Occupational Therapy Principles in Physical Health

Occupational Therapy Treatment in Rehabilitation, Disability, and Participation

Introduction

  • Occupational Therapy Practitioners (OTPs) serve individuals, groups, and populations by facilitating engagement in occupational performance.

  • Environments referred to as practice settings are made up of physical, social, and economic structures; these represent the continuum of care.

  • Practice settings vary widely from intensive care to home health, where OTPs address physical dysfunction.

  • Various theories and models of practice utilized include:

    • Model of Human Occupation (MOHO)

    • Biomechanical Approach

    • Sensorimotor Approach

    • Motor Learning Approach

    • Rehabilitation Approach

Distinct Value of OT in Rehabilitation, Disability, and Participation (RDP) Practice

  • The Occupational Therapy Practice Framework details the realm of occupational therapy concerning physical disabilities and highlights OTP's distinct value.

Treatment Continuum in Physical Dysfunction

  • The treatment continuum commences with the onset of injury or disability, concluding with the goal of maximal possible functional return.

  • Patients may enter the continuum at various stages during rehabilitation.

  • Table 1.3 illustrates the stages involved in the treatment continuum.

  • Figure 1.2 depicts the treatment continuum for practicing with physical disabilities.

Stages of Treatment Continuum

  1. Adjunctive Methods

    • Used to prepare the patient to engage in activities and include exercises, facilitation, selected Physical Agent Modalities (PAMs), and devices such as splints and braces.

    • Commonly used in the acute illness or injury stages but not limited to these phases.

  2. Enabling Activities

    • Require enhanced patient involvement and must meet at least two of the three key criteria:

      • Patient actively participates in the activity.

      • Activity necessitates and elicits coordination of sensory, motor, psychosocial, and cognitive systems.

      • There exists an autonomous goal beyond motor functions needed for the task.

    • Special equipment can be used, e.g., wheelchairs, ambulatory aids, assistive devices, special clothing, communication devices, and environmental control systems.

  3. Purposeful Activities

    • Core element of OT practice, part of daily routines, conducted within the natural context of occupational performance.

  4. Occupational Performance and Occupational Roles

    • Refers to the timeframe when a patient resumes or assumes occupational roles in their living environment or community.

Theories and Models of Practice in Physical Dysfunction

  • Each model has distinct advantages and limitations, assisting OTPs in strategizing treatments tailored to individual clients.

Model of Human Occupation (MOHO)

  • Basic Tenet: Humans possess intrinsic motivation to explore, interact with, and master their environment.

  • Individuals are inseparable from their environments, mutually interacting and influencing one another.

  • Contrasts Holistic model (encompassing complete individual) vs. Reductionistic model (focusing narrowly on one aspect, e.g., muscle function).

Subsystems of Human Occupation

  1. Volition

    • Refers to motivations to engage in occupations, encompassing:

      • Personal Causation: Sense of control.

      • Values: What is meaningful and important to the individual.

      • Interests: Activities deemed satisfying and interesting.

  2. Habituation

    • Involves the development of habits (to conserve energy) and internalized roles personalized by the individual.

    • Role Change or Transition: Noted in the text on page 8.

  3. Performance Capacity and the Lived Body

    • Involves the ability to participate in activities, subjective experiences, and beliefs regarding capabilities.

    • Lived Body: “The experience of being and knowing the world through a particular body.”

    • Perceptions of activities shift in response to bodily disabilities.

Complex Interactions and Interdependence

  • MOHO illustrates how disability impacts human occupation, allowing OTPs insight into challenges faced by individuals in varied functionalities.

  • Individuals may experience alternating optimism and despair, with varying intensities.

  • Factors such as:

    • Severity of the disability.

    • Duration (temporary or permanent).

General Principles of OT Intervention Using MOHO

  • Focus of therapy shifts towards client-driven change; the patient must actively engage in the therapeutic process.

  • Therapy must involve actual versus contrived occupations for maximal therapeutic gain, emphasizing relevance, meaningfulness, and appropriateness of activities.

  • OTPs play a crucial role in modifying tasks and environments to create the “just right challenge.”

Biomechanical Approach

  • This approach views the human body as a living machine, utilizing techniques informed by:

    • Kinetics: Study of motion and the forces acting on different objects.

    • Statics: Study of forces on stationary objects.

  • Employment of assessment and treatment techniques like measuring joint range of motion (ROM), muscle strength, therapeutic exercise, and orthotics.

  • Most appropriate for patients with intact central nervous systems (CNS) yet dealing with lower motor neuron or orthopedic disorders.

Sensorimotor and Motor Learning Approaches

  • Developed for individuals with CNS dysfunction.

  • Focused on normalizing muscle tone and eliciting more natural motor responses.

  • Integrates reflex mechanisms during purposeful activity.

Rehabilitation Approach

  • Aims to enable individuals to live as independently as possible despite existing disabilities.

  • Focused on helping patients learn adaptive strategies around or compensatory methods for their physical limitations.

Evidence-Based Practice

  • Emphasizes the necessity for research supporting practitioners in applying various models to enhance functional independence.

  • Occupational Therapy Assistants (OTAs) encouraged to adopt thoughtful approaches:

    • Formulate and answer questions for outcome research.

    • Engage with varied perspectives from clients and practitioners.

    • Utilize electronic databases and print sources for relevant information.

    • Contribute to data gathering, publication of outcome studies, and case study reports.

Chapter 2: Exploring Perspectives on Illness and Disability throughout the Continuum of Care

Introduction

  • OTPs must exercise empathy to acknowledge the individual’s experience with disability, reflecting on both temporary or permanent physiological changes and associated psychological, social, and spiritual changes.

  • Utilizing therapeutic communication skills is essential for providing client-centered care.

  • Collaboration with clients in defining meaningful goals using occupation-based interventions is a primary focus.

Disability Experience Throughout the Continuum of Care

  • Case Study: Lydia

    • Initiation of the disability experience showcases various stages:

    • Acute Hospitalization.

    • Acute Rehabilitation.

    • Transition to Home Preparation.

    • Subacute Rehabilitation.

    • Adjustments to a New Home Environment, with focus on regaining function.

Authentic Engagement with the Client

  • Therapeutic Use of Self: Building relationships through effective communication, which entails:

    • Active listening.

    • Clinical reasoning and critical thinking skills.

    • Collaboration with clients for information gathering.

Effective Communication Across the Continuum of Care

  • Essential for conflict resolution and rapport building, considering the involvement of family, significant others, and caregivers.

  • Involves attention to both verbal and nonverbal cues.

Supporting Psychosocial Adjustment to Disability

  • OTP's attitude towards clients and awareness of changes in behaviors/emotions are vital.

  • Implementation of strategies like the CALMER Approach demonstrates effective case management (see Box 2.3 on page 21).

Strategies for Working with a Difficult Client

  • Employing empathy, encouragement, and collaboration while recognizing barriers to participation (refer to page 22 bullet points).

Professional Reasoning and Clinical Reasoning

  • Clinical Reasoning: Facilitates the client's comprehensive understanding and fosters discovery of personal meaning through the intervention process, enhancing hope (AOTA).

  • Professional Reasoning: Represents an advanced term for OTP’s clinical reasoning; a multifaceted, metacognitive process in planning, directing, performing, and reflecting on client care across both medical and non-medical settings.

  • Narrative Reasoning: Empowers OTPs to grasp client perspectives on their disability experiences.

  • Scientific/Procedural Reasoning: Incorporates a focus on the client's diagnosis, allowing formulation of hypotheses based on referrals.

  • Pragmatic Reasoning: Considers practice context, encompassing available resources, service reimbursement, delivery realities, and familial involvement.

  • Ethical Reasoning: Ensures morally justifiable choices throughout the OT process, always prioritizing the client’s best interests.

  • Interactive Reasoning: A cooperative communication process enhancing trust between OTP and client.

  • Conditional Reasoning: Integrates all types of reasoning for responsive intervention modifications related to conditions and contexts of therapy delivery.

Developing Appropriate Occupational Therapy Goals

  • Involves collaboration between the client, family members/significant others, and the practitioner.

  • OT goals should attentively mirror the client’s aspirations and requirements.

  • Examination of Lydia's case through various reasoning types can inform tailor-made interventions.