Updated Activity Analysis Using the Occupational Therapy Practice

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Updated Activity Analysis Using
the Occupational Therapy Practice
Framework III:
Paralleling Craft Activity Skills
to Everyday Occupations
Cynthia Evetts, Ph.D., OTR
Emily Leenerts, B.S., OTS
Emily Miller, B.S., OTS
With Dr. Suzanne Peloquin, UTMB Professor Emerita
School of Occupational Therapy
Outline and Objectives of Workshop
Outline
1.
2.
3.
Orient you to updates in the new OTPF-III
Analyze your own meaningful occupations and discuss what other craft
activities help to build related skills.
Analyze a patient’s meaningful occupations and discuss what craft
interventions help to reach functional outcomes.
Craft
4.
----------break
Explore the research with Emily Leenerts.
Craft
5.
Discuss tips to successful therapeutic use of craft.
Craft
School of Occupational Therapy
Outline and Objectives of Workshop
Objectives
• Demonstrate activity analysis of craft activities and parallel skills to
everyday occupations
• Get you updated on current OT terminology
• Collaborate on ADL analysis
• Demonstrate documentation of craft intervention
• Build confidence to use therapeutic craft activities as an intervention
• Have fun! Share ideas! Ask questions!
School of Occupational Therapy
Orientation to the Updated OTPF-III
• The purpose of the OTPF-III is to “describe central concepts that
ground occupational therapy practice and build a common
understanding of the basic tenets and vision of the profession”.
• Two parts: Domain and Process
– Domain: OT body of knowledge and expertise.
• The “what”
– Process: Client-centered evaluation and intervention.
• The “how”
School of Occupational Therapy
OTPF-III
Domain
– Occupations
– Client Factors
– Performance Skills
– Performance Patterns
– Contexts & Environments
School of Occupational Therapy
OTPF-III
Process
• Evaluation
• Intervention
• Targeting of Outcomes
School of Occupational Therapy
OTPF-III
Terminology: Important for Today’s Workshop
• Activity Analysis: Analysis of “the typical demands of an activity,
the range of skills involved in its performance, and the various
cultural meanings that might be ascribed to it”.
– Activity analysis is a distinguishing skill of occupational
therapists that sets us apart from every other profession in the
health industry.
– We do activity analysis on a regular basis and we are good at it!
– It includes knowing our client’s limitations and strengths, using
skill-building interventions that are geared to reaching functional
outcomes, and grading the activity to meet a just-right challenge.
– We do this whole process within a reflective thought process
while working with a client.
School of Occupational Therapy
OTPF-III
Terminology: Components of Activity Analysis
• Activity Demand: Aspects of an activity or occupation needed to
carry it out, including:
–
–
–
–
–
–
–
relevance and importance to the client
objects used and their properties
space demands
social demands
sequencing and timing
required actions and performance skills
required underlying body functions and body structures
• Performance Skill: Goal-directed actions that are observable as small
units of engagement in daily life occupations. They are learned and
developed over time and are situated in specific contexts and
environment.
– Motor skills
– Process skills
– Social interaction skills
School of Occupational Therapy
OTPF-III
Terminology: Components of Activity Analysis
• Activity and Occupational Demands
• Relevance and importance to client
• Objects used and their properties
• Space demands
• Social demands
• Sequencing and timing
• Required actions and performance skills
• Required body functions
• Required body structures
OTPF-III
Terminology: Related to Craft Interventions
• Preparatory Tasks: Actions selected and provided to the client to target
specific client factors or performance skills. Tasks involve active
participation of the client and sometimes compromise engagements that
use various materials to simulate activities or components of occupations.
Preparatory tasks themselves may not hold inherent meaning, relevance, or
perceived utility as stand-alone entities.
Examples include:
- Assertiveness training to prepare for self-advocacy
- Hand strengthening exercises with therapy putty, exercise bands, and
grippers.
- Craft activities can be an example of preparatory task
School of Occupational Therapy
OTPF-III
Therapeutic Use of Craft
Occupation is both a means and an end!
Therapeutic use of craft is more than just doing crafts. Crafts have preparatory
elements, building proficiency in specific skills that directly relate to
functional goals and outcomes.
(Usually more engaging for the client than rote practice of ADLs.)
Craft can be included in all five approaches to intervention:
- Create, Promote
- Establish, Restore
- Maintain
- Modify
- Prevent
School of Occupational Therapy
OTPF-III
What’s New?
- Sensory
- Emotional
- Relevance
School of Occupational Therapy
renewal
pleasure
companionship
coherence
agency
12
things I
like to do
every day
affirmation
Occupational needs
accomplishment
Self-Assessment of Meaningful Occupations
X
Shower
X
Take the dogs for a walk
Cook breakfast
X
X
Email friends and family
School of Occupational Therapy
X
Worksheet:
Activity Analysis of Everyday Occupations
Activity Analysis: Analysis of “the typical demands of an activity, the range of
skills involved in its performance, and the various cultural meanings that might be
ascribed to it”.
Step 1: Activity analysis of the everyday occupation. What is required to do the
task? Fill in the first column.
Step 2: Select and analyze a craft activity that helps to build competency in the
skills of everyday occupation. Fill in the second column.
Pick one important everyday occupation:
Driving to work (IADL)
School of Occupational Therapy
http://www.thevehiclesite.co.uk/blog-details/13/Dogs-that-can-drive
Worksheet:
Activity Analysis of Everyday Occupations
Components of Analysis
Relevance/Meaning
Objects/Tools
Space
Social
Sequencing
Required Actions/
Performance Skills
Motor
Process
Social
Body Functions/
Body Structures
Mental
Sensory
Musculoskeletal
Speech
Cardiovascular
Other
Everyday Occupation
Driving to work
Exercise independence. Important for community mobility.
Car: Steering wheel, foot pedals for braking and accelerating, rear view and side
mirrors, blinker signal to turn, chair
Moderate room in cabin of car to move arms and feet. Everything in about
arm’s reach.
Rules of the road, respecting the space and signals of other drivers, respect
speed limit.
Turning on the car, checking mirrors, buckle seat belt, change gears. Sequence
changing lanes or turning.
- Grip the steering wheel, coordination of motor skills to move the steering
wheel, keep body and head upright.
- Scan the road for potholes and other drivers, plan your navigation or route,
attention to the road and task, respond to unexpected traffic or car
- Takes turns at a stop sign, socializes with passenger while not maintaining
consistent eye contact
- Alert and conscious, ability to focus for prolonged periods
- Sensation of the wheel, proprioception, visual acuity
- Upper extremity and lower extremity strength (use of arms and legs)
School of Occupational Therapy
Worksheet:
Activity Analysis of Everyday Occupations
Components of Analysis
Relevance/Meaning
Craft Activity
Knitting
Interest or hobby. Expression of creativity. Make gift for another person.
Objects/Tools
Yarn, knitting needles or loom.
Space
Moderately small space to work on project in lap or on table. Everything is
within arms reach.
Sharing supplies if in a group and cleaning up after you are done.
Social
Sequencing
Required Actions/
Performance Skills
Motor
Process
Social
Body Functions/
Body Structures
Mental
Sensory
Musculoskeletal
Speech
Cardiovascular
Other
School of Occupational Therapy
Steps to position hand, yarn, and knitting needles. Turning needle and
manipulating the yarn.
- Fine motor manipulation, movement of the shoulder, elbow, and fingers.
Coordination of upper extremity.
- Scan for knots or tangles in the yarn. Plan steps to finished product.
Respond to unexpected mistakes. Attention to task.
- Alert and focused on sequence of task. Image the finished product.
- Sensation of the yarn and needle, proprioception, visual acuity.
- Upper extremity strength and ROM. Gross and fine movement
Worksheet:
Activity Analysis of Everyday Occupations
Tips for craft:
- Craft activity should be meaningful
- Grade the craft for a just-right challenge
- Outcomes of craft activity should be directly related to your
goals
http://dianne-jones.blogspot.com/2011_11_01_archive.html
School of Occupational Therapy
http://www.instructables.com/id/Make-a-Frame-Loom-for-Weaving/
Activity Analysis of Everyday Occupations:
Group Work!
Activity Analysis: Analysis of “the typical demands of an activity, the range of
skills involved in its performance, and the various cultural meanings that might
be ascribed to it”.
Step 1: Activity analysis of the everyday occupation. What is required to do
the task? Fill in the first column.
Step 2: Select and analyze a craft activity that helps to build competency in the
skills of everyday occupation. Fill in the second column.
Pick one important everyday occupation:______________________________
School of Occupational Therapy
Worksheet:
Activity Analysis and Craft Intervention
Client: 54 yr-old female with left CVA
Occupation: Brushing teeth
https://www.healthtap.com/user_questions/174095
School of Occupational Therapy
Activity Analysis and Craft Intervention
Components of Analysis
Everyday Occupation
Brushing teeth
Relevance/Meaning
Hygiene and self-care
Objects/Tools
Tooth brush, tooth paste, water, sink
Space
Good lighting, small work space
Social
Expectation from others to have a clean mouth.
Sequencing
Process of untwisting the cap of the tooth paste, applying tooth paste to brush, wetting tooth
brush, back and forth motion in mouth to clean. Usually performed at morning and night.
- Grip the tooth brush, squeeze paste from the tube, gross and repetitive movements of the
shoulder, spits out saliva
- Attends to task without distraction, uses tools for intended purpose
Required Actions/
Performance Skills
Motor
Process
Social
Body Functions/
Body Structures
Mental
Sensory
Musculoskeletal
Speech
Cardiovascular
Other
- Alert and oriented
- Sensation of saliva in mouth and need to spit, not swallow or choke. Proprioception.
- Use of one or both hands, upper extremity. Upright position
- Automatically timed breathing so no choking occurs.
School of Occupational Therapy
Activity Analysis and Craft Intervention
Components of Analysis
Craft Activity
Paper Heart Basket
Relevance/Meaning
Gift for another person, hold message, seasonal ornament
Objects/Tools
Scissors, paper, table to work on
Space
Good lighting, space for individual work area
Social
Sharing supplies, following verbal directions or cues, cleaning up after done
Sequencing
Follow sequence of steps, measuring, cutting and weaving.
Required Actions/
Performance Skills
Motor
Process
Social
- Manipulates tools, manipulates paper to weave.
- Uses tools appropriately, initiates step after reading instruction, finds mistakes
- Asks questions when confused, asks to share supplies
Body Functions/
Body Structures
Mental
Sensory
Musculoskeletal
Speech
Cardiovascular
Other
- Orientation and attention to task
- Sensation of tools and supplies, proprioception
- Upper extremity movement. Gross and fine motor
- Ask for help or communicate
School of Occupational Therapy
Activity Analysis and Craft Intervention
Craft Intervention: Heart Basket
http://radmegan.com/2010/12/weaving-danish-heart-baskets-for-jul.html
School of Occupational Therapy
Heart Basket
• Occupational therapy is both art and science
• Heart enhances the art of therapy
– Values
– Passion
Activity Analysis and Craft Intervention
Craft Intervention: Heart Basket
1. Cut construction paper into four even sections (hamburger style)
2. Cut the edges so each one is a long oval with rounded edges
3. Cut three parallel lines out of the oval shape, stopping an inch before the
edge
4. Fold each oval shape in half and face the folds together so it resembles a
heart shape
School of Occupational Therapy
Activity Analysis and Craft Intervention
5. Begin weaving with the top fold of the right oval. Thread it through the top
folds of the left oval piece.
6. Make sure to weave the right fold you are working on through each left
fold. This will help it look checkered, and also give the heart a basket shape.
7. Weave each right fold completely and move it up to begin the next.
School of Occupational Therapy
Activity Analysis and Craft Intervention
Grade the activity by:
- Using a different medium. Eg: felt, foam, or paper.
- Precut the shapes, like we did for you today.
- Give a premade sample to disassemble and assessable.
School of Occupational Therapy
Activity Analysis and Craft Intervention
Tips for documentation:
 Use language that illustrates specific skill building in progress note.
 Track progress with measureable degree in mind (time, cues, etc.)
 LTG is related to occupation and function.
 STG is related to specific skill building (accomplished via craft).
 When using electronic documentation, focus on documenting the skill.
Leisure activity or therapeutic exercise may be accurate categories, but
may not give adequate credit to the skill building and functional
outcomes.
School of Occupational Therapy
Activity Analysis and Craft Intervention
Document Goals:
LTG: Client will perform morning teeth hygiene using both hands by end of two weeks.
STG: Client will demonstrate use of affected hand to stabilize and grasp objects during
skilled, purposeful task.
STG: Client will demonstrate reduced neglect of affected arm by using it in 40% of
activity with verbal cues.
Document Progress:
Subjective: “My bad side can help out a little bit more today”.
Objective: Client lifted affected forearm to table with use of unaffected hand with no
verbal cues. She held the paper heart with her affected hand and manipulated the paper
weaving with her unaffected hand.
Assessment: Client recognized progress in use of affected hand. Client demonstrated
gross motor weakness in affected arm and functional use of fingers in affected hand.
Plan: Progress towards goals met through the use of crafting. Continue to use skillbased craft modality for this client. OR … Progress towards goals not met through the
use of crafting. Discontinue use of skill-based craft modality for this client.
School of Occupational Therapy
Activity Analysis and Craft Intervention:
Group Work
Client:
___________________________________________________________
Occupation:_________________________________________________
Step 1: Activity analysis of the client occupation. What is required to do
the task? Fill in the first column.
Step 2: Select and analyze a craft activity that helps to build competency in
the skills of this occupation. Fill in the second column.
School of Occupational Therapy
Research
http://ihealthtran.com/wordpress/2014/08/research-shows-effectiveness-of-emr-in-positively-impacting-clinical-outcomes/
School of Occupational Therapy
Is Craft Relevant among Adults?
• Introduction
– Craft was part of occupation-based treatment in
early history of OT (Bathje, 2012)
– Craft fell out of favor during Reductionist
Movement (Christiansen & Haertl, 2014)
– Full-circle, are we returning to craft?
School of Occupational Therapy
Social Media Research
• Social Media Research data (Guistini, 2010; Lomborg,
2012; Wu, Sun, & Tan, 2013; Jacobson, 2011)
– Pinterest selected; craft is popular topic
http://pro.psychcentral.com/private-practice/wpcontent/uploads/sites/2/2014/09/oa4qcmjpg_zpsf989836b.png
Study Methods
• 6 weeks, 4 hrs/week on Pinterest
• Data gathered
– Crafts from commonly found materials in clinics,
inexpensive (<$1) materials at craft stores, or
recycled materials
– Other criteria
Gender
Female-oriented
www.buzzfeed.com
Neutral
www.babble.com
Male-oriented
www.craftgawker.com
Age
Young Population
Neutral
Mature Population
www.babble.com
de-tout-et-de-rien-caroline.blogspot.ca
www.pinterest.com/CristinaKopecky
Conditions
Changing Laterality
marisa-ramirez.tumblr.com
Low Vision
www.indianainking.blogspot.ca
Weak Pincer Grasp
www.cfabridesigns.com
Decreased Memory
www.mysocalledgreenlife.com
Holidays
www.smcarney.blogspot.com
www.embraceyourchaos.com
http://www.pinterest.com/Patriciuca/
Meaningfulness
www.naturallife.com
www.marthastewart.com
www.marthastewart.com
Playfulness and Joy
www.blog.honest.com
www.playbasedlearning.com.au
www.moonfrye.com
www.redtedart.com
www.pinterest.com/mobileprofessor
www.homemadesimple.com
www.craftsncoffee.com
Crafts can be adapted!
www.buzzfeed.com
http://www.pinterest.com/Patriciuca/
Using Craft
• Fortune Cookie Craft
– Many ways to adapt craft
– Portable, clean
• Instructions found in bag with
materials
http://www.dumpaday.com/wp-content/uploads/2014/01/do-ityourself-crafts-14.jpg
Fortune Cookies
• Good fortune comes to those who….
• Pay it forward
– Write a piece of advice for good occupational
therapy
Advocate and Promote Therapeutic Use of Craft in
Your Work Setting:
• Crafts don’t have to be a huge project. Try incorporating creativity into
the intervention. Example: Have patient peel off own paraffin wax and
create a figurine.
• Petition to your department director for basic supplies.
• Barriers to not using craft activities might include a personal lack of
knowledge about craft. Therapists tend to use interventions that their
facility endorses or that they are more familiar with. Be open- craft is
simply creating.
• Understand your client. What craft activities are meaningful to them?
• Use documentation to demonstrate the usefulness and efficacy of
therapeutic craft activity. Focus on skill building.
School of Occupational Therapy
Butterfly or Moth
http://en.wikipedia.org/wiki/Viceroy_(butterfly)
http://www.edupic.net/leps4.htm
School of Occupational Therapy
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd Ed.).
American Journal of Occupational Therapy, March/April 2014, Vol. 68, S1-S48. doi:10.5014/ajot.2014.682006
Bathje, M. (2012). Art in occupational therapy: An introduction to occupation and the artist. The Open Journal of Occupational
Therapy, 1(1).
Christiansen, C. H., & Haertle, K. (2014). A contextual history of occupational therapy. In B. A. B Schell, G. Gillen, & M. E.
Scaffa (Eds.). Willard & Spackman’s Occupational Therapy (12th ed., pp. 9-34). Philadelphia: Lippincott Williams & Wilkins.
Giustini, D. (2010). Building research capacity among a group of social media adopters in Canada: introducing the Social Media
Research Team (SMeRT). Journal of the Canadian Health Libraries Association, 31, 119-121.
Jacobson, J. (2011). Leveling the research field through social media. American Journal of Nursing, 111(10), 14-15.
Lomborg, S. (2012). Researching communicative practice: Web archiving in qualitative social media research. Journal of
Technology in Human Services, 30, 219-231.
Wu, J., Sun, H., & Tan, Y. (2013). Social media research: A review. Journal of Systems Science and Systems Engineering, 22(3),
257-282.
Questions and Comments?
Thank you for your participation!
Get Crafty!
School of Occupational Therapy
Contact us…
• [email protected]
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