Chapter 26 Occupational Therapy Interventions for Individuals

1. Chapter 26Occupational TherapyInterventions for Individuals Glen Gillen

2. Learning Objectives • Understand the overarching themes that occupational therapists embrace when choosing interventions for their clients • Differentiate between interventions that are categorized as “occupation as ends” and “occupation as means” • Develop and choose interventions for clients that combine the principles of occupation as ends and occupation as means • Compare and contrast a variety of specific intervention approaches that are used for clients receiving occupational therapy services • Begin to understand when to choose one type of intervention over another, combine interventions, and/or switch the intervention plan • Understand the concept of grading interventions

3. Overarching Interrelated Themes • Client centered • Evidence based • Chosen based on sound professional reasoning

4. Occupation as Endsas Intervention • Directly teaching the activity or task • Using clients’ abilities to learn a task • Providing adaptations to learn a task or activity • A rehabilitative approach; A skills training approach

5. Occupation as Endsas Intervention (Continued) • The therapist serves as teacher or adaptor of a task • Influenced by learning and cognitive information processing theories • Not used to make therapeutic change of underlying capabilities • such as strength or memory

6. Occupation as Meansas Intervention • Including a variety of interventions, such as arts and crafts, and specific daily activities • Requiring more constrained responses as compared to occupation as ends • Chosen based on both client interest and potential to remediate an underlying impairment • Providing a challenge that is slightly beyond what the client can easily achieve • finding “just the right challenge”

7. Combining Occupation asMeans and as Ends • A collaborative approach is used to determine goals and client’s interests • The practitioner uses skills of occupational analysis to determine underlying performance skills • and/or client factors may need to be challenged

8. Preparatory interventions • Preparatory interventions have been defined as “methods and techniques that prepare the client for occupational performance” (AOTA, 2008, p. 653).

9. Example Preparatory Interventions • Applying a therapeutic hot pack to and stretching both shoulders prior to a remediation session that uses reaching into kitchen cabinets as a means to improve shoulder range of motion. • Teaching a person with an anxiety disorder to use deep breathing and guided imagery to promote relaxation prior to interviewing for a new job.

10. Remediation or Restoration Examples • Therapeutic exercise to strengthen a muscle • Use of a video game to improve sustained attention • Goal-oriented reaching to improve upper limb function • Constraint-induced movement therapy to improve upper limb control

11. Additional Remediation or Restoration Examples • Mall walking program to improve endurance • Using homemaking tasks to challenge cognitive functions such as safety and judgment • Sensory integration techniques

12. Occupational Skill Acquisition Examples • Teaching meal preparation skills • Task-specific practice of handwriting • Mental practice of IADL • Teaching adaptive coping skills • Using motor learning principles to learn or relearn self-care skills • Teaching a recently widowed woman how to manage monthly bills • Developing crawling ability in a nonambulatory child with developmental delays

13. Example Adaptation/CompensationApproaches • Use of a wrist extension orthosis to allow keyboarding • Using a checklist system to perform assigned tasks in a supported employment program • Using a tub seat, handheld shower, and long-handled sponge to enable bathing • Using lightweight cookware during meal preparation

14. Example Adaptation/CompensationApproaches (Continued) • Using built-up handles on school supplies • Using a power scooter during grocery shopping • Using an augmentative communication device to interact with other students

15. Example Environmental Modifications • Performing a home visit and suggesting removing throw rugs, sliding shower doors, and unnecessary furniture to promote wheelchair access. • Recommend appropriate playground equipment for children with varying skills. • Recommending minimizing environmental stimuli (e.g., television on in the background, many people talking at once) for those who are easily distracted.

16. Example Environmental Modifications (Continued) • Providing specific information re: the gradient for a wheelchair ramp. • Setting up a bathroom so that needed grooming and hygiene items are placed on the right for those who do not attend to the left.

17. Educational Approach Examples • Instructing caretakers on proper transfer techniques • Informing a person as to the signs and symptoms of emerging depression • Leading a stroke education group focused on community resources and leisure opportunities • Providing information about alternative community access after a driver’s license is lost due to visual impairment • Instructing a client or caregiver on skin inspection techniques and the signs of skin breakdown

18. Prevention Approach Examples • Instructing a stock person in a retail store on proper lifting techniques • Instructing nursing staff on an appropriate in-bed turning schedule to prevent the development of decubitus ulcers • Educating a person who types most of the day on proper posture, rest breaks, etc. to prevent carpal tunnel syndrome • Preventing social isolation by suggesting appropriate leisure-based after-work activities such as a bowling league, participation in a chorus, etc.

19. Palliative Approach Examples • Prescribing positioning equipment that allows more time out of bed • Engaging in reminiscence activities • Engage in activities related to leaving a legacy such as finally writing down and sharing a secret recipe, engagement in creative arts, scrapbooking, etc. • Physical agent modalities, positioning, edema management, and orthoses to reduce pain • Teaching caregivers handling techniques for bed mobility assist as the client’s physical status declines

20. Examples of Therapeutic Use of Self • Developing rapport • Appropriate use of humor • Maintaining open communication • Being empathetic • Establishing trust • Being motivational • Maintaining a caring attitude • Active listening

21. Case Applications • Benjamin: A Married Older Man Whose Family Is Concerned about His Driving Abilities • James: A Married Banker Who Survived a Stroke • Sahar: An 8-Year-Old Girl Living with Cerebral Palsy • Lois: An Adult Living with Schizophrenia at Home • Shirley: Receiving Home Hospice with End-stage Amyotrophic Lateral Sclerosis