OTA II

1. OTA II Types of Activities

2. Class Outline • Course outline and expectations • Purposeful Activities • Activity Analysis • Adapting and Grading Activity • Therapeutic Exercise • Physical Agent Modalities • In-class Activity Analysis

3. Assessment • Attendance & Participation: 10% • Assignment: 15% • Presentation: 15% • Practical Laboratories: 40% • Final Examination: 20%

4. **Mark the Dates!

5. Online Resources http://occupationaltherapyassistant.edublogs.org

6. Learning Objectives

7. Source: CAOT, 2009.

8. Roles of the OTA • Expert in enabling occupation • Professional • Communicator • Scholarly Practitioner • Collaborator • Change Agent • Practice Manager • (optional) Focused Skill-Specialist

9. Introduction OT’s use purposeful activities in addition to skillful applications of therapeutic exercise, physical agent modalities, as well as facilitation and inhibitation techniques associated with the sensorimotor approaches to treatment. OT’s use these strategies to promote the development of the individual’s ability to engage in Occupational Performance.

10. Purposeful Activity • What makes an activity purposeful? • Why is purposeful activity important? • List examples of purposeful activity

11. Purposeful Activity: • Goal directed behaviours or tasks that comprise of occupations. An activity is purposeful if the individual is an active, voluntary participant and if the activity is directed toward a goal that the individual considers meaningful. • Primary treatment modality of OT • Activity must have an intrinsic or inherent goal beyond the motor function required to perform the activity • Brings focus for the individual to the goal as opposed to focusing on the processes required for the activity.

12. Objectives of use of Purposeful Activities: • To maintain strength/ROM/endurance/work tolerance/ coordination • To practice and use voluntary/authentic movement in activities • To provide purposeful use and general exercise to the affected parts • To explore vocational potential • To improve sensation/perception/cognition • To improve socialization skills and enhance emotional growth • To increase independence of occupational performance

13. Activity Analysis • A breakdown of an activity where the activity characteristics match with the performance components needed in treatment. • Ex. In order to stir ingredients in a bowl during cooking the person requires two-handed skills, grasp, grip strength, coordination, and sensation • Can be done from varying approaches, for example a biomechanical approach (muscles, joints, motor patterns), vs. a sensorimotor approach (movement patters and perceptual skills).

14. Principles of Activity Analysis • To be goal directed • Have some significance/meaning to the client to meet individual needs in relation to social roles • Require client’s mental or physical participation • Be designated to prevent or reverse dysfunction • To develop skills to enhance performance in life roles • Relate to client’s interest • Be adaptable/gradable/age appropriate • Be selected through knowledge and professional judgment of the OT practitioner with the client’s input

15. Let’s Try! • Pair up! • Choose an activity that you do in your day to day life, and ANALYZE! • Share your results with the group

16. How do I analyze an activity? • Break the activity down • Determine skills required for each step • Determine where the challenge is present • Let’s do it together

17. Adapting and Grading Activities: • Adapting Activities: change activities in order to accommodate for the client’s residual abilities • Examples? • Grading Activities: gradual increase in demands to increase levels of performance as patient’s capabilities increase • Examples?

18. Activity Selection • Activity selected should relate to desired outcome • Activities should provide repetition • Activities should allow for more than one type of grading • Activities should remain as close as possible to the end goal. i.e. Active resistance are most often used in purposeful activities (ex. Lifting a grocery bag)

19. Enabling Activities • Purpose is to engage the patient’s mental and physical participation, to practice specific motor patterns, train in perceptual and cognitive skills and practice sensorimotor skills that will be necessary for functioning in the home and community • When are they appropriate?

20. Therapeutic Exercise: • Exercise (preparation) and activity (application) are complementary to one another. Both can be part of the treatment plan if the exercise is applied to a purposeful activity. • Is used to prepare the patient for occupational performance • Used to decrease or eliminate substitution patterns. (ex. Holding on to a glass in neutral wrist position vs. too much pronation (palms down) or too much supination (palms up). • Purpose is to remediate sensorimotor dysfunction, augment purposeful activity and prepare the patient for doing tasks in performance areas.

21. Indications and Contraindications for use of therapeutic exercise: • Indications: • Effective in treatment of orthopedic problems, weakness and flaccidity • Must be able to medically participate in an exercise regimen • Able to understand direction • Be interested and motivated • Potential for recovery or improvement in strength, ROM, coordination, or movement patterns. • Direct correlation of movements with purposeful activities • Sensation at least partially intact so the patient can perceive motion and position of exercise part and have some sense of superficial and deep pain • Muscles and tendons must be intact • Have an effective ROM • Relatively free of pain during movements • Client uses proper breathing • No substitute movements are occuring

22. Contraindicated for: • Patients with poor general health, or inflamed joints or who have had recent surgery. • Severely limited ROM caused by well-established permanent contractures • Spasticity • Lack of voluntary control of isolated motion or those with involuntary movements

23. Types of Activities • To increase muscle strength • Active assisted – OT/OTA helps movement • Active – independently move • Resistive isotonic – contraction of muscle and joint with gravity or weight • Isometric exercises – static without joint movement and only muscle contraction • To increase muscle endurance • Exercise for physical conditioning and cardiovascular fitness • Exercise to improve coordination • Exercises for ROM and joint flexibility • Active • passive

24. Physical Agent Modalities: • Thermal Modalities • Cooling Modalities • Electrical Modalities

25. Thermal Modalities • Types: • Paraffin wax use • Hot packs • Whirlpool • ultrasound • Purpose: • Increase ROM • Decrease joint stiffness • Decrease muscle spasms • Decrease edema • Increase blood flow • Assist with treatment strategies (ex. Splinting, stretching) • Contraindications: • Acute conditions • Clients with sensory loss • Clients with vascular structures • Very young or old clients

26. Cooling Modalities • Types: • Cold packs • Cooling devices • Ice massage • Purpose: • Decrease edema • Decrease pain • Decrease inflammation • Decrease muscle spasms • Contraindications: • Clients with cold intolerance • Vascular repairs Contrast Baths (hot and cold) are sometimes used to increase circulation, which decreases edema and pain

27. Electrical Modalities • Transcutaneous electrical nerve stimulation (TENS) • Provides constant electrical stimulation with a modulated current to reduce pain (ex. Acute/chronic injuries, after surgery) • Functional Electrical Stimulation (FES) • Provides continuous interrupted current and applied to motor point of the muscle (ex. Use after nerve injury

28. Selecting appropriate modalities: • Occupational performance stage = purposeful activities • Practice stage = use of enabling activities • Preparation = use of adjunctive modalities

29. Activity Analysis Exercise • In groups of 2 (switch partners) • We’re going to try again • Choose a more complex activity to analyze • We will come back and share when you are done