OTPF Competency Exam Study Material – Part I

Occupational Therapy Practice Framework: Domain and Process, Fourth Edition (OTPF-IV)

official document of the American Occupational Therapy Association (AOTA) that was intended for OT practitioners and students, other health care professionals, educators, researches, payers, policymakers, and consumers; presents a summary of interrelated constructs that describe OT practice

occupational therapy

therapeutic use of everyday life occupations with persons, groups, or populations (i.e., the client) for the purpose of enhancing or enabling participation

OT clients

persons (including those involved in care of a client), groups (collections of individuals having shared characteristics or a common/shared purpose), populations (aggregates of people with common attributes such as contexts, characteristics, or concerns, including health risks)

domain of OT

occupations, contexts, performance patterns, performance skills, client factors

occupations

everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life; include things people need to, want to, and are expected to do

activities of daily living (ADLs), instrumental activities of daily living (IADLs), health management, rest and sleep, education, work, play, leisure, social participation

occupations

activities of daily living (ADLs)

(8); activities oriented toward taking care of one's own body and completed on a routine basis

bathing/showering

obtaining and using supplies; soaping, rinsing, and drying body parts; maintaining bathing position; transferring to and from bathing positions

toileting and toilet hygiene

obtaining and using toilet supplies, managing clothing, maintaining toilet position, transferring to and from toileting position, cleaning body, caring for menstrual and continence needs (including catheter, colostomy, and suppository management), maintaining intentional control of bowel movements and urination and, if necessary, using equipment or agents for bladder control

dressing

selecting clothing and accessories with consideration of time of day, weather, and desired presentation' obtaining clothing from storage area; dressing and undressing in a sequential fashion; fastening and adjusting clothing and shoes; applying and removing personal devices, prothetic devices, or splints

eating and swallowing

keeping and manipulating food or fluid in the mouth, swallowing it (i.e., moving it from the mouth to the stomach)

feeding

setting up, arranging, and bringing food or fluid from the vessel to the mouth (includes self-feeding and feeding others)

functional mobility

moving from one position or place to another (during performance of everyday activities), such as in-bed mobility, wheelchair mobility, and transfers (e.g., wheelchair, bed, car, shower, tub, toilet, chair, floor); includes functional ambulation and transportation of objects

personal hygiene and grooming

obtaining and using supplies; removing body hair (e.g., using a razor or tweezers); applying and removing cosmetics; washing, drying, combing, styling, brushing, and trimming hair; caring for nails (hands and feet); caring for skin, ears, eyes, and nose; applying deodorant; cleaning mouth; brushing and flossing teeth; removing, cleaning, and reinserting dental orthotics and prosthetics

sexual activity

engaging in the broad possibilities for sexual expression and experiences with self or others (e.g., hugging, kissing, foreplay, masturbation, oral sex, intercourse)

instrumental activities of daily living (IADLs)

(11); activities to support daily life within the home and community

care of others (including selection and supervision of caregivers)

providing care for others, arranging or supervising formal care (by paid caregivers) or informal care (by family or friends) for others

care of pets and animals

providing care for pets and service animals, arranging or supervising care for pets and service animals

child rearing

providing care and supervision to support the developmental and physiological needs of a child

communication management

sending, receiving, and interpreting information using systems and equipment such as writing tools, telephones (including smartphones), keyboards, audiovisual recorders, computers or tablets, communication boards, call lights, emergency systems, Braille writers, telecommunication devices for deaf people, augmentative communication systems, and personal digital assistants

driving and community mobility

planning and moving around in the community using public or private transportation, such as driving, walking, bicycling, or accessing and riding in buses, taxi cabs, ride shares, or other transportation systems

financial management

using fiscal resources, including financial transaction methods (e.g., credit card, digital banking); planning and using finances with long-term and short-term goals

home establishment and management

obtaining and maintaining personal and household possessions and environments (e.g., home, yard, garden, houseplants, appliances, vehicles), including maintaining and repairing personal possessions (e.g., clothing, household items) and knowing how to seek help or whom to contact

meal preparation and cleanup

planning, preparing, and serving meals and cleaning up food and tools (e.g., utensils, pots, plates) after meals

religious and spiritual expression

engaging in religious or spiritual activities, organizations, and practices for self-fulfillment; finding meaning or religious or spiritual value; establishing connection with a divine power, such as is involved in attending a church, temple, mosque, or synagogue; praying or chanting for a religious purpose; engaging in spiritual contemplation; may also include giving back to others, contributing to society or a cause, and contributing to a greater purpose

safety and emergency maintenance

evaluating situations in advance for potential safety risks; recognizing sudden, unexpected hazardous situations and initiating emergency action; reducing potential threats to health and safety, including ensuring safety when entering and exiting the home, identifying emergency contact numbers, and replacing items such as batteries in smoke alarms and light bulbs

shopping

preparing shopping lists (grocery and other); selecting, purchasing, and transporting items; selecting method of payment and completing payment transactions; managing internet shopping and related use of electronic devices such as computers, cell phones, and tablets

health management

(7); activities related to developing, managing, and maintaining health and wellness routines, including self-management, with the goal of improving or maintaining health to support participation in other occupations

social and emotional health promotion and maintenance

identifying personal strengths and assets, managing emotions, expressing needs effectively, seeking occupations and social engagement to support health and wellness, developing self-identity, making choices to improve quality of life in participation

symptom and condition management

managing physical and mental health needs, including using coping strategies for illness, trauma history, or societal stigma; managing pain; managing chronic disease; recognizing symptom changes and fluctuations; developing and using strategies for managing and regulating emotions; planning time and establishing behavioral patterns for restorative activities (e.g., meditation); using community and social supports; navigating and accessing the health care system

communication with the health care system

expressing and receiving verbal, written, and digital communication with health care and insurance providers, including understanding and advocating for self or others

medication management

communicating with the physician about prescriptions, filling prescriptions at the pharmacy, interpreting medication instructions, taking medications on a routine basis, refilling prescriptions in a timely manner

physical activity

completing cardiovascular exercise, strength training, and balance training to improve or maintain health and decrease risk of health episodes, such as by incorporating walks into daily routine

nutrition management

implementing and adhering to nutrition and hydration recommendations from the medical team, preparing meals to support health goals, participating in health-promoting diet routines

personal care device management

procuring, using, cleaning, and maintaining personal care devices, including hearing aids, contact lenses, glasses, orthotics, prosthetics, adaptive equipment, pessaries, glucometers, and contraceptive and sexual devices

rest and sleep

(3); activities related to obtaining restorative rest and sleep to support healthy, active engagement in other occupations

rest

identifying the need to relax and engaging in quiet and effortless actions that interrupt physical and mental activity; reducing involvement in taxing physical, mental, or social activities, resulting in a relaxed state; engaging in relaxation or other endeavors that restore energy and calm and renew interest in engagement

sleep preparation

engaging in routines that prepare the self for comfortable rest, such as grooming and undressing, reading or listening to music, saying goodnight to others, and engaging in meditation or prayers; determining the time of day and length of time desired for sleeping and the time needed to wake; establishing sleep patterns that support growth and health (patterns are often personally and culturally determined); preparing the physical environment for periods of sleep, such as making the bed or space on which to sleep, ensuring warmth or coolness and protection, setting an alarm clock, securing the home (e.g., by locking doors or closing windows or curtains), setting up sleep-supporting equipment (e.g., CPAP machine), and turning off electronics and lights

sleep participation

education

(3); activities needed for learning and participating in the educational environment

formal education participation

participating in academic (e.g., math, reading, degree coursework), nonacademic (e.g., recess, lunchroom, hallway), extracurricular (e.g., sports, band, cheerleading, dances), technological (e.g., online assignment completion, distance learning), and vocational (including prevocational) educational activities

informal personal education needs or interest exploration (beyond formal education)

identifying topics and methods for obtaining topic-related information or skills

informal educational participation

participating in classes, programs, and activities that provide instruction or training outside of a structured curriculum in identified areas of interest

work

(6); labor or exertion related to the development, production, delivery, or management of objects or services; benefits may be financial or nonfinancial (e.g., social connectedness, contributions to society, structure and routine to daily life)

employment interests and pursuits

identifying and selecting work opportunities consistent with personal assets, limitations, goals, and interests

employment seeking and acquisition

advocating for oneself; completing, submitting, and reviewing application materials; preparing for interviews; participating in interviews and following up afterward; discussing job benefits; finalizing negotiations

job performance and maintenance

creating, producing, and distributing products and services; maintaining required work skills and patterns; managing time use; managing relationships with coworkers, managers, and customers; following and providing leadership and supervision; initiating, sustaining, and completing work; complying with work norms and procedures; seeking and responding to feedback on performance

retirement preparation and adjustment

determining aptitudes, developing interests and skills, selecting vocational pursuits, securing required resources, adjusting lifestyle in the absence of the worker role

volunteer exploration

identifying and learning about community causes, organizations, and opportunities for unpaid work consistent with personal skills, interests, location, and time available

volunteer participation

performing unpaid work activities for the benefit of selected people, causes, or organizations

play

(2); activities that are intrinsically motivated, internally controlled, and freely chosen and that may include suspension of reality (e.g., fantasy), exploration, humor, risk taking, contests, and celebrations; complex and multidimensional phenomenon that is shaped by sociocultural factors

play exploration

identifying play activities, including exploration play, practice play, pretend play, games with rules, constructive play, and symbolic play

play participation

participating in play; maintaining a balance of play with other occupations; obtaining, using, and maintaining toys, equipment, and supplies

leisure

(2); nonobligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep

leisure exploration

identifying interests, skills, opportunities, and leisure activities

leisure participation

planning and participating in leisure activities; maintaining a balance of leisure activities with other occupations; obtaining, using, and maintaining equipment and supplies

social participation

(5); activities that involve social interaction with others, including family, friends, peers, and community members, and that support social interdependence

community participation

engaging in activities that result in successful interaction at the community level (e.g., neighborhood, organization, workplace, school, digital social network, religious or spiritual group)

family participation

engaging in activities that result in "interaction in specific required and/or desired familial roles"

friendships

engaging in activities that support "a relationship between two people based on mutual liking in which partners provide support to each other in times of need"

intimate partner relationships

engaging in activities to initiate and maintain a close relationship, including giving and receiving affection and interacting in desired roles; may or may not involve engagement in sexual activity

peer group participation

engaging in activities with others who have similar interests, age, background, or social status

contexts

the environmental and personal factors specific to each client (person, group, population) that influence engagement and participation in occupations

environmental factors and personal factors

contexts

environmental factors

(5); aspects of the physical, social, and attitudinal surroundings in which people live and conduct their lives

natural environment and human-made changes to the environment, products and technology, support and relationships, attitudes, services/systems/policies

environmental factors

personal factors

(13); the particular background of a person's life and living and consist of the unique features of the person that are not part of a health condition or health state

age, sexual orientation, gender identity, race and ethnicity, cultural identification/cultural attitudes, social background/social status/socioeconomic status, upbringing and life experiences, habits and past and current behavioral patterns, individual psychological assets, education, profession and professional identity, lifestyle, other health conditions and fitness

personal factors

performance patterns

acquired habits, routines, roles, and rituals used in the process of engaging consistently in occupations and can support or hinder occupational performance

habits, routines, roles, and rituals

performance patterns

habits

"specific, automatic behaviors performed repeatedly, relatively automatically, and with little variation"; can be unhealthy or healthyr, efficient or inefficient, and supportive or harmful

routines

patterns of behavior that are observable, regular, and repetitive and that provide structure for daily life; can be satisfying, promoting, or damaging; require delimited time commitment and are embedded in cultural and ecological contexts

roles

aspects of identity shaped by culture and context that may be further conceptualized and defined by the client and the activities and occupations one engages in

rituals

symbolic actions with spiritual, cultural, or social meaning contributing to the client's identity and reinforcing values and beliefs; have a strong affective component and consist of a collection of events

performance skills

observable, goal-directed actions that consist of motor skills, process skills, and social interaction skills

motor skills, process skills, social interaction skills

performance skills

motor skills

the group of performance skills that represent small, observable actions related to moving oneself or moving and interacting with tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life) in the context of performing a personally and ecologically relevant daily life task

positioning the body, obtaining and holding objects, moving self and objects, sustaining performance

motor skills categories

positioning the body

(3); stabilizes, aligns, positions

stabilizes

moves through task environment and interacts with task objects without momentary propping or loss of balance

aligns

interacts with task objects without evidence of persistent propping or leaning

positions

positions self an effective distance from task objects and without evidence of awkward arm or body positions

obtaining and holding objects

(4); reaches, bends, grips, manipulates

reaches

effectively extends arm and, when appropriate, bends trunk to effectively grasp or place task objects that are out of reach

bends

flexes or rotates trunk as appropriate when sitting down or when bending to grasp or place task objects that are out of reach

grips

effectively pinches or grasps task objects such that the objects do not slip (e.g., from between fingers, from between teeth, from between hand and supporting surface)

manipulates

uses dexterous finger movements, without evidence of fumbling, when manipulating task objects

moving self and objects

(7); coordinates, moves, lifts, walks, transports, calibrates, flows

coordinates

uses two or more body parts together to manipulate and hold task objects without evidence of fumbling or task objects slipping from the grasp

moves

effectively pushes or pulls task objects along a supporting surface, pulls to open or pushes to close doors and drawers, or pushes on wheels to propel a wheelchair

lifts

effectively raises or lifts task objects without evidence of excessive physical effort

walks

during task performance, ambulates on level surfaces without shuffling feet, becoming unstable, propping, or using assistive devices

transports

carries task objects from one place to another while walking or moving in a wheelchair

calibrates

uses movements of appropriate force, speed, or extent when interacting with task objects (e.g., does not crush task objects, pushes a door with enough force to close it without a bang)

flows

uses smooth and fluid arm and wrist movements when interacting with task objects

sustaining performance

(2); endures and paces

endures

persists and completes the task without demonstrating physical fatigue, pausing to rest, or stopping to catch breath

paces

maintains a consistent and effective rate or tempo of performance throughout the entire task performance

process skills

the group of performance skills that represent small, observable actions related to selecting, interacting with, and using tangible task objects (e.g., tools, utensils, clothing, food or other supplies, digital devices, plant life); carrying out individual actions and steps; and preventing problems of occupational performance from occurring or reoccurring in the context of performing a personally and ecologically relevant daily life task

sustaining performance, applying knowledge, organizing timing, organizing space and objects, adapting performance

process skills categories