Introduction For best practice, clinicians must make numerous decisions during the therapeutic process Clinical reasoning: “ Complex multi-faceted cognitive process used by practitioners to plan, direct, perform, and reflect on intervention and Assessment ” (OT practice framework, 2008)

Narrative reasoning Provides a way of learning about the person’s life story Storytelling: practitioners tell stories about clients to each other Helps the practitioner reason how particular clients may be experiencing their disabilities and how treatments might proceed Example: informally during breaks or formally through case-studies Create stories: practitioner envisions how the future may be for the client so that he/she may guide intervention process Practitioners create experiences for the client to make activities more meaningful Example: Developing the occupational profile

Procedural Reasoning Involves thinking about the client’s performance Used to think about disability level (diagnosis) focusing mainly on the body Using this reasoning one would choose specific occupation based intervention activities to maximize function while addressing client’s performance problems

Interactive Reasoning Used to individualize the therapeutic approach and to understand the client as a human being Suggests how a clinicians may interpret and use verbal and nonverbal cues to engage the client Used to: Try to understand the extent and limitation to occupational performance from the client’s perspective Engage the client in the intervention Individuals the treatment plan Impart a sense of trust and acceptance to the client Relive tension by using humor

Conditional Reasoning Encompasses the holistic context of the person, his/her illness, and the possible and actual intervention Scientific reasoning is used to understand the condition that may be affecting the person and family Logical thinking about the nature of the client's problems and the optimal course of action in intervention Requires clinician to consider background knowledge that might help one to understand the characteristic better

Pragmatic Reasoning Used to understand the practical issues that may have an impact on the situation with the person and the family Enables clinicians to incorporate idea into the situation the family is enduring, allowing one to identify practical strategies for intervention Examples can include what the family, caregiver, community resources available to support intervention and following recommendations? What materials and interdisciplinary support is available for intervention?

Ethical Reasoning Used to make sure one selects the morally justifiable choices What “should” be done in the best interest of the person and the family

Best Clinical Reasoning EBP Clinical Context Clinical Experience

Development of Clinical Reasoning Skills Clinical reasoning at five different stages of career development Stage I: Novice Practitioner Feels most comfortable with performing the techniques and procedures learned and refining these skills Do not feel comfortable in using interactive reasoning Stage II: Advanced beginner learning to recognize additional cues and beginning to see the client as an individual Still does not see the whole picture Stage III: Competent Practitioner Able to see more facts and to determine the importance of these facts and observations Has broader understanding of the client’s problem and is more likely to individualize treatment Flexibility and creativity is still lacking Stage IV: Proficient Practitioner Able to view situations as a whole instead of an isolated parts Able to develop a direction and vision of where the client should be going Can easily modifies initial plan Stage V: Expert Practitioner Recognize and understand rules of practice Using intuition to know what to do next Use both procedural and interactive reasoning without difficulties Conditional reasoning: can rely on past clinical situations to help process imagined outcome for the client