OTA II

Types of Activities

Class Outline

Course outline and expectations Purposeful Activities Activity Analysis Adapting and Grading Activity Therapeutic Exercise Physical Agent Modalities In-class Activity Analysis

Assessment

  Attendance & Participation: 10% Assignment: 15% Presentation: 15% Practical Laboratories: 40% Final Examination: 20%

**Mark the Dates!

Evaluation Date

Assignment Paper August 14, 2012

Assignment Presentation September 4, 2012

Practical Laboratories Weekly

Final Examination September 11, 2012

Online Resources

http://occupationaltherapyassistant.edublogs.org

Learning Objectives

Source: CAOT, 2009.

Roles of the OTA

1. Expert in enabling occupation2. Professional3. Communicator4. Scholarly Practitioner5. Collaborator6. Change Agent7. Practice Manager8. (optional) Focused Skill-Specialist

Introduction

OT’s use purposeful activities in addition to skillful applications of therapeutic exercise, physical agent modalities, as well as facilitation and inhibitation techniques associated with the sensorimotor approaches to treatment.

OT’s use these strategies to promote the development of the individual’s ability to engage in Occupational Performance.

Purposeful Activity

What makes an activity purposeful? Why is purposeful activity important? List examples of purposeful activity

Purposeful Activity:

Goal directed behaviours or tasks that comprise of occupations. An activity is purposeful if the individual is an active, voluntary participant and if the activity is directed toward a goal that the individual considers meaningful.

Primary treatment modality of OT Activity must have an intrinsic or inherent goal

beyond the motor function required to perform the activity

Brings focus for the individual to the goal as opposed to focusing on the processes required for the activity.

Objectives of use of Purposeful Activities: To maintain strength/ROM/endurance/work

tolerance/ coordination To practice and use voluntary/authentic

movement in activities To provide purposeful use and general

exercise to the affected parts To explore vocational potential To improve sensation/perception/cognition To improve socialization skills and enhance

emotional growth To increase independence of occupational

performance

Activity Analysis

A breakdown of an activity where the activity characteristics match with the performance components needed in treatment.

Ex. In order to stir ingredients in a bowl during cooking the person requires two-handed skills, grasp, grip strength, coordination, and sensation

Can be done from varying approaches, for example a biomechanical approach (muscles, joints, motor patterns), vs. a sensorimotor approach (movement patters and perceptual skills).

Principles of Activity Analysis To be goal directed Have some significance/meaning to the client to

meet individual needs in relation to social roles Require client’s mental or physical participation Be designated to prevent or reverse dysfunction To develop skills to enhance performance in life

roles Relate to client’s interest Be adaptable/gradable/age appropriate Be selected through knowledge and professional

judgment of the OT practitioner with the client’s input

Let’s Try!

Pair up! Choose an activity that you do in your

day to day life, and ANALYZE! Share your results with the group

How do I analyze an activity? Break the activity down Determine skills required for each step Determine where the challenge is

present

Let’s do it together

Adapting and Grading Activities: Adapting Activities: change activities in

order to accommodate for the client’s residual abilities Examples?

Grading Activities: gradual increase in demands to increase levels of performance as patient’s capabilities increase Examples?

Activity Selection

Activity selected should relate to desired outcome

Activities should provide repetition Activities should allow for more than one

type of grading Activities should remain as close as

possible to the end goal. i.e. Active resistance are most often used in purposeful activities (ex. Lifting a grocery bag)

Enabling Activities

Purpose is to engage the patient’s mental and physical participation, to practice specific motor patterns, train in perceptual and cognitive skills and practice sensorimotor skills that will be necessary for functioning in the home and community

When are they appropriate?

Therapeutic Exercise:

Exercise (preparation) and activity (application) are complementary to one another. Both can be part of the treatment plan if the exercise is applied to a purposeful activity.

Is used to prepare the patient for occupational performance

Used to decrease or eliminate substitution patterns. (ex. Holding on to a glass in neutral wrist position vs. too much pronation (palms down) or too much supination (palms up).

Purpose is to remediate sensorimotor dysfunction, augment purposeful activity and prepare the patient for doing tasks in performance areas.

Indications and Contraindications for use of therapeutic exercise: Indications:

Effective in treatment of orthopedic problems, weakness and flaccidity

Must be able to medically participate in an exercise regimen Able to understand direction Be interested and motivated Potential for recovery or improvement in strength, ROM,

coordination, or movement patterns. Direct correlation of movements with purposeful activities Sensation at least partially intact so the patient can perceive

motion and position of exercise part and have some sense of superficial and deep pain

Muscles and tendons must be intact Have an effective ROM Relatively free of pain during movements Client uses proper breathing No substitute movements are occuring

Contraindicated for: Patients with poor general health, or

inflamed joints or who have had recent surgery.

Severely limited ROM caused by well-established permanent contractures

Spasticity Lack of voluntary control of isolated motion

or those with involuntary movements

Types of Activities

To increase muscle strength Active assisted – OT/OTA helps movement Active – independently move Resistive isotonic – contraction of muscle and joint with

gravity or weight Isometric exercises – static without joint movement and

only muscle contraction To increase muscle endurance Exercise for physical conditioning and cardiovascular

fitness Exercise to improve coordination Exercises for ROM and joint flexibility

Active passive

Physical Agent Modalities:

Thermal Modalities Cooling Modalities Electrical Modalities

Thermal Modalities Types:

Paraffin wax use Hot packs Whirlpool ultrasound

Purpose: Increase ROM Decrease joint stiffness Decrease muscle spasms Decrease edema Increase blood flow Assist with treatment strategies (ex. Splinting, stretching)

Contraindications: Acute conditions Clients with sensory loss Clients with vascular structures Very young or old clients

Cooling Modalities

Types: Cold packs Cooling devices Ice massage

Purpose: Decrease edema Decrease pain Decrease inflammation Decrease muscle spasms

Contraindications: Clients with cold intolerance Vascular repairs

Contrast Baths (hot and cold) are sometimes used to increase circulation, which decreases edema and pain

Electrical Modalities

Transcutaneous electrical nerve stimulation (TENS) Provides constant electrical stimulation

with a modulated current to reduce pain (ex. Acute/chronic injuries, after surgery)

Functional Electrical Stimulation (FES) Provides continuous interrupted current

and applied to motor point of the muscle (ex. Use after nerve injury

Selecting appropriate modalities: Occupational performance stage =

purposeful activities Practice stage = use of enabling

activities Preparation = use of adjunctive

modalities

Activity Analysis Exercise

In groups of 2 (switch partners) We’re going to try again Choose a more complex activity to

analyze We will come back and share when you

are done