1. What is the difference between theory, model, frame of references, and framework?

Theory is a set of ideas that helps explain concepts and principles and defined broadly as “a plausible or scientifically acceptable general principle or body of principles offered to explain phenomena”.

Model is “a symbolic representation of concepts or variables, and interrelationships among them’’ (Polit, D. F. and Beck, C. T. (2004))  

There are 2 types of models 1- is the conceptual models that help occupational therapists to analyze and understand occupation. And 2- is the Practice models, help therapists to know what to do in clinical practice.

 

Frame of reference is “a structure used to transform theory into applicable information – to link theory to practice (Mosey, A. C. (1986) )”. A frame of reference is a collection of principles that was selected and synthase from theories formed into practical form therapist can use them.

 

Framework is the basic conceptional structure. is divided into two sections: the domain, which outlines the profession's purview and the areas in which its members have an established body of knowledge and expertise, and (2) the process, which describes the practitioner's action when providing services that are client centered and focused on occupational engagements.

 

Therapeutic use of self

“Therapist’s “planned use of his or her personality, insights, perceptions, and judgments as part of the therapeutic process” ( (Punwar & Peloquin, 2000, p. 285 as cited by Taylor et al. 2009).)

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Therapeutic use of occupation and activities.  

Any activity which is meaningful to an individual person in order to achieve a particular therapeutic outcome.

 

 

 

OT process:

1. Evaluation Process: through view profiles, interviewing the client or the care giver, evaluation assessment ex: checklist and observations

2. Intervention Process

   1. Intervention plan: developing plans after the evaluation and doing some assessments intervention plan develop to reach a specific goal within timeframe and measurable object.

   2. Intervention implementation

   3. Intervention review

      1. Re-evaluating the plan

      2. Modify the plan

      3. Determining the need for continuation or discontinuation of OT services

 

Outcome Process

Depending on the case and the goals we will have specific type of outcome that we have to select, including:

• Occupational performance

  • Improvement

  • Enhancement

• Prevention

• Health and wellness

• Quality of life

• Participation

• Role competence

• Well- being

• Occupational justice

 

Then we use these outcomes to measure progress and adjust goals and intervention:

​Assessing outcome results to make decisions about the future direction of the intervention

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Approaches to intervention:

• Create, promote.

A method of intervention that does not presume a disability is present or that there are any factors that could cause barrier with performance. This approach is designed to provide enhanced contextual and activity experiences that will enhance performance for all.)

• Establish, restore (remediation.)

A method of intervention designed to create a mapping of client variables in the attempt to establish a skill/ability that has not yet been established or to restore a skill/ability that has been impaired.)

• Maintain

A method of intervention designed to provide aids that will allow clients to continue with their performance capabilities that have regained, that continue to meet there needs in an occupational environment or both. It is assumed that without routine maintenance intervention, performance would decrease, there occupational need would fail to be met, or both, affecting the client’s health and quality of life.)

• Modify (compensation, adaptation)

A method of intervention directed at finding methods to revise the current context or demands to support the performance of the client in a natural setting. This includes but is not limited to: compensatory techniques, reducing other features to reduce3 distractibility, or enhancing some features to provide cues.)

• Prevent (disability prevention)

A method of intervention designed to tackle clients with or without a disability who are at risk for occupational performance problems. This method was designed to thwart the occurrence or progression of barriers to performance in context. Interventions may be aimed at the client, activity variables, or the context. )

 

 

Types of occupational therapy intervention:

Preparatory methods and tasks:

• Preparatory method: Preparatory method invokes the use of devices, modalities, and techniques in the aim of preparing the client for occupational performance that will be used as part of a treatment session and also provides concurrently with the occupation and activities that are performed to the client without requiring active client participation.

• Preparatory task: Preparatory task is a specific action that is selected and provided to target specific client factors or performance skills tasks that involve active client participation. Occasionally, this task can comprise engagement through the use of various material in the aim to stimulate activities or components of occupation.

• Splints: use of devices to mobilize, immobilize and support body structures to enhance participation

• Assistive technology and environment modification: use of assistive technologies, application of universal design principles, and recommend changes to the environment or activity to support engagement

• Wheeled mobility: use technologies to facilitate client’s ability to maneuver through space, including seating and positioning to enhance participation and reduce risk of complications.

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Education and training

• Education: Education is the imprinting (rapidly and briefly educating) of information about occupation, well-being, health, and participation that enables the client to acquire helpful behaviors, habits and routines that might require application at the times of the intervention session

• Training: Training is facilitation of the acquisition of concrete skills for meeting specific goals in a real-life, applied situation.

 

By the end of the training the client should be able to apply the education in real life situations. And we differentiate between as training goal is to enhance performance as opposed to enhance understanding, although these goals often go hand in hand.

 

 

Advocacy

• Advocacy:  promoting the Occupation justice and empowering clients to seek and obtain resources to fully participate in daily life occupations. (by the OT)

• Self-advocacy: advocating for oneself, (by client, but It is the practitioner’s role to promote and support the client’s self-advocacy). Including: making one’s own decisions about life, knowing one’s rights and responsibilities, etc.

Self-advocacy can be linked heavily with training however self-advocacy allows self-treatment to occur rather than assistance. Applying a mixture of self-advocacy and training and result in a client’s recovery being smoother.

Group intervention:

Use of distinct knowledge and leadership techniques to facilitate learning and skill acquisition across lifespan through the dynamics of group and social interaction. Also, there might be activity groups, social groups and functional groups that are used with patients.

 

Steps of activity analysis

• Activity Identification:

What is the occupation that is being analyzed?

• Sequence and Timing:

Identify the step and the time that is consumed to do these steps

• Objects, tool/ supply/equipment’s/social demand/ space demand:

 objects, materials, and equipment that the client must use.

• Supply: non reusable materials ex: milk/ tissues

• Tools: reusable materials ex: pen/ book/ bottle

•  Equipment: big materials that are reusable consume space and needed to associate the activity ex: table/ chair/ bed

• Social demand: the people who help and be in the activity ex: mother, father

• Space demand: the place that the activity occurs ex: ward, bed room, school

• Required Body Functions: 

Mental, physical, neurological, and other body functions are utilized and challenged during the activities the client must perform.

• Required Body Structures:

Parts of the body are required to complete the activities.

• Required Actions / Performance Skills:

Motor praxis, sensory, emotional, cognitive, and communication/social skill levels are needed to complete the activities.

• Analysis for Intervention:

Evaluate the outcome for successful results.

 

problem statement:

1. Client: who is doing the activity and have difficulty in achieving it

2. Area of occupation: the occupation the client having difficulty in achieving it (ADL, IADL, rest and sleep, Education, work, play, leisure, social participation)

3. Contributing factors: it is the skills and factors that limit engagement in the desired occupation (Client factors, performance skills, performance pattern, context and environment, activity demand)

 

1. GOALS: (ABCDE/ COAST/SMART )

   1. ABCDE:

      • Audience: who will do the occupation

      • Behaviour: official performance of the activity or task that supported the behavior  

      • Condition: circumstance that supports behavior or the occupation performance

      • Degree: measurable part of the goal

      • Expected time: time frame went to be completed

   2. COAST:

      • Client: the one is the main key in this statement client will perform ..

      • Occupation that the client wanted to achieve and was mentions in the problem statement and want to be improve) client will perform 5 steps of cooking

      • Assistants level: how much assistants/ independence the client needs include physical and verbal cues

      • Specific condition: under which condition is expected to perform the diseased action (adaptive equipment/ without pain/ modified techniques)

      • Timeline: By when the target level of performance can be achieved.

   3. SAMRT

      • Specific: the goal should be specific not general (for example: go to toilet independently)

      • Measurable: you are able to measure the goal (for example: strength, length, duration, etc.)

      • Attainable/ achievable: the goal can be achieved by the patient within the given time.

      • Realistic: the patient is capable of achieving this goal.

      • Timely: time limited, it has a deadline

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OT Role in work (career ladder)