Foundations for OT Practice

Pediatric Populations

Infants-Adolescents

Core Beliefs

All people need to be able or enabled

to

engage in occupations of their need and choice,

to

grow through what they do

and

experience independence or interdependence, equality, participation, security, health, and well-being

(Wilcock and Townsend, 2008)

Participation in Occupation

Participation in Occupation

Participation in Occupation

Occupation Based Pediatric Practice

The Occupational Therapy Practice Framework (OTPF)

Why OTPF?

Designed to explain how occupational therapy contributes to health and participation

of people, organizations, and populations

through engagement in occupation.

OTPF

Core belief in the positive relationship between occupation and health

People are “occupational beings”

FORMATIVE DOCUMENT

• Another Review in 5 yrs (2013)

• Changes will emerge from AOTA

2017 Centennial Vision

• Grounded in 1917 founding principles

2 Major Components of OTPF

D

O

M

A

I

N

THE OT PROCESS

Areas of Occupation

ADL

IADL

REST AND SLEEP

EDUCATION

WORK

PLAY

LEISURE

SOCIAL PARTICIPATION

Client Factors

Values, Beliefs and Spirituality

Body Functions

Body Structures

Client Factors

Body Functions and Structures

Impairments

Anatomy

Physiology

Disabling Conditions

Neurokinesiology

Impairment• ROM

• Strength

• Sensory Processing

• Praxis

• Manipulation

• Eye Hand Coordination

• Visual Perceptual Skills

Performance Skills

Sensory Perceptual Skills

Motor and Praxis Skills

Emotional Regulation Skills Cognitive Skills

Communication and Social Skills

Performance Skills

Communication and Social

Motor and Praxis

Emotional Regulation

Cognition

Performance Patterns

Habits Routines

Roles

Rituals

Activity Demands

Objects Used and Properties

Space Demands

Social Demands

Sequencing and TimingRequired Actions

Required Body FunctionsRequired Body Structures

EVALUATION

OCCUPATIONAL PROFILE

ANALYSIS OF OCCUPATIONAL PERFORMANCE

INTERVENTION

PLAN IMPLEMENTATION

REVIEW

OUTCOMES

TYPES OF INTERVENTION

OCCUPATION BASED

PURPOSEFUL ACTIVITY

ADVOCACY

CONSULTATION

EDUCATION

PREPARATORY METHODS

Person

Person

Organizations

Populations

INTERVENTION APPROACHES

CREATE AND PROMOTE HEALTH

ESTABLISH AND RESTORE

MAINTAIN

MODIFY

PREVENT

Context

• Physical

• Social

• Cultural

Cultural Values and Styles

• Family Composition

• Decision Making/Primary Caregiver

• Independence/Interdependence

• Feeding Practice

….APPLIED VIA ETHNOGRAPHIC INTERVIEW

Cultural Values and Styles

• Sleeping Patterns

• Discipline

• Perception of Disability

• Help Seeking

• Communication and Interaction

THE Process…

Types of Clinical Reasoning

• Scientific

• Narrative

• Pragmatic

• Interactive

• Ethical

• Conditional

Legitimate Tools of Practice

For OT With Children

B. Atchison, 9/08

Legitimate Tools…

• Specific tools used to bring about change

• Held in high regard

• Symbolic

What are LT’s for OT’s?

• Conscious Use of Self

• The Nonhuman Environment

– Toys– Technology– PAMS– Pets!

And…

• Purposeful Activities

• Activity Analysis and Adaptation

• Activity Groups

• Teaching Learning Process

Application of LT’s to Frames of Reference

Psychosocial/Psychodynamic

Parent-Child Interaction– Parent-Child Activity Groups:

• Games, constructional play, gross motor activities

Activity groups and peer interactions• Grading Levels: Parallel, Project, Cooperative• Choosing Activities: Art, constructional, social skills, work

skills• Club Model: use of rituals and depersonalized controls • Skills for Living Group (OT Clinic, WMU)• School Intervention Project (CTAC, WMU)

Psychosocial

• Off The Shelf Programs– TARGET

– School Intervention Project (SIP)

OT-SI

• Environmental Engineering:– Physical Safety:

• Space• Mats• wooden floor is best, • tile on floor non-distracting, • overhead suspension system—load of 500 lbs

OT-SI• Clinical Equipment

– scooter board – ramp– hammock net– assorted large therapy balls– mats– air mattress– a bolster– mini- trampoline– foam rubber pillows– mouth toys– sucking and chewing items– *large box with styrofoam packing material (“Ball Pool”)– any active toys– CD player

OT-SI

• Off the Shelf Programs– Alert Program– Astronaut Program– Henry’s OT for Students and Teachers– School Intervention Program (SIP)– Handwriting Without Tears– Ready, Set, Go

NDT

• Handling-– Hands of the therapist, various sized balls, rolls,

benches, hard mat (plinth)

• Positioning and Adaptive Equipment– To facilitate postural alignment via external

stabilization– Prone wedge, prone lyer, sidelyer, adapted chair

(Rifton) harness in a wheelchair, angled work surface, prone stander, scooter board, adaptive tricycle, adapted potty seat

Visual Processing

• Also referred to as Visual Perception and Visual Information Analysis, Visual Discrimination, depending on source

• Visual Cognitive Triad fits with Visual Discrimination concept in SPD

Reference

American Occupational Therapy Association (2008). Occupational Therapy Practice Framework, Domain and Process. (2nd ed.) American Journal of Occupational Therapy, 62, 625-683.