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1. Occupation is dynamic & context-dependent
2. Volition: thoughts & feelings
3. habituation: organized, recurring patterns
4. perf. capacity: physical & mental skills
Environment impacts ind. through opportunities, demands, resources, & constraints
Intervention focus: occ. engagement & includes act. that are purposeful, relevant, meaningful in social context.
MOHO-Model of Human Occupation
1. Seeks to identify & describe the nature & critical "doing" elements of an env. support & foster achievement of a satisfying, productive lifestyle.
2. Match between env. & ind. needs
3. Perf. & QOL can be enhanced by an env. that provides 10 fund. human needs
4. Perf. measures in 4 domains: 1) self-care & maintenance 2) intrinsic gratificaton 3) service to others, 4) reciprocal relationships
Life-style Perf. Model
1. Role of ind. context & how env. impact person and his task perf.
2. 4 contructs: 1) person, 2) tasks 3) context 4) personal-context-task transaction
3. Interventions: Establish restore 2) alter 3) adapt/modify 4) prevent 5) create
Ecology of Human Perf. EHP
Process ind. goes through to adapt to en.
2. 3 elements: 1) person, 2) env. 3) interaction between the 2
1. Intervention focused on skills needed to fun. in env.
2. ind. employs tasks & skills to meet demand of personally desired/necessary roles
3. TX act. include teaching-learning
Based on stages of cognitive dev.
Cog. ability is determined by biological factors & potential for improvement is dictated by those factors.
Once max level is reached compensations must be made.
Cog. perf. placed on continuum divided into 6 levels
Cognitive Disabilities Model
Automatic motor responses
changes in ANS
Conscious response to external env. minimal
Level I: Automatic actions
Mov. associated with comfort
some awareness of large objects
May assist caregiver with simple tasks
Level II: Postural Actions
Begin to use hands to manipulate objects
May perform limited number of tasks with long term repetitive training
Level III: Manual Actions
Ability to carry out simple tasks through to completion
Relies heavily on visual cues
May be able to perform established routines
Can't cope with unexpected events
Level IV: Goal Directed Actions
Overt trial & error problem solving
New learning occurs
Level V: Exploratory Actions
Absence of disability
Think in hypothetical situations
Mental trial-error problem solving
Level VI: Planned actions
1. Especially effective with depression
2. Works to alter negative thoughts by correcting misinterpretations
3. Used with other psychosocial disorders
4. Combines cognitive (thoughts/beliefs) & behavioral (actions & attempts to change maladaptive behavior) therapy
5. Cognitive restructuring is key which alters cognition & cog. processes to facilitate behavioral & emotional changes
- Cognitive Behavioral Frame of Reference
- Cognitive Behavioral Therapy (CBT)
Interventions using CBT
- 1. Help pt. identify current problems & solutions
- 2. help learn to identify distorted/unhelpful thinking, recognize, change inaccurate beliefs, relate to others in more positive way
- 3. Dev. coping & meaningful healthy occ. patterns
- 4. homework/structures assignments to get pt. active in therapeutic process
- 5. Self-reliance training (ADLs)
- 6. Role play
- 7. Diversion techniques & visual imigary
- 8. Meaningful tasks & therapetutic act.
- 9. Activity grading
1. Form of CBT
2. Addresses suicidal thoughts & actions & self injurious behavior
3. borderline personality disorder
4. also-depression, substance abuse, eating disorders
5. Intervention includes teaching assertiveness, coping, interpersonal skills
6. Groups adress how the acquisition of skills affects occ. perf. & provide opp. to practice skills
7. Strong client-therapist relationship needed, rapport is used for validation as confromtation
Dialectical Behavior Therapy (DBT)
1. Use of Snoezelen multi-sensory env. to calm/alert ind. with psychiatric, ASD, PDD, & dementia
2. Weighted blankets, dolls, stuffed animals as a modaility to assist in self-soothing (alternative to restraints)
3. "Comfort rooms" in mental health settings vs. restraints
4. Sensory diets include calm/alerting stimuli & heavy work patterns
Approach rarely used
Need specialized training
Ind. may protect self from anxiety through use of defense mechanisms (some health, some not)
2. quick screen of cog. fun.
3. structured tasks in interview format
4. Part I=verbal responses to assess orientation, memory, attention
5. Part II=ability to write a sentence, name objects, follow verbal & written directions, & copy complex polygon design
6. Max score=30
7. 24 or below=cog. impairment
Mini-Mental State Examination or Folstein Mini-Mental
1. intellectual fun.
2. short questionnaire (9 questions)
3. subtraction task request
4. Get point if response is wrong/1 point high school, -1 didnt complete high school
0-2 intact intellectual fun
3-4 mild intellectual fun.
5-7 mod. intellectual fun.
Short Portable Mental Status Questionnaire
Focus: allows pt. to identify personal behavioral responses & dev. strategies for enhanced participation
Method: questionnaire measures ind. reactions to daily sensory exp.
Scoring: typical to probable, definite, sign. diff.
Can be used for intervention planning
Adult/Adolescent Sensory Profile
1. Leather lacing act. to assess cog, fun. based on Allen cog. levels
2. Info related to ind. abilities & limitations
3. Age: afults with pshycihiatrc/cog. dysfunction
Describe three levels it addresses
- Allen Cognitive Levels Screen
- Level III-running stitch
- Level IV-whipstitch
- Level V-cordovian stitch
Focus: measurement of presence & depth of depression
Method: Questionnaire or interview (language, comp. diff.)
rates feelings to 21 characteristics
Scoring: 21 item ratings totaled with higher scores=higher levels depression
Age: adolescent & adults
Beck Depression Inventory
Focus: depression in elderly
Method: 30 item checklist that looks at characteristics of depression
Scoring: 10-11 indicates depression
Elder Depression scale
Focus: measures the severity of illness & changes over time in ind. diagnosed with depressive disorder/mood disorder
Method: Info gathered from interview, consult w family, staff, others informed
rates info related to 17 symptoms/characteristics
also rated=diurnal variation, depersonalization, paranoid, obsessional
Scoring: Significant changes are noted
Population: ind. diagnosed with mood disorder
Hamilton Depression Rating Scale
Focus: assess cogn, affective, perf., & social interactions skills needed to perf. ADLs
Method: 1) Interview
2) The Task Oriented Assessment (TOA)
3) Social Interaction Scale (SIS)
4) Optional Self-report
5) Perceptual Motor Screening
TOA & SIS are used as indicators of overall fun. perf. & provide info about cog,. affective, social & perceptual motor skills
Population: adults w psychiatric, neurological, dev. diagnosis
Bay area Functional Performance Evaluation (BAFPE)
Focus: structured method for observing & rating behaviors & behavioral changes in areas of general (appearance, activity level, interpersonal (cooperation), & task skills (concentration).
Method: behavior observed while ind. complete task chosen by therapist
behavior rated according to criteria
Scoring: 0=normal, 4=severe
Use: initial assessment and record progress. Results can be used for tx plan & D/C plan
Pop: adults with psychiatric diagnoses
Comprehensive OT Evaluation Scale (COTE)
Focus: identify level & amount of involvement in instrumental, leisure, social act.
Method: Ind. sorts cards into piles according to level (never done, gave up, more than in the past)
Scoring: percentage obtained, can be used to monitor changes in act. part. over time
Used for initial assessment, goal setting, intervention planning
Pop: originally for elder with dementia
Activity Card Sort (ACS)
Focus: Time usage, patterns, & configuration of act., roles, & underlying skills & habits.
Method: Idiosyncratic Activities configuration depicts how time is spent during typical week
Scoring: determination of person's activities health is made by person & therapist
Significance is placed on person's interpretation of balance, satisfaction, & comfort
Pop: adults through elders
Activities Health Assessment
Focus: assesses the dev. of internalized roles withing family, school, and social settings
Method: semi-structured interview generates discussion related to roles
Scoring: indicates behavior appropriate, marginal, inappropriate
Adolescent Role assessment
Focus: time usage, roles, underlying skills & habits
Method: typically in group, develops chart with way time is spent during typical week
COTE can also be completed based on this session.
Scoring: percentages of time calculated & sign. of info based on app. use of time & discussion w ind.
Barth Time Construction (BTC)
Focus: identifies ind. satisfaction w perf. & changes over time in areas of self-care, productivity, & leisure.
Method: semi-structures interview
Problem areas identified
Identified problems are rated by ind. as to perf. & satisfaction
Reassess at app. intervals
Scoring: items rated on scale 1-10 with 10 being highest
total scores are used to identify tx focus, tx outcomes, & ind. satisfaction
Population: ind. over age 7 or parents of younger
Canadian Occupational Performance Model (COPM)
Focus: nature & extent of ind. occ. adaptation
Based on MOHO
Interview obtains, analyzes, & reports info relevant to intervention & D/C planning
12 areas of occ. adaptation explored
Method: semi-structured interview
Scoring: items rated 0-4, 4 highest
Case analysis used to interpret data according to MOHO for ind. strengths/weaknesses
Pop: originally adult-elder with psychiatric diagnoses, now broader
Occupational Circumstances Assessment Interview Rating Scale (OCAIRS)
Focus: info about ind. life hx, past & present occ. perf. & impact of the incidence of disability, illness, or other event in ind. life.
Method: semi-structured interview, 5 content areas occ. roles, occ./act. choices, critical life choices, & occ. behavior setting.
Scoring: rates occ. identity & competence & impact of occ. behavior settings on scale 1-4
1=extreme occ. dysfunction, 4=exceptional occ. competent
Life hx pattern
POP: able to participate in comprehensive interview, adolescent-adult
NOT recommended with children less than 12
Occupational Performance History Interview (OPHI)
Focus: self-reported tole part. & value of specific roles to the ind.
Method: checklist, major roles in past, present, and future
2nd part-degree to which she vales each role
Scoring: identify roles continuous, disrupted, and designed for future.
Roles that are valuable, somewhat or very valuable
address goal & tx planning, QOL, D/C plan
POP: adolescent-elder w physcial or psychosocial dysfunction
Designed to gather info related to ind. task & group interaction skills to establish goals & tx plan.
assist members in becoming more aware of their needs, values, ideas, & feelings through the perf. of shared task.
Purpose is to assist members in acquiring & developing group interaction skills
Ind. tasks with min. interaction required
common, short-term act. requiring some interaction/cooperation
joint interaction on long-term task, completion of task is not the focus. Members are beginning to express their needs & address those of others.
learn to work together cooperatively, no specifically to complete task, but to enjoy eachothers company & meet emotional needs
responsive to all members needs & carry our variety of tasks. Good balance between carrying out tasks & meeting needs to the members.
Learning of specific skills
discussion of act. & issues outside of group that are current or anticipated
Concerned with meeting health needs & maintaining function
Procedures for developing a group (6)
- 1. Needs assessment to identify intervention needs
- 2. develop protocol
- 3. present protocol to team/admin
- 4. select potential members who would benefit
- 5. meet with each potential member to explain the purpose & circumstances
- 6. hold introductory sessions & revise protocol as needed.
Directive Groups dev. by Kathy Kaplan
Highly structured, assist low fun. ind. to dev. basic skills
Each session is divided into 5 parts followed by 15min review of session by leaders
- I. Orientation to purpose/goals (max 5min)
- II. review all names & introduce new ind. (5-10min)
- III. warm-up act. for comfort & engagement in group (5-10min)
- IV. activities designed to address goals of group & needs of members (15-20min)
- V. Act. designed to give meaning to the act. & closure of group (10min)
Mildred Ross' 5 Stage Groups
Extended use of sensorimotor approaches with other chronic populations
- I. Orientation
- II. Movement uses a variety of vigorous gross motor act. to be stimulating & alerting.
- III. Perceptual-motor uses breif (30min or less) act. that utilize perceptual motor skills designed to be calming & increase ability to focus
- IV. cognitive includes act. for cog stimulation to promote organized thinking
- V. closure consists of brief discussion to promote sense of satisfaction & closure.
Each session is rotated that allows ind. to join at any time
Ind. Living Skills group that addresses nut first session, money mngmt 2nd, and transportation 3rd)
Classroom format & principles of learning to provide info to members & teach skills
Use of homework to facilitate skill dev. & generalization of
Act. designed to dev. basic cog. skills necessary for completion of simple tasks
Basic Tasks Groups
Interventions used to dev. communication, socially acceptable behavior, & interpersonal skills
May be modular or psychoeducational
Social interaction group
Focus on self-care & ind. living skills
Modular or psychoeducational
Focus on identification & use of resources
mod or psychoed.
Identification of skills, limitations, interests, work behaviors, job hunting skills
identify interests, dev,. of act. specific skills, identification of resources, & recognition of importance of health use of unstructured time.
Review past life exp. to promote cognition & sense of personal worth.
Current memory not necessary or facilitated.
Act. to promote sesnory functions & env. awareness
Act. including values, awareness personal assets, limitations, & behaviors. Ind. impact on others
act. to identify personal objectives & tx goals & steps to their achievement.
identifying problem-solving & stress mngmt needed to cope with life stressors.
act. to problem solve potential obstacles & identify resources for successful community reintegraiton
Managing Hallucinations (3)
- 1. env. free of distractions
- 2. highly structured, simple, concrete act. that hold ind. attention
- 3. When focusing on hallucinations, attempt to redirect to reality-based thinking & actions
Managing Delusions (2)
- 1. redirect thoughts to reality-based thinking/actions
- 2. avoid discussions & other exp. that focus on & validate/reinforce delusional material.
Managing Akathisia (3)
- 1. all person to move around as needed without disrupting others
- 2. part. on many levels & forms can be beneficial to the ind.
- 3. Select gross motor act. over fine motor or sedentry ones
Managing offensive behavior (physical & verbal) (4)
- 1. set limits, immediately address behavior during a session
- 2. reasons behavior is not acceptable should be presented in clear, non- confrontational/judgmental way.
- 3. Consequences for cont. behavior clearly communicated
- 4. Staff protects members from threat harm. needs of entire group kept in mind.
Managing Lack of initiation/participation (2)
- 1. With ind. discuss reason for lack of participation
- 2. Motivational hints
- more likely to participate in interests
- more ownership, increased participation
- success is motivating
- fun is motivating
- Identify ind. motivator
- curiosity can be motivator
- Food can be motivating, use of secondary motivators such as praise is preferred over primary motivators (food)
Managing Manic or monopolizing behavior (3)
- 1. highly structured act. that hold attention & requires shift of focus from pt. to pt.
- 2. thank ind. for participation & redirect to another pt.
- 3. Limiting settings standards as discussed in offensive behaviors
Managing Escalating Behavior
- 1. avoid what may be perceived as challenging behavior (eye-contact, standing in front of person)
- 2. maintain comf. distance
- 3. actively listen
- 4. use calm, not patronizing tone. Speak softer,lower
- 5. dont make/communicate value judgements about ind. thoughts, feelings, behaviors
- 6. clearly present what you want them to do
- 7. avoid positions where you/ind. feel trapped
- 8. Ind typically calm with above strategies, if not, add. steps needed for safety.
- 9. remove other pt. from area
- 10 get or send for other staff.
Effects of Alzheimer's Disease
- 1. make eye contact & show you are interested in ind.
- 2. Valule & validate what they say
- 3. maintain positive & friendly facial expressions & tone
- don't give orders
- use short, simple words & sentences
- don't argue/criticize
- 4. Dont speak about ind. liek they aren't there
- 5. use non-verbal comm.
- 6. routine with familiar & enjoyable act.
- personal interest & independence
- dont intro. infantilizing act.
- analyze & grade
- dont rush act-process of engagement is imp. not task completion
- 7. note effects of time of day on behavior & act. perf.
- 8. attend to safety issues at all times.
Develope a trusting relationship & use RADAR approach to screen for & respond to domestic violence
- R: routinely ask. Asking about potential abuse when interviewing pt. can be first step to intervention
- A: affirm & ask. acknowledge/support ind. ask direst questions to determine risk (do you feel safe with your partner?)
- D: document objective findings & record client's statement in quotes
- A: assess & address safety (abuse more violet, are their weapons in the house)
- R: review options & referrals
Areas to address with ind. who has been abused (4)
Other areas to address
- 1. stress & safety
- 2. fear & abuse
- 3. family, friends, support network
- 4. emergency plan
- 1. provide info about tx & support programs which enable empowerment
- 2. provide intervention for physical & emotional injuries & develop skills needed for ind. empowered life
- 3. inform SPV &/or other team members
- 4. mandatory reporting is some states
Interventions for Psychological Reaction to Disability
- 1. identify what ind. can do w emphasis on personal accomplishments
- 2. assist ind. in his assumptions of an active role in shaping his life
- -use of person-centered approaches based on empowerment theory are critical
- 3. reduce limitations through changes in physical & social env.
- 4. dev. skills needed fort part. valued & meaningful occ.
- 5. acquisition of resources & supports to enable full social participation.
Identification of risk (suicide) (3)
- 1. Member of team will ask about suicidal thinking
- 2. degree of detail indicates the seriousness of intent
- 3. the potential for the plan to succeed also indicates risk.
OT intervention for suicide
- 1. id motivation behind intent & id alternatives
- 2. dev. problem-solving skills & stress mngmt to increase resilience & ability to manage life stressors
- 3. Id positive goals & interests to increase motivation for recovery
- ID positive personal attributes & support systems to increase hopefulness (can be review of past success)
- 4. act. w successful outcomes. visible-end product=positive thinking
- 5. act. designed for expression & validation of feelings
- 6. Mod. physical act. elevates mood
- 7. dev skills that increase fun. perf.
Stages in Death/Dying
- 1. Denial
- 2. anger
- 3. bargaining
- 4. depression
- 5. acceptance
OT intervention for denial
stage 1. allowing person to ask questions & discuss situation at her pace
OT intervention anger
stage 2. allow to vent anger while identifying its source & dev. more effective coping strategies.
OT intervention Barganing
stage 3. respond honestly to questions
OT intervention for depression
stage 4. provide physical & psychological comfort for both the ind. & loved ones
OT interventions Acceptance
stage 5. ongoing support for ind. & family
General considerations for death/dying
- 1. ind. vary in how they go through each stage
- 2. may stop at any stage
- 3. needs of loved ones must be considered as they are going through stages too
- 4. assist ind. in coping without pushing for progression to nest stage
OT intervention throughout stages of death/dying
- 1. help ind. maintain as much control & I as possible
- 2. respond honestly & at app. depth to questions
- 3. assist with coping skills
- 4. encourage positive life review & support the legacies the ind. leaves
- gifts & mementos can be made/selected for sign. others
- 5. help pursue interests & maintain meaningful roles
- 6. actively listen
- 7. incorporate family/friends into tx
- 8. while being realistic, dont deprive the ind. of hope
T/F initial sessions at a homeless shelter would likely focus on basic survival skills & personal self-care skills
T-locating basic resources is essential, vocational, employment, & IADLs follow in subsequent sessions.
When using a client-centered approach with survivors of domestic violence, which is the best approach to use?
- Paraphrase the ind's statements to help clarify their feelings
- Main goal of working with domestic violence survivors is to increase their awareness of feelings.
- Accept person unconditionally & reflect back what they are saying in nonjudgmental way
Parnate & Nardil are used to treat depressive symptoms. What should the OT review with the pt. regarding precautions for taking these drugs.
Tyramine increases blood pressure & may lead to stroke or cardiovascular reactions.
Contact dr. if symptoms occur
T/F statements of hopelessness and lack of future vision can indicate suicide risks.
T-these statements should be taken seriously especially with those with boarderline personality disorder due to self-destructive behaviors. Need to speak to the ind. to ask if they are feeling self-destructive.
When interviewing an individual with OCD, it is best to
complete in highly structured situations with limiting the time available to answer questions.
Positive symptoms of schizophrenia
- False perception of reality
- bizarre delusions
- insulting or commanding auditory hallucinations
- Positive symptoms are those that are conspicuously disturbing to others
Negative symptoms of schizophrenia
- Persist after the positive symptoms
- treated with medications
- restricted emotion (little facial expression)
- decreased thought & speech (toneless voice, inattention)
- lack of motivation or initiation
- inability to relate to others
T/F Assembling a complex airplane model with detailed instructions is the best initial activity for an intellectual individual with paranoid schizophrenia in an acute care setting.
- T-is has many of the characteristics that appeal to ind. with this diagnosis
- complicated enough to engage him intellectually & sustain interest
- and it uses controllable materials & requires organization to complete
- need something challenging
Gross Motor act. invloving either aerobic ex, stretching, or relaxation can help decrease physical symptoms associated with anxiety such as muscle tension.
Steps in social skills training
- 1. instruction-teachign about social skills
- 2. demonstration of desired behaviors by group leader
- 3. guided practice-client performs an actual social skill under the eyes of the OT & members (ROLE PLAYING)
- 4. independent activities-ind. practice in real life situations or practicing how to self-evaluate one's social behavior
When working with an ind. severely depressed & demonstrates psychomotor retardation (slowing of cognitive & motor fun.) it is best to
give simple directions & patiently wait for responses
Medication side effects for antianxiety
- decreased arousal & drowsiness
- sleep, relax muscles, & impair memory
Medication side effects for Antipsychotic
Akathesia (motor restlessness), extrapyramidal syndrome (Parkinson like motor symptoms), tardive dskinesia (involuntary movements).
Neuroleptic medications, one should avoid __________
Support group for clients & families & focuses on ed. & support related to mental illness
National Alliance for Mentally Ill
support group for alcohol use among family members
self-help support group for members with mental disorders
T/F Seeing others as similar has been identified by ind. as a curative factor
- T- in groups, an OT who encourages group members to share similar situations & reactions with one another is an approach designed to develop cohesivenss & universality among members.
- This is an important curative act for ind. in groups
- Example: assertiveness training
Reality-testing of negative thinking
- Used with ind. with depression
- helps develop the ind. ability to test & correct negative thinking to help develop ability to set goals.
T/F When using a sensorimotor approach, the activities should not requires ind. to think about the steps needed to complete the activity. They should be spontaneous, non-cortical, and fun.
- Example includes keeping balloons afloat while music plays.
- teacher student format
- often includes homework
- Ex: program to promote healthy eating habits-watch video about nutrition & keep weekly eating diary.
- activities used to provide subjective experience for a catalyst for learning
- activities that look at one's perceptions of life events
- EX: act. exploring past, current, and future events and how they are connected.