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Typical Occupational Performance Issues in Obese Children and the Implications for Occupational Therapy Amy Brazil OT

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Typical Occupational Performance Issues in Obese Children and the Implications for Occupational Therapy Amy Brazil OT

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    1. Typical Occupational Performance Issues in Obese Children and the Implications for Occupational Therapy Amy Brazil OT (R) NL amy.brazil@easternhealth.ca Sandy Delaney OT (R) NL sandy.delaney@easternhealth.ca

    2. Did You Know? 59% of the Canadian adult population is overweight and 1 in 4 are obese The growing rate of obesity among children is increasing at a quicker pace then it is occurring among adults Percentage of obese children in Newfoundland and Labrador is twice the national average and is the highest in the country For the first time in over a century, Canada’s children may be the first generation to expect worse outcomes then their parents

    3. Did You Know? Many health related problems associated with obesity are occurring at a much earlier age Approximately 1 in 10 deaths among Canadian adults between 20-64 is directly linked to overweight and obesity The impact of non-communicable diseases in obese individuals is threatening to overwhelm health systems and the need for prevention and control is visibly clear.

    4. What’s Being Done in Eastern Health? The Janeway Lifestyle Program Grew out of need identified by adolescent team and endocrinology Implemented for clinically obese children aged 6-14 years old Current team members: - Psychologist - Dietitian Physicians Social Worker Physiotherapist Recreational Therapist Nurse Practitioner *A.Wareham, personal communication, January 7, 2008

    5. But….No OT!!! WHY?

    6. Project Purpose… Complete a literature review discussing typical occupational performance issues in obese children and the implications for occupational therapy Administer the Canadian Occupational Performance Measure on two children scheduled to participate in the Janeway Lifestyle’s Program Provide a personal reflection of my experience as an occupational therapy student working with the Lifestyle group sessions and why I feel an occupational therapist could be an essential part of the Lifestyles team

    7. Findings… An extensive review of the literature revealed little information regarding typical occupational performance issues in obese children However, the search did raise some interesting common themes and problems that appeared prevalent in many obese children

    8. Findings… Many children who are obese typically have problems in the areas of: Peer socialization and engagement* School performance Their physical ability to “keep up with the other kids on the playground” Balancing physically active and sedentary occupations

    9. The Implications for Occupational Therapy What is our role? Enhancing an individual’s quality of life is an area that occupational therapists hold near and dear to their hearts Ability to identify barriers to occupational performance Knowledge of psychosocial, physical, environmental, and spiritual factors Ability to incorporate everyday life activities therapeutically to improve health and quality of life

    10. The Implications for Occupational Therapy? What is our role? We have the knowledge and expertise to assess children and prescribe adaptive equipment, recommendations or home and school-based programs that may enhance a child’s performance in the classroom or in activities of daily living Tools and assessments such as the COPM that can be administered to determine everyday areas impacted by obesity

    11. Case # 1 9 year old boy with asthma. Occupational Performance Problems: Walking with friends/family Playing hockey with friends Participation in gym class

    12. Case #1 Continued… Initial rating of Performance & Satisfaction P1 S1 Walking 6 9 Hockey 5 6 Gym 7 7 Performance score 1 is 18/3 = 6 Satisfaction score 1 is 22/3 = 7.33

    13. Case #1 Continued Reassessment of Performance & Satisfaction   P2 S2 Walking 8 10 Hockey 7 9 Gym 9 9 Performance score 2 is 24/3 = 8 Satisfaction score 2 is 28/3 = 9.3

    14. Case #1 Continued Change in Performance is P2 – P1 8 – 6 = 2 Change in Satisfaction is S2 – S1 9.3 – 7.3 = 2 **A change of 2 points is clinically significant as an outcome measure. (Law et al., 1998)

    15. Case #2 14 year old girl with new diagnosis of a medical condition which contributes to her overeating. Occupational Performance Problems: Eating Difficulty shopping in trendy stores Swimming (due to dislike of body in bathing suit) Difficulty running

    16. Case #2 continued Initial rating of her Performance & Satisfaction P1 S1 Eating 4 3 Shopping 5 5 Bathing suit 6 4 Running 4 2 Performance Score 1 is 19/4 = 4.75 Satisfaction Score 1 is 14/4 = 3.5

    17. Case #2 Continued Reassessment rating of her Performance & Satisfaction is P2 S2 Eating 5 5 Shopping 7 7 Bathing suit 9 10 Running 7 6 Performance Score 2 is 28/4 = 7 Satisfaction Score 2 is 28/4 = 7

    18. Case #2 Continued Change in Performance is P2 – P1 7 – 4.75 = 2.25  Change in Satisfaction is S2 – S1 7 – 3.5 = 3.5 **A change of 2 points is clinically significant as an outcome measure.

    19. Conclusion The client-therapist relationship that occupational therapists highly value can permit them to work closely with their client to design and implement effective programs that emphasize participation in a variety of meaningful health-promoting occupations that go beyond the conventional methods of diet and exercise.

    20. The Next Step… From the project findings a proposal for a part time occupational therapy position with the Janeway Lifestyles Program is currently being developed. Use of the COPM as an outcome measure will be recommended to the leader of the Lifestyles Team.

    21. References Case-Smith, J., (2005). Occupational Therapy for Children. 5th ed. Missouri: Elsevier Inc. Clark, F., Saliman Reingold, F., Salles-Jordan, K., (2007). Obesity and Occupational Thearpy (Position Paper). American Journal of Occupational Therapy, 61(6). 701-703. Taras, H., Potts-Detema, W., (2005). Obesity and Student Performance at School. Journal of School Health, 75(8). 291-295.   MacDonald, M., (2007). Clinically obese children identified facilitators and barriers to initiating and maintaining the behaviors required for weight loss. Evidence Based Nursing, 10. 92.   Forfan M., Richmond J., (2002). The Impact of Obesity on Occupation: Implications for Occupational Therapy. OT Now Lau, D.C.W., Douketis, J.D., Morrison, K.M., Hramiak, I.M., Sharma, A.M., Ur, E. (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children: Executive Summary. Canadian Medical Association Journal, 176(8). 1-117. Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H., Pollock, N., (2005). Canadian Occupational Performance Measure. Toronto: CAOT

    22. References Poulsen, A.A., Ziviani, J.M., (2004). Health enhancing physical activity: Factors influencing engagement patterns in children. Australian Occupational Therapy Journal, 51. 69-79.   Lush, R., (2007). Healthy Living – Helping Your Child Overcome Obesity. Our Health. 21-23.   Janssen, I., Craig, W.M., Boyce, W.F., Pickett, W., (2004). Associations Between Overweight and Obesity With Bullying Behaviors in School-Aged Children. Pediatrics, 113(5). 1187- 1194.   Gavin, M.L., Dowshen, S.S., Izenberg, I., (2004). FitKids: A practical guide to raising healthy and active children from birth to teens. Toronto: Dorling Kindersley Ltd.

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