Week 4 - Intervention Planning Flashcards
ADL performance difficulties arise from:
- Changes in a person’s functional capacities as a result of ageing , injury, impairment
- Variations in occupational demands or the way activities are undertaken
- Barriers or challenges presented by the environment
Intervention focus
- Person
- Occupation
- Environment
Intervention focus: Person
- Skill development, preparatory methods & purposeful activity
Intervention focus: Occupation
- Grading, adapting task
- Use of assistive devices
Intervention focus: Environment
- Structure and modify physical and social environment
Intervention is a:
- Preparatory method
- Purposeful activity
- Meaningful activity
For the case study: a preparatory method, purposeful & meaningful activity
- Preparatory method: exercises, implementation of a splint
- Purposeful activity: activities that work on range, endurance, strengthening (e.g. cone stocking, theraputty)
- Meaningful activity: encourage Mrs L to do the laundry as it is an occupation that is part of her role and works on range and strengthening of the upper limb (can be graded)
Occupation as ‘means’
- Occupation as a medium of change *occupational therapy intervention may involve the therapeutic use of occupation as a “means” or method of changing performance.
Occupation as ‘ends’
- Humans as occupational beings
- goal (and outcome) of occupational therapy intervention is the client’s improved engagement in meaningful occupation and patterns of engagement
What is it meant by ‘grading activities’
Changing the complexity of the activity to decrease/increase demand
What is it meant by ‘adapting activities’
Modifying or substituting techniques or objects to be used in performing the activity
Grading strategies
- Duration: more time/breaks
- Complexity: simplify the activity
- Resistance: the weight of the objects
- Reach: where the objects are placed
- Repetition: number of times action is required
Adapting strategies
- Alternative methods/strategies to complete activities
- Assistive devices to enable participation in activities
What are environment-based interventions?
- Concerned with structuring or modifying the environment to support/promote occupational performance
Environmental modification approaches
- Reorganising: restructuring the exisiting environment
- Repositioning: relocating objects
- Enhancing: improving aspects of the environment
- Adding: providing additional resources
- Removing: taking away challenges
How to address occupational performance issues
- Alternate strategies
- Tool/AT
- Social support
- Environment modification
ALWAYS think about the PEO fit
For Mrs L: alternate strategies (toileting difficulties)
- Regulate toileting/water intake
- Nose over toes
- Leave walker outside the room
- Push up on knees
For Mrs L: tools/AT
- Toilet frame
- Higher toilet seat
For Mrs L: social supports
- Supervision
- Verbal encouragement
- Gestures
- Physical support
For Mrs L: environmental modification
- Raise toilet pedestal
- Install grab rails
- Widen doorway
- Increase brightness of lighting
Modifications impact
- Costly
- Permanent
- Impact on all occupations
- Change the nature of the spaces
Interventions must
- Be practicable and acceptable
- Adequately control the hazard or enable performance
- Not cause undue stress & discomfort
- Not create new hazards
- Accommodate all people in the environment
How to decide on best option
- Clinical evaluation of issues and options - evaluating P, E and O
- Person’s goals and preferences
- Relative costs
- Available evidence
Documentation: reports must include
- Statement of client goals
- Description of function & risks
- Evaluation of proposed options
- Client’s preferences and where these differ from therapist’s recommendations, discussion of concerns
- Any training provided or risks discussed
- Validation of recommended option
- Record of decision making NOT just the outcome
