The Occupational Therapy Process

First steps in the Occupational Therapy Process

Referral and Screening Evaluation and Assessment Treatment Planning

◦ Frames of Reference◦ Types of Reasoning◦ Activity Analysis

Referral Screening (Ask Questions) Evaluation (Gather Data, Identify

function/dysfunction) Treatment Planning (Frame of

Reference/Goals/Objectives) Treatment Implementation (Treatment Method)

◦ Largest role for OTA

Reevaluation Discharge Planning Termination of Treatment

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.

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.

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 client’s specific

strengths and deficits

Create a list of your clients:◦ Functions/dysfunctions◦ Assets/capabilities◦ Deficits/limitations/problems

This becomes the basis of the treatment plan

When therapy services require referral or doctor’s 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.

Working with the client, OT develops a plan for restoring, improving, or maintaining the client’s ability to function in ADL’s and IADL’s

Treatment plan includes goals and methods for reaching them

Recognizes the client’s values and goals and considers the cultural, social, and environmental situation

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?

◦ 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?

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.

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

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 client’s well being

Procedural reasoning◦ Consider the client’s 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 individual’s unique needs for reclaiming a valued sense of self and a meaningful life.

Research found that OT’s 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 client’s 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 client’s 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.

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

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

Next Week: Goal-setting

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

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

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

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

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?

See you at 12:00 for 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

See you at 1:15 for OTA 2