LEARNING OBJECTIVES
1.Select occupation as means to achieve
particular goals.
2. Grade occupations to challenge person’s
abilities to improve performance
3. Analyze occupations to determine their value
for remediation of impaired abilities&capacities.
4. Adapt occupation to increase their therapeutic
value.
INTRODUCTION
 Occupation is the therapeutic medium of
Occupational Therapy with the goal of
facilitating participation in life--- (AOTA)
 The therapist must select the appropriate
Occupation for patient to remediate deficit
abilities or capacities-(Occupation as means)
or to enable independent performance of
value occupation-(Occupation as end).
SELECTION & GRADATION OF THERAPEUTIC OCCUPATION-ASMEANS
No
REMEDIAL GOALS
KEY FACTORS OF THE ACTIVITY
1.
To retrain sensory
awareness of
discrimination
Offer various textures ,sizes, shapes ,grade from
diverse, coarse, large to similar, smooth, small
2.
To decrease
hypersensitivity
Offer various textures and degrees of hardness or
softness .Grade from acceptable to
3
To reacquire skilled
voluntary , movement
Require sought-after, goal directed response: allow
feedback. Grade from simple to complex
movements.
4
To improve coordination
and dexterity
Require ROM the patient can control. Grade from
slow ,gross movement involving limited number of
joints to ------fast, precise movement involving a
greater number of joints.
5
To increase Passive ROM
Provide controlled stretch or traction. Grade from
lesser to greater ROM
6
To increase strength
Require movement or holding against resistance.
Grade from lesser to greater resistance or from
slow to fast movements
No
REMEDIAL GOALS
KEY FACTORS OF THE ACTIVITY
7.
To improve cardio
pulmonary endurance
Use activities related at the patients current
MET level .Grade by increasing duration
frequency ,then intensity (MET)
8.
To improve muscular
endurance
Require movement or holding against 50%
or less of maximal strength. Grade by
increasing repetitions or duration.
9.
To decrease oedema
Allow use of extremity in an elevated position
and require isotonic contraction
10
To improve problem
solving
Require performance at the outside edge of
patients current skill. Grade from simple
(one step) to complex (multiple steps) and
from concrete to abstract.
ACTIVITY ANALYSIS
Activity analysis or Task analysis is
Fundamental skill of OT.
OT analyze an activity because they want to know
i)
Whether the patient, given certain abilities, can be expected to
do the activity.
ii)
Whether the activity can challenge latent abilities or capacities
and thereby improve these.
Activity–Focused Analysis
Using an analytical approach ,the therapist examines an
activity to determine its components and the level of capability
demanded. The outcome can be used to select activities for
remediation or to match a particular person’s skill with the
demands of the task.
The biomechanical approach prompts that therapist to
examine the physical aspects such as grasp and ROM .
The cognitive –perceptual approach examines the activity
according to its cognitive or perceptual demands.
ACTIVITY – FOCUSED ANALYSIS
1. Name the activity goal
2. Describe the task demands
 Task constraints: How are the person and materials positioned,
especially in relation to one another?
 Task constraints: What utensils/tools/materials are normally used to do
this activity/
 Environmental constraints: Where the activity is carried out?
 Contextual constraints: Does this activity or the way it is carried out hold
particular meaning for certain cultures or social roles? Is there a time
factor involved in carrying out the activity.
.
3. What capacities and abilities are prerequisites to successful
accomplishment of this activity.
4.List the steps of activity.
5. Describe the biomechanical internal constraints for the most therapeutic
or repetitive step
.6. What must be stabilized to enable doing this activity and how will that
stabilization be provided.
7.For which ages is this activity appropriate?
8. What is the estimated MET level of this activity?
9. What precautions must be considered
10.For which short term goal is this activity appropriate?
11. How can this activity be graded to improve Strength, ROM, ,endurance,
coordination, edema, perceptual abilities and cognitive skills.
PERFORMANCE FOCUSED ANALYSIS
Performance focused analysis according to occupational
performance Model:
 One role is composed of several task
 Each task consists of several activities
 Each activity depends on varying degrees of
sensorimotor, cognitive and perceptual and
psychosocial abilities.
 Those abilities depend on supporting capacities.
ADAPTATION
Activity adaptation is a process of modifying an
activity of daily living, craft ,game, sport or other
occupation to enable performance, accomplish a
therapeutic goal or prevent cumulative trauma injury
CHARACTERISTICS OF A GOOD ADAPTATION
 Accomplishes the specific goal
 Does not encourage or require odd movements or postures.
 Is not dangerous to patient
 Intrinsically demands a certain response that patient does not
have to concentrate on
 Does not demean the patient : some contrived adaptations
seems to be ridiculous or embarrassing
REASONS TO ADAPT AN ACTIVITY
Reason.1:
The activity is modified to make it therapeutic when
ordinarily it would not be so. Eg. Wall checkers, tic tac
toe on wall
These adapted methods help in reaching up exercise
Reason.2:
To graduate the exercise offered by the activity along the therapeutic
continua to accomplish goals. Grading of activity for this purpose
is an original principle of Crieghton 1993.
Example:
To increase coordination ,the activity must be graded along a
continuum from gross, coarse movement to fine , accurate
movement
Reason.3:
To enable a person with physical impairment to do an activity or task
he or she unable to do.
ExampleA stroke patient learn a new method to wear shirt that requires only
one hand.
Reason.4:
Adapting work activities that are engaged in for long periods of time
to prevent cumulative trauma injury.
Example:
Changing the table height to reduce strain on the back or upper
extremities or doing the work task while seated to reduce stress
on low back.
ADAPTATIONS FOR THERAPEUTIC USE
S.No
ADAPTATION
THERAPEUTIC PURPOSE
1.
Position the task relative
to person
Increase ROM, specify muscles,
motions enable person to d od
task
2.
Arrange objects in
relation to others
Improve perceptual responses
requires specific movements
decrease energy expenditure
3.
Change lever arms
Increase strength, reduce
strength needed , prevent
injuries
Arrange objects in relation to others
Change lever arms
ADAPTATIONS FOR THERAPEUTIC USE- CONT…
s.no
Adaptation
Therapeutic purpose
4.
Change materials or
texture of materials
Increase strength, coordination,
challenge sensory system
5
Padding handles of
tools
Reduce stress on painful joints, enable
use of tools or utensils
6.
Change level of
difficulty
Increase cognition ,perception,
increase motor planning, enable
person to do task.
7.
Change the size or
shape
Improve dexterity, enable activities
such as feeding, with enlarged
handles on utensils, increase
strength,ROM
PADDING HANDLES OF TOOLS
ADAPTATIONS FOR THERAPEUTIC USE- CONT..
S.NO
ADAPTATION
THERAPEUTIC PURPOSE
8.
Change color contrast
between objects
Improve figure-ground discrimination,
Enable performance by those with low
vision
9.
Change method of doing
activity
Enable person to do task. Increase of
strength, ROM, coordination ,dexterity,
increase cognitive perceptual demand
10.
Modify tool
Enable person to do task, prevent
deformity, prevent cumulative, trauma
disorder
11.
Add weights
Increase strength, reduce in
coordinated movements provide PROM
12.
Add springs or rubber
bands
Increase strength reduce in
coordinated movements provide
PROM, assist weak muscles