strength.

Body Structures

Anatomical parts of the body, such as organs, limbs, and their components, that support body function.

Performance Patterns

Acquired habits, routines, roles, and rituals used in the process of engaging consistently in occupations.

Contexts

Broad construct in OTPF-4 (replacing 'context and environment') encompassing environmental factors (physical, social, and attitudinal surroundings) and personal factors (unique internal background of the individual).

Activity Demands

Aspects of an activity analyzed during intervention planning, including required objects and their properties, space demands, social demands, sequencing and timing, and required underlying body actions.

Occupational Therapy Process: Evaluation

The initial step of service delivery focusing on finding out what the client wants and needs to do; consists of developing the occupational profile and analyzing occupational performance using a client-centered approach.

Create/Promote (Health Promotion)

An intervention approach designed to provide enriched contextual and activity experiences that enhance performance for all persons in natural contexts of life, such as establishing community exercise programs (e.g., Knock out Parkinson's at the International Boxing Club).

Establish/Restore (Remediation)

An intervention approach designed to change client factors to develop a skill or ability that has not yet been developed, or to restore an impaired capacity or lost skill.

Maintain

An intervention approach designed to provide supports that allow clients to preserve the performance capabilities they have regained or to continue using functional capacities at their current level.

Modify (Compensation/Adaptation)

An intervention approach directed at revising the current context or activity demands to support performance despite residual or chronic functional limitations (e.g., using a raised toilet seat or adaptive eye-drop dispenser).

Prevent

An intervention approach designed to address the needs of clients with or without a disability who are at risk for occupational performance problems; focuses on slowing down or preventing disease, trauma, or decline (e.g., home hazard modification and fall prevention programs).

Therapeutic Use of Self

A central cornerstone of occupational therapy practice in OTPF-4 (not an intervention type) involving the practitioner's planned use of personality, insight, perceptions, and judgment within the therapeutic relationship to build rapport and facilitate client goals.

Interventions to Support Occupations

Methods and tasks that prepare the client for occupational performance, categorized into preparatory methods (done TO the client, such as PAMs, passive ROM, and orthotics) and preparatory tasks (done BY the client, such as theraputty exercises and cone stacking).

Consultation

An intervention type where the practitioner uses knowledge and expertise to collaborate with a client or organization to identify problems, create solutions, and make modifications to improve effectiveness without direct clinical administration.

OTPF-4 Outcomes

The end results of the occupational therapy process, comprising occupational performance, prevention, health and wellness, quality of life, participation, role competence, well-being, and occupational justice.