1. OCCUPATION AS THERAPY: SELECTION, GRADATION, ANALYSIS &ADAPTATION CAMS, MAJMAAH UNIVERSITY

2. LEARNING OBJECTIVES 1.Select occupation as means to achieve particular goals. 2. Grade occupations to challenge person’s abilities to improve performance 3. Analyze occupations to determine their value for remediation of impaired abilities&capacities. 4. Adapt occupation to increase their therapeutic value.

3. INTRODUCTION  Occupation is the therapeutic medium of Occupational Therapy with the goal of facilitating participation in life--- (AOTA)  The therapist must select the appropriate Occupation for patient to remediate deficit abilities or capacities-(Occupation as means) or to enable independent performance of value occupation-(Occupation as end).

4. SELECTION & GRADATION OF THERAPEUTIC OCCUPATION-AS- MEANS NoREMEDIAL GOALSKEY FACTORS OF THE ACTIVITY 1.To retrain sensory awareness of discrimination Offer various textures,sizes, shapes,grade from diverse, coarse, large to similar, smooth, small 2.To decrease hypersensitivity Offer various textures and degrees of hardness or softness.Grade from acceptable to 3To reacquire skilled voluntary, movement Require sought-after, goal directed response: allow feedback. Grade from simple to complex movements. 4To improve coordination and dexterity Require ROM the patient can control. Grade from slow,gross movement involving limited number of joints to ------fast, precise movement involving a greater number of joints. 5To increase Passive ROMProvide controlled stretch or traction. Grade from lesser to greater ROM 6To increase strengthRequire movement or holding against resistance. Grade from lesser to greater resistance or from slow to fast movements

5. NoREMEDIAL GOALSKEY FACTORS OF THE ACTIVITY 7.To improve cardio pulmonary endurance Use activities related at the patients current MET level.Grade by increasing duration frequency,then intensity (MET) 8.To improve muscular endurance Require movement or holding against 50% or less of maximal strength. Grade by increasing repetitions or duration. 9.To decrease oedemaAllow use of extremity in an elevated position and require isotonic contraction 10To improve problem solving Require performance at the outside edge of patients current skill. Grade from simple (one step) to complex (multiple steps) and from concrete to abstract.

6. ACTIVITY ANALYSIS Activity analysis or Task analysis is Fundamental skill of OT. OT analyze an activity because they want to know i)Whether the patient, given certain abilities, can be expected to do the activity. ii)Whether the activity can challenge latent abilities or capacities and thereby improve these.

7. Activity–Focused Analysis Using an analytical approach,the therapist examines an activity to determine its components and the level of capability demanded. The outcome can be used to select activities for remediation or to match a particular person’s skill with the demands of the task. The biomechanical approach prompts that therapist to examine the physical aspects such as grasp and ROM. The cognitive –perceptual approach examines the activity according to its cognitive or perceptual demands.

8. ACTIVITY – FOCUSED ANALYSIS 1. Name the activity goal 2. Describe the task demands  Task constraints: How are the person and materials positioned, especially in relation to one another?  Task constraints: What utensils/tools/materials are normally used to do this activity/  Environmental constraints: Where the activity is carried out?  Contextual constraints: Does this activity or the way it is carried out hold particular meaning for certain cultures or social roles? Is there a time factor involved in carrying out the activity..

9. 3. What capacities and abilities are prerequisites to successful accomplishment of this activity. 4.List the steps of activity. 5. Describe the biomechanical internal constraints for the most therapeutic or repetitive step

10. .6. What must be stabilized to enable doing this activity and how will that stabilization be provided. 7.For which ages is this activity appropriate? 8. What is the estimated MET level of this activity? 9. What precautions must be considered 10.For which short term goal is this activity appropriate? 11. How can this activity be graded to improve Strength, ROM,,endurance, coordination, edema, perceptual abilities and cognitive skills.

11. PERFORMANCE FOCUSED ANALYSIS Performance focused analysis according to occupational performance Model:  One role is composed of several task  Each task consists of several activities  Each activity depends on varying degrees of sensorimotor, cognitive and perceptual and psychosocial abilities.  Those abilities depend on supporting capacities.

12. ADAPTATION Activity adaptation is a process of modifying an activity of daily living, craft,game, sport or other occupation to enable performance, accomplish a therapeutic goal or prevent cumulative trauma injury

13. CHARACTERISTICS OF A GOOD ADAPTATION  Accomplishes the specific goal  Does not encourage or require odd movements or postures.  Is not dangerous to patient  Intrinsically demands a certain response that patient does not have to concentrate on  Does not demean the patient : some contrived adaptations seems to be ridiculous or embarrassing

14. REASONS TO ADAPT AN ACTIVITY Reason.1: The activity is modified to make it therapeutic when ordinarily it would not be so. Eg. Wall checkers, tic tac toe on wall These adapted methods help in reaching up exercise

15. Reason.2: To graduate the exercise offered by the activity along the therapeutic continua to accomplish goals. Grading of activity for this purpose is an original principle of Crieghton 1993. Example: To increase coordination,the activity must be graded along a continuum from gross, coarse movement to fine, accurate movement

16. Reason.3: To enable a person with physical impairment to do an activity or task he or she unable to do. Example- A stroke patient learn a new method to wear shirt that requires only one hand.

17. Reason.4: Adapting work activities that are engaged in for long periods of time to prevent cumulative trauma injury. Example: Changing the table height to reduce strain on the back or upper extremities or doing the work task while seated to reduce stress on low back.

18. ADAPTATIONS FOR THERAPEUTIC USE S.NoADAPTATION THERAPEUTIC PURPOSE 1.Position the task relative to person Increase ROM, specify muscles, motions enable person to d od task 2.Arrange objects in relation to others Improve perceptual responses requires specific movements decrease energy expenditure 3.Change lever armsIncrease strength, reduce strength needed, prevent injuries

19. Arrange objects in relation to others

20. Change lever arms

21. ADAPTATIONS FOR THERAPEUTIC USE- CONT… s.noAdaptationTherapeutic purpose 4.Change materials or texture of materials Increase strength, coordination, challenge sensory system 5Padding handles of tools Reduce stress on painful joints, enable use of tools or utensils 6.Change level of difficulty Increase cognition,perception, increase motor planning, enable person to do task. 7.Change the size or shape Improve dexterity, enable activities such as feeding, with enlarged handles on utensils, increase strength,ROM

22. PADDING HANDLES OF TOOLS

23. ADAPTATIONS FOR THERAPEUTIC USE- CONT.. S.NOADAPTATIONTHERAPEUTIC PURPOSE 8.Change color contrast between objects Improve figure-ground discrimination, Enable performance by those with low vision 9.Change method of doing activity Enable person to do task. Increase of strength, ROM, coordination,dexterity, increase cognitive perceptual demand 10.Modify toolEnable person to do task, prevent deformity, prevent cumulative, trauma disorder 11.Add weightsIncrease strength, reduce in coordinated movements provide PROM 12.Add springs or rubber bands Increase strength reduce in coordinated movements provide PROM, assist weak muscles