Occupations

There are 9 categories of Occupations as listed in the OT Framework.

The first two BIG categories are our “bread and butter”

  1. ADL (activites of daily living) - Axs involving taking care of one’s own body on a routine basis

  2. IADL (Instrumental Activities of Daily Living) - Axs to support daily life w/in the home & community


ADLs - Activites of Daily Living

This is the number one Area of Occupations listed in our OT Framework.

*Separates US from other disciplines!


Bathing

  1. Obtaining/using supplies

  2. soaping body

  3. rinsing body

  4. drying off

  5. maintaining bathing position

  6. transferring to/from bathing positions


Toileting and Toilet Hygiene

  1. obtaining/using toileting supplies

  2. managing clothing*

  3. maintaining toileting position

  4. t/f to/from

  5. cleaning body

  6. etc. (see framework)

  • Add link to video


Dressing

  1. select clothing and accessories appropriate to time of day, weather, occasion, etc.

  2. Obtain clothing from storage area

  3. Dress (Don) and Undress (Doff) in sequential fashion

  4. Fastening/adjusting clothing/shoes

  5. Applying/removing personal devices (i.e. - splint, orthotic, prosthetic)


Feeding

  1. setting up

  2. arranging

  3. bringing food or fluid from plate/cup to the mouth

  • AKA - self-feeding and is a goal written by OTR quite often

    • Lots of A/E available PRN (PD spoon)


Functional Mobility

  1. Moving form one position to another

  2. Bed mobility - i.e. rolling from side to side, side-laying to supine to prone - supine to sit, bridging, etc.

  3. W/C (wheelchair) mobility

  • Also include functional ambulation and transfer of objects

    • we must differentiate when we perform “functional mobility tasks” with pts (patients) from what PT (physical therapy) is doing. It’s easy to do this by the WAY IN WHICH we document


Hygiene/Grooming

  1. obtaining and using supplies

  2. removing body hair (shaving and tweezing)

  3. Applying/removing makeup

  4. Washing, drying, combing, styling, brushing, and trimming hair

  5. nail trimming (both fingers and toes)

  6. caring for skin

  7. applying deodorant

Oral Hygiene:

  1. brushing/flossing teeth

  2. removing, cleaning, reinserting dentures or partials


Sexual Ax (activity)

  1. ?


Grading ADLs

  • This is VERY important as medicare and other payor sources are looking for MEASURABLE data within your documentation for which they can gauge patient progress and justify paying for YOUR services.

  1. How can they know HOW your patient is doing UNLESS it is explicitly documented in a universally “accepted” language?

  2. “Objective” and measurable data are necessary for everyone that is involved with your patient to interpret things in as similar a way possible.


What are therapy scores?

  • D or TD - dependent or totally dependent (interchangeable terms) - this means the pt is 100% dependent on his/her caregiver to perform the task

  • TD+ - dependent BUT patient attempts to assist with the task (even if they cannot do much). This rating is not used in every therapy setting.

  • Max A - maximal assist - Pt requires 76-99% assistance with the task

  • Mod A - moderate assist - pt requires 26-75% assistance with the task

  • Min A - minimal assist -pt requires 1-25% assistance with the task

  • CGA - Contact guard assist - pt requires a hand on him/her during the task for safety

  • SBA - standby assist - caregiver/therapist “stands by” and assist pt as necessary with components of the task

  • S - supervision - pt may require an eye on him/her for safety and/or occasional v/cs to complete the task.

  • S/U - set up - pt completes the task w/o S once he/she is set up with the items needed for the task.

  • MI - Modified I - pt performs the task entirely, but may need A/E or EXTRA time.

  • I - Independent - This means there is NO A/E or AD (cane, walker, Rollator) or extra time needed to perform tasks.

    • This type of person does not need us and it’s what everyone strives to be!


How does this look in “real life”?

Using our hypothetical pt, Jack as an example….


Scenario 1: I practice UB dressing with Jack and he cannot follow my verbal commands to use his strong right arm to assist in placing his paralyzed left arm into the sleeve of the shirt. He is completely confused and makes little attempt to move. This goes on as I attempt various methods of cuing during the task. Inevitably, I end up donning the shirt for him.

My documentation would look like this:

Pt performed UB dressing tasks as D d/t inability to follow Max tactile, visual, and v/cs to initiate hemi-dressing technique.


Scenario 2: Let’s say Jack was able to perform 80% of this by himself and he only required my verbal coaching twice during the session.

My documentation would look like this:

Pt performed UB dressing tasks w/Min A and Min v/cs utilizing hemi-dressing technique.


IADLs - Instrumental Activities of Daily Living

  • These are more COMPLEX activities of daily living that support daily life within the HOME and COMMUNITY

  • Three big ones that speak for themselves:

    • Care of others

    • Care of pets

    • Child rearing

  • Just think about how each of these tasks requires so much.


Communication Management

  • In a BROAD sense it is sending, receiving, and interpreting info using a variety of systems and equipment. We can do all of that via:

    • writing tools

    • phones

    • computers/tablets

    • call lights

    • communication boards

    • braille writers

    • Augmentative communication systems


Driving and Community Mobility