OTA I

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OTA I

• The Occupational Therapy Process

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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

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Steps in the Occupational Therapy Process

• Referral
• Screening (Ask Questions)
• Evaluation (Gather Data, Identify
  function/dysfunction)
• Treatment Planning (Frame of Reference/Goals/Objec
  tives)
• Treatment Implementation (Treatment Method)
• Largest role for OTA
• Reevaluation
• Discharge Planning
• Termination of Treatment

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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.

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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.

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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 clients
  specific strengths and deficits

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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

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Evaluation (Assessment)

• When therapy services require referral or
  doctors 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.

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Treatment/Intervention Planning

• Working with the client, OT develops a plan for
  restoring, improving, or maintaining the clients
  ability to function in ADLs and IADLs
• Treatment plan includes goals and methods for
  reaching them
• Recognizes the clients values and goals and
  considers the cultural, social, and environmental
  situation

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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?

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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?

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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.

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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

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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 clients well being

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Types of Reasoning

• Procedural reasoning
• Consider the clients 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
  individuals unique needs for reclaiming a valued
  sense of self and a meaningful life.

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Steps of Clinical Reasoning

• Research found that OTs 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 clients 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 clients 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.

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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

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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

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Treatment Planning

• Next Week Goal-setting

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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

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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

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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

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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

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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?

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Break!

• See you at 1200 for Lab Activity 2

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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

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Break!

• See you at 115 for OTA 2