1. Observation Skills Related to Treatment

2. Lesson Objectives
1. Students will identify types of observations skills.
2. Students will demonstrate understanding of non- verbal communication related to patient/client interaction.
Students will identify client factors related to the Practice Framework used in observation of clients for activity planning (localizing pain, attention, endurance, coordination, bp, heart rate, respirations, voice, etc.)

3. Types of Observation Skills
Non-verbal signs
Physiological signs
Verbal signs

4. Non-verbal signs of Distress or Fatigue
Slow movements
Facial grimacing
Closing eyes
Grabbing a limb or body part

5. Physiological Signs Increased heart rate Increase bp
Decreased oxygen saturation
Sweating
Limb shaking
Difficulty breathing (breathing faster, harder, irregular)

6. Verbal Signs
Voice pitch and rate change (faster or slower)
Shaking voice
What is actually being said

7. Signs during activity completion
Watch the client’s:
Coordination (both gross and fine motor)
Speed of movements (both gross and fine motor)
Apparent cognitive effort (seem to be struggling with attention, problem solving)
Signs of fatigue (see physiological signs)
Verbal cues (they will tell you, most of the time)

8. What the therapist needs to ask
Are you ok?
Are you tired?
Are you having pain? Where? How much?
Do you need to rest?
Can you keep going?
Get client’s feedback after activity is over, but still during session
Was that hard/easy? Did it make you sore/tired? Could you feel it in your arm/hand/leg/back/etc.?

9. Follow up at next treatment session
After our last session were you:
Tired? For how long? What made it go away? Did it go away?
Sore? For how long? What made it go away? Did it go away?
In pain? For how long? What made it go away? Did it go away?
Do you have any new goals for this session? (ask of patient, and ask of yourself as the therapist)
Are there any changes that need to be made? (ask of patient, and ask of yourself as the therapist)

10. Suggestions for planning activity
Try not to use the same activity twice in a row
Find different activities that achieve the same goals
Occupation-based activities can be used more often, but don’t “overuse” them
Check in with the patient often; make sure their goals have not changed
Is their goal “too hard”?
Changed priorities?
Living situation goals have changed?

11. If I observe these things, what do I do?
Report changes to your supervisor
Including: BP, Pulse, respirations, etc. that would indicate problems/trouble
Note any incongruencies (the physiological not matching with the non-verbals/verbals

12. Pain… Pain is one of the most difficult to assess
Some patients report pain to get out of having to work
Physiology usually correlates to the pain reporting (BP, pulse, respirations increase)
Speech often changes
Be objective, but don’t ignore your intuition
DON’T accuse your patient of lying, but you can ask other professionals, family, medical chart, etc. to find out more (history of injuries, anxiety, etc.)
Keep your radar up, and you can usually tell when things just don’t match up