OCCUPATIONAL THERAPY (RHPT 492)
After studying this chapter reader will be able to do the
following :

Describe four lines of clinical reasoning.

Effectively document occupational therapy services.

Differentiate between short term and long term goals.

Consider a variety of approaches in planning therapy.
PLAN OF CARE : A document prepared by all members of the
rehabilitation team (including patient) that describes the
interdisciplinary treatment goals, intervention and time frames
for a specific episode of care.
GOAL : defined as end result of therapy to be achieved in a
specified time . Goals are usually designed as long term or short
term goals.

Clinical reasoning : it is the thinking process by
which therapists collect and use information to
make decisions about care of an individual client.
 FOUR LINES OF CLINICAL REASONING :
 Scientific reasoning.
 Narrating reasoning.
 Pragmatic reasoning.
 Ethical reasoning.

Scientific reasoning - It refers to logical
thinking about the nature of clients problems
and optimal course of action in treatment.

Narrating reasoning – It refers to thinking in
story form to place the client’s functioning in
the context of his or her background and
broader experience.

Pragmatic reasoning – it refers to thinking
about logistics and practical aspects of
delivering services to clients within a given
setting or organization.

Ethical reasoning – It refers to idealistic
thinking about what should be done on
behalf of a specific individual.
EBP is the conscientious explicit and judicious
use of current best evidence in making
decisions about care of individual patients.
STEPS OF EBP :
1. Write an answerable clinical question.
2. Gather based evidence to answer the
question(including clinical assessment
findings and other primary studies)
3. Evaluate the validity & clinical usefulness of
the gathered evidence.
4. Synthesize the findings.
5. Communicate with family members
regarding assessment and treatment.
6. Apply findings to practice.
7. monitor, evaluate and document the results.

Clinical documentation in occupational
provides a chronological record of the
patient’s status and condition related to
occupational functioning and details the
course of therapeutic intervention.

Documentation formats include
computerized records, checklists, forms and
narrative notes.

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Focus on function.
Focus on underlying cause.
Focus on progress.
Focus on safety.
State expectations for progress or explain
slow progress or lack of progress.
Summarized needed skilled services.
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Screening.
Assessing.
Planning.
Intervening.
Monitoring.
Discontinuing treatment.

SCREENING – it is defined as reviewing
information relevant to a prospective patient to
determine the need for further evaluation and
intervention.
ASSESSING – elements of assessing
occupational function are:
 Interview.
 Observation of function.
 Evaluation.
 Synthesis of result.


PLANNING INTERVENTION : After
formulating a hypothesis for treatment, the
occupation therapist plans intervention.
Clinical reasoning is involved in estimating
outcomes, setting goals and select
treatment.

Planning includes – Short term and Long
term Goals.

In occupational therapy long term goals
always relate to expectations of patients’s
functional skills.

Short term goal re small steps that
cumulatively result in long term goal
achievement.