Occupational Therapy
Content
OCCUPATIONAL THERAPY
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Assesses what muscles need strengthening and coordination to enable ADL and recommends practical activities to improve strength Improves basic self care s ills, such as dressing, eating, and personal hygiene Recommends adaptive e!uipment and upper e"tremity orthoses to facilitate ADL and trains patient in use of upper e"tremity orthoses and protheses #eaches homema ing s ills and determines at what level the patient can participate #eaches energy conservation and wor simplification methods to improve wor tolerance Improves communication s ills, such as reading, writing, and using telephone Redirects vocational, avocational, recreational interests, and social activities to accommodate disability #o ac!uire ob$ective evidence of the patient%s functional capacity, as him or her to demonstrate activities such as dressing, feeding, and attending to personal hygiene. Record any assistance re!uired, the ability to perform the tas independently, or the necessity for another person to perform the activity Also record any adaptive e!uipment and assistive devices needed and the time re!uired to complete the tas #est balance in both the sitting and the standing positions. #he
Occupational Therapist
Dr. Lanny Indriastuti, SpRM
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Occupational Therapist
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Occupational Therapist
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Activities of Daily Livin
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!alance
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normal person is able to remain stationary in the sitting and standing positions unsupported and does not fall when nudged from side to side. Record any deviations from normal balance, as these may impair ambulation. Also a prere!uisite for ambulation, transfer ability involves turning in bed, sitting up, and standing up. If the patient can perform these maneuvers, evaluate the ability to move to a chair or mat.
Transfers
l l
&valuation of ambulation consists of the ability to propel a wheelchair or wal using a functional and efficient gait pattern. As the patient ambulates, observe coordination, and speed and record any deviations from a smooth, rhythmic pattern. 'hanges in muscle strength or the s eletal structure produce abnormal shifts in the center of gravity, leading to abnormal gait patterns and additional energy re!uirements.
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A"#ulation
In$epen$ent( )atient can perform activities without verbal or physical assistance. %upervision nee$e$( )atient may re!uire verbal instruction or standby assistance to perform functional activity. Assistance nee$e$( )atient re!uires assistance of another person at minimal, moderate, or ma"imal level to perform the functional activity. Depen$ent( )atient cannot perform the activity even with the assistance of adaptive e!uipment or another person and the functional activity must be performed totally by someone other than the patient.
Level of $epen$ence
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Level of $epen$ence
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l Activities of Daily Living
*ccupational )erformance Areaa
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+rooming *ral hygiene ,athing #oilet hygiene Dressing -eeding and eating Medication routine Sociali.ation -unctional communication -unctional mobility Se"ual e"pression
/or Activities
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*ccupational )erformance Areas
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)lay or leisure activities
l &"ploration l )erformance
0ome management 'are of others &ducational activities 1ocational activities
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l Sensory integration l Sensory awareness l Sensory processing 2tactile, visual,etc.3 l )erceptual s ills l 4euromuscular l Refle" l Range of motion l Muscle tone l Strength l &ndurance l )ostural control l Soft tissue integrity l Co nitive inte ration an$ co"ponents l Level of arousal l *rientation l Recognition l Attention span l Memory 2short5term, long5term,etc3
Sensory motor components
)erformance 'omponents
)erformance 'omponents
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Se!uencing 'ategori.ation 'oncept formation Intellectual operations in space )roblem solving +enerali.ation of learning Synthesis of learning
Motor
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)erformance 'omponents
Activity tolerance +ross motor coordination 'rossing the midline Laterality ,ilateral integration )ra"is -ine motor coordination6 de"terity 1isual motor integration *ral motor control
l
)sychosocial s ills and psychological components
l )sychological l Social l Self management
)erformance 'omponents
Physical Disa#ility & %erious Illness pose a "a'or threat to an in$ivi$ual precipitate a life crisis
l l l l l l l l l l l
!efore The patient coul$ love & (or) The patient (as unrestricte$ & coul$ "ove a#out freely The patient ha$ outlets for physical tension* a ression an$ creativity After His fa"ily life & his future plans (ere $isrupte$ His #o$y i"a e (as altere$ His (or) roles (as ter"inate$ His self+estee"* security* in$epen$ence* opportunities (ere re$uce$ His psycholo ical inte rity (as threatene$ His control over inti"ate physical functions (ere lost
)S7'0*L*+7
l l l l l
The Perfectionist personality The Authoritative personality The %ociopathic & i"pulsive personality The passive a ressive personality The paranoi$ personality
Pre"or#i$ Personality
The perfectionist personality , l The perfectionist has internali-e$ hi h stan$ar$s for "aintenance of self+estee". l The criteria #y (hich he 'u$ es hi"self "ay #e infle/i#le l %lo( an$ less+than+perfect achieve"ent an$ a re$uction in the a#ility to "aintaine$ value$ #y stan$ar$s (ill #e threatenin The authorative personality , l The authorative personality nee$s to #e in control. l They (ant thin s $one a certain (ay an$ have ri i$ perceptions a#out rules* values an$ the (ay people shoul$ live an$ #ehave. They ten$ to #e 'u$ e"ental* concerne$ (ith status* li"ite$ a#ility to $evelop insi ht or to e"pathi-e$ (ith others. l A$aptation to $isa#ility re0uires co"pro"ise an$ acceptance (hich (ill #e $ifficult for hi" The sociopathic an$ i"pulsive personality , l They cannot tolerate the restrictions of hospitali-ation an$ the rules & proce$ures of "e$ical treat"ent such as costs* turnin fra"es* or even splints. l They fail to e/ercise oo$ "e$ical 'u$ e"ent l They often e/acer#ate their $ysfunctions #y failure to co"ply (ith self+care proce$ures. l Actin out #ehaviours are $isruptive on the (ar$ an$ in treat"ent The passive+a ressive personality , l They are $efensive an$ a ressive* e/pressin hostility passively throu h stu##orness* procrastination* o#structiveness an$ inten$e$ inefficiency. l They (or) poorly (ith others an$ "ay have a $e"orali-in influence on the staff an$ in therapy roups The paranoi$ personality , l They are hypersensitive* 'ealous* envious an$ self i"portant. l %uch a patient is alert in collectin clues throu h staff #ehaviours or "e$ical proce$ures (hich he interprets as a plan to har" hi" l %uch a patient is un(arrante$ly suspicious of the intentions of
others The narcissistic personality , l They feel superior l They are threatene$ #y re$uction of this i"a e. l They nee$ to )no( that they are still accepta#le. l %o"eti"es* they have a history of (ith$ra(al an$ poor interpersonal s)ills. l %o* they (ill fin$ the closeness of the reha#ilitation environ"ent à an/iety provo)in .
l l l l l l l l l l l
Denial Depression 1rief & 2ournin Re ression An/iety An er Co"pensation Overco"pensation Repression Day$rea"in & 3antasy Depen$ency
fre0uently seen in reaction to in'ury & chronic illness
Defenses & E"otional Reactions
The $isa#lin %/ The painful %/ The $ecrease funct+ional a#ility The resultin $efor"+e$ physical appear+ance An/iety 3ear Depression %ha"e
l l l l
Rheu"atoi$ Arthritis 4 RA 5
1enetic Autoi""une Infection Pyscholo ical
The hypothesis of RA etiolo ies
l
Overreaction to illness
%econ$ary responses to the RA
l l l l l l l l l
2asochis" Ri i$ity Confir"ity Perfectionis" Difficulty in $ealin (ith hostility & a
!e very sensitive !e vulnera#le to stress Have $i"inishe$ #o$y i"a e relate$ to cripplin $efor"ity Have $ifficulty in , a. fle/i#le "ana e"ent of their lives an$ #. seein alternative (ays of pro#le" solvin
In turn RA patient are seen to ,
ression
Psycholo ical treat"ent %u estion , l A oo$ relationship (ith a )in$ #ut fir" therapist (ho provi$es a consistent* stress+free structure in (hich the pt can learn l Treat"ent activities $esi ne$ to "eet special lernin nee$s l Clarity an$ repetition for reinforce"ent l 3ee$#ac) to #ench"ar) even s"all ains
Cere#ral 6ascular Acci$ent
Or anic $enial. 7 Un a(areness of a#ility of the ina#ility to rea$ or ne lect of the affecte$ si$e Psycholo ical $enial 7 !elief in a co"plete recovery an$ hi h interpretation of the sli htest chan e or spas"
l The therapist8s role is to focus on the assets an$ stren ths an$ s)ills l l
Cere#ral 6ascular Acci$ent
Reha#ilitation Potential
of the patient. Helpin the patient to reach one oal at a ti"e )eeps hi" fro" #ein over(hel"e$ (ith the enor"ity of his tas). The therapist shoul$ #e clear on (hen to support* (hen to ive "ore responsi#ility for self* (hen to #e the patient8s a$vocate an$ (hen to encoura e hi" to solve his o(n pro#le"s an$ initiate his o(n plannin .
l The therapist can assist the patient in his acco"o$ation to $isa#ility
Reha#ilitation Potential
#y provision of e/periences (here the patient feel "ore in control of
his life an$ "ore a(are of his co"petencies to(ar$ the $evelop"ent of "astery of environ"ent. Inte ration an$ per"anence of the ne( s)ills an$ attitu$es (ill $epen$ on the presence an$ 0uality of transitional an$ co""unity treat"ent an$ follo(+up pro ra"s
l Can #e increase$ #y involvin the patient in a partnership of choice
Reha#ilitation Potential
(ith the therapist in the $evelop"ent of treat"ent o#'ectives. l If the patient8s oals are initially too a"#itious* the therapist shoul$ re"e"#er that these are not necessarily the final choice. Patients* li)e the rest of us* are capa#le of e/periencin failure an$ of reassessin an$ thin)in throu h the nee$ to chan e $irection. The therapist can ui$e treat"ent #y se0uencin achieva#le short+ter" oals to support the patient8s lon +ter" o#'ectives.
l
Assesses what muscles need strengthening and coordination to enable ADL and recommends practical activities to improve strength Improves basic self care s ills, such as dressing, eating, and personal hygiene Recommends adaptive e!uipment and upper e"tremity orthoses to facilitate ADL and trains patient in use of upper e"tremity orthoses and protheses #eaches homema ing s ills and determines at what level the patient can participate #eaches energy conservation and wor simplification methods to improve wor tolerance Improves communication s ills, such as reading, writing, and using telephone Redirects vocational, avocational, recreational interests, and social activities to accommodate disability #o ac!uire ob$ective evidence of the patient%s functional capacity, as him or her to demonstrate activities such as dressing, feeding, and attending to personal hygiene. Record any assistance re!uired, the ability to perform the tas independently, or the necessity for another person to perform the activity Also record any adaptive e!uipment and assistive devices needed and the time re!uired to complete the tas #est balance in both the sitting and the standing positions. #he
Occupational Therapist
Dr. Lanny Indriastuti, SpRM
l
Occupational Therapist
l
l
Occupational Therapist
l l l
Activities of Daily Livin
l
l
l
!alance
l
l
normal person is able to remain stationary in the sitting and standing positions unsupported and does not fall when nudged from side to side. Record any deviations from normal balance, as these may impair ambulation. Also a prere!uisite for ambulation, transfer ability involves turning in bed, sitting up, and standing up. If the patient can perform these maneuvers, evaluate the ability to move to a chair or mat.
Transfers
l l
&valuation of ambulation consists of the ability to propel a wheelchair or wal using a functional and efficient gait pattern. As the patient ambulates, observe coordination, and speed and record any deviations from a smooth, rhythmic pattern. 'hanges in muscle strength or the s eletal structure produce abnormal shifts in the center of gravity, leading to abnormal gait patterns and additional energy re!uirements.
l
A"#ulation
In$epen$ent( )atient can perform activities without verbal or physical assistance. %upervision nee$e$( )atient may re!uire verbal instruction or standby assistance to perform functional activity. Assistance nee$e$( )atient re!uires assistance of another person at minimal, moderate, or ma"imal level to perform the functional activity. Depen$ent( )atient cannot perform the activity even with the assistance of adaptive e!uipment or another person and the functional activity must be performed totally by someone other than the patient.
Level of $epen$ence
l
Level of $epen$ence
l
l
l Activities of Daily Living
*ccupational )erformance Areaa
l l l l l l l l l l l l
+rooming *ral hygiene ,athing #oilet hygiene Dressing -eeding and eating Medication routine Sociali.ation -unctional communication -unctional mobility Se"ual e"pression
/or Activities
l l l l
*ccupational )erformance Areas
l
)lay or leisure activities
l &"ploration l )erformance
0ome management 'are of others &ducational activities 1ocational activities
l
l Sensory integration l Sensory awareness l Sensory processing 2tactile, visual,etc.3 l )erceptual s ills l 4euromuscular l Refle" l Range of motion l Muscle tone l Strength l &ndurance l )ostural control l Soft tissue integrity l Co nitive inte ration an$ co"ponents l Level of arousal l *rientation l Recognition l Attention span l Memory 2short5term, long5term,etc3
Sensory motor components
)erformance 'omponents
)erformance 'omponents
l l l l l l l l
Se!uencing 'ategori.ation 'oncept formation Intellectual operations in space )roblem solving +enerali.ation of learning Synthesis of learning
Motor
l l l l l l l l l
)erformance 'omponents
Activity tolerance +ross motor coordination 'rossing the midline Laterality ,ilateral integration )ra"is -ine motor coordination6 de"terity 1isual motor integration *ral motor control
l
)sychosocial s ills and psychological components
l )sychological l Social l Self management
)erformance 'omponents
Physical Disa#ility & %erious Illness pose a "a'or threat to an in$ivi$ual precipitate a life crisis
l l l l l l l l l l l
!efore The patient coul$ love & (or) The patient (as unrestricte$ & coul$ "ove a#out freely The patient ha$ outlets for physical tension* a ression an$ creativity After His fa"ily life & his future plans (ere $isrupte$ His #o$y i"a e (as altere$ His (or) roles (as ter"inate$ His self+estee"* security* in$epen$ence* opportunities (ere re$uce$ His psycholo ical inte rity (as threatene$ His control over inti"ate physical functions (ere lost
)S7'0*L*+7
l l l l l
The Perfectionist personality The Authoritative personality The %ociopathic & i"pulsive personality The passive a ressive personality The paranoi$ personality
Pre"or#i$ Personality
The perfectionist personality , l The perfectionist has internali-e$ hi h stan$ar$s for "aintenance of self+estee". l The criteria #y (hich he 'u$ es hi"self "ay #e infle/i#le l %lo( an$ less+than+perfect achieve"ent an$ a re$uction in the a#ility to "aintaine$ value$ #y stan$ar$s (ill #e threatenin The authorative personality , l The authorative personality nee$s to #e in control. l They (ant thin s $one a certain (ay an$ have ri i$ perceptions a#out rules* values an$ the (ay people shoul$ live an$ #ehave. They ten$ to #e 'u$ e"ental* concerne$ (ith status* li"ite$ a#ility to $evelop insi ht or to e"pathi-e$ (ith others. l A$aptation to $isa#ility re0uires co"pro"ise an$ acceptance (hich (ill #e $ifficult for hi" The sociopathic an$ i"pulsive personality , l They cannot tolerate the restrictions of hospitali-ation an$ the rules & proce$ures of "e$ical treat"ent such as costs* turnin fra"es* or even splints. l They fail to e/ercise oo$ "e$ical 'u$ e"ent l They often e/acer#ate their $ysfunctions #y failure to co"ply (ith self+care proce$ures. l Actin out #ehaviours are $isruptive on the (ar$ an$ in treat"ent The passive+a ressive personality , l They are $efensive an$ a ressive* e/pressin hostility passively throu h stu##orness* procrastination* o#structiveness an$ inten$e$ inefficiency. l They (or) poorly (ith others an$ "ay have a $e"orali-in influence on the staff an$ in therapy roups The paranoi$ personality , l They are hypersensitive* 'ealous* envious an$ self i"portant. l %uch a patient is alert in collectin clues throu h staff #ehaviours or "e$ical proce$ures (hich he interprets as a plan to har" hi" l %uch a patient is un(arrante$ly suspicious of the intentions of
others The narcissistic personality , l They feel superior l They are threatene$ #y re$uction of this i"a e. l They nee$ to )no( that they are still accepta#le. l %o"eti"es* they have a history of (ith$ra(al an$ poor interpersonal s)ills. l %o* they (ill fin$ the closeness of the reha#ilitation environ"ent à an/iety provo)in .
l l l l l l l l l l l
Denial Depression 1rief & 2ournin Re ression An/iety An er Co"pensation Overco"pensation Repression Day$rea"in & 3antasy Depen$ency
fre0uently seen in reaction to in'ury & chronic illness
Defenses & E"otional Reactions
The $isa#lin %/ The painful %/ The $ecrease funct+ional a#ility The resultin $efor"+e$ physical appear+ance An/iety 3ear Depression %ha"e
l l l l
Rheu"atoi$ Arthritis 4 RA 5
1enetic Autoi""une Infection Pyscholo ical
The hypothesis of RA etiolo ies
l
Overreaction to illness
%econ$ary responses to the RA
l l l l l l l l l
2asochis" Ri i$ity Confir"ity Perfectionis" Difficulty in $ealin (ith hostility & a
!e very sensitive !e vulnera#le to stress Have $i"inishe$ #o$y i"a e relate$ to cripplin $efor"ity Have $ifficulty in , a. fle/i#le "ana e"ent of their lives an$ #. seein alternative (ays of pro#le" solvin
In turn RA patient are seen to ,
ression
Psycholo ical treat"ent %u estion , l A oo$ relationship (ith a )in$ #ut fir" therapist (ho provi$es a consistent* stress+free structure in (hich the pt can learn l Treat"ent activities $esi ne$ to "eet special lernin nee$s l Clarity an$ repetition for reinforce"ent l 3ee$#ac) to #ench"ar) even s"all ains
Cere#ral 6ascular Acci$ent
Or anic $enial. 7 Un a(areness of a#ility of the ina#ility to rea$ or ne lect of the affecte$ si$e Psycholo ical $enial 7 !elief in a co"plete recovery an$ hi h interpretation of the sli htest chan e or spas"
l The therapist8s role is to focus on the assets an$ stren ths an$ s)ills l l
Cere#ral 6ascular Acci$ent
Reha#ilitation Potential
of the patient. Helpin the patient to reach one oal at a ti"e )eeps hi" fro" #ein over(hel"e$ (ith the enor"ity of his tas). The therapist shoul$ #e clear on (hen to support* (hen to ive "ore responsi#ility for self* (hen to #e the patient8s a$vocate an$ (hen to encoura e hi" to solve his o(n pro#le"s an$ initiate his o(n plannin .
l The therapist can assist the patient in his acco"o$ation to $isa#ility
Reha#ilitation Potential
#y provision of e/periences (here the patient feel "ore in control of
his life an$ "ore a(are of his co"petencies to(ar$ the $evelop"ent of "astery of environ"ent. Inte ration an$ per"anence of the ne( s)ills an$ attitu$es (ill $epen$ on the presence an$ 0uality of transitional an$ co""unity treat"ent an$ follo(+up pro ra"s
l Can #e increase$ #y involvin the patient in a partnership of choice
Reha#ilitation Potential
(ith the therapist in the $evelop"ent of treat"ent o#'ectives. l If the patient8s oals are initially too a"#itious* the therapist shoul$ re"e"#er that these are not necessarily the final choice. Patients* li)e the rest of us* are capa#le of e/periencin failure an$ of reassessin an$ thin)in throu h the nee$ to chan e $irection. The therapist can ui$e treat"ent #y se0uencin achieva#le short+ter" oals to support the patient8s lon +ter" o#'ectives.
