SCO101

2 types of isotonic contractions:

Concentric: muscle shortens, joint angle decreases, overcomes resistance (occurs at the elbow when bringing glass to your mouth Eccentric: muscle lengthens under stress, joint angle increases, muscle does not overcome resistance, deceleration (placing a glass on the table)

Ideas for grading/remediation

Craft as a means -have client participate in planning & prepping materials -Increase/decrease # of steps -place/remove time requirement -Increase/decrease resistance -place objects to facilitate reach or postural changes -Increase/decrease # of tools/supplies available -Change # of choices available -Change design -have client participate in clean-up -provide sample -provide more or fewer modes of instruction -complete task in group -modify environment: distraction, rearrange tools

Adaptions to enable participation/compensation

Craft as an end -alter the method -use enlarged or reshaped handles -reduce the number of steps/complexity -provide a stabilizing surface -provide extra lighting/magnification -use adaptive tools (electric scissors) -provide preferred method of instruction -change work surface- height, area -rearrange tools/materials for easier access

Skeletal system

Determinants of movement available: -planes/axes: -frontal plane w/ sagittal axis (abduction/adduction, lateral flexion, bending) -sagittal plane w/ frontal axis (flexion/extension) - transverse plane w/ vertical axis (rotation) -degree of freedom -type of joint: ball & socket, hinge, condyloid, gliding, saddle, pivot (synovial joints)

Philippe Pinel

Father of Morale treatment- persuaded tradesmen in Paris to give craftwork to his asylum patients in Bicêtre. -treatise (1806) moral treatment is treating emotions; out of balance & own emotions can restore it -patient farms-build respect, self-esteem & dignity

Eleanor Clarke Slagle

MOTHER OF OT -established first training program for occupation workers (Hull House) -Habit Training: re-education to overcome disorganized habits, modify & construct, restore/maintain health -pioneered developing OT in State Dept of Mental Hygiene in NY -3 phases: kindergarten (music, color, games), Ward classes (group activities), Occupational center: change in environment responsibilities & seeing work produced

Body functions - Neuromuscular & Movement-Related functions

Nervous System -Central Nervous System (CNS): brain and spinal cord; upper motor neurons -Peripheral Nervous System (PNS): all neural tissue outside of CNS; lower motor neurons -Autonomic Nervous System (ANS): regulates functions of vital organs; innervates smooth, cardiac muscle and glands afferent: sensory neurons, ascending to CNS; send info to cortex for interpretation efferent: motor neurons exiting CNS; terminate on muscle fibers causing contractions

Adolf Meyer

Philosophy of OT: human is unit of study, rather than composite symptoms. -holistic approach; he was committed to a holistic perspective and developed the psychobiological approach to mental illness -emphasized occupation, time, productive use of energy -big 4: work, play, rest, sleep -established occupational behavior

Body functions - Muscular functions

Skeletal muscles- voluntary movement, stability against gravity, protection for internal organs, support posture and produce body heat

William Tuke

York retreat (quakers); approach w/ kindness & consideration; gain patient confidence, self-esteem, arrest attention & fix objects

Occupations

activities that bring meaning to the daily lives of individuals, families, and communities and enable them to participate in society; influence health, their development, and well-being across lifespan. increase independence, promotes overall health and well-being

Recycled Material crafts:

articles, materials, or supplies not intentionally prepared for use in crafting. -craft kits start around $3/ea so recycled materials are more cost effective; client chooses from a list of projects then decide on finding materials- creative thinking -crafts can teach knowledge of and appreciation of other cultures (teach children recycling) Discarded Water Bottles: water bottle fish, for bird feeders, small planters, sun catchers, flowers- main caution kids (or other clients) sharp edges of the cut plastic. Milk Jug Butterfly Pinecone Christmas Tree: client working on fine motor, visual scanning, or visual discrimination skills. Brick/Greeting Card doorstop: motor control to avoid tearing wet paper, grade force applied Jar organizer/Behive vase Build a town (group): structured to promote motor, cognitive, and/or social skills while allowing participants to express their individuality, this activity stimulates their imagination and helps them visualize new possibilities. Candles: low in cost, few specialized tools and materials (cooking); wax is malleable at low heat levels, and can be melted over and over- achieve a satisfactory end product. -Basic methods of candle making are pouring, dipping, and rolling. Molded ice candle: time sensitive- hardens quickly once poured and ice added will melt in mold before wax is poured -Grade/adapt: differently shaped mold, by not using the ice, or by adding color during the melting process or after the candle has hardened. Down: client prepare mold and choose color or scents but therapist assists with melting/pouring; just decorate outside of prepared candle (carving, painting) Up: omit ice and have client pour wax in layers-different color for each one; cut colored wax chunks and fill mold with them before pouring white wax -Documentation: relate steps to cooking; safe handling of heat and sharp tools; follow sequential instructions and waiting appropriate length of time for each step; motor skills-reaching, lifting, pouring, grasping; ability o gather supplies or incorporate joint protection techniques. -precautions: risk of burns from wax or heat source, poured candles adequate muscle strength and control to manage the container during pouring (pot holders/mitts); roll candles little to no risk; judgment or supervision to use the candle safely at home; make as gift; sharp tools; expensive-paraffin cheaper but old candle remnants cheaper and buy in bulk; messy-clothes and objects; never pour down drain

Activity Analysis

breakdown of a task or occupation into parts to determine the skills and other factors needed for, and the barriers to, its performance. -determines how, where and when adaptations can be made to maximize occupational competence

Occupational Behavior Models

client interest, level of engagement, task competence, desired roles and occupations, context in which activity is performed, interaction between person and contexts (any craft meaningful to client) -activity components: decision-making, creativity, individualized, adapt to circumstances -craft examples: home decor craft, collage, making a gift- important for client to choose -Competence will result: development of skill in handling the materials, continued motivation, and formation of new habits.

Occupation

client-centered, has individual meaning and context, and goal is participation. -occur in context and are influenced by interplay among performance patterns, performance skills, and client factors

Cognitive model

compensatory and remedial models, task performance, attention, memory, following directions, sequencing, perceptual skills, problem-solving, evaluation, task/environment modifications, safety, cognitive skill build and adaptive strategies -Activity components: structure, procedure specific, visuals/cues/patterns/samples, structure, repetition, cues or memory aids -Craft ex: kits, tile mosaic, cooking w/ recipes, reproduction models, freeform projects, group work; origami, woodwork kits

Degrees of Freedom

determines amount of movement -one degree: moves in one plane around one axis (hinge) knee and elbow -two degree: can move in 2 planes around 2 axis (metacarpophalangeal and toes) -three degree: moves in 3 planes around 3 axis (ball and socket- glenhoid fossa/head of humerus and acetabulum and head of femur

Characteristics of Occupation

everything people do to occupy them- -everyday personalized activities that people do as individuals, family or community to occupy time -have purpose, meaning and are useful to individual -occur w/in context-environmental and personal factors specific to client that influence engagement and participation in occupations -Influenced by interactions between client factors, performance skills and patterns

Activities

facilitate occupational goals through the development of performance skills/patterns , should be meaningful and relevant to the client

After WWII

greater emphasis on physical dysfunction rehabilitation, focus was on motions and strength—physical demands—needed for a task.

Components of craft work are analogous with daily life:

having to wait, experiencing control or lack of control, encountering resistance to efforts and determining how much force is reasonable, and being aware of time. -may provide needed escape, personal fulfillment, an alternative to spoken language, or an alternative to destructive behaviors -children: craftwork can help evaluate motor skills, impulse control, task perseverance, and the ability to follow directions

Allen Cognitive Level Test

info on patient's level of cognitive function; scale 1 (24 hr supervision) to 6 (normal; independent/organized) (Claudia Allen)

Why do therapists adapt activities?

make abilities more efficient/safer -Enable performance-make it possible -Improve performance- make it more efficient -Make performance safer (Dropping cup-adapt to cups with handles)

Purpose of Occupational Therapy

make it possible for people to perform the everyday activities that they need and want to perform in their daily lives

Prior to WWII

making something, compatibility of the craft process with precautions of the medical diagnosis, cost and availability of materials, and the usefulness of the end product

creative options

meet individual needs in terms of role performance, offer the "just right challenge," stimulate interest & age appropriate -Characteristics of the activity: level of challenge, sensory components, best done individually or in a group, and potential to satisfy emotional needs or provide a sense of self-efficacy for the client -therapist must think about cost, time, space

Adaption

modification of, assistance with or changing: -way activity is performed (pasta instead of tiles) -performance skills of the activity -context and/or environment activity is performed -materials or tools used in activity (tile nipper w/ resistance issues change to pre-cut tiles)

Neurologically- Based Models

motor behavior (applying weight), sensory processing, sensory integration, normal movement patterns, graded sensory input, positioning, tactile, proprioceptive,vestibular input w/in CNS -Activity components: weight bearing, bilateral involvement, postural facilitation, repetition, textural variation, movement/vestibular motion, visual interest Craft ex: sawing, sanding, rolling dough or clay, rubbing, mixing, stirring; sensory- paper mâché, leaf rubbing, stirring/mixing by hand (sensory model- ability to self-regulate; kids/mental health)

Muscular System

muscle cell= muscle fiber sarcomere= contractile unit in muscle fiber twitch= response to single stimulus, fast or slow, most muscle are a combo of both, each motor unit is made of same type (fast type II, slow type I)

Biomechanical Model

musculoskeletal system, ability to move and maintain postures, joint ROM, muscle strength, endurance, positioning, pain management, compensate for limited motion -Activity components: resistance, object placement, tool/object use (pinch/grasp) -Craft ex: macrame, sawing, sanding, mosaics, ceramics- good if familiar w/ craft and need help adapting -good for: orthopedics, arthritis

Body Functions

physiological functions of body systems -3 primary types of muscles: skeletal, cardiac, smooth a. Neuromuscular & Movement-Related functions: b. Cardiovascular and respiratory c. Muscular d. Skeletal

Gradation

process of advancing step by step; simple to complex or complex to simple

Contractions

produced by muscle force/tension Isometric: tension develops in muscles; no change in muscle length or joint angle (static) Isotonic: maintains muscle at equal tension; length of muscle changes causing change in joint angle (dynamic)

IADLs (instrumental activities of daily living)

require interaction with one's environment; participation in care of others, pet care, child rearing, communication device use, community mobility, financial management, health management/maintenance, home establishment/management, meal prep/clean-up, safe procedures/emergency response, shopping

Occupational Therapy process has several steps:

screening and evaluation; intervention planning; intervention implementation; re-evaluation -determine a client's functional level through evaluation- list the client's deficit areas, prioritize them, and collaboratively compose long-term goals that address those considered to be most important and/or achievable through intervention (Long-term goals- 3 months to 1 year) -treatment planning is to select activities that could help the client accomplish the short-term objectives and thus take steps into direction of long-term goals

Needlework

simple sewing- make, mend, modify, quilting emotional symbolism, religious or cultural Embroidery: cross-stitch (counted, time consuming) -Grade: size thread/yarn, type weave, type of needle/size Needlepoint: less precise motor control, mistakes easy to pull/correct, dull needles (less hazardous) -Grade: size of yarn, needle, canvas- size of design and complexity Knit/Crochet: require time & patience; stress reducing (repetitive) *Loom Knitting: done single handed if loom is secured, different fine motor demands; inexpensive *Latchhook: time consuming, repetitive and easily learned. -requires bilateral hand use, grip strength & force, but. less precise grasp *Locker hooking: latchhook/needlepoint; repetitive and simples *Needle felting: sharp needle (safety), less precision-simple & repetitive -Consideration/Precautions: fine motor function, visual acquity, perception; hard to accommodate poor grasp; if stabilized can do one handed; impaired visually-frustrating to follow pattern or assess stitch accuracy; decreased dexterity- need less precision; consider time; needles/scissors (sharp)- blood borne pathogens, thinners, fragile skin, incoordination & cognitive deficits; gender- men may not want to participate -tools/materials inexpensive: L/R scissors, thimbles, needles, threader, various size embroidery loops, fabric, thread and yarn- loops for table, b/t legs or clamped & magnifying glass Ex: Button Tree: Down: glue instead sew, mark button placement or color match sequence, paint tree trunk, 1-2 stitches for button or connect all button thread then cut Up: hem edges, sew tree trunk by hand or machine, create as pillow top or wall hanging, embellish with stitch/applique, knot/cut thread after each button -Performance skills: use scissors, different types of pinch and strength to manipulate buttons, needles, thread; plan/execute design, ability to follow directions in sequence, use/compensate for deficits in field vision -tactile cues (vision loss), create supply list (cognitive strategy), create visual cues for object placement Covered coat hanger: repetitive motor skills; little need for strength, precision or acute vision -learning necessary (repetitive knotting) -Grade/Adapt: different weight yarn, design by color sequence, hanger can be stabilized for one hand-yarn loose or tangled, can create frustration -Document: length time client focuses on task w/out cueing (attention) or continue motor operation w/out break (endurance); ability to learn/remember knot sequence; ability to use on or both hands; ability to persist or manage frustration Other Grade ideas: size of needle, yarn weight, work surface change to meet clients needs; complex or plain design, small or large stitch, one or multiple steps, create or use pre-printed design, glue or sew, adapted scissors, floor stand, clamp loop, roll cutters Physical Dysfunction: bed bound-easy, little energy, start/stop to rest, inexpensive, easily sterilized -Uses primarily distal joints & muscle action-elbow/forearm movement and proximal stability; little resistance but minimize static hold for arthritic pain/deformities; maintaining static grasp for extended time can inflame joints; avoid resistive pinch/grasp; frequent rest breaks & respect pain by. stopping -reduced anxiety and depression, relief from pain, development of social contacts & good days in course of chronic illness/disability; decrease HR, BP & perspiration -Visually impaired: tactile; hemiplegia (stabilizer) or one extremity- equipment; translate skills to functional daily tasks-dressing, grooming, feeding *visual scanning: needlepoint book mark w/ simple design *dexterity: counted cross stitch with larger weave *upper extremity strength: latch-hook pillow top-grip strength Mental Health: depression- littler exertion and can accomplish while fatigued -stress relief, calming, cognition- ability to organize thoughts & think thru problems, improve memory & concentration; confidence in calculation skills & spatial relationships -group participation: sense of belonging, increase self-confidence, effective communicators -coping: rejuvenated, engaged; various textiles- grounded -clients w/ issues focusing thoughts & benefit from repetition -Intellectual impairments- repetitive visual & motor patterns; once learned becomes relaxing *Self-esteem: needlepoint holiday bookmark gift *Coping: cross stitch positive quote/saying *follow instructions: sew and stuff a pillow or throw Pediatrics: hand/eye coordination- too much repetition will lose interest , more open weave-dull needle group- cut & thread needles ahead of time, trouble waiting & maybe distracted *Communication: sew/glue sock puppet *Fine motor skills: three ribbon catepillar *self-esteem- make headband/accessory Adolescents: gender discrimination or old fashioned group- quilt/flag w/ coming theme or old t-shirts; unity & belonging or costume for a play Older Adults: low vision-bright color yarn & light background; clamp w/ magnifying glass; full spectrum lamp -peripheral neuropathy (diabetes): thimble to avoid would- longer heal time, increase risk of infection -attention to those on blood thinners, dementia or cognitive impairments- affect judgement & behavior regulation Groups: quilts/flags for extended period groups (addiction/rehab or resident facility); can provide a theme and the group can apply creativity; kids can glue vs sew & create story-outlet for negative feelings

Other categorization of muscles:

size, location, action, # of divisions, points of attachment (origin: muscle begins; closer to trunk/midline, more stable, insertion: end point; distal, farther from trunk/midline, most moveable part)

Crafts started after 2 World Wars for...

socialization and work skills (PTSD/Shell shock)

Muscle contractions

speed of contraction depends on... -diameter of axon -thickness of myelin sheath -properties of muscle fibers *faster the contraction, the quicker the muscle fatigues *muscles that contract more slowly are better suited for tasks requiring endurance Strength of contraction is dependent on... -number of muscle fibers recruited -size of muscle fibers -size of axon (larger each of these are, the stronger the contraction)

Graded task are sometimes selected more for

their physical, cognitive, and/or psychosocial demands (i.e., their utility in targeting specific performance skills)

Clinical reasoning

understand the client's occupational needs, make decisions about intervention services, and think about what we do...therapist uses this form of reasoning to engage with, understand, and motivate the client. scientific (systematic & highly cognitive)- data collection/hypothesis & narrative (improvisational & intuitive)- client's interests, values, beliefs, and subjective experience.

Crafts and the body:

*cognitive- richly stimulating environment increases neuronal connections, reroute/rearrange cortical maps to compensate for damage in other areas, activation/inhibition of neurotransmitters, reduce cortisol, increase serotonin, improves concentration and clear thinking, lower anxiety, increase feelings of internal control, to demonstrate mastery over the materials and the process, and to foster a sense of meaning and coherence. *mental health- reduce stress, distract from everyday worries, social connection and improving self-esteem *lower HR, reduction in mood disturbance, increase in interpersonal engagement

Muscle Properties - determine how much a muscle can shorten or lengthen

-Contractility: ability to shorten -Extensibility: ability to be stretched or lengthened -Elasticity: ability to return to original length -Irritability: ability to respond to stimulus (chemical, electric or mechanical)

Before the learner arrives:

-Determine what is to be learned -What is to be taught this session -Prepare any needed modifications -Break activity into small units of instruction (chunking) -Assemble materials -Arrange workspace for learner's needs

Leatherwork

-Cowhide is most common- versatile and less expensive; usually kits -relatively safe- puncture injury is minimal; easily transported; completed with few tools; done without noise or fumes; suitable for almost any setting. -6 basic tools for leather stamping: veiner, the seeder, the camouflage tool, the beveler, the pear shader, and the background tool -coloring leather: being sure of abilities and choices before making an irreversible commitment. -Allen's Cognitive Levels Screening Test (ACLS): leather lacing reveals information about tactile awareness, strength, motor planning, dexterity, visual perception, sequencing, frustration tolerance, and the ability to learn, problem solve, and recognize errors. Ex: Key Fob Grade: different shape, doing more or less tooling, or dyeing the leather and using colorful plastic lacing. Down: square shape, pre-punch hole for lacing, select steps as only lacing, omit lacing, simple project/kit, simple laces-running/whip stitch Up: tool leather w/ design of choice, Lace the edge using the double cordovan stitch for a greater fine motor and perceptual challenge. Documentation: illuminate perceptual and cognitive performance- distinguishing between the smooth and rough sides of the leather, using caution with stamping tools, and recognizing errors or twists in lacing. Physical Dysfunction: ideal for clients who are bed-bound or have significant mobility limitations-quiet, do not require the use of water or other liquid, and do not create dust or fumes, started and stopped, can be disinfected -Upper extremity: leather punching and tooling require upper extremity strengthening, bilateral coordination, eye-hand coordination, and endurance. -Grasp strength and proximal stability—for holding tools and using the mallet—are necessary for tooling and stamping, coordination of both hands. -Lacing: activation distal muscle groups and is useful in improving fine motor function (pad-to-pad pinch and dexterity), compensate for poor proximal stability/ inability to use one hand -Fragile or inflamed joints- cautioned against using resistive activities (cutting and hammering) -Visual impairments- increase tactile awareness *Handling coins and identifying textures in putting clothes on right side out. Mental Health: Allen Cognitive Level Screening in assessment of cognitive function- leather lacing; task persistence, problem solving, visual attention and processing, and ability to follow directions. -perceived and appreciated as value, performance and self-worth -mania: high structured, material is controllable, frequently stopped and started w/out consequence -Intellectual delay: motor coordination/dexterity skills & concentration for repetitive actions (stamping/lacing) -Measure & document improved performance: accuracy in lacing and time spent on task w/out redirection Childhood/adolescents: longer term settings (cancer hospitals, outpatient or psych) -relate to handwriting or scissor work -strong proprioceptive input, avoided for individuals who are hypersensitive to the noise. -Completion of a leather project, especially one with multiple steps, will offer a sense of accomplishment and competence. Older Adults: less common as most elderly patients are female; work on fine motor skills (dull needles) and for clients who used to sew (deficits in vision and dexterity) -stamping/tooling requires strength- cause cuts/bruises slower to heal; higher risk of injury- diminished coordination, tactile sensation, visual skills -Osteoarthritis- resistive gripping of tools may aggravate the pain or deformities symptomatic of this condition Groups: not typical; parallel groups or higher-functioning may help planning and executing tooled designs- also pieces are typically small so cannot accommodate groups

4 basic steps for good instruction

-Prepare patient or group -present instructions -have patient do a "tryout" -Evaluate performance, and correct/repeat instructions/assess

Key Variables that Influence Adaptive Device selection:

-What area of occupation does it address? -What client factors require the adaptation? -What performance skills are facilitated by the adaptation? -How might the adaptation impact the client's performance patterns? -How might the adaptation impact the context and/or environment of the activity?

Motor Unit

-building block of muscle tone -allow for graded contractions -several motor units make up one muscle, if activated entire motor unit responds -# of motor units activated at a time can determine strength of contraction

Crafts as an end (adapting an activity)

-client centered -compensation approach -fulfills a desired occupational role -adapted to enable participation

Activities that commonly require adaption:

-eating by oneself -toileting -bathing and grooming -dressing -functional communication (phone/computer) -functional and community mobility (modify environment- remove rugs if tripping)

One handed

-first, figure out how to do activity one handed -provide for stabilization (when 2 hands available this is done by non-dominant) -use weights, clamps, other devices but be sensitive to patients response

Vision Impairment

-have consistent work area -use clock-face format (sequence of order) -provide high tactile input -provide contrast -give clear verbal instructions

Papercrafts

-low cost, readily available; consider frequency of use and storage capacity Consider/precautions: paper cuts (decreased sensation), scissors, glues/solvents (ventilation/gloves), messy (area preparation, drying, and clean-up time should be considered) Ex: Paper Mache: tissue paper is thin and hard to manage and frustrating for an individual with motor or sensory impairments. Ex: Paper pulping/casting: sensory re-education or hand strengthening; advance prep and hours to dry Ex: Paper folding: motor performance skills- bilateral fine motor coordination, hand dexterity, and strengthening and cognitive (process) performance skills (sequencing and following verbal or written directions) Ex: paper cutting: (snowflakes) requires the use of both hands and some degree of precision, it is useful for fine motor work, and the intricacy can be graded according to client ability. Ex: collage: failure free activity Ex: Decoupage: few steps and low-functioning client can participate; requires the use of both hands and some degree of precision, it is useful for fine motor work, and the intricacy can be graded according to client ability. Ex: Scrapbooking: easily graded and end product that is personalized and meaningful to the client; work on orientation to place, time, or people; to reminisce; or to build visual skills- scanning, or executive function skills-planning and organization; reinforce sense of identity -Paper Mache- Decorative bowl: requires minimal dexterity, good choice for someone with a short attention span (each layer can be completed in a short period of time); require several sessions to complete due to drying time; challenging for a client with sensory defensiveness but at the same time may be a good way of habituating to tactile input. -Grade/Adapt: alter size or select surface Down: strips already torn, glue pieces instead of painting, flat item, larger strips easier to handle, make smaller item- Task persistence can be a challenge with this repetitive activity. Up: larger, more complex more contoured; cut/tear photos to make collage; paint design (require manipulation of a tool, greater visual acuity, and attention to detail); place supplies out of reach or side to side -Documentation: manipulate the paper with one or both hands; sensory tolerance of the wet, sticky texture; the ability to scan and visually discriminate to check for full coverage; and maintenance of attention and task persistence Origami Small Box: low cost; fine motor skills; following written or demonstrated instructions in a specific sequence. Vision is helpful, but it may be possible to complete this activity using only tactile cues and verbal instruction. -Grade/adapt: change size/thickness of paper, type of pattern Down: pre-fold, use larger sheets, simple pattern w/ few steps & folds, demonstrate each step one at a time, small amount glue/tape to hold folds Up: thicker paper (increase motor demand, complexity); smaller paper (fine motor dexterity); complex pattern; written instruction only -Documentation: sequential directions, attention to task, hand-eye coordination, fine motor manipulation, and visual perception; can also be frustrating-observe for task persistence and evidence of coping skills. Woven Paper/vase w/ paper flowers: need for motor control and strength will be highly variable; design that requires measurement, careful cutting, and/or fitting will naturally be more difficult.; work on improved motor function -impaired coordination or apraxia: Construction or sculpture of more abstract forms -Documentation: multiple parts and steps- observe for the ability to follow more than one set of instructions, organization of materials, and management of frustration; high fine motor demand, so manipulation skills, bilateral coordination, and calibrating of motions can be observed. (spatial relations, fine motor dexterity & ideomotor praxis) Thematic Bulletin board (group): diverse functional abilities and affordable Physical Dysfunctions: -home health craft (affordable and accessible); emphasize fine motor skills/distal upper extremity function; range of motion, dexterity, and strength needed will depend on the method; little strength is required, but endurance (and patience) may be required for repetitive processes or for keeping pieces in a position until the adhesive dries enough to hold; good for clients with cardiac and/or respiratory conditions because little exertion -working on gross motor, fine motor, and perceptual skills; difficult for clients with hypertonia or lack of fine motor control because paper is easily bent or crushed; normally require bilateral hand function (practicing adapted methods, such as using a weak hand as a stabilizer or learning to incorporate joint protection techniques. *Gross range of motion: origami oversized paper, decorate mounted bulletin board *Dexterity: mosaic w/ paper squares, cut and place scrapbook *Upper extremity strength: paper pulp, cut snowflakes or decorate, rubber band around scissors for resistance Mental Health: alert to those clients who have a low tolerance for failure, low cost allows trial and error if the client is willing to persist in the task. -Cognitive impairment/tendency to perseverate: difficulty judging how much glue to use; applying the -glue with a small brush may remedy this problem. -stamps, stencil, simple cutting, collage- minimal attention or decision making or problem-solving skills. -Simple paper folding can be used to assess cognitive function- ability to follow directions, perceptual skills, and emotional regulation, including frustration tolerance. *specific mental functions- orientation, memory & organizational skills- scrapbook of family, friends or fav places *Temperament (self-esteem): draw tree trunk of flower and crumple tissue as leaves or flowers *sensory tolerance- paper mâché or paper sculpture Pediatrics: useful in gaining fine motor skills needed for activities related to academic success (scissors use and handwriting) -rounded scissors for safety, too much glue *fine motor control (scissor use): snowflake paper cut outs *following directions: origami item (hat or boat) *social interaction: magazine or collage in group Adolescents: origami can be used with this age group to foster cooperative or creative behaviors; picture collages to express one's identity and feelings; low cost and daily use Older Adults: adapt quilt/applique to paper designs; older clients are less likely to enjoy experimentation and those with cognitive deficits can struggle with new learning, so projects that have a familiar structure are most appropriate (paper cuts) -Visual demands: having to copy a design, and cognitive demands, such as the number of steps or the need to following written or verbal directions. *Papier mâché, after set-up, is a simple repetitive process that requires little or no vision and few cognitive skills and yet provides upper extremity exercise and tactile stimulation. *Origami may be difficult for some clients due to the precision and sequencing required and making the well-defined creases could be stressful to the small joints of the hand. Group: collaborative and individual efforts; making something for others will often entice someone to participate who would otherwise decline the activity -collages as a means of sharing thoughts or feelings in a social interaction session.

Mosaic

-not messy, steps involved are useful in assessing or treating diverse skill areas (size and color discrimination); spatial awareness; fine motor manipulation; ability to follow directions; and executive functions (decision making, ability to organize and execute a plan) (Grade Mosaic by project size) *Precautions: tile cutter (flying shards) goggle or under table; sharp edges- gloves, grout-abrasive material; allergenic chemicals; dust-respiratory Ex: Tiled Tray- at least 2 sessions; differ tray size/tiles, change design- need good fine motor control and patience -Grade Down: no grout, glue tiles next to each other, random design or large tiles -Grade Up: large tray (more tiles), small tray (smaller tiles), complex design, cover vertical or curved surface *Documentation: whether client completes project and how much assistance was needed- observe for tip-to-tip pinch & coordination, organizational capacity, task timing and termination, ability to follow pattern, visual scanning & other skills for daily living tasks- visual scanning and discrimination skills Ex: Simple Bean Mosaic- food/other natural items Ex: Faux Stained Glass Vase: container or flat piece, can be costly, mix acrylic paint and glue Physical Dysfunction: pick/place repetitive; tile size can grade pinch; tweezers add resistance; squeeze tile cutter- strengthen cylindrical grasp -minimal proximal movement- client w/ shoulder ROM can succeed -Cognitive: plan/arrange design; structure & guide minimize frustration -self organization deficits: simple geo pattern w/ 1, 2 or 3 colors -gross range of motion: large paper Ural, small paper mosaic mounted/on easel -dexterity: mosaic w/ 1/2" tiles and pre-drawn design on backboard -visual scan: mosaic trivet, alternating color rows Mental Health: assess cog problems- decide attention span/concentration, ability to plan or sequence & poor awareness of spatial relationships -thoughtful set-up & instruction for client w/ perseveration behavior or poor decision-making to minimize cueing or assistance from therapist- client cannot tolerate frustration or attend to detail well Pediatrics: improve fine motor performance -time to glue exceeds attention span, seeds/beads as alternative to tiles- reduce fine motor skills & attention demand -paper squares- low cost alternative to tiles, large format- multi step group activity; challenge for hyperactive Interaction/Social Skills: wadded tissue paper murrain group -manipulation skills: cardstock/cardboard , spread glue on small color coded areas then sprinkle the colored sand -sensory tolerance: press glass beads/tiles onto cement or plaster of Paris that is spread in a mold Adolescents: structured (grout and dry times) & unstructured (design, spacing & colors) components -patience permits small projects: slow, detail-oriented process that's absorbing and soothing in emotional turmoil Older Adults: larger tiles can be completed more quickly, high, high contrast colors improve visibility & discern spacing -usually not breakable- reduce grip strength, coordination & balance more likely to drop -low strength requirements and good for clients w/ upper extremity weakness -about 2-3 sessions before complete- easy to finish before losing interest or discharged Groups: specific pattern, therapist supervision for placement & spacing tiles- charge glue, tile container, increase opportunity for sharing interaction

Mosey's Teaching/Learning Process

1. Good communication skills. Collaboration is a valued aspect of the therapeutic relationship. Sit squarely toward patient without crossing arms or legs; use good eye contact and a relaxed approach. Ask open-ended questions in patient conversations, ones that require more than a one word answer. This type of question should compromise the majority of the questions. Use closed-ended questions carefully and only when you need a specific answer. 2. Accept the client for who he/ she is. All humans have the right to good health. Remain the professional in the relationship. 3. Begin treatment at patient's current level. This allows the person initial success before moving on to the next level. (gradation) 4. Acknowledge the patient's culture and environment; i.e. heritage, country of origin, age, gender, and memberships. All of these factors can have a positive and/or negative influence on returning to health. 5. Communicate effectively in volume and pace. Consider how you are saying something as well as what you are saying. Patients with hearing problems usually hear better with their eyeglasses on picking up on visual clues of speech. Confused patients perform better with simple, clear cues. 6. Encourage patient to be an active learner. Empower the client to be the leader of his or her treatment. (reflect, ask ?'s, feedback) 7. Control the consequences of learning. Pleasurable experiences reinforce learning again. Provide opportunities for errors and then discuss how things could go better next time. Always stop an experience if safety is an issue- safety is always addressed first in treatment. 8. Provide an opportunity for trial and error Use first and last experiences to demonstrate how far the patient has improved. Stay open-minded to ways that the patient wants to try something-- patient may know better than the practitioner. 9. Provide opportunity for practice and repetition. Opportunities to practice skills provide mastery. Use first and last experiences to show progress. 10. Encourage patient to set his/ her goals. The patient should always work with the therapist in developing goals because of motivation and responsibility. The practitioner's expertise is making sure the goals are not too high or too low. 11. Practice skills in different situations. Learning is often specific to an experience but practice in different situations allows the client to generalize the skill or transfer the training. 12. The patient should understand what is being learned. Too often, patient does not understand what is being learned, for example, in the case of head injured or confused patients. The practitioner must repeat the purpose of the task until he or she is sure the patient understands. Check for understanding during the process and educate staff, family, and friends at every available opportunity. 13. Learning moves from simple to complex. The idea of learning moving from simple to complex is nicely illustrated by the rating system for ski slopes- bunny trail to black diamond. 14. Encourage creative problem solving. Often times traditional approaches to a problem may not be the right approach for clients with nontraditional issues. The practitioner should role model and encourage the patient to 'think outside of the box'. 15. Acknowledge that everyone handles stress and anxiety differently. Learning is frustrating, stressful, and anxiety producing. Learners deal differently with stress; some may shut down and become quiet, some get loud and angry, and others may giggle and laugh at everything. Watch for signs of stress or anxiety and process this information with the patient.

Context and Environment

1. Physical 2. Social 3. Personal 4. Cultural 5. Temporal: time 6. Virtual

George Barton

1914 consolation house Clifton spring NY -main theme: hospitals responsibility to discharged patients, conditions faced, need to return to work, occupations/education convalescents. -re-emerge moral treatment: psych reconstruction and re-education thru employment

CNS & PNS

CNS: upper motor neuron lesions-cerebral tumor, traumatic head injury or CVA -spastic paralysis, hypertonia (increased muscle tone), hyperreflexia (exaggerate deep tendon reflexes), clonus, minimal to no atrophy PNS: injury to lower motor neurons -flaccid paralysis, hypotonia (decreased muscle tone), hypotonia, hyperreflexia, anterior horn cell, peripheral nerves, significant atrophy

Examples of Occupation

Preschool- play skills for socialization School aged- learn motor skills needed for classroom Young adult- educational/career planning Homemaker- cooking Leisure & hobbies of retiree Personal self-care

Mosey Teaching-Learning Process

Psychosocial OT- link education and psychological -learning principles provide a base for learning -therapist judgement is key to patient success

Rule #1 for Special Needs

Put yourself in the patients position and try the activity

Occupational Therapy Practice Framework

Therapeutic use of everyday life occupations with persons, groups, or populations (clients) for the purpose of enhancing or enabling participation- interaction with environment

Body Structures

anatomical parts that support body functions -nervous system -muscular system -skeletal system

Accessory motions

cannot be performed voluntarily, accompany normal movement, allow pain free range of motion -roll (rocking), glide (slide/transition), spin

Primary aim of adaption

change the activity so that a client can continue to participate in a valued occupation

Scaffolding

gradually decreasing amounts of physical assistance and/or verbal cues as a client completes an activity

Body functions - cardiovascular and respiratory systems

interdependent system *Functions that support the muscular system: -oxygenation -metabolic needs -waste removal *Muscular systen support: -muscle contraction aids blood flow -muscles of inspiration and expiration allow breathing to occur *Disease or limitations can lead to decreased: endurance, functional movement, independence (COPD, congestive heart failure, asthma)

Developmental/Acquisitional Models

stages of growth and development, milestones, age-appropriate behaviors and skills, repetition, mastery -dysfunction: neurological impairment, trauma, or environmental insufficiency -activity components: posture, grasp dexterity, repetition craft ex: finger-painting for school aged kids- beading, paper coats, metal tooling

ADLs (activities of daily living)

taking care of one's body; bathing, showering, bowel, bladder management, dressing, eating, feeding, functional mobility, personal device care, personal hygiene, grooming, sexual activity, sleep/rest, toilet hygiene.

Grading

to increase or decrease the activity demands for an individual performing a task -structuring an activity such that the challenge or demand will gradually increase and thereby facilitate improvement in a client's function. -client's values, developmental or functional level, and occupational profile.

Susan Tracy

- book Invalid Occupations promote crafts for physical/psych needs "occupation room", need for stronger leaders -1902 coined term Occupational nurse -high quality work, worth doing well, practical & well-made are therapeutic value -patient is product, not article they make

Woodwork

- vocational skills, acute mental health & physical dysfunctions Consideration/Precautions: costly; hand tools- sharp, pointed ends-decreased strength, coordination, or sensation or compromised immune systems; splinters- diminished sensation or impulsive; messy and potentially toxic-paints/stains (covers/gloves); fumes/sawdust- ventilation needed, respiratory issues (masks); noisy; less forgiving and requires care- sand w/ grain, glue will not take stain Ex: One board birdhouse: Grade- modified by using narrower board, straight opening instead of round hole, made more or less decorative Down: adapted sander to accommodate grasp, clamp to secure pieces during sanding, have client sand or assemble only, battery powered screwdriver, leave unfinished, use a kit Up: cut boards under supervision, add deco touches (tin roof), manual drill or screwdriver assembly, plan/execute complex finish, embellish w/ wood burn tool; Nail together rather than using screws to alter grip pattern, range of motion, and strength demands. Ex: Wood or Picture blocks Grade/adapt: changing the number and/or size of blocks, the manner of assembly, and the method of decoration. Down: adapted sander to accommodate grasp, clamp to secure pieces in sanding, leave wood unsanded, leave wood unfinished, sand only and therapist assembles, glue blocks instead of metal tape, power screwdriver, reduces number of pieces Up: manual drill/screwdriver, plan/execute complex finish, embellish with wood burn tool, scrap wood that requires sanding; standing, wear wrist weights while sanding, or do the sanding with the pieces clamped on an incline. Documentation: good for strength, endurance, weight bearing; stabilization, ability to coordinate both upper extremities, the ability to sand until smooth (strength and endurance) -Carving: physical force, useful for strengthening or as an emotional outlet, but proper supervision is mandatory. -Sanding table (incline table)-raised or lowered to achieve range of motion in targeted upper extremity joints. -Decreased grip strength or poor precision grasp: hand tools can be adapted by adding foam padding to the handles. -Impaired coordination/dexterity: larger pieces and less detail. ' Physical Dysfunction: Improved upper extremity range of motion, strength, and dexterity through carpentry. Hammering, carving, hand drilling, sawing, sanding, and painting all require combinations of upper extremity movement; larger the project, the greater the movement required. -Changing the height or position of the wood and the type of tools used- structure task for upper extremity joint motion and muscle activation. -Visually impaired: less precision work Mental Health: establish sense of normalcy and accomplishment -Illuminate, or remediate, deficits in sensory processing, motor control, praxis, attention span, sequencing, spatial operations, and problem solving, stopped/started at any point useful for clients with decreased attention or memory Pediatrics/Adolescents: part of play (e.g., popular hammer-and-peg toys)-facilitate development of hand-eye coordination, motor control, and object manipulation. - count and discriminate size/shape-learn shapes and use numbers in measurement -splinters, wood working from plans and raw materials may be difficult -Teens: adult occupation and responsibility; sanding, sawing, and hammering to sublimate negative emotions but may exacerbate those feelings in some clients; self-efficacy or gifting Older adults: diminished memory, vision, and hearing, as well as decreased mobility and increased pain require more simple projects (pre-cut kits with few steps) - time on repetitious steps (sand/rub stain), each step taught separate to accommodate short-term memory; dark paint/stain for more contrast for low vision patients; reduced sensation- more vulnerable skin, and heal more slowly than younger people (pain in joints/diminished sensation) Groups: useful for parallel group activity, help one another and share materials with little supervision from therapist by using kits, motivation and friendly competition, philanthropic purposes (kids toys for charity)

What can be adapted?

-Activity itself: methods, techniques, performance components -Position of the activity: context and environment (instead of painting on easel, paint flat) -Equipment or tools used: adaptive equipment (battery operated tile cutter instead of tile nipper, electric toothbrush, electric carving vs. knife) *universal design that can be used for many people

Principles of Gradation:

-Begin where the learner is (cognitive, processing, motor activity) -Choose an activity that can be graded -Observe learner's progress and listen to self-assessment to decide when to increase the challenge -Keep increasing challenge within the learner's reach "just right challenge"

CNS levels of control

-Cerebral or motor cortex: voluntary movement -Basal ganglia: posture, equilibrium, plan/initiation/inhibition of movements -Cerebellum: coordinated movement and timing -Brainstem: integration of CNS, muscle tone, respiration -Spinal cord: integrates reflexes and higher level activity

First, Find Out about the learner:

-Client-centered: What are the needs of learner? -Previous experience w/ activity? -Interest in activity? -Belief in self as learner? -Values and goals related to what needs to be learned? -How does activity fit w/ person's life -Learning style or special needs? -What is the best way for this person to learn? -Adult vs child learner- consider education of learner

Examples of Adaption

-Equipment Modification to everyday items: long-handled sponge, one-handed cutting board, shoe lace tier -Method Changes: putting on slacks lying down (supine) and rolling from side to side if unable to stand or move legs -Rearranging or modifying the environment: placing most used objects at counter height for person in wheelchair to work in kitchen -Assistive technology: switch access for toy, voice activated

Skills approached by Grading:

-ROM -endurance -muscle strength -pinch and release -manipulation -coordination -stabilization -rate of time -sequencing -choosing or decision making -relating to one or more persons (interaction) -Development of habits and routines

Body functions - skeletal

-Support: framework for body and attachments for muscles which enable movement at the joints -Protection: vital organs such as brain, heart and lungs -Movement: joints, all skeletal movement in body occurs at joints -Other functions: blood cell formation in bone marrow and mineral storage

3 types of joint classifications based on movement:

-Synarthrodial: immoveable (suture joints in skull) -Amphiarthrodial: (cartilaginous joints) limited movement (pubic symphysis) -Diarthrodial: freely moveable; movement is limited by muscle, tendons and ligaments -enclosed w/in joint capsule that secretes synovial fluid to lubricate joints -majority of joints in the body

Examples Grading - Motor Skills

-improve ability in fine pinch, start with objects learner can grasp (large tiles) and move toward smaller and smaller objects (peas) -Increase strength, start w/ weight or resistance learner can manage, move toward heavier weights or more resistance (heavier spoon to normal spoon)

Examples Grading - Communication & Interaction

-increase ability to relate, start with one-to-one, then move to trio, and gradually introduce more people (parallel play) -Improve info exchange, start by responding positively to any attempt at communication. Ask learner to express self in more specific ways.

Examples Grading - Process Skills

-increase decision-making (choosing), start w/ simple choice of two items, add choices and complexity as learner can tolerate -Improve accommodation to errors that arise in task activity, provide gradually more complex activity

Hearing impairment

-make sure person can see you and mouth at all times -use pantomime/gestures -provide clear demonstrations -written demonstration may be less useful- pictures or diagrams can help

Cognitive impairment

-many psych disorders or neurological -may not think clearly, remember instructions, have trouble with sequencing steps in an activity -choose familiar activities, necessary and simple (kit) -teach one step at a time (higher functioning persons-perhaps 2 steps) -Remember 4 C's: clear, concrete, concise, consistent

Modifications for learning style

-match language to patient's -speak to patients level of intelligence and education -some people need to take notes -some can't follow written directions or diagrams -some can't learn in a group, need one-to-one

Crafts are able to naturally activate the spatial and intuitive functions of the nondominant side of the brain:

-right hemisphere: linked to intuition, images, and emotion -left hemisphere: analytical and detail-oriented tasks

Ceramics

-room for creativity, self-expression & varied end product (Graded for diverse functional levels, safe & can use no tools) -drawbacks: cost, time/space requirements, ventilation, fire codes (kiln), clay traps in sinks needed; Drying to skin (moisturizer)- delicate skin or peripheral neuropathies (clay abrasive)- use polymer; create dust- respiratory (mask), client trouble differentiating edible/non-edible -Arthritis- joint damage using force in shaping; small joints in hands vulnerable- wounds may not tolerate stress & inflammation, pain -Prep, time required, cost, grading possibilities & documentation emphasis Ex: Pinch Pot/Slab building/Coil building/Sculpture -Slip Casting: chances of success are good, please client & improve self-confidence -Glazes: time consuming; many steps in firing *Bisque stain: unfired, not moisture resistant, less time/steps, lacquer- need ventilation *Kiln: bisque firing (4-8 hours) and glaze firing (longer); increase temp slowly to avoid exploding- necessary but difficult to let it cool as it needs twice as long as firing (crack if cooled to quickly, ventilation carbon monoxide) -Air dry magic made- small objects, costly but can be re-worked -non-clay modeling- simplest, limits creating and increase cost -kids: homemade salt dough Physical Dysfunction: achieve ,motor benefits (therapy putty) squeezing, pushing, pinching, Patting, rolling, smoothing & manipulating clay target- wrist/hand movement -strengthens upper extremities; easily graded- delicate carvings to larger, resistive actions (wedging) -wedging, rolling or pressing activates muscles in trunk & upper extremity; promotes elbow, wrist & finger extension -adjust table/chair to facilitate upper extremity, biomechanical-correct postures or have client stand to work on balance and weight bearing; positioning dictates muscle demand & skilled activity analysis determines best placement of work & selection of tools -Distal muscles- pinch pots; coils w/ less grip strength, roll out slab- proximal movement, bilateral coordination put slab pieces together; rolling pin incorporates upper extremity that is weak/dominated by pattern movement -ataxia/tremors: draped slab method -Fine motor skills- add surface details w/ selected tools, intricate glazes -Low vision- tactile -Bedside: pre-wedged clay, non-toxic, washable & quiet; patient in isolation- less expensive & leave in room Mental Health: express mood, project feelings & perspective of reality; wedge/pounding- release aggression but watch for escalation; vigilance w/ tools -clay sculpt is least structured -Structured: illuminate cognitive deficits: inability to follow instructions & Unstructured: show depressed mood or bizarre thoughts -Structure slab/coil: help w/ sensory integration for adult clients b/c wedge & roll- ROM & proprioceptive input upper extremities -Cognitive deficits: use samples to help conceptualize -material allows mistakes & correction; outlet for expression; improve attention span & build relation w/ others Pediatrics: natural & unstructured, facilitate intrinsic hand strength, pre-req for in hand manipulation skills -main caution: ingestion -small objects/easy wash at bedside Adolescents: glaze/fire instructive in prevocational lessons; follow procedures/rules and waiting for results Older Adults: slip molding- regressed patient, simple had built- hand strength, attention to task, self-expression -orthopedic limits/pain: grade for ROM, hand function & tolerance for resistance -sensory loss- low vision, decreased hearing, reduced tactile perception - diminished sensation risk- unnoticed injury: sensory re-education or desensitization - sensory/cognitive function: objects to reminisce or use for discussions Groups: foster self-revelation & discussion

Opposite dominance

-show how to do activity using hand patient will use -consider lighting (over opposite shoulder) when prepping workspace -remember to sit where person can observe movements

Craft as a means (grading the activity)

-therapist selected -remediation approach -targets performance skills -graded to target specific skills

Special Needs

-vision impairment -hearing impairment -cognitive impairment -hand dominance opposite of therapy practitioner -one handed

Client Factors

1. Body Functions: mental functions (memory, attention, thought,emotion, body systems), sensory functions/pain (Interoception, vestibular, small, touch), voice/speech functions (fluency, rhythm) 2. Body structures: anatomical parts that support body function 3. Values: cultural (commitment to family), Beliefs (hard work pays off), Spirituality

Performance Patterns

1. Habits: specific, auto behaviors performed repeatedly (keys in tray) 2. Routines: observable, regular, repetitive (night time) 3. Rituals: symbolic and contribute to identity (saying goodnight) 4. Roles: set by society (middle child)

Performance skills include

1. motor skills- position body, obtain/hold objects, move self/object, sustaining performance 2. process skills: think about- apply knowledge, organize time/space/objects, adapting performance 3. social interaction skills: manage emotions and cognitive tasks (produce speech); initiate/terminate conversation, produce social interaction, physically support social interaction, maintain flow, verbally supporting, adapting interaction

3 main components of occupation as a health promoting intervention:

1. one elicits a response from the neurological reward system, producing flow and a state of relaxation 2. reduces stress and the potential of stress-related illnesses 3. stimulates neural connections, helping to preserve cognitive ability

Fiber arrangement

2 types: -Pennate: favor force, oblique. (feather); peroneus fibula's longus, peroneus fibula's brevis, deltoid -Parallel: factor range of motion, run length of muscle (flat-thin/broad, fusiform-wide belly/thin ends (biceps brachii), radiate, strap-uniform in diameter and longer (sartorius) or sphincter-circular (mouth))

Activities

Actions designed and selected to support the development of performance skills and performance patterns to enhance occupational engagement. -goal directed & client sees a meaning or purpose ex: practice slicing veggies, writing with non-dominant hand, safe ways to get into/out of tub (grab bars), role play ways to manage anger, role play going for job interview

Types of Occupations

Activities of Daily Living (ADLs) Instrumental Activities of Daily Living (IADLs) Health Management Rest & Sleep Education Work Play Leisure Social Participation

Reference positions

Anatomical: most common, palms facing forward Fundamental: palms facing side of body

Nervous System - Peripheral Nervous System (PNS)

Autonomic: maintains internal balance Somatic: responds to external environment Sensory: afferent or ascending, specific area of skin-dermatome Motor: efferent or descending, muscular movement -Plexus: interjoin and branch off nerve route; brachial C5-T1 & lumbosacral L1-S3