Clinical Reasoning and Activity Analysis- Week 5

Occupational Justice

  • Definition: Occupational Justice – “A justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences” (Nilsson & Townsend, 2010).

    • every person has the right to occupational justice

  • Key components:

    • Includes access to and participation in the full range of meaningful and enriching occupations afforded to others.

    • Includes opportunities for social inclusion.

    • Includes resources to participate in occupations to satisfy personal, health, and societal needs.

  • Significance: Frames OT practice around equitable participation in everyday life activities, not merely remediation of deficits.

Course Announcements

  • Week 5 announcements: guest lecture and lab substitution on Wed, Aug 20th for Dr. K’s Lab.

  • OT Case Study Paper due by 11:59 PM on Sunday, Aug 31st.

  • Exam 1 on Wed, Sept 3rd at 2:00 PM; duration: 1 hr1\,\text{hr}; format: 5050 multiple-choice questions; covers content from weeks 1 – 7; administered through Edverum.

Fieldwork

  • Fieldwork request: open Prism portal and add address(es) you’re willing to commute from for Level IA (Jan 26–30, 2026 or Feb 2–6, 2025).

Definitions

  • Occupational Justice (reiterated): as above.

Clinical Reasoning

  • Overview: A cognitive process comprising thought, evidence, and experience used to plan, direct, perform, and reflect.

  • Purpose: To guide clinical decision making across OT activities.

Types of Clinical Reasoning

  • Narrative Reasoning

    • helps us figure out patients though their history and story

      • Narrative slope: draw a line to represent your timeline, and major points

  • Procedural Reasoning

    • understanding the procedures and protocols necessary for the setting your are working in

      • e.g.: gowning and gloving protocols are critical to maintaining a sterile environment, ensuring patient safety, and minimizing the risk of infection.

  • Interactive Reasoning

    • the interpersonal approach to build rapport

      • e.g. looking at non-verbal cues to notice client is uncomfortable with seating, then you adjust their seat

      • with resistant clients- taking on the role of nurturing patient instead of OT- what’s going on?

        • e.g. structure for neurodivergent teens- they know what to expect, have parents involved at the end

  • Pragmatic Reasoning

    • looking at what’s possible within your context

    • Do the things necessary for care

    • e.g. know client needs vestibular input- plan ahead with swing ready for session

      • or putting the supplies back such as toys for other OT’s and clients

      • scheduling- how many client sessions for them to meet their goal

  • Ethical Reasoning

    • doing the right thing at the right time- doing the moral action

  • Scientific Reasoning

    • evidence-practice- process medical conditions

    • using all scientific knowledge to apply to our client

  • Diagnostic Reasoning

    • taking the scientific reasoning and applying specifically to the client diagnosis

      • not general knowledge but unique to the client

  • Conditional Reasoning

    • combination of other types of reasoning

    • the whole person

    • usually for more experienced OT’s

Narrative Reasoning

  • BAD vs GOOD visualization (example illustrates life story influence on practice):

    • Elements include personal history (e.g., impoverished childhood, early diagnoses), major life events (e.g., hospital admissions), current goals (advocacy, financial stability), and interactions with support systems.

    • Narrative traces a client’s life story to inform understanding and rapport.

  • Narrative Reasoning – Key characteristics:

    • Personal and client-focused.

    • Provides a framework to learn about a person’s life story.

    • Helps build rapport with the client.

    • Narrative slope- use with clients for them to identify life and milestones

  • Source reference: Ennals & Fossey (2009).

Procedural Reasoning

  • Definition: Use of protocols or specific therapeutic interventions.

  • Components:

    • Standardized assessments

    • Setting-specific procedures

      • gowning if it is required by the facility, ensuring all staff adhere to infection control protocols.

Interactive Reasoning

  • Definition: Client-centered approach that builds rapport and tailors therapy.

  • Key elements:

    • Individualizing therapeutic approach

    • Therapeutic Use of Self

Pragmatic Reasoning

  • Definition: Identifying practical strategies for real-world implementation.

  • Considerations:

    • Teamwork

    • Scheduling

    • Space and Equipment needs

    • Insurance coverage

      • how much will it cost for their coverage for equiptment required for patient- do the afforadable ooption or if they can get more

Ethical Reasoning

  • Definition: Selecting morally justifiable choices.

  • Guiding framework: Occupational Therapy Code of Ethics

Scientific Reasoning

  • Definition: Evidence-based practice focus.

  • Orientation: Focuses on diagnosis, conditions, guiding theory, and research.

  • Note: Not necessarily client-based.

Diagnostic Reasoning

  • Definition: Incorporates client-based information in addition to evidence-based data.

Conditional Reasoning

  • Definition: Combines other types of reasoning.

  • Focus: Whole person; respects autonomy and client values.

Professional Reasoning Continuum

  • When starting to practice as an OT professional- we will develop are clinical reasoning

  • Stages and typical experience levels:

    • Novice (No experience)

    • Advanced beginner ((<1) year)

    • Competent (1--3 years)

    • Proficient (3--5 years)

    • Expert (5--10 years)

Activity and Occupational Analysis

  • Context: OT practice framework elements and analysis processes.

  • Page markers show the focus on activity demands and client context.

Activity Analysis (Framework and OTPF-4)

  • According to Framework-III (AOTA, 2014):

    • OTs analyze the demands of an activity or occupation to understand the specific body structures, body functions, performance skills, and performance patterns required.

    • Determine the generic demands the activity or occupation makes on the client.

  • OTPF-4 (AOTA, 2020):

    • Generic and decontextualized analysis to understand typical activity demands within a given culture.

Activity Analysis – Definition and Purpose

  • Definition: Systematic process of breaking down an activity into its component parts to understand its demands, the skills and performance patterns it requires, and its potential meaning for the client.

    • Other definition: Breaking it to component parts that are essential for the activity

  • Factors examined:

    • Steps, tools, and materials needed

    • Motor, process, and social interaction skills required

    • Cognitive, sensory, and emotional demands

    • Environmental and contextual influences

    • Safety considerations

Case Example: Parkinson’s Disease and Journaling

  • 72-year-old patient with Parkinson’s reports difficulty writing due to hand tremors but still journals daily.

  • Purpose: Identify adaptations or strategies to continue journaling.

  • Ideas?

    • voice detecting; video diary

    • timing with medication- is it slow/fast release?

    • pen can be weighted

Occupational Analysis

  • Focus on a particular occupation.

  • Client foregrounds:

    • Life experiences

    • Values

    • Interests

    • Goals

  • Understand what’s important to the client, the activities that are meaningful

    • look at pain management

    • or improve performance

      • e.g. working with professional gamers, wanted to do more productivity with work

Activity and Occupational Analysis in OT Practice

  • OT practice components:

    • Evaluation

      • Set goals and objectives

    • Intervention plan

      • Preparatory activities

      • Chose meaningful and purposeful activities

      • Occupation-based activities

    • Outcome measures

Key Uses of Analyses

  • OT practitioners should understand:

    • General properties and demands of activities as typically performed in a given arena/culture

    • How to select activities that are occupationally relevant to clients

    • How to use occupations valued by clients to achieve their goals as occupational beings

Activity and Occupational Analysis – Demands (OTPF-4, Table 11)

  • Categories include:

    • Relevance and importance to the client

    • Objects used and their properties

    • Space demands

    • Social demands

    • Sequencing and timing

    • Required actions and performance skills

    • Required body functions

    • Required body structures

  • Do we learn all these occupations?

    • Yes, we want to be client centered

      • e.g. latte art, important to client

Grading Activity

  • on the test so be familiar with this

  • Concept: Grading involves making an activity easier or harder for the client.

  • Principle: “Just-right challenge.”

    • trying to find the balance, building the skills or making it harder to progress the skills

Adapting Activity

  • Adapting involves changing the actual task to adjust difficulty.

  • May involve:

    • Assistive technology

    • Environmental modifications and adaptations

    • Adjusting physical environment and social environment

Modifying Activities to Reduce Body-Structure Impact

  • Guiding question: How could this activity be modified to be less impactful on body structures?

  • Examples from slides:

    • Walking is less impactful than running.

    • Resting is less impactful than walking.

    • Modify the location to change demands.

    • Modify the level of difficulty.

    • Modify the level of assistance.

    • Change roles.

    • Modify the position (sit rather than stand).

    • Environment modifications.

    • Context modifications.

    • Add play, sensory experience, or turn the activity into a game.

    • Add socialization or creativity.

Activity and Occupational Analysis – Practical Examples

  • Brushing Teeth: Analyze relevance, objects used, space, social demands, sequencing, required actions, performance skills, body functions and structures; determine what performance skills are required.

    • electronic toothbrush

    • toothpaste dispenser

    • chair so don’t lean over

    • cup for water

    • faucet that has set time/sensory

  • Washing Dishes: Similar analysis examining the same domains

    • Skills: bending and gripping when holding dishes

    • soap dispenser

    • separation for side- so be faster when rinsing- closer to put away dishes

    • seated position

    • make sure to ask them how they do this?

      • cultural differences

Adaptive Pediatric Clothing

  • Reference to resources/videos on pediatric adaptive clothing.

Pediatric Adaptive Grips

  • Focus on grips suited for pediatrics (visuals referenced).

Adaptive Communication

  • Examples of communication options and contexts, including:

    • I want … to toilet, drink, food, play iPad, nap, wash

    • I feel happy, sad, mad, tired, etc.

    • Contexts: car, baby, music, TV, cuddle, headphones, etc.

    • Various vocabularies and symbol sets used to express needs and preferences.

Adaptive Equipment and Devices

  • Adaptive Equipment

  • Durable Medical Equipment (DME)

  • Assistive Devices

  • These sections cover tools and devices that support participation in occupations.

References

  • Ennals, P., & Fossey, E. (2009). Using the OPHI-II to Support People With Mental Illness in Their Recovery. Occupational Therapy in Mental Health, 25(2), 138–150. https://doi.org/10.1080/01642120902859048

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