OTA I

1. OTA I The Occupational Therapy Process

2. Class Objectives • First steps in the Occupational Therapy Process • Referral and Screening • Evaluation and Assessment • Treatment Planning • Frames of Reference • Types of Reasoning • Activity Analysis

3. Steps in the Occupational Therapy Process • 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 • Reevaluation • Discharge Planning • Termination of Treatment

4. Referral and Screening • Referral • Physician or other legally qualified professional request OT services for the client. Referral may be oral, but a written record is also necessary. • Screening • Registered OT performs a quick assessment to determine whether OT services would be helpful to the client.

5. Referral and Screening– Gather Data • Sources Include: • 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.

6. Evaluation • 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

7. Evaluation - Identify Functions and Dysfunctions • Create a list of your clients: • Functions/dysfunctions • Assets/capabilities • Deficits/limitations/problems This becomes the basis of the treatment plan

8. Evaluation (Assessment) • 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.

9. Treatment/Intervention Planning • 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

10. Treatment Planning • 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?

11. Treatment Planning • 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?

12. Treatment Planning - Select a Frame of Reference • 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.

13. Review of Examples of Common OT Treatment Approaches • Biomechanical Approach: • Orthotics • Splinting • Therapeutic Modalities • Ex. To increase stength and ROM • Sensorimotor Approach: • Ex. • Neurodevelopmental Treatment of Adults with Hemiplegia (Bobath Approach) • Sensory Integration (Jean Ayres) • Rehabilitative Approach: • Wheelchair use • Assistive devices • Work hardening/ergonomics • Home/vehicle modifications

14. Clinical Reasoning • Complex process to describe thinking • Must consider: • The client • The disability • The circumstances • The 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

15. Types of Reasoning • Procedural reasoning • Consider the client’s physical problems; an example is evaluating and analyzing the extent and possible cause of limited ROM • Interactive Reasoning • Guide interacting with the client; for example, when trying to obtain information, elicit cooperation, or develop rapport • Conditional Reasoning • Considers clients within their personal and social contexts and futures. It uses a “what if” approach. • Clinical Reasoning • A complex, changing process for meeting the individual’s unique needs for reclaiming a valued sense of self and a meaningful life.

16. Steps of Clinical Reasoning • 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.

17. Activity Analysis • 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 • Activity Analysis Model • Page 227 - Early

18. In-Class Activity • Work in pairs to develop a set of 5 activities that will work on one of the following deficits: • Grasp • Stability • Cutting Skills • Motor Planning • Bilateral Hand-Use • Visual Memory • Finger Isolation

19. Treatment Planning • Next Week: Goal-setting

20. Treatment Implementation • Treatment Implementation • OT team carries out the treatment plan. OTA may have significant responsibilities for this part of the process • 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

21. Treatment Implementation • 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

22. Choosing Treatment Methods • 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 • ROM, strength and endurance are applied to the problem

23. Consider these Environments: • 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

24. Choosing Treatment Methods • In selecting treatment methods other factors influence the selection of treatment methods. • 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?

25. Break! • See you at 12:00 for Lab Activity 2

26. Lab Activity 2: • 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

27. Break! See you at 1:15 for OTA 2