Occupational Therapy 101
OT101 - BSOT
Foundations in Occupational Therapy and Rehabilitation
Week 1 Lecture - Miss Nikki
What is OT?
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Therapeutic use of everyday life activities (occupation) with
individuals or groups for the purpose of participation in
roles and situations at home, school, work or community
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OT services are provided for the purpose of promoting
health and wellness and to those who have/are at risk for
developing an illness, injury, disease, disorder, condition,
impairment, disability, activity limitation/participation
restriction
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OT addresses the physical, cognitive, psychosocial, and
other aspects of performance in a variety of contexts to
support engagement in everyday life activities that affect
health well-being and quality of life
OCCUPATION
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Goal-directed pursuits extend over time and has meaning to
the performer and involves multiple tasks
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1. Ordinary and familiar things that people do everyday
Form: objective set of circumstances, independent and
external to a person
EXAMPLE: Kuya G drives a taxi for a living
2. Function: goal of actions
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EXAMPLE: Kuya G’s job is to drive a taxi in order to provide
his family with enough income and to support his children’s
school matriculations.
3. Meaning: reason behind actions
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EXAMPLE: Kuya G’s job as a taxi driver is essential for him
because he is able to bring people from one place to
another and makes him feel that he was able to help the
passengers relieve their stresses because of how they tell
Kuya G their life secrets and express their emotions.
THERAPY
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Treatment of an illness/disability
AREAS OF OCCUPATION
1) Activities of Daily Living (ADL)
Oriented toward taking care of your own body (e.g bathing)
2) Instrumental Activities of Daily Living (IADL)
Oriented toward interacting with your environment (e.g care for
others)
3) Play
Provides enjoyment, entertainment, amusement/diversion
4) Leisure
Any non-obligatory activity that is intrinsically motivated and
engaged in during free time (e.g homeless & imprisoned people
are educated by OTs on opportunities that are available to them)
5) Work
Act of seeking employment, maintaining/performing a job,
preparing for retirement, or volunteering
6) Social Participation
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Engaging in the community and among friends
elderly/aging individuals
Inability to drive/community mobility difficulties
7) Education
Any activity required for learning and engaging in the learning
environment
8) Sleep and Rest
Process of preparing for sleep, act of sleeping, and
any quiet action that results in relaxation.
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GOAL?
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Increase ability of clients to participate in everyday
activities
THREE PRACTICES
1. Client-centered practice
Approach to service that incorporates respect for
partnership with clients as active participants in the
therapy process
2. Occupation-centered practice
Focuses on meaningful occupations by clients and
performed in their typical settings
3. Evidence-based practice
Being able to integrate research evidence into the
professional reasoning process to explain the rationale
behind interventions and predict probable outcomes
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1. 2. 3. 4. 5. HOW?
Assessments: knowing their role what they usually do,
environment in home, people they’re usually with, skills,
strenghts and weaknesses
Setting goals: what the client wants to achieve, talk to theur
significant other (prents, guardians) if they’re unable to
communicate
Developing a plan: plan of how to achieve the goals that we
have set by exercise, practice, modifying the environment,
speaking to a child’s teacher, speaking to the employer’s
boss if he/she is a disabled worker
Implementing: of intervention strategy such as playing,
exercide, buttoning the shirt
After implementing, go back to assessment to see if our
treatment was effective/there is a need for revision.
OTs May…
1. Advocate for clients
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Helping the client participate in their natural environment
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If a person is working and he/she got injured then is still
having the injury upon returning to work but is already able
to do something with the use of a wheelchair
-
Includes talking to the manager and educating him/her that
the client is in a wheelchair if we can remove the bumps in
the road/if we can let the person work in the 1st floor
WHAT DOES AN OT DO?
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Foundations in Occupational Therapy and Rehabilitation
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More on helping the person settle in their natural
environment
2. Make Equipment
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Not necessarily make but OTs can but equipment
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Ex. a rubber can opener can be used for clients with weak
fingers/hands
3. Provide experiences
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Since our clients have limitations on their actions, it’s our
job to provide them with the experiences before they got
injured/create new experiences that would help them be
more functional individually and in the society
DO OTs HELP PEOPLE GET JOBS?
YES, because:
1. We have them do what they can do
2. Fit the skills of the clients and to the employees
3. Make sure they can adapt to the workplace
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People who have problems that interfere with their ability
dysfunctions that it is necessarily a diagnosed disorder
DYSFUNCTIONS DISORDERS
genetic emotional
neurolgical phychological
musculoskeletal social
immunological behavioral
cardiac
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WHERE DO OTs WORK?
1) Community settings
-
When we work in a community, we need to identify
the things that impaired their ability to function as a
community
-
E.g. OTs suggests participating in health programs
like zumba, medical missions, regular check-up
2) School
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● PEOPLE SERVED & PROBLEMS/DISABILITIES ADDRESSED
BY OTs
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Anything that a person might have that makes it difficult for
them to do everyday activities
OTs can help people who are NOT DIAGNOSED (ex.: clients
are not diagnosed with anything but find it difficult to
interact with other people, OTs can help by: practicing
social skills, provide them with strategies on how to be
comfortable with speaking to others, relaxation techniques)
Working with children who have difficulty in their
school activities like reading, writing, playing with
other children
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-
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OTs can work in normal regular education, they can
be with the clients in school hours, even inside the
client’s classroom
3) Hospital
-
OTs get patients who are admitted (in-patients) or
those that have been discharged and go to the
rehabilitation center
4) Government
Some programs include disaster risk reduction and
management, wherein OTs help people who got
affected by natural calamities
E.g people who get PTSD from a typhoon and won’t
be able to get out of their houses because they’re
scared that they might be hit by the typhoon
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Working with a larger scale of people in the LGU
(local government unit)
5) Clinics
6) Prisons
-
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Includes adult and pediatric clinics
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Correctional facilities
OTs help people correct themselves and not just
allow people to be locked up forever
OTs help prisoners build skills such as getting a
place to rent once they get out, getting a job and
interact with people around them
7) Offices
-
E.g call center agents who sit on their chair for a long
time and talk with clients which result to back pain
and neck pain
-
-
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OTs help in adjusting the environment like the
measurement of the client’s chair and table
OTs providerecommendations that agents have
to rest or take a break or stretching exercises in a
regular interval
8) Psychiatric Institutions
Working with in-patient and out-patient clients who
have mental health problems
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ACTIVITIES DURING INTERVENTION
→ Purposeful Activities
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Meaningful to clients and are chosen by them
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E.g patient says he/she likes to cook, so the OT can give
activities wherein the client can practice cooking like
slicing, tasting the soup, measuring ingredients
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Assigning tasks to clients depending on the ability of the
client to perform them
1) Occupations and Activities
Occupations: daily life activities (e.g going to the
grocery to buy canned goods)
Activities: Actions designed and selected to support
the development of performance of skills and
performance patterns to enhance occupational
engagement. These are what you do in the center,
role playing (e.g buttoning the polo)
2) Interventions to support occupations
Prepare the client for occupational performance
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Supervision of wheelchair
Using electricity in equipments which produce a
small current that relieves pain to help with
movement
3) Education and Training
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Education: knowledge and information about
occupation, health, well-being, and participation
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If the patient has limited knowledge about their actions,
OTs can educate them
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Teaching clients how to use equipments
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Training: facilitation of the acquisition of concrete skills for
meeting specific goals in a real-life, applied situation
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E.g: if you have a new leg, training the patient on how to put
it on, how to clean it, how to walk using it
4) Advocacy
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Efforts directed toward promoting occupational justice and
empowering clients to seek and obtain resources to fully
participate in daily life occupations
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Could be that the patient can ask for an accommodation or
the occupational therapist will do
5) Group Interventions
Facilitate learning and skill acquisition across the lifespan
through the dynamics of group and social interactions
If OT’s clients have similar skills, we can group them
together and have them do an activity together. Together,
they can share materials/make something
6) Virtual Interventions
-
Use of simulated, realtime, and near-time technologies for
service delivery absent of physical contact, such as
telehealth or mHealth
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EXAMPLES FOR ACTIVITIES DURING INTERVENTION
1) Occupations and activities
OCCUPATIONS ACTIVITIES
Reaching a jar using a
reacher
paralympics
eating Buttonng a shirt
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2) Interventions to support occupations
Provision of wheelchair
Using barbel
Putting pegs on a pegboard to improve coordination
OT measuring the client’s body dimensions to check
if the wheelchair will fit the patient perfectly/there
needs to be some adjustments
Provision of prosthesis
Meditating (regulating your emotions)
3) Education and Training
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Parents: teaching clients and their significant other on the
importance of therapy, routine, exercise
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4) Advocacy
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Allowing wheelchairs in the classroom
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Helping clients get back to work
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Providing education to the disabled
5) Group Interventions
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Teaching clients how to count
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Old people exercising together
6) Virtual Interventions
OT asks client/s how he/she is today, what he/she
ate
Ask the significant other of the client to record the
client doing their occupations
QUESTIONS
What if the workplace of the client will not try to
implement what was suggested for that client?
Law for Discrimination of Disabled persons
Consider the accommodations you are suggesting (must be
reasonable, feasible in the workplace, not too expensive)
If accommodation is not given by the head of workplace,
you can use them for it or ask the client to work in another
workplace with the same job
1) -
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DOCUMENTATION IN OT
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TYPES OF RECORDS:
1. Clinical Records
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Patient care (ex.: OT notes, referral notes, assessment
notes)
2. Administrative or Departamental Records
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Statistical records, personal management records,
equipment supply records, financial records
● PURPOSE
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Provide legal, serial record of client’s condition (legal
document)
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Information resource for client care to facilitate effective
interventions
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Communicate information about client from OT perspective
(can be used when a patient or client transfers to another
OT)
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Provide data for use in intervention, evaluation, research
and education (this will be used as a proof for
reimbursement to their insurance)
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PURPOSES OF RECORD KEEPING
1) For betterment of patient care
2) Education
3) Communication (OTs to parents, OTs to OTs)
4) Third party payers, reimbursement
5) Social benefits (SSS)
6) Legal aspects
7) Research
8) Motivation tool
9) Administrative control
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AUDIENCE
1) Medical Professionals
2) Education professionals
3) Accreditation agencies
4) Payers
5) The client/caregivers
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CONTENTS
1) Function and purpose
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records should be clear and purposeful
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record the activities per session (OT notes)
2) Communicability
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Records should be clear because this will be shared to
doctors, teachers, etc.
3) Standardization
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Achieve consistency which is essential for comparison
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Ex.: evaluation: use same format and re-evaluation to see
difference/improveme nts/problems solved
4) Form development and design
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Ex.: color, sizes, font style of the paper must be consistent
5) Ownership and Retention
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All records are owned by clinic and cannot be released
without permission
Documentation in Clinical Settings
In hospitals, we have rehabilitation facilities, out-patient clinics,
mental health centers, and home health. Similar types of
documentation are used although the frequency of documentation
may vary.
In clinical documentation, it generally involves reporting and
interpreting a client's response/s or assessments in interventions
in a medical record. These are the things that must be seen in a
document in an OT practice.
● Date of completion of report
● Full signature and credentials (of the OT)
● Type of document (if its OT notes, initial evaluation)
● Client name and case number on each page (not just in the first
page)
● Acceptable abbreviations as determined by the facility
● Acceptable terminology as determined by the facility (always
follow the uniform terminology and abbreviations in OTs)
● Corrections made with a single line through the error and initials
of the person who made the error are written above
● No use of an eraser or correction tape or fluid
● Record storage and disposal that complies with federal and state
laws and facility procedures
● Protections of confidentiality (we are not allowed to put other
client’s name sa patient’s document, bali dapat name rajd sa tagiya
anang document ang naa)
● Black or blue ink, never pencil (Sames, 2005) - this applies to
hand written notes
Documentation of the Initiation of Occupational Therapy
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● Screening - if the client is seen for screening or introduction
prior to an evaluation, a short note is usually written in the
medical records summarizing the conversation and the results of
the screening. (in abroad, it's the OT assistant who is usually
taking down the notes but here in the PH, it's the direct OTs are the
one doing it)
- Determine whether or not the person would benefit from an
occupational therapy evaluation.
● Evaluation - this is written by the OTs to document the starting
point of the Occupational Therapy intervention and it contains
factual data collected during the evaluation process and the
interpretation of the evaluation findings.
There is a need to document the OT services before interventions
can be implemented.
The very first evaluation is initial evaluation nya mao to di nalng
ko mo discuss unsay sulod ani pero ang initial evaluation will take
place first before the treatments begin and is the foundation of
selecting treatment objectives and methods. It also identifies the
Physics, performance areas and components.
Typically, the evaluation report contains the following:
● Identifying information and background information
● Referral information
● Evaluation procedures and/or test used
● Occupational profile (the client’s perception of the need for
occupational therapy. The context that supports or hinder
occupational performance or brief history of Occupation)
● Findings or results of the evaluation process
● An interpretation of the meaning of the findings or results that
reflects the occupational needs of the client
● A plan, including goals, frequency, duration, and location of
intervention
● Signature and credentials of the occupational therapist (printed
name of the OT and licensed number)
Documentation of Continuing OT Services
● Progress notes - these are used periodically to document the
interventions used, the progress towards functional goals and the
updating of the goals and interventions/ treatment plan. It is
usually written after each intervention session
● Clinical notes/OT notes - these are used to document individual
occupational therapy sessions. Same, it is also written after each
intervention session.
One of the most common forms of documenting the client’s
progress is through the “S-O-A-P” notes.
S - Subjective (experience of the client)
O - Objective (OT’s objective)
A - Assessment
P - plan
Soap notes is a practice that strengthens the communication of the
OT professionals
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RUMBA (Relevant, Understandable, Measurable,
Behavioral, Achievable)
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POMR (Problem-Oriented Medical Record) - SOAP , BIRP
(Behavior, Intervention, Response, Plan)
Documentation of Discontinuation of Occupational Therapy
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Two types of documentation in discontinuation:
● ENDORSEMENT NOTES
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Used to document client’s basic information, the problems
and improvements for the continuation of treatment.
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made for the next OT if ever the client transfers.
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Content: (1) name, (2) age, (3 sex, (4) address, (5) the
referral source and the services requested, (6) the
problems list, (7) the management and activities that were
given during the past OT sessions, (8) list of improvements
and progress after a number of treatment sessions, and (9)
the recommendation from the past OT to the next therapist.
● DISCHARGE NOTES
- These documents are used as a summary of the course of therapy
and any recommendations.
- Content: therapy process, goal attainment, the functional
outcome of the client’s interventions (summary2
●OTPF (GOALS)
- SMART (Specific, Measurable, Attainable, Realistic,
Time-bounded)
-Specific: tangible outcome, what does client want to do
-Measurable: tracking progress and gives concrete data on the
client’s performance
-Attainable: how much time you have with the client along with
their current level of functioning
-Realistic: be realistic, do something the client can actually achieve
-Time-Bound: certain time for the goal
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ABCD (Audience, Behavior, Condition, Degree)
Audience: performer
Behavior: desired functional behavior to be demonstrated
or increased
Condition: circumstances
Degree: time period goal to be met
Ex: The child (audience) will be able to eat
(behavior) using a spoon without difficulty
(condition) within 8 weeks of the OT session
(duration).
- CARE (Clarity, Accuracy, Relevance, Exceptions)
Not usually used in the Philippines and other places but
there are still OTs that will use this format.
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➔
➔
left out.
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GUIDELINES:
Legible handwriting (prefer handwritten than encoded).
Correct grammar and spelling
Be concise, but complete, non-important details should be
Be objective with clear distinctions between facts vs
behaviors and opinions vs interpretations (the therapist should
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not be biased, be more objective and more aware of our opinions
vs interpretations/observations).
➔
Be current and accurate, active
rather than passive voice.
➔
Use first person language at all times (ex: child with autism
or child with a mental disorder).
9. Corrections made with a single line through the error and
initials of the client who made the error are to be placed or written
above - False
10. One of the most common forms of documenting the client’s
progress is called SOAP . Subjective Objective Assessment and Plan
- True
DOCUMENTATION QUIZ
1. It is the type of document made prior to evaluation, a short
note written in medical record summarizing the result -
Screening
2. This is a document written to record the starting point of
the OT intervention - evaluation
3. These are used periodically to document care coordination,
interventions, progress toward functional goals, into update
goals and intervention or treatment plan - progress notes
4. 5. This is used to document individual OT session - OT notes
In a goal-oriented statement SMART , letter R means -
Realistic
6. The following are the requirements in documentation in OT
services, except:
- clients name and case number on the top of the first page
7. This pertains to patient care records - Clinical records
8. The purpose of documentation is for communicating
information about the client in OT perspective - True
OT PROCESS (MORE NOTES ABOUT THIS IN LECTURE 4 BECAUSE
MISS NIKKI HAD A SHORT DISCUSSION ABOUT IT)
1) Referral - Referral Notes
2) Screening - Screening Report
3) Evaluation - Evaluation Report
4) Intervention - Progress Notes, OT Notes, SOAP Notes
5) Re-evaluation - Re-evaluation Report
6) Discontinuation of OT/Discharge - Endorsement Notes,
Discharge Notes
TOOLS OF PRACTICE
(ACTIVITY & OCCUPATIONAL ANALYSIS, GROUP PROCESS,
PROFESSIONAL, REASONING, THERAPEUTIC USE OF SELF AND
CONTEXT & ENVIRONMENT)
ACTIVITY AND OCCUPATIONAL ANALYSIS: We have to identify
the things that a person has to do in order to complete something
(activity or occupation) that one is engaged in.
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Occupational Analysis: systematically analyzing what and
how a person or groups of people actually do an activity
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Activity Analysis: considering a more general idea of how
things are usually done.
Let’s differentiate them more:
Grading: the part of modifying or either increasing or decreasing
the challenge of an activity.
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Can involve increasing or decreasing the level of difficulty.
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If the person finds it too easy, we can add something to
make it more difficult to help our clients to include the
skills they have right now. And if the person finds it too
hard, we modify it to make them perform the activity easier.
Ex:
Method: if a person can’t chew properly, we can give them soft
food. Then, if a person is able to easily chew after weeks of therapy,
you can modify their food and give them something that requires
more chewing like biscuits, sticky food, etc.
Environment: things that u are using, natural environment, setting
that you are eating in which could be a restaurant or at home.
Materials and equipment: provide seat belts for people who are
not able to sit properly.
In performing AA (Activity Analysis) and OA (Occupational
Analysis), you have to include specific procedures: Before, During
and After the Activity, Duration, Frequency and Preparation.
Ex:
BEFORE Meals: setting the table, going to the dining area, sitting
down, washing your hands, praying. DURING Meals: picking up the
food using the utensils, eating.
AFTER Meals: wash the dishes, making the clients go to the sink to
wash the plates, paying for the meal (if in a restaurant).
DURATION: eat for 10 mins, FREQUENCY: eating thrice a day
PREPARATION: prepare the food, prepare plated meals, etc.
BRIEF OVERVIEW OT PROCESS:
(as explained by Miss Nikki)
● SCREENING: meeting your patient and identifying if the patient
needs further evaluation. Just to give an overview of the strengths
and weaknesses of the patient.
● EVALUATION: detailed skills, abilities and basic personal
information of the clients and everything that is important for OT .
● GOAL SETTING: talking to your clients and discussing what they
want to achieve.
● TREATMENT PLANNING:
planning what activities you’re going to give the patients.
● INTERVENTION/ TREATMENT IMPLEMENTATION: this is
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when the patient performs all of the activities discussed during the
planning.
● REVIEW/REEVALUATION:
trying to know if there’s been progress and how you can improve
the treatment to the patient. This can also determine if the patient
should continue their therapy session or discontinue.
You perform OA and AA during the assessment or Evaluation in the
OT Process because:
- For OA: the client has difficulty in eating, this will tell you the
specific portion to where they have difficulty in. Is it the way they
hold their utensils? Do they choke on their food? Do they know
how to sequence things like cutting then putting it in the mouth or
different order?
This also determines the cultural consideration like chopsticks or
using hands.
- For AA: you are trying to visualize what a person usually does
when they eat. List down the things of how eating is usually done.
After writing OA or an AA, you have to observe how the clients
perform it in your analysis. If you see what portion the client has
difficulty in, that’s when we do the Grading.
Having an OA and an AA gives us a baseline of where the client is
so that we can modify activities as part of the Evaluation process.
IMPORTANT NOTES:
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When making an OA, we consider the person, take note of
their habits, roles, routine, and analyze factors that could affect
and support their performance.
● CONTEXTS: Encompasses both environmental and personal
factors. It provides more details to a specific situation.
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Environmental Factors: aspects of the physical, social, and
attitudinal surroundings in which people live and conduct
their lives. These are things happening around us. The
things we can and can’t see and control.
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Natural Environment and Human-Made Changes to the
Environment: living and nonliving things that probably have been
modified by people. Also include the characteristics of the people
in that area.
Ex:
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Physical geography
→
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geographical location of where the person is living
→ ex.: i live in the city pero it’s “sudlunon”
, it’s like 200 meters
from the main road so it’s quieter here than in the highway
Population
→ groups of people living in an
environment who share the same pattern of
environmental adaptation
→ ex.: for those who live in Cebu City, it’s a little bit cloudy so it’s a
little cooler than usual. With that, we wear sleeved shirts or pants
instead of our usual sleeveless shirts and shorts
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flora and fauna (plants and animals)
- climate
→ weather pattern that requires a long period of time
→
ex.:
october-december: rainy season; march-may: hot,
summer season
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natural events
→ regular or irregular atmospheric changes that cause disruption
in the typical environment
→ earthquake, typhoon, or the weather is too hot
→ if you live in an earthquake-prone area, it is regular for you to
experience earthquakes
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Human-caused events
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Light intensity and quality
→ if you’re working or writing, you can’t do it efficiently if your
surrounding is too dark
→ if your surrounding is too bright, it’s gonna be painful for your
eyes to look at
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Time-related changes
→ natural, regularly occurring or predictable changes. Time of
day, week or month.
→ ex.: holy week: people pray the rosary, attend mass
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sound and vibration
→ heard or felt
→ ex.: neighbor’s car is noisy (sound), the walls of a room is where
the gate is built on so every time the gate is
opened/closed, the floor of the room vibrates (vibration)
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air quality
→ if the neighbor’s car is on, the smoke from it gets into the
person near the car (bad air quality)
→ if you’re near plants and trees, the air quality is breezy
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Products and Technology:
→ things that we use, can be held, gathered, create
→ ex.:
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Food & drugs
- general products for personal use (ex.: modified can openers,
lightweight materials that a person with hand weakness can use)
- indoor and outdoor mobility (golf cart, scooters, bikes,
wheelchairs, stroller)
- Communication (everything that we use to
send and receive information like J&T Express,
ninjavan, messenger, mobile phone providers, telephone)
- Education (acquiring information and skills like formal education
and informal education like enrolling in a TESDA course,
books, computers, crayons)
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Employment (paid work activities, the things you do in your
work)
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Cultural, recreational, sporting (badminton racket)
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practice of religion and spirituality (having a grotto at
home)
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indoor and outdoor human-made environment (planned,
constructed or designed for public and private use; ex.:
malls, pools)
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assets for economic exchange (trading for something
like money; ex.: in barter communities, people exchange
their TVs for a DVD player)
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virtual environments (could occur in simulated, in real-time
or near-time situations but there has
to absence of physical contact like the person
is in his/her room then he/she calls his/her sister
throughthe phone, this is considered a virtual
environment because even if they are under the same roof,
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the person is still using the phone to communicate his/her
sister)
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Supports and Relationships:
Everyone that’s around you
could include people who could harm you
→ immediate and extended family
→ friends acquaintances
→ people of authority (police, boss)
→ personal care providers (OT , psychiatrist)
→ domesticated animals (they help us emotionally either
good or bad)
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Attitudes:
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Observable customs, practices, ideologies, values that
people hold other than the client
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Ex:
→ individual (not your attitude but the attitudes of those around
you; individual attitudes of your immediateor extended family, of
your friends, of people around you. Ex.: only one of your family
members is vegetarian but everybody else eats meat)
→ societal attitudes (as a whole, that is their
perspective/viewpoint of a certain situation including
discriminatory practices; ex.: a group of people are
discriminative to the LGBT people and saying bad things about
them)
→ social norms, practices and ideologies (these are practices
that marginalize specific populations; ex. (1): same sex marriage -
this can marginalize to a specific community because if
2 men cannot marry each other, they also have a lesser chance to
have a child together. Because it’s a social norm, it could affect the
occupation of certain individuals/communiti es. Ex. (2): people
who are disrespectful to the people living in the streets, like they
throw stuff at them because they are seen as “less”
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Services, Systems and Policies:
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Systems that we are able to help us meet our needs
including the people who do them
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More on products
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Ex.: LBC, scrolling through shopee or buying there then the
items you buy get delivered to you
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services designed to meet the needs (ex.: getting your
national ID)
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systems established by governments (ex.: the ayuda that
people received when the pandemic started)
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policies constituted by rules, regulations, conventions,
and standards established by governments (ex.: avoid
loitering, people are expected to be in their homes at 10
o’clock
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Personal Factors: 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.
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→ Ex:
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Age
sexual orientation
gender identity
race and ethnicity
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cultural identification and cultural attitudes (own values
and beliefs)
social background, social status, socioeconomic status
(including if you were shy as a kid and didn’t have many
friends or if you were a social butterfly and like to spend
time with people)
upbringing and life experiences (including family life,
education, work experiences; ex.: people who have
experienced heart attack which is commonly caused by
eating unhealthy food or having sedentary lifestyle)
habits and past, and current behavioral patterns (if the
person eats 10x a day of lechon, it’s not going to be good for
the heart. As an OT , you could help the client modify that
one)
individual psychological assets (including character traits,
impairments, coping, how they handle responsibility
and stress. If you are extroverted, shy, confident, insecure)
Education (where you went to school, how students dealt
with online classes, the performance of a person reading
books)
profession and professional identity (includes work
or volunteer jobs, things that you like doing)
Lifestyle (Eating habits, emotional regulation, physical
exercise)
other health conditions and fitness (physical and
physiological factors of a person, condition of a person’s
heart)
I. Professional Reasoning
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The process that practitioners use to plan, direct, perform,
and reflect on client care
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During practice, wherever we are, we incorporate
professional reasoning to how we view client’s diagnosis,
how we create goals, and interact with our patients
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This will help us in being able to successfully create
treatment goals for our client
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We use our cognitive skills but more importantly this
requires the metacognitive analysis
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metacognition: thinking about how you think, allows us to
reflect on what we did or what we are doing in the moment
or after session (example: your client is doing exercises,
then you feel like your client is still unable to carry the
weight that you provided, so right then and there you’ll be
able to adjust your activities for your patients or maybe
provide lesser weight or have them perform something else
before moving on to a heavier weight
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Cognition: use attention, concentration, judgment,
executive function,
I. Cognitive Process Underlying Professional Reasoning
1. CUE ACQUISITION
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searching for the helpful and targeted information through
observing and questioning
Tools of Practice (part 2)
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Since we don’t know anything about our clients yet, we look
for information such as their occupational profile,
objective
assessment (strengths, range of motion, cognitive skills) through
observation in their everyday activities
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If we simulate activities in the center
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By asking the patients directly like what they are used to
doing, what they find difficult, what strategies they use to
compensate for the skills that are not all there
2. PATTERN RECOGNITION
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noticing similarities and differences among situations
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Patients who undergo the same diagnosis might have the
same occupational problem or might have differences also
depending on what they want to achieve, beliefs, so many
factors that make each patient different and similar to one
another
3. LIMITING THE PROBLEM SPACE
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using patterns to help focus cue acquisition and knowledge
application on the most fruitful areas
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When we meet our patients, sometimes we see all the
difficulties and it becomes too broad, too big of a problem,
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in identifying the main goal of the client so that we can
adjust those problems immediately and we won't focus on
things that they don't find important
4. PROBLEM FORMULATION
developing an explanation of what is going on, why it is going on,
and what a better situation or outcome might be
Before we create interventions, we have to identify the problems of
our client, their goals, difficulties and strengths so we can work
around those information
5. PROBLEM SOLUTION
Identifying courses of action based on the problem formulation
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Sometimes these solutions work, sometimes not so much
and it takes time and repetition of experiences as a
practitioner to fully understand the efficiency of a
treatment intervention strategy or in how efficient we
create goals, on how quickly we can modify activities
during treatment session
→ All these cognitive processes are backed up by both long term
memory and working memory
→ LONG TERM MEMORY
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contains all information we gathered from schools
(knowledge from high school and elementary and our everyday
experience as OTs)
→ WORKING MEMORY
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If you know how to ride a bike, how to swim, but then you
haven't taken a dip in the pool for how many years or if you haven't
gone for a ride on your bike for how many years, eventually when
you do it, you still remember how it’s done and while you’re doing
it, you're also practicing what to do next
→ SHORT TERM MEMORY
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the things that are going on in a shorter span of time. (ex:
asking your patient what they had for breakfast, being
introduced to new people)
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will help us quickly identify if there's anything new to talk
about to our patients especially during our treatment
sessions because as we build rapport and trust with our
patients, we usually make chikka with them about how
their day is going or what they did the day before that they
found difficulty in doing or maybe the things they found
success in their small achievements that they had
throughout the week that you haven't seen each other
→ in order to do these cognitive processes, we also have to chunk
information into smaller parts or group information together for
us to have a categorized set of knowledge. For example, for mental
health, you have all these information you stored, all these
strategies that you found to be effective. for pediatrics or kids with
ADHD, Autism, you also have this set of techniques that you found
effective and so when you meet a client with a specific diagnosis or
when you meet a new patient and you have an idea of what they
have, you can directly get information from those chunks that you
already have
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→ cognitive processes don't happen one by one, sometimes
they are interwoven with each other. as you recognize patterns,
you also identify problems. If you have one patient that's new
while you're still figuring out the other one, you'll be able to be
more flexible in creating intervention strategies or in interacting
with them.
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→ People have different ways of communicating. Some
people are shier than others, some people are more extroverted
than others. So, we have to adjust also during practice
IB) ASPECTS OF PROFESSIONAL/CLINICAL REASONING
1. SCIENTIFIC
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understand the condition that is affecting an individual and
to decide on interventions that are in the client’s best
interest
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focused mostly on the condition/diagnosis of the patient
primarily and moving towards interventions from there
2. DIAGNOSTIC
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concerned with clinical problem sensing and problem
definition
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includes the signs and symptoms of the disease, the
prognosis or the clinical outcome of the disease, how long
it's supposed to feel (if it gets worse or better)
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looking primarily for occupational performance problem
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focused on the condition of the client
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2.1 MEDICAL DIAGNOSIS
→ diagnosing clinical condition like Autism, ADHD, mental
illnesses, cough, colds
→ what the doctors give/ advised
→ example, if you have fever which could be caused by dengue
(this is diagnosed by a doctor, while the OT’s diagnosis would be
difficulty in ADL specifically in bathing due to body mallae or
difficulty moving because of painful joints)
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2.2 OT DIAGNOSIS
→ pinpointing the occupational difficulties that the client has
→ the OT diagnosis would be that the client requires assistance in
meal preparations due to weakness in the limbs, sequencing
issues, temperature sensitivity
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→ we’re specifying what occupations they have difficulty in and
what they are caused by.
For example, the doctor will diagnose you with dengue, whereas
the OT will diagnose you on the difficulties of doing ADL (difficulty
in moving: painful joint, feeding: body malaise). By this example,
the difference of how we see and identify problems is based on
what we observed from our client (their functional performance)
3. PROCEDURAL
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occurs when practitioners are “thinking about the disease
or disability and deciding which intervention activities
(procedures)
they might employ to remediate the person’s functional
performance problems”
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getting information through interviews asking about how
they do things, observing the person doing something or
engage in a task, formal evaluation using standardized
measure (using NTAE)
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we are not entirely basing our clinical reasoning on the
diagnosis of the patient because the manifestation of the
client is different from case to case. For example, in the case
of dengue fever, some people cannot stand up because they
have internal hemorrhage, some just have plain fever,
others get to stay at home or in the hospital.
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we ask the clients to perform their daily occupations either
in the hospital room or at home. From there, we map out
what we do next. It is focused on the order what we provide
for the patient, specifically the procedure what we give to
them.
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HOW IS PROFESSIONAL REASONING USED/HOW IS IT
OBSERVED BY OTs?
For example, if the client experienced a stroke.
Diagnostic: we are looking at the effects of stroke such as
weakness in the limb, forgetting, being out of balance. From there
we are trying to figure out what interventions to use. It could be
through exercise, stretching, strengthening, balance and
coordination exercise.
Procedural: it's more on the step by step, or in order of the
condition that we can implement. In the example case, the set
procedures that we have is to strengthen, increase the range of
motion, restoring function like: balance, coordination
TYPES OF PROFESSIONAL REASONING
1. NARRATIVE - used to make sense of people's
circumstances; imagine the effects of illness,or occupational
performance problems on their daily lives;and create a
collaborative story through intervention.
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Thinking in a story form. When you have a new patient, you
have to understand where they come from, what their
interests and goals are, why they find it important to seek
out OT services. In the case where a child has dengue, you
have to ask the child what they usually do, if he/she plays
outside, the environment he/she lives in (if there are
stagnant waters that may be the cause of dengue). By
understanding those factors, you will be able to provide
interventions, such as giving strategies to avoid recurrent
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problems; getting rid of stagnant waters, using off-lotion,
and drinking lots of water when sick.
Through learning their background, we can locate the cause
and find solutions for what they want to achieve.
2. PRAGMATIC - used to fit therapy possibilities into the
current realities of service delivery (scheduling, therapist’s skills,
payment options, equipment, availability).
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Pragmatic reasoning is Practical reasoning since we use the
resources that we have already.
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For example a patient cannot afford OT services that may
last for 6 months and even though that’s the best solution
you can give to the patient since their recovery is gradual,
still you cannot force the client to OT services that they
can’t afford. What we can do is to provide immediate
solutions to their problems. An example of that is when a
client has difficulties going to the toilet, you can
recommend using a commode chair to be put inside the
room so that they won’t have to go to the comfort room
whenever they need to use the toilet. If ever that alternative
is still unaffordable for the client then the best way is to ask
a caregiver or S/O of the client to help him/her in going to
the toilet. And, if there’s no one present in the client’s home,
the OT can suggest on using some adult diapers
- This kind of reasoning is more on being realistic and practical.
Especially here in the PH, where most people don’t really see the
importance of going to therapy because it’s expensive and they
have to travel. Some will just plainly accept that they had a stroke
and there’s nothing you can do about it. When that happens, be
ready to adjust your goals and the recommendations that you can
give when they decide to stop going to therapy sessions. By the
advice you can give, they can still perform it at home to continue
recovery even though they already stop doing OT services.
3.ETHICAL - directed towards analyzing ethical dilemmas,
generating alternative solutions, and determining actions to be
taken.
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One example is doing sexual activity. This is not common
here in the PH but this part on the scope and domain of
practice. Before recommending this to your client, you have
to assess your values first if it’s comfortable for you to give
assistance to your client on this matter or if ever not, you
can refer your client to another OT that is more expert on
this area. If you are comfortable providing interventions of
that kind to your client then you are very welcome to do so
but if not you may prefer doing the referral instead and as
long as the client also is comfortable with you providing
them that kind of intervention.
Another example, if the goals of the patient and the S/o
differ, you have to think and prioritize more on the client's
goals. But if the client is not reasonable enough of his/her
goals, or if they are more demotivated or seeking therapy,
you can speak to the family and discuss other options they
can pursue.
4. INTERACTIVE - thinking directed toward building positive
interpersonal relationships within clients, permitting collaborative
problem identification and problem solving.
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Gives importance to the therapist and client relationship or
professional relationship, being able to provide motivation
enough for the client to be able to stand on their own since
we cannot be with them forever but at the same time we
establish trust to be able to work and achieve their goals.
Being interactive with the client and them to each other
people also relates to it.
5. CONDITIONAL - a blending of all forms of reasoning for the
purposes of flexibly responding to changing conditions for
predicting possible client futures.
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Sometimes, we expect certain results or a span of timeline
for the recovery of our client. Oftentimes they get worse
throughout the time of the therapy session or get better
more than we expected them to. If that happens, we can
adjust the interventions or we can reevaluate our client so
that we can know what activities we could provide for
them.
All of these aspects of reasoning, we don’t only focus on one when
we become practitioners, it is almost always a mixture of
everything. As you go along with the practice, it's like figuring out
what style you have as a therapist. Some therapists focus on
scientific and diagnostic, some focus on what the client wants like
a narrative perspective, and etc. It’s not wrong if you only use one
type of reasoning, but sometimes focusing on only one aspect
could cloud one’s judgement on the other important aspects. It
may result in not covering other significant bases if you put your
mind on only one specific reasoning.
As a therapist we have to be reflective of our actions. Like now, we
have our reflective journals every week because in this way it
helps us to be able to reflect on what we have difficulty in, how we
solve problems, feelings about classes, the topic and how we can
apply it to real life.
Starting this early on, being reflective, will help us understand our
actions in the future.
Reflection on action - reflecting on what has already happened.
Ex. You feel the patient is not that interactive with you. In the next
session, you work on more interactive activities.
Reflection in action - reflecting right then and there on the action
that is happening. Ex. In class discussion, you participate in the
oral recitation and you somewhat give a wrong answer, you can
provide additional information that would correct what you have
said.
Professional reasoning also depends on the personality traits of
the therapist. There are different characteristics of every person.
As long as you have the best interest in mind for your client, you
can utilize any of the different types of reasoning.
EXPERTISE CONTINUUM
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How consistently an OT practitioner is effective within a
given context.
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Outlines how experienced a therapist is in what they do and
characterizes how long they are practicing
1. NOVICE (no experience)
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Depends on theory to guide practice
Uses rule-based procedural reasoning to guide actions but
does not recognize contextual cues, not skillful in adapting
rules to fit situation (too fixed on their plan already since
they are not experienced enough to
know what other possibilities that may happen)
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Narrative reasoning is used to establish social relationships
but does not significantly inform practice (sometimes they
might miss out some important informations since they
lack of practice)
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Job survival skills
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Recognizes overt ethical issues (recognize outwardly
expressed ethical issues, but underlying causes of this
issues will leave them challenged as they cannot read easily
between the lines)
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They also have difficulty looking into the future since they
have started their practice just recently.
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The longer you have been practicing, it also reflects how far
you can envision to the future
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These are mostly fresh graduates or newly passed in the
board exams. They usually follow by the book rules.
2. ADVANCED BEGINNER (<1 year)
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Begins to incorporate contextual information to rule-based
thinking (can use context clues depending on the needs of
the patient)
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Recognizes the difference between theoretical expectations
and presenting problems (sometimes we are so fixed
on the theories we learn, that it is difficult to be flexible on the
actual needs of the client. As you go along to the practice, you
become flexible as well)
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Does not prioritize well
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Relies on external guides, recognizes more subtle ethical
issues (in an OT clinic or center, there will always be seniors
or more older and experienced than us. With that they can
help us recognize our limitations and we can observe their
practice and learn from them.)
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Gaining skill in pragmatic and narrative reasoning
3. COMPETENT (1-3 years)
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Automatically performs more therapeutic skills (less
thinking and more on doing)
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Able to develop communal horizon with people receiving
service
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Able to sort to relevant data and prioritize intervention
goals
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Planning is deliberate, efficient, and responsive to issues
(when planning they are now able to do plans that is
aligned to the needs of the patient)
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Uses conditional reasoning to modify intervention but
lacks flexibility (1-3 years is still a short time of practice but
can now adapt more quickly on changing circumstances)
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Recognizes ethical dilemmas posed by practice setting
(they have strong commitment on ethical practice meaning
they always rely on the right thing to do)
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They have a heightened awareness of their practice
performance so they are more reflective on how well they
are on the problems they have. They are more creative in
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providing activities, don’t solely rely on routines, but can
improvise a lot faster and better, they have more sensitivity
and empathy for their patient. Also culturally sensitive
because they handle a lot of clients already. They are more
exposed, they can act out on cultural issues and family
issues.
4. PROFICIENT (3-5 years)
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Perceives situations as wholes (they can see their clients
more holistically as compared to seeing problem per
problem. They can understand more of how one problem
can affect the whole life of the patient. Not just the physical
problem or diagnosis but including the context that
supports or hinder performance)
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Reflects on expanded range of experience, permitting more
focused evaluation and more flexibility in intervention
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Creatively combines different diagnostic and procedural
approaches
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More attentive to occupational stories and relevance for
intervention (they are not “by-the-book” in doing
interventions)
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More skillful in negotiating resources to meet patient needs
(this is pragmatic reasoning. They are more practical and
they can improvised on the needs of the patients) (since we
have a small community in this practice we most likely
know most of the people in a certain place and with that we
can refer other clients to other OTs for conveniency)
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Increased sophistication in recognizing situational
nature of ethical reasoning (it’s okay if you don’t get paid
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immediately per session but the important thing is that the
client have come to the center and had their OT session)
In this stage we are also more proficient in the part where
we are ready to say goodbye to our long term patient even
though it's sad but we are glad that our client can live on
their own already.
5. EXPERT (5-10 years)
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Clinical reasoning becomes a quick intuitive response (even
though without thinking, you ask just one question of how such a
thing happened you can quickly act on it, hence we have that
gut-feeling.)
- Procedural and pragmatic reasoning more detailed
- Able to flow conversation and action smoothly (you don’t get lost
in the middle of the conversation even if you are having an activity
with your client)
- Use understanding of the client's perspective to determine
intervention (can understand more on the importance of
occupations for the client. For example, they can understand more
that it is very important for a client to be independent on their
everyday activities, if they don’t want help from their relatives or
they can understand that the client doesn’t want to learn the skill
because they have a caregiver to do it for them.)
- Relies on internal guides or images to support actions (they can
think more about what is more important for their client.
Somehow, they kind of know that it’s the right thing to do. But
there is a disadvantage in practicing for a long period of time,
because you have an instant answer to a specific problem, maybe
the other problems will not be seen anymore because you
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already have an answer to it. Sometimes, you may probably miss
out something that’s important as well. Although, being an expert
is good, it’s also good to see fresh perspectives especially to new
treatment strategies because sometimes also if you’re doing the
same thing for years, you will not be updated on your practice on
what’s new, and the current trends in practice)
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Experts Add qualities to your work, or to the output of your
profession.
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Experience helps you identify cues, form strategies quicker
because it is based on having an experience, gaining
experience and being experienced. You cannot grow if you
are not experiencing things; including good and bad
experiences.
THERAPEUTIC USE OF SELF
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The therapist’s role in working consciously with the
interpersonal side of the therapeutic relationship to
facilitate an optimal experience and outcome for the client
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Related to interactive reasoning
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It’s how we carry ourselves so that our patients will be able
to engage more in our treatment sessions. Example, if
you're working with children, you should be more active in
talking to them and child-friendly
as compared to when you're speaking with adults.
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How you use yourself to engage the patient in therapy
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You have to be self-aware of your own characteristics,
personality, emotional responses and behavior and your
effect on other people because it’s difficult to get the
response that you want from your client. For example, you
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have to be aware if you get mad easily so that you’ll be able
to regulate your emotions if you get triggered by something
the client says or if you get harassed by a client
Self-awareness has 3 aspects
1) Ideal self
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expectations of your best self. (As an OT , I have to be kind,
empathetic, patient) but sometimes this gets challenged by
certain situations
2) Perceived self
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what others think of you without them knowing your
intentions(first impression)
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Example: “ay kani sha maldita ni kay nipis ug kilay”
, “angry
man ni sha kay red ug lipstick always”
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How other people see you without getting to know you
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Sometimes, those around us notice certain things that we
cannot notice ourselves in our own behavior
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Communication is good because it helps you realize that
maybe you spoke something that's too harsh to your
patient, maybe you're not assertive enough that's why your
patient doesn't listen to you
3) Real Self
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Blending of external and internal worlds.
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For example, you understand that you are shy and you also
understand that you have to be active so that your patient
(a child) will listen to you.
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Being able to modify your behavior according to the needs
of your client is the real self
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You know that “I’m doing this for my patient but this is not
actually how I am all the time”
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At least you know who you are without your patients
● THINGS THAT WE HAVE TO CONSIDER WHEN WE’RE USING
OUR BEHAVIOR AS ADJUNCT TO THERAPY:
1) Empathy
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Being able to understand others’ perspective by putting
yourself in the shoes of others
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Empathy is understanding how your patient feels while
sympathy is showing your patients that you feel
sorry/happy for them
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Pity is not good because you don't want to feel sorry for
your patients, you only want your patients to be
empowered in themselves so that they can believe that they
will be able to get back to what they did before. In order to
practice this, watch documentaries, talk to people with
disabilities and try to understand how they're feeling from
their perspective
2) Trust
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Your relationship with your patient should have a mutual
trust
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Trust your patients to carry out their activities even when
they're at home and they trust you to provide them with the
best care that you can give them
3) Verbal and non-verbal communication
→ VERBAL COMMUNICATION
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Includes tone of voice, pitch (lowness and highness of
voice), jargon, language, speedness of how you talk that
affects the behavior of other people
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For example: some people find people with soft voice
irritating; while some people find those with a deeper voice
comforting
You have to gage your patients about which voice will best
work with them. For example, if you have attended
childrens party, the host usually has a high voice but if you
are attending a funeral, mas modulated ang voice sa host to
accommodate the feelings and emotions of other people
and to get into the moment
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As OTs, we have to figure out if what works best for our
patients and use layman’s terms (words that are not
scientific) because our patients if they are not doctors, PTs,
they won't be able to understand what we’re talking about.
We have to give our patients something that they
understand
→
NON-VERBAL
COMMUNICATION
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Includes eye contact, facial expressions, gestures, body
language, and touch
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Other people find touch irritating, others find it comforting.
If you don't need to touch the patient in the first session,
the patient might think that you are feeling too close with
him/her, so we need to gage our abilities
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If you’re talking to children, your facial expressions are
more exagged than when you’re talking with adults. We
have to adjust our communicative skills
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Body Language: When you talk to patients, for them to be
able to open up to you, you should have an open posture
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showing that you are receiving information which includes
leaning forward, nodding, not crossing your legs, open your
arms
4) Active listening
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Listening in a way that allows the person you are talking to
to make them think that you are really listening to them.
When they’re talking, you should nod, insert something that
relates to them
-
Giving feedback to patients on how they did during their
exercises helps them be more aware of how they did.
Example, you tell your patients that your exercise will just
be 2 pounds of weight and you see your patient very
motivated, you give them encouragement like “very good ka
today because you were able to complete the exercises
today. Next time, we’ll use na heavier weights” this
motivates them to do better and makes them feel that they
achieved something
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MODES OF INTENTIONAL RELATIONSHIP
1) ADVOCATING
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Ensuring that the client’s rights are enforced and resources
are secured. May require the therapist to communicate with
external persons and agencies.
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If you feel like the patient can benefit from
reasonable accommodation, you can suggest those.
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If the patient is a victim of bullying, you can talk to the
school administrators and provide opportunities to lessen
the bullying in general
2) COLLABORATING
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Expecting the client to be an active and equal participant in
therapy. Ensuring choice, freedom, and autonomy to the
greatest extent possible.
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This is collaborating with not only the patient but also the
other members of the team such as the PT , teachers, nurses,
doctors.
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Example: a person who is experiencing substance abuse
(shabu) should be provided with meaningful activities that
would put their minds off of using the substance and using
their time more efficiently to be useful members of the
community. You can give them a structured routine on what
they can do everyday so that they won’t have idle time on
using drugs
3) EMPATHIZING
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On going striving to understand the client’s thoughts,
feelings, and behaviors while suspending any judgment.
Ensuring that the client verifies and experiences the
therapist's understanding as truthful and validating.
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Putting yourself in the shoes of others and suspending
judgment because we don’t know what’s happening in the
lives of our clients so empathizing helps them feel that you
are not judging them and you’re them to support them
4) ENCOURAGING
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Seizing the opportunity to instill hope in a client.
Celebrating a client’s thinking or behavior through positive
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Foundations in Occupational Therapy and Rehabilitation
reinforcement. Conveying an attitude of Joyfulness,
playfulness and confidence.
5) INSTRUCTING
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Carefully structuring therapy activities and being explicit
with clients about the plan, sequence, and events of therapy.
Providing clear instruction and feedback about
performance. Setting limits on a client’s requests or
behavior.
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It’s important to be able to instruct clearly on what you
want your patients to do
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Example: today, i’d like you to talk to 3 nurses and ask them
how their day was (has to have structure, clear instructions,
so that the person who is confused will also be able to do
specifically what you ask them to do)
6) PROBLEM SOLVING
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Facilitating pragmatic thinking and solving dilemmas by
outlining choices, posing strategic questions, and providing
opportunities for comparative or analytical thinking.
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Enabling clients to think for themselves so that they can
solve their own problems and they can create solutions to
the problems they’re experiencing
● BASIC THERAPEUTIC USE OF SELFs (ORDER OF FRIENDLINESS)
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Attitudes that we use to interact with our clients to
encourage the best or to bring out the best result
1) Active friendliness
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simply being very friendly just like talking to a child. Your
pitch and tone is more pronounced.
when you’re meeting a new person
2) Passive friendliness
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If you are talking to someone who’s shy or suspicious, you
don’t want to be overly friendly. If you feel that the person is
uncomfortable with too friendly people, you opt for passive
friendliness.
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You are not expecting them to be as active as you but you
are being friendly. You ask them about their interest or
anything but not in a bombarding way.
3) Kind firmness
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used to people who are stubborn or persistent.
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If clients feel like they can play you, mind games you, use
kind firmness because you’re still kind but you want them
to do what you tell them.
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You show/act kindness to the person but still hold firm on
having them obey and respect you on what you told them to
do. For example, manipulative kids/adults or on kids who
don’t want to do things, or in the case of depressed people
who tend to be demotivated.
4) Matter-of-factness
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This is when you want to assert them. For example, on
clients who are aggressive, or clients who are sexually
preoccupied, or have an intention to harass you, you use
matter-of-factness by stating what is wrong and their
actions are not right.
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Foundations in Occupational Therapy and Rehabilitation
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You can use this if the patient understands that what they
did is wrong. This is the ultimate way of stating their wrong
doings in the right degree of strictness.
5) No demand
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We use this to patients who are overly aggressive to the
point where they hit you physically and do tantrums. We
wait for them to regulate their emotions. You sit down at a
corner, observing them and give them time to regulate
themselves. It makes them feel you are not overly
demanding something from them. And, you are just there
for the patient.
GROUP INTERVENTIONS
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Very useful for people who are working on their social
skills. Like, a man who is socially anxious wants to get to
know a certain person. With that you can practice doing
activities like GTKY and do role-playing.
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This is not limited only to people who have psychosocial
problems but they can also entail to people who have
physical problems. Especially, if they are demotivated or
they need social support from others who have the same
problems
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Cost-effective and versatile, build social relationships,
provide a context for social support, and can be designed to
achieve multiple goals simultaneously. In addition, group
interventions: (the sequence of the activity would depend
with the therapist so that they can encourage interaction
between other people)
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“Enhance communication and self-expression, provide an
atmosphere of non judgemental acceptance,” (especially if
the members of the group are experiencing the same
condition, it is a sense of community of their common
problem.)
“Offer multiple opportunities to share learning,” and
“Facilitate client participation” and provide a context for
problem solving relationships
A group intervention consist of two or more people
A people in a group, they also have to be on the same level
so that it’s not too erratic on the changes and they can work
on the same goals
●
WHY OCCUPATIONAL THERAPY PRACTITIONER SHOULD
INCORPORATE GROUP INTERVENTIONS IN THEIR PRACTICE?
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Groups provide an occupation-based
experience that is reality-oriented and that promotes
adaptation. (For example, a person who doesn’t want to
ride a jeepney because they don’t want to bother the person
beside him/her to pass the fare to the driver. What you can
do is to have a group of patients ride a jeepney together so
that they can practice the same skills along with other
patients who are struggling with the same thing.)
Groups are a natural environment that can provide
feedback and support for individual and social needs. (They
can see the other performance of the other people in the
group and with that they will be motivated to do better.)
Through participating in group activities that promote
growth and change, members can learn and practice skills
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Foundations in Occupational Therapy and Rehabilitation
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to master and achieve competence in activities required for
daily life. (You can have activities like sewing, so that they
can sew clothes for their children; you can also have
children who aren't talking with each other but playing the
same game or doing the same activity)
Doesn’t require that much participation but you're still
getting them used to being with other people at a specific
time
When groups provide an opportunity for dealing with
real-life issues and objects, people can maintain, improve or
enhance their occupational nature to fulfill social demand
because no man is an island, it's very true, because even if
you live alone, you still interact with other objects around
you like animals, plants, the world. You can't live inside your
own self. You have to interact with other people and things
and issues with other people. You can't go to school and not
be in groups. You can't go to work and not pass by the guard
of the building every day.
Working in groups enables our clients to get used to the
presence of other people, to be able to talk with other
people, to achieve the same goals of movement and
strength, anything that you would like 2 or more people to
achieve together is considered as group interventions