Transcript OTA 1: Therapeutic Skills for the Occupational Therapy

OTA 1:
Therapeutic Skills for the
Occupational Therapy Assistant
LECTURE 1: HISTORICAL PERSPECTIVE AND
PERFORMANCE COMPONENTS OF OCCUPATIONAL
THERAPY
INSTRUCTOR:
DANIELLE N. NAUMANN, OT REG(ONT)
MSC (OT), PHD CANDIDATE 2015
Class Outline
 Introductions
 Course outline and expectations
 Practice Profile
 “Occupation”
 Historical perspective
 Roles and Relationships
 Models of OT
 Theoretical basis
 Occupational Performance Areas
Assessment
 Attendance & Participation:10%
 Midterm Exam: 20%
 Accessibility Lab: 5%
 Group Activity Lab: 10%
 Case History Presentations: 25%
 Final Examination: 30%
**Mark the Dates!
Evaluation
Date
Midterm Exam
July 10
Case History Presentations
August 21
Final Examination
September 4
Group Activity Lab
September 11
Online Resources
http://occupationaltherapyassistant.edublogs.org
Learning Objectives
Source: CAOT, 2009.
Roles of the OTA
1.
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6.
7.
8.
Expert in enabling occupation
Professional
Communicator
Scholarly Practitioner
Collaborator
Change Agent
Practice Manager
(optional) Focused Skill-Specialist
Brainstorm…
 Occupation
 Occupational Therapy
 Enabling
 Task
 Activity
What are Occupations?
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Occupations are everything people do in their daily
lives to occupy themselves, including:
 Looking after themselves (self-care)
 Enjoying life (leisure)
 Contributing to society (productivity)
(Townsend & Polatajko, 2007)
What is an Occupational Therapist (OT)?
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An occupational
therapist (OT) is a
healthcare professional
who helps people engage in
occupation.
Occupational therapy
helps to solve the problems
that interfere with your
ability to do the things that
are important to you.
Person
Environment
Occupation
Uses clues from three main
areas:
 The person
 Environment
 Occupation
(Townsend & Polatajko, 2007)
What does Occupation mean to a…
 Infant
 Child
 Teenager
 Young adult
 Adult
 Retired adult
 Senior
“Activity treatment”
form the mentally ill
(100BC)
Age of Enlightenment:
Moral Treatment and
Occupation (Phillipe
Pinel)
Historical Perspective of OT
Moral Treatment
 Religion and culture
 Principles of Moral Treatment
 Respect for individuals
 Belief in unity of the mind and body
 Importance of a regular daily routine
 Value of productive activity for even the most disabled
individuals
Arts and Crafts Movement
 Late 1800’s
 response to industrial revolution
 All people should receive training in productive
activities and “occupation” was seen as a healing
agent
 Occupation was promoted as being
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Aesthetically satisfying
Therapeutic for the individual
 Decline in the late 18th Century driven by economic
costs of the civil war and large numbers of
immigrants
WWI (1914)
 Reconstruction aides were recruited to occupy hands
and minds of war injured patients
 “Occupational Nurse” (Mental health context)
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Informal training
 “Occupational Aides” (Physical health context)
 1918: Short course /diploma conducted at University of
Toronto, 356 graduates
 Following the war the focus returned to those with
psychiatric disorders
Occupational Therapy in Canada! (1920’s-30’s)
 1926:
A 2-year diploma course for OT through
the University of Toronto
 Canadian Association of Occupational
Therapists(CAOT) developed 1926
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Minimum standards of practice developed
OT qualifications and knowledge governed by registration to
protect the public
Great depression resulted in clinic closures, staff layoffs
Roots of OT remained that of Moral Treatment (holism: value
of the whole above the sum of its parts)
Trend towards reductionism (analysis in small measurable
parts, eg. ROM/strength)
WWII and it’s aftermath (1940’s):
 Rehabilitation Movement: Increased demand for services
 Predominant role in mental health
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Branching into physical disabilities to treat “modern medicine’s
miracles”
 Goals for OT in physical dysfunction:
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Increase ROM/strength
Increase coordination/motor skills/work tolerance
Prevent build up of unwholesome psychological reactions
 Focus turned to patient’s posture, position of furniture,
and undesirable substitutions
 Shift lead to an increase in use of techniques rather then
occupation (eg. Splinting, parrafin wax, mechanical
exercisers)
1950-1970’s: Enter the OTA
 Shift into more physical settings including nursing
homes, school settings and acute care hospitals
 Medical model drove theoretical base for practice
 OT developed theoretical frameworks for treatment
under different models:
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Psychoanalytic Model
Biomechanical (Kinesiological) Model
Neurological Model
 Increased need for OT: Decreased availability
 In 1950: AOTA approved a 3-month training program
and established national standard for OTA
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In 1953, the first OTA program at Kingston Psychiatric Hospital
Psychoanalytic Model of OT
 Belief that patients experience intrapsychic conflicts
that were not consciously understood
 Engaging in occupation would alleviate tension
building conflicts and provide satisfactory
experiences
 Goal of treatment included
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Psychosexual maturation
Effective communication
Expression and reduction of psychiatric symptoms
Biomechanical (Kinesiological) Model of OT
 Increase independence despite pathology
 Techniques include: exercises, constructive activities,
adaptive equipment, bracing of affected body parts,
retraining in activities of daily living and
prevocational training
 Goals of treatment:
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Increase ROM, muscle, strength, endurance and coordination
Enable patients to engage in daily living activities
Increase independence and maintain function
Neurological Model of OT:
 Treatment of perceptual motor dysfunction
 Sought to decrease the dysfunction and provide
opportunities for adaptive responses by controlling
sensory input and eliciting more appropriate motor
input
 Training or retraining the brain
 Sensory Integration techniques used
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Adapting the sensory environment to enable engagement in
occupations.
Today:
 OT’s and OTA’s work in a variety of physical and
mental healthcare settings and utilize a combination
of OT approaches:
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Provincial/local hospitals
Private clinics
Long-term care facilities
Schools
Specialized treatment facilities
Community
And More…
Relationship between OT and OTA
 When OTA role originally developed in the 1970’s there was
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a significant lack of clarity for the position, responsibilities
and supervision
OTA training was inconsistent and varied
In the 1990’s AOTA initiated clarification of practice
guidelines and published supervision guidelines for the
OTA by the OTR. CAOT followed suit in the new
millennium.
Legal requirements for supervision still under debate in
both US and Canada.
CAOT has published multiple documents related to the
supervision of support personnel.
CAOT Website: http://www.caot.ca/
Break!
SEE YOU ALL BACK AT
12:00
FOR THE LAB PORTION
OTA 1: Lab Component
OCCUPATIONAL PERFORMANCE
Occupational Therapy’s Domain of Concern:
 Occupational Performance (OP):
 The way humans carry out functional life activities and
occupational roles
 Humanistic and reductionism perspectives combined
 Important to clarify purposes, aims and concerns of
OT when working in all areas of practice
 Primary concern needs to be on a client’s
occupational functioning in life’s roles that
are of importance to the client.
 CLIENT CENTREDNESS
Occupational Performance Areas:
 Broad Categories of human
activity that are typically
part of daily life
 Can be subdivided in 3
categories:
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Self-Care (ADL’s): Those
activities that relate to taking
care of ourselves
Productivity (Work): Those
activities that contribute to
society or personal welfare
Leisure (Play): Activities
generally performed for
enjoyment
Occupational Performance Components:
 Defined as functional human abilities that to varying
degrees in differing combinations are required for
successful engagement in performance areas.
 Performance components support a person’s ability
to engage in performance areas
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Ex. Strength and finger coordination which is needed for
opening jars
 Assessment of Motor and Process Skills
 Motor and process skills and their effect on the ability of an
individual to perform complex or instrumental and
personal activities of daily living (ADL).
Performance Components:
 Sensory: Processes are responsible for receiving and
interpreting information that comes through the
senses; what we see, hear, smell, feel by touch, feel
by balance mechanisms, and feel through joints
 Perceptual: Processes organize the information
received through the senses into meaningful patterns
to help us understand what we are experiencing
through our senses
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Ex. When crossing an unfamiliar intersection and trying to get
your bearings by using your eyes to see and search.
Performance Components:
 Neuromusculoskeletal: processes concern the ability to move
parts of the body
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Ex. To sit or stand or to control muscles against gravity
Cognitive: Processes integrate the ability to use higher cortical brain
functions to organize and interpret information. Focus is on thinking
and awareness skills
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Ex. Memory, reasoning, attention span
 Psychological and Psychosocial: Processes that contribute to a
person’s ability to relate to others and to deal with feelings
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Ex. Values, interests, self-concept, role performance, social conduct,
interpersonal skills, self-expression, self-management, skills of
coping, managing time, self control, sexual expression etc…
Occupational Performance Contexts:
 “Situations or factors that influence an individual’s
engagement in desired and/or required performance
areas” (AOTA, 1994)
 Provides a setting for occupational performance and
different meanings are attached depending on this
context.
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Ex. Cutting food with a knife
A person recovering from a stroke
 A child with cerebral palsy learning to do this for the first time
 A person with aids (palliative) and wanting to preserve his skills
 A person who is a professional chef
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Other Performance Factors
 Temporal aspects:
 Affects expectations for performance
 Ex. Chronological age, developmental years, place in life cycle,
health status
 Environmental aspects:
 Affects aspects of performance in the areas of:
Physical (ex. Building/furniture/tools/machines)
 Social (ex. Spouse, relatives, caregivers)
 Cultural considerations (ex. Ethnic, political)
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P-E-O Model
Person Factors:
Environment
Factors
Occupation
Factors
LAB Activity #1
Occupational Performance Case Study
Jillian is a 21 year old woman who broke her leg last
week. She is employed as a receptionist at a dentist’s
office and does all the clerical work there, she is also
a single parent to a 3-year old. She enjoys running,
spending time with her daughter at the park, lives at
home with her elderly aunt.
What occupational issues do you anticipate Jillian will
face as she returns home to her occupations?
Lab Activity #2: Individual Scenario
 Choose an occupation from
the following and complete
it with a partner watching,
paying attention to each
step of the process:
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Folding a paper airplane
Writing a note
Putting your hair in a
ponytail
Putting on your shoes
 Observer, record:
 What does the person do
(step 1, step 2…)
 Was there a time you could
not do this activity? Why?
 Discuss what occupational
performance issues you
would expect to
see/experience with:
 Use of only one side of your
body
 Amputation
 Blindness
 Age/Developmental Stage