Transcript Working with the client

The Occupational Therapy Process
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First steps in the Occupational Therapy
Process
Referral and Screening
Evaluation and Assessment
Treatment Planning
◦ Frames of Reference
◦ Types of Reasoning
◦ Activity Analysis
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Referral
Screening (Ask Questions)
Evaluation (Gather Data, Identify function/dysfunction)
Treatment Planning (Frame of
Reference/Goals/Objectives)
Treatment Implementation (Treatment Method)
◦ Largest role for OTA
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Reevaluation
Discharge Planning
Termination of Treatment
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Referral
◦ Physician or other legally qualified professional
request OT services for the client. Referral may be
oral, but a written record is also necessary.
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Screening
◦ Registered OT performs a quick assessment to
determine whether OT services would be helpful to
the client.
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Sources Include:
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The referral form
The medical record
Social, Educational, Vocational and Play Histories
The interview with the patient or family and friends
Results of procedures completed by OT service and
other services.
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Evaluation
◦ Registered OT identifies the information to be
collected and the areas to be evaluated and selects
the evaluation and assessment instruments
◦ Parts of evaluation can be carried out by the OTA
◦ Data is analyzed to determine the client’s specific
strengths and deficits
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Create a list of your clients:
◦ Functions/dysfunctions
◦ Assets/capabilities
◦ Deficits/limitations/problems
This becomes the basis of the treatment plan
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When therapy services require referral or
doctor’s orders, the therapist must start from
the deficit noted in the original order but is
also obliged to consider the client more
globally
The challenge may be to find a way to identify
and obtain permission to address other
occupational performance areas and tasks
that are troublesome to the client, without
exceeding the requests of the original
referral.
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Working with the client, OT develops a plan
for restoring, improving, or maintaining the
client’s ability to function in ADL’s and IADL’s
Treatment plan includes goals and methods
for reaching them
Recognizes the client’s values and goals and
considers the cultural, social, and
environmental situation
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When analyzing a proposed course of action,
some questions should be considered for the
planning process.
◦ What is the most appropriate frame of reference?
i.e. Biomechanical Approach, Sensorimotor
Approach, Rehab Approach?
◦ What are the patients capabilities and assets?
◦ What are the patients limitations and deficits
◦ What does occupational therapy have to offer this
patient?
◦ What are specific long term objectives?
◦ Are the treatment objectives consistent with the
patients needs and personal aspirations?
◦ If objective are not compatible, how do they need to
be modified?
◦ Which treatment methods are available to meet
these objectives?
◦ When should the patient have met objectives?
◦ What standards will be used to determine when the
patient has reached an objective?
◦ How will the effectiveness of the treatment plan be
evaluated?
◦ What is the estimated length of treatment?
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Select your frame of reference to establish
evaluation procedures, objective and
methods of treatment that are appropriate for
the patient.
Ex. If the therapist is treating a fractured arm
with limited R.O.M and muscle weakness
from disuse, the biomechanical model might
be selected. After performing evaluations
procedures for R.O.M. and muscle strength
testing you can incorporate therapeutic
exercise and activities.
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Biomechanical Approach:
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Sensorimotor Approach:
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Orthotics
Splinting
Therapeutic Modalities
Ex. To increase stength and ROM
◦ Ex.
 Neurodevelopmental Treatment of Adults with Hemiplegia
(Bobath Approach)
 Sensory Integration (Jean Ayres)
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Rehabilitative Approach:
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Wheelchair use
Assistive devices
Work hardening/ergonomics
Home/vehicle modifications
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Complex process to describe thinking
Must consider:
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The
The
The
The
client
disability
circumstances
meaning of disability to the client
The clinical reasoning is a process of deciding
how to act and what to do in a specific
circumstance involving the client’s well being
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Procedural reasoning
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Interactive Reasoning
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Conditional Reasoning
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Clinical Reasoning
◦ Consider the client’s physical problems; an example is
evaluating and analyzing the extent and possible cause
of limited ROM
◦ Guide interacting with the client; for example, when
trying to obtain information, elicit cooperation, or
develop rapport
◦ Considers clients within their personal and social
contexts and futures. It uses a “what if” approach.
◦ A complex, changing process for meeting the
individual’s unique needs for reclaiming a valued sense
of self and a meaningful life.
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Research found that OT’s in physical disability
settings used the following 6 stages of clinical
reasoning during the initial evaluation:
◦ Obtaining available information from the medical record,
referral statement and reports before meeting the client
◦ Selecting evaluation procedures based on medical
diagnosis, prognosis, and the client’s ability to cooperate
and participate in the evaluation
◦ Implementing the evaluation plan by interacting with the
client and carrying out selected evaluation procedures
◦ Defining problems and possible causes
◦ With the client’s involvement, defining treatment objectives
based on the problem list and selecting some treatment
tasks and plans to carry out additional evaluation
◦ Evaluating the effectiveness of the evaluation plan and the
reliability of the evaluation results.
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Foundational skills for practice
Essential to the selection of appropriate
treatment activities
Activities evaluated from 3 perspectives:
◦ Mental and physical contributions of the person
engaged in the activity
◦ Effects of the physical environment
◦ Implications of the social environment
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Activity Analysis Model
◦ Page 227 - Early
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Work in pairs to develop a set of 5 activities
that will work on one of the following deficits:
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Grasp
Stability
Cutting Skills
Motor Planning
Bilateral Hand-Use
Visual Memory
Finger Isolation
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Next Week: Goal-setting
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Treatment Implementation
◦ OT team carries out the treatment plan. OTA may
have significant responsibilities for this part of the
process
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Therapist role is to facilitate and empower
problem identification and problem solving
by clients and caregivers
Creativity and problem-solving skills required
Ensure Client-Centred Practice
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Four Key Methods
◦ Remediation
 Aims to alter the function of the body so the
occupations can be performed
◦ Compensation
 Aims to compensate for the deficit present, without
changing the function of the body
◦ Adaptation
 Aims to adapt the nature of the task to allow the client
to perform
◦ Modification
 Aims to modify the environment to allow for optimal
function
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Treatment method chosen to help achieve the
objectives
Refer back to frame of reference then apply
the principles within this frame of reference
Ex. Frame of reference is Biomechanical
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ROM, strength and endurance are applied to the problem
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acute care general hospitals
rehabilitation and convalescent facilities
nursing homes, long term care facilities
community care
mental health agencies
vocational rehabilitation programs
community and government health agencies
schools
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In selecting treatment methods other factors influence the selection of
treatment methods.
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What is the goal for the patient?
What are the precautions or contraindications?
What is the prognosis for recovery?
What were the results of evaluations in other services?
What other treatment is the patient receiving?
What are the goals of other treatment programs? Are they compatible with OT
program?
How much energy does the patient expend in other therapies?
What is the state of the patients general health?
What are the patients interests, vocational skills and psychological needs?
What is the patients’ physical and social environments?
What roles will the patient assume in the community?
What kinds of activities or exercises will be most useful and meaningful to the
patient?
How can treatment be graded to meet the patients changing needs as progression or
regression occurs?
What special equipment or adaptations of therapeutic equipment are needed for the
patient to perform maximally?
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See you at 12:00 for Lab Activity 2
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In pairs:
Choose a treatment environment
Choose a health issue
Consider treatment methods
Come up with a case study and treatment plan that
addresses the “treatment method questions” posed
last slide
◦ Present your case to the class
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See you at 1:15 for OTA 2