Chapter 26
Occupational Therapy
Interventions for Individuals
Glen Gillen
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Learning Objectives
1. Understand the overarching themes that occupational therapists
embrace when choosing interventions for their clients
2. Differentiate between interventions that are categorized as
“occupation as ends” and “occupation as means”
3. Develop and choose interventions for clients that combine the
principles of occupation as ends and occupation as means
4. Compare and contrast a variety of specific intervention approaches
that are used for clients receiving occupational therapy services
5. Begin to understand when to choose one type of intervention over
another, combine interventions, and/or switch the intervention plan
6. Understand the concept of grading interventions
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Overarching Interrelated Themes
• Client centered
• Evidence based
• Chosen based on sound professional reasoning
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Occupation as Ends
as Intervention
• Directly teaching the activity or task
• Using clients’ abilities to learn a task
• Providing adaptations to learn a task or activity
• A rehabilitative approach; A skills training approach
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Occupation as Ends
as Intervention (Continued)
• The therapist serves as teacher or adaptor of a
task
• Influenced by learning and cognitive information
processing theories
• Not used to make therapeutic change of
underlying capabilities
– such as strength or memory
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Occupation as Means
as Intervention
• Including a variety of interventions, such as arts and crafts,
and specific daily activities
• Requiring more constrained responses as compared to
occupation as ends
• Chosen based on both client interest and potential to
remediate an underlying impairment
• Providing a challenge that is slightly beyond what the client can
easily achieve
– finding “just the right challenge”
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Combining Occupation as
Means and as Ends
• A collaborative approach is used to determine goals
and client’s interests
• The practitioner uses skills of occupational analysis to
determine underlying performance skills
– and/or client factors may need to be challenged
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Preparatory interventions
• Preparatory interventions have been defined as “methods and
techniques that prepare the client for occupational performance”
(AOTA, 2008, p. 653).
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Example Preparatory Interventions
1. Applying a therapeutic hot pack to and stretching both shoulders
prior to a remediation session that uses reaching into kitchen
cabinets as a means to improve shoulder range of motion.
2. Teaching a person with an anxiety disorder to use deep breathing
and guided imagery to promote relaxation prior to interviewing for a
new job.
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Remediation or Restoration Examples
• Therapeutic exercise to strengthen a muscle
• Use of a video game to improve sustained attention
• Goal-oriented reaching to improve upper limb function
• Constraint-induced movement therapy to improve upper
limb control
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Additional Remediation or Restoration
Examples
• Mall walking program to improve endurance
• Using homemaking tasks to challenge cognitive functions
such as safety and judgment
• Sensory integration techniques
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Occupational Skill Acquisition Examples
• Teaching meal preparation skills
• Task-specific practice of handwriting
• Mental practice of IADL
• Teaching adaptive coping skills
– Using motor learning principles to learn or relearn selfcare skills
• Teaching a recently widowed woman how to manage monthly
bills
• Developing crawling ability in a nonambulatory child with
developmental delays
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Example Adaptation/Compensation
Approaches
• Use of a wrist extension orthosis to allow keyboarding
• Using a checklist system to perform assigned tasks in a
supported employment program
• Using a tub seat, handheld shower, and long-handled
sponge to enable bathing
• Using lightweight cookware during meal preparation
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Example Adaptation/Compensation
Approaches (Continued)
• Using built-up handles on school supplies
• Using a power scooter during grocery shopping
• Using an augmentative communication device to interact
with other students
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Example Environmental Modifications
• Performing a home visit and suggesting removing throw rugs,
sliding shower doors, and unnecessary furniture to promote
wheelchair access.
• Recommend appropriate playground equipment for children
with varying skills.
• Recommending minimizing environmental stimuli (e.g.,
television on in the background, many people talking at once)
for those who are easily distracted.
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Example Environmental Modifications
(Continued)
• Providing specific information re: the gradient for a wheelchair
ramp.
• Setting up a bathroom so that needed grooming and hygiene
items are placed on the right for those who do not attend to
the left.
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Educational Approach Examples
• Instructing caretakers on proper transfer techniques
• Informing a person as to the signs and symptoms of
emerging depression
• Leading a stroke education group focused on
community resources and leisure opportunities
• Providing information about alternative community
access after a driver’s license is lost due to visual
impairment
• Instructing a client or caregiver on skin inspection
techniques and the signs of skin breakdown
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Prevention Approach Examples
• Instructing a stock person in a retail store on proper lifting
techniques
• Instructing nursing staff on an appropriate in-bed turning
schedule to prevent the development of decubitus ulcers
• Educating a person who types most of the day on proper
posture, rest breaks, etc. to prevent carpal tunnel
syndrome
• Preventing social isolation by suggesting appropriate
leisure-based after-work activities such as a bowling
league, participation in a chorus, etc.
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Palliative Approach Examples
• Prescribing positioning equipment that allows more time out of bed
• Engaging in reminiscence activities
• Engage in activities related to leaving a legacy such as finally writing
down and sharing a secret recipe, engagement in creative arts,
scrapbooking, etc.
• Physical agent modalities, positioning, edema management, and
orthoses to reduce pain
• Teaching caregivers handling techniques for bed mobility assist as the
client’s physical status declines
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Examples of Therapeutic Use of Self
• Developing rapport
• Establishing trust
• Appropriate use of humor
• Being motivational
• Maintaining open
communication
• Maintaining a caring attitude
• Being empathetic
• Active listening
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Case Applications
• Benjamin: A Married Older Man Whose Family Is
Concerned about His Driving Abilities
• James: A Married Banker Who Survived a Stroke
• Sahar: An 8-Year-Old Girl Living with Cerebral Palsy
• Lois: An Adult Living with Schizophrenia at Home
• Shirley: Receiving Home Hospice with End-stage
Amyotrophic Lateral Sclerosis
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