Principles of OT in Physical Health

Pima Medical Institute Principles of OT in Physical Health

Chapter 1: Occupational Therapy Treatment in Rehabilitation, Disability, and Participation

Introduction

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

  • The environment, known as practice settings, comprises physical, social, and economic structures that represent the continuum of care for OTPs addressing physical dysfunction.

  • Practice settings differ widely, ranging from intensive care units to home health environments, effectively covering diverse patient needs.

  • Theories and models contributing to OT practice include:

    • Model of Human Occupation (MOHO)

    • Biomechanical Approach

    • Sensorimotor and Motor Learning Approach

    • Rehabilitation Approach

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

  • The Occupational Therapy Practice Framework delineates the domain of OT in the context of physical disabilities, thus showcasing OTP's distinctive value.

Treatment Continuum in Physical Dysfunction

  • The treatment continuum commences immediately following the onset of an injury or disability, targeting maximum possible functional recovery.

  • Patients may enter the treatment continuum at various stages, as illustrated in Table 1.3.

  • Figure 1.2 illustrates the continuum of treatment for physical disabilities:

    • Adjunctive Methods: Techniques employed to prepare the patient for activity engagement, which may include exercises, facilitations, and Physical Agent Modalities (PAMs) such as splints and braces; typically utilized during the acute phases of illness or injury but not exclusively limited to this phase.

    • Enabling Activities: Involve more patient participation, which meets at least 2 of the following 3 criteria:

    • The patient engages actively.

    • The activity necessitates coordination involving sensory, motor, psychosocial, and cognitive systems.

    • An inherent goal other than motor functioning is present during the task.

    • Special equipment may be utilized, examples include:

    • Wheelchairs

    • Ambulatory aids

    • Assistive devices

    • Special clothing

    • Communication devices

    • Environmental control systems

    • Purposeful Activities: Fundamental aspect of OT, these activities constitute part of the daily routine and occur in the authentic context of occupational performance.

    • Occupational Performance and Occupational Roles: Timeframe when the patient resumes or takes on occupational roles in their living environment or wider community.

Theories and Models of Practice in Physical Dysfunction

  • Each theory/model presents unique advantages and limitations; they guide OTPs in shaping treatment strategies tailored to individual clients.

Model of Human Occupation (MOHO)

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

  • Individuals cannot be disassociated from their environment; their interactions are reciprocal, shaping both parties.

  • Holistic vs. Reductionistic Models:

    • Holistic models consider the person-environment interaction, while reductionistic models focus narrowly on specific components, such as muscular function.

  • Subsystems of Human Occupation (Refer to Fig. 1.3):

    • Volition:

      • Individual's motivation to participate in occupations, involving components such as:

      • Personal Causation: Refers to the individual's locus of control.

      • Values: Define what is meaningful and significant to the individual.

      • Interests: Identify what is personally satisfying and engaging.

    • Habituation:

      • Habits: Developed to conserve energy and optimize cognitive resources.

      • Internalized Roles: Roles that individuals embody, often influenced by personal experiences.

      • Role Change/Transition: The dynamic process of modifying roles throughout life stages.

    • Performance Capacity and the Lived Body:

      • Performance Capacity: Refers to the individual's ability to participate in activities.

      • Lived Body: The subjective experience of being and interacting with the world through one’s own body, noting that perceptions may shift when physical abilities alter due to disability.

Complex Interactions and Interdependence

  • MOHO allows OTPs to address multifaceted challenges faced by disabled individuals across various functions, recognizing the fluctuating emotional states—optimism and despair—that can occur.

  • Factors influencing disability experiences include:

    • Severity

    • Temporality (temporary vs. permanent)

General Principles of OT Intervention Using MOHO

  • Therapy focuses on enabling client change, requiring active involvement from the client in their change process.

  • Occupations as Therapeutic: Activities must be real and meaningful rather than contrived for optimal therapeutic benefits.

  • OTPs should be innovative with available resources to adapt activities when real scenarios are impractical.

  • Therapeutic change necessitates alterations in individuals, environments, and interpersonal relationships; OTPs should provide tasks modified to offer “just right challenges”.

  • The OT Practitioner plays a crucial role in facilitating change by:

    • Encouraging and supporting the client.

    • Validating their experiences.

    • Analyzing tasks.

    • Offering feedback.

    • Providing alternative strategies.

Biomechanical Approach

  • This perspective views the human body as a living machine, employing insights from kinetics (motion and associated forces) and statics (forces acting on stationary objects).

  • Common evaluations and treatment methods encompass:

    • Joint range of motion (ROM) assessments

    • Muscle strength evaluations

    • Therapeutic exercises

    • Orthotic interventions

  • This method is particularly suited for patients whose Central Nervous System (CNS) is intact but who experience lower motor neuron or orthopedic disorders.

Sensorimotor and Motor Learning Approaches

  • Developed for individuals with CNS dysfunction; these approaches leverage neurophysiologic mechanisms aiming to normalize muscle tone and restore typical motor responses.

  • Incorporates reflex mechanisms within purposeful activities to integrate reflexive actions.

Rehabilitation Approach

  • This method employs strategies that support individuals in achieving maximum independence in the face of existing disabilities.

  • A pivotal goal includes equipping patients to adapt to their limitations, promoting compensatory strategies.

Evidence-Based Practice

  • More research is crucial for establishing evidence correlating which models most effectively enhance functional independence tied to occupational roles.

  • Occupational Therapy Assistants (OTAs) bear a responsibility to adopt a reflective approach in practice, which includes:

    • Asking and addressing inquiry for outcomes research.

    • Factors influencing client perspectives and practitioner roles.

    • Utilizing electronic and print resources for relevant information searches.

    • Gathering data to publish outcome studies and preparing case reports.

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

Introduction

  • OTPs are required to practice empathy, respecting the breadth of experiences tied to disabilities, which may entail:

    • Temporary or permanent changes in physical function.

    • Role transitions within personal and societal contexts, including psychological, social, and spiritual dimensions.

  • The therapeutic self-usage along with effective communication skills are foundational for delivering client-centered care.

  • Collaborating with clients to establish meaningful, occupation-based goals is a critical component of effective treatment.

  • Early experiences of disability are often characterized by:

    • Loss of bodily function or body parts.

    • Loss of autonomy and independence.

    • Repercussions on one’s roles, identity, and overall quality of life.

Experiencing Disability Throughout the Continuum of Care

  • Case Study - Lydia: Includes various stages such as:

    • Initiation of the illness/disability experience.

    • Acute hospitalization.

    • Acute rehabilitation processes.

    • Preparation and transition to home environments.

    • Subacute rehabilitation phases.

    • Adjusting to new home environments and regaining function therein.

Authentic Engagement with the Client - Therapeutic Use of Self

  • Effective communication strategies emphasizing:

    • Active listening.

    • Clinical reasoning and critical thinking skills.

    • Information gathering through collaborative interactions with the client.

Client-Centered Care Requirements

  • Client-centered care demands:

    • Agility and adaptability in interactions.

    • Awareness of significant occupations and important environments.

    • Informed assessment and decision-making.

    • Empowering clients to assert their control over rehabilitative choices.

Effective Communication Across the Continuum of Care

  • Essential for conflict resolution, trust-building, idea exchange, decision-making, and problem-solving.

  • Involves family, caregivers, and significant others in the communication matrix.

  • Recognizes the importance of both verbal and non-verbal cues in therapeutic settings.

Supporting Psychosocial Adjustment to Disability

  • Awareness of practitioner attitudes is crucial, as it influences client reactions.

  • Attention to behavioral and emotional changes in clients is critical; utilizing frameworks like:

    • The CALMER approach (detailed strategies listed on page 21, Box 2.3).

Strategies for Working with a Difficult Client

  • Empathy, encouragement, and collaborative .

  • Understanding various barriers impacting client participation.

  • Comprehensive strategies outlined in bullet points on page 22.

Professional Reasoning and Clinical Reasoning

  • Clinical Reasoning: Promotes client's understanding of treatment information to find meaning and hope in their rehabilitation journey (as stated by AOTA).

  • Professional Reasoning: A holistic term for OTPs' clinical reasoning encompassing:

    • Planning, directing, performing, and reflecting on client care—applies to both medical and non-medical contexts.

    • Outcomes of the reasoning process directly impact service delivery and client outcomes.

  • Forms of Reasoning:

    • Narrative Reasoning: Understanding a client's viewpoint regarding their disability experience.

    • Scientific/Procedural Reasoning: Utilizing knowledge about the client’s condition to form hypotheses.

    • Pragmatic Reasoning: Considering resource availability and practice context when implementing interventions.

    • Ethical Reasoning: Ensuring ethically sound decisions that prioritize the client’s best interests.

    • Interactive Reasoning: Facilitating a trust-filled and open conversational environment between OTP and client.

    • Conditional Reasoning: Using a blend of all reasoning types to adjust interventions based on changing conditions and contexts of therapy.