Occupational Therapy and Physical Dysfunction E-Book

Michael Curtin; Matthew Molineux; Jo-Anne Webb (formerly Supyk/Mellson)

BOOK

Occupational Therapy and Physical Dysfunction E-Book

Michael Curtin | Matthew Molineux | Jo-Anne Webb (formerly Supyk/Mellson)

(2009)

Additional Information

Book Details

ISBN: 978-0-7020-4877-7
Edition: 6
Language: English
Pages: 672
Subjects: Occupational therapy
Medical study & revision guides & reference material

Abstract

The sixth edition of this classic book remains a key text for occupational therapists, supporting their practice in working with people with physical impairments, stimulating reflection on the knowledge, skills and attitudes which inform practice, and encouraging the development of occupation-focused practice. Within this book, the editors have addressed the call by leaders within the profession to ensure that an occupational perspective shapes the skills and strategies used within occupational therapy practice. Rather than focusing on discrete diagnostic categories the book presents a range of strategies that, with the use of professional reasoning, can be transferred across practice settings.

The new editors have radically updated the book, in response to the numerous internal and external influences on the profession, illustrating how an occupational perspective underpins occupational therapy practice. A global outlook is intrinsic to this edition of the book, as demonstrated by the large number of contributors recruited from across the world.

Covers everything the student needs within the physical disorders part of their course
Links theory of principles to practice and management
Written and edited by a team of internationally experienced OT teachers, clinicians and managers
Gives key references and further reading lists for more detailed study
Written within a framework of lifespan development in line with current teaching and practice
Includes practice scenarios and case studies
Focuses on strategies

Subtitle reflecting the primacy of occupation in occupational therapy practice

Inclusion of practice scenarios to illustrate the application of theory to practice

Features such as chapter summaries and key points, providing a quick overview of each chapter

A focus on strategies rather than diagnostic categories

Consideration of individuals, groups and communities

An international perspective

Language that is person-centred and inclusive

New editorial team endorsed by the former editors including Annie Turner

Section Title	Page	Action	Price
Front cover	cover
Half title page	i
Occupational Therapy and Physical Dysfunction	iii
Copyright page	iv
Table of Contents	v
Contributors	ix
Foreword	xiii
Preface	xv
One Occupation and occupational therapy in context	1
One Defining occupational therapy	3
CHAPTER CONTENTS	3
SUMMARY	3
KEY POINTS	3
The importance of a clear and recognisable definition	4
Threats inherent in being inarticulate	4
Benefits of a clear definition	5
Problems of articulation	5
Occupation: core philosophy but peripheral reality?	5
Challenges to clearly articulating occupational therapy	7
Over-inclusive definitions	8
Problems of ‘fit’: epistemological difference	9
Ways of describing and defining occupational therapy	10
Giving up ‘function’: becoming ‘experts in occupation’	10
Promoting the ‘health through occupation’ message	11
Towards a clearer articulation of occupational therapy	12
References	13
Two The nature of occupation	17
CHAPTER CONTENTS	17
SUMMARY	17
KEY POINTS	17
Introduction	17
Defining occupation	18
The nature of occupation	19
Occupation as active engagement	19
Occupation as purposeful	20
Occupation as meaningful	20
Occupation as contextualised	21
Occupation as human	22
Occupation and health: just a good idea?	22
Conclusion	24
References	24
Three Occupational therapy: a disability perspective	27
CHAPTER CONTENTS	27
SUMMARY	27
KEY POINTS	27
Introduction	28
From the standpoint of disabled people	28
Contrasting perspectives: the social model of disability	30
Contrasting perspectives: the affirmative model of disability	31
Changing therapy: client-centred	32
Changing therapy: citizen-centred	34
Conclusion	35
References	36
Four Contesting assumptions in occupational therapy	39
CHAPTER CONTENTS	39
SUMMARY	39
KEY POINTS	40
Introduction	40
Challenging ‘thinking as usual’	40
Taking a global perspective	41
Contesting assumptions	41
The nature of the occupational therapy profession	41
Outcome assessment: who assesses our client-centredness?	42
Services: client-centred and needs-led or therapist-centred and bureaucracy-led?	42
Services: client-centred and needs-led or economic-led?	42
Services: needs-led or discriminatory?	42
Services: client-centred and needs-led? Taking a sceptical approach	43
The nature of occupational therapy’s goals	43
Striving for normality	43
Striving for physical independence	44
Enhancing quality of life	45
Normality, independence and quality of life: taking a sceptical approach	45
The nature of occupation	45
We can influence our health by hands and willpower	45
Work is supportive of health	45
Humans participate in occupations as autonomous agents	46
Occupations are goal-directed and socially sanctioned	46
Productive occupations contribute to life’s meaning	46
Occupations enable economic self-sufficiency	47
Occupations are divisible into categories	47
A balance of occupations is beneficial to health and well-being	47
Individuals interact with the environment through occupation	48
Humans need to master the environment	48
Assumptions informing occupational therapy: taking a sceptical approach	49
Occupational rights: occupation, health and well-being	49
Human rights, occupational rights and well-being	49
Values, knowledge and skills in occupational-therapy practice	50
References	50
Two An overview of occupational-therapy practice	55
Five Occupational reasoning	57
CHAPTER CONTENTS	57
SUMMARY	57
KEY POINTS	57
The case method	58
Conceptual frameworks for occupational performance and engagement	58
Phases of the occupational therapy process	59
Assessment	59
Diagnosis	60
Intervention	61
Re-assessment	61
Occupational reasoning strategies	61
Comparative analysis	62
Hypothesising	63
Conditional reasoning	63
Inferential reasoning	63
Argumentative reasoning	64
Reframing	64
Evidence-based reasoning	64
Application of strategies	64
Sharpening occupational reasoning	64
Conclusion	65
References	65
Six Understanding models of practice	67
CHAPTER CONTENTS	67
SUMMARY	67
KEY POINTS	67
Introduction	67
The mysteries of models	68
The established wisdom	68
Understanding terminology	69
Pondering the puzzle	70
Sheltering from the semantic storm	71
The Umbrella Framework for Understanding Models	71
Conclusion	77
References	78
Seven Process of assessment and evaluation	81
CHAPTER CONTENTS	81
SUMMARY	81
KEY POINTS	81
Introduction	82
Getting the right information: complexities and contexts	82
An occupational focus	83
Occupation-based assessment	84
When to assess	85
Steps in the process: screening, assessment and evaluation	85
Screening	85
Assessment	87
Evaluation	87
How to elicit information	88
Selecting and using standardised assessments	88
Professional responsibility and standardised assessments	89
Non-standardised assessments	90
Conclusion	91
References	91
Eight Writing occupation-focused goals	95
CHAPTER CONTENTS	95
SUMMARY	95
KEY POINTS	95
Background	95
Occupation-focused plans: an overview	97
Referral to occupational therapy	97
Assessing the person–environment–occupation fit	98
Writing occupation-focused aims	100
Setting occupation-focused goals	100
Writing SMART goals	101
Specific (S)	101
Example goal 1	101
Example goal 2	101
Three Essential foundations for occupational therapy	125
Ten The art of person-centred practice	127
CHAPTER CONTENTS	127
SUMMARY	127
KEY POINTS	127
Setting the scene	127
Defining a person-centred approach	128
Issues in the implementation of person-centred practice	129
Valuing uniqueness and autonomy of the individual	129
Respect and dignity	129
Enabling choice	130
Developing trust	130
Empowerment	130
Encouraging participation through partnerships	131
Practical application	131
Conclusion	132
References	133
Eleven Occupation in context	135
CHAPTER CONTENTS	135
SUMMARY	135
KEY POINTS	135
Introduction	136
Context 1 – Family of origin: shaping the emergent occupational persona	136
History and values	136
Opportunities: the enabling or delimiting impact of families on participation	137
Tempo and rhythm: families, time use and occupation	138
Context 2 – Communities in which we live	139
Physical and geographic characteristics of communities and occupational engagement	139
Naturally occurring geographic features	139
Built spaces	140
The sociocultural aspect of communities	141
Theme 1: culture influences norms and forms of occupational performance and engagement	142
Theme 2: cultural norms proscribe acceptable occupational participants	142
Theme 3: relationship between time and occupation differs across cultural contexts	143
Theme 4: sociocultural influences on places and spaces associated with specific occupations	143
Differences between communities: culture and occupation	143
Universality	144
Relationship between doing and being	144
Colonialisation	144
Context 3 – Political and economic environments	145
Legislation, policy and occupational participation	146
Conclusion	147
References	147
Twelve Enabling communication in a person-centred, occupation-focused context	151
CHAPTER CONTENTS	151
SUMMARY	151
KEY POINTS	151
Introduction	152
Person-centred practice	152
Occupation-based practice	152
Personal autonomy	153
Team-based practice	153
Strategies to enable communication	153
Developing communication skills	154
Empathy and sympathy	154
Barriers to communication	155
Assumptions	155
Frameworks to guide the search for understanding and establishing relationships	155
The Calgary Cambridge Model of History Taking	155
The Canadian Occupational Performance Measure	157
Conclusion	159
References	160
Thirteen Analysis of occupational performance	161
CHAPTER CONTENTS	161
SUMMARY	161
KEY POINTS	161
Introduction	162
What is analysis of occupational performance?	162
Why is analysis of occupational performance important?	165
Analysis of occupational performance	165
Performance areas	166
Performance skills	167
Motor skills	167
Process skills	167
Communication/interaction skills	170
Skills and capacities	173
Performance patterns: Roles, habits and routines	174
Role	175
Habits and routines	175
Performance contexts	177
Environments	177
Activity demands	178
Person factors	178
Application of occupational performance analysis	182
Conclusion	184
References	186
Fourteen Psychosocial support	189
CHAPTER CONTENTS	189
SUMMARY	189
KEY POINTS	189
Introduction	190
Holism	190
Adjustment to physical impairment	191
Psychosocial impairment	191
Clarifying communication – concept and purpose	191
The therapeutic relationship and communication	192
Effective communication within the occupational therapy process	192
Training	193
Application of skills	193
Skills for effective interpersonal communication	194
Environment-creating skills	194
Relationship-building skills	195
Advanced communication skills	196
Personal awareness and the therapeutic use of self	199
Psychosocial rehabilitation and support	200
Psychosocial enabling strategies	200
Enabling adjustment – managing stress and emotions	200
Emotional Intelligence	200
Aims of occupational therapy	201
Intervention	201
The application of psychosocial enabling strategies	206
Summary	206
Conclusion	207
References	208
Fifteen Advocating and lobbying	211
CHAPTER CONTENTS	211
SUMMARY	211
KEY POINTS	211
Introduction	212
Understanding and contextualising models of disability	212
Models of disability	212
Vulnerable identities	213
Advocacy and lobbying in occupational therapy	214
Advocacy	214
Lobbying	215
The occupational therapist as an agent of change	215
Strategies to effect change	217
Managing the dilemmas and tensions associated with advocacy and lobbying	218
Conclusion	219
References	219
Sixteen Educational strategies	221
CHAPTER CONTENTS	221
SUMMARY	221
KEY POINTS	221
Introduction	222
Why do occupational therapists educate?	222
Theories, models and principles that guide the provision of educational interventions	223
Adult learning theory	223
Health Belief Model	224
Self-efficacy theory	224
Transtheoretical Model	225
Partnerships between therapists and the people with whom they work	225
Considerations when planning and providing an educational intervention	227
Determine educational needs and establish objectives	227
Decide on format for providing education	228
Decide when to provide the information	229
Consider impairments that may impact on receiving and/or understanding information	230
Consider health literacy	230
Content and design principles for effective written health education materials	230
Evaluating the outcome of educational interventions	231
Conclusion	233
References	235
Further reading	237
Seventeen Health promotion and occupational therapy	239
CHAPTER CONTENTS	239
SUMMARY	239
KEY POINTS	239
Introduction	240
Key ideas within health promotion	240
Approaches to health promotion	243
Naidoo and Wills’ five approaches to health promotion	243
Medical approach	244
Behavioural change	244
Educational approach	244
Empowerment approach	244
Social change approach	244
Beattie model of health promotion	244
Settings for health promotion	245
Evidence and evaluation	245
Occupational therapy and health promotion	246
Education	247
Behaviour change	248
Conclusion	249
References	250
Eighteen Working with groups	253
CHAPTER CONTENTS	253
SUMMARY	253
KEY POINTS	253
Introduction	254
Valuing group work in physical rehabilitation	254
Types of group work	254
Psycho-educational groups	255
Occupational groups	255
The value of group work generally	256
Sense of community connectedness	257
Creative and/or productive opportunities	257
Evidence on the effectiveness of group work	257
Planning a group	258
Creating the group stage	258
Recruiting stage	259
Engaging stage	259
Planning stage	259
Managing the group	259
The beginning stages of a group	260
The middle stages of a group	261
The ending stages of a group	261
Conclusion	261
References	264
Four Working with and within communities	265
Nineteen Community development	267
CHAPTER CONTENTS	267
SUMMARY	267
KEY POINTS	267
Introduction	268
What is community?	268
Why community development approaches are necessary	271
Social opportunities and social capital	272
Is the community to be developed or is the community the vehicle for development?	273
Solutions	274
Arts and cultural action	274
Environmental action	274
Education and learning	275
Social activism and disability	275
Conclusion	276
References	277
Useful resources	280
Twenty Developing partnerships to privilege participation	281
CHAPTER CONTENTS	281
SUMMARY	281
KEY POINTS	281
Introduction	282
Marginalisation and barriers to participation: occupational therapists working with disabled people to eradicate occupational injustice	283
The United Nations’ Convention on the Rights of Persons with Disabilities as an advocacy tool	284
A partnership approach: Five actions for achieving participation and occupational justice	288
What can we learn from these two scenarios?	294
Conclusion	295
References	295
Twenty-One Working towards inclusive communities	297
CHAPTER CONTENTS	297
SUMMARY	297
KEY POINTS	297
Introduction	298
Poverty	298
Vulnerability	298
Poverty and disability	299
Theoretical and policy overview	299
Social and occupational (in)justice	299
Occupational deprivation and occupational apartheid	300
Social policies and participation strategies	301
Social cohesion	302
Mainstreaming	302
Occupational therapy contributing to social reform	302
Practical implications	303
Establishing partnerships	303
Capacity building	306
Facilitating inclusive education (including attitudes)	308
Managing and monitoring impact	310
Conclusion	311
References	311
Twenty-Two Community-based rehabilitation: opportunities for occupational therapists in an evolving strategy	313
CHAPTER CONTENTS	313
SUMMARY	313
KEY POINTS	313
Introduction	314
Understanding community-based rehabilitation: an evolving strategy	315
Early community-based rehabilitation	315
Community-based rehabilitation re-conceptualised: A community development strategy	317
Occupational therapy and community-based rehabilitation	321
Roles, skills and opportunities for occupational therapists in community-based rehabilitation	322
Transfer of rehabilitation knowledge and skills	322
The provision of direct therapy	322
Referral services	322
Programme development and implementation	323
Facilitating collaboration	323
Other roles	323
Conclusion	323
References	324
Twenty-Three Entrepreneurial opportunities in the global community	327
CHAPTER CONTENTS	327
SUMMARY	327
KEY POINTS	327
Global influences and directions for occupational therapy	328
Entrepreneurial practice	329
Inspired by the pioneers of the profession	329
Being entrepreneurial	331
Working entrepreneurially	332
Forward planning	332
Strategic intent	332
Marketing	332
Examples of innovation and entrepreneurship	333
Using technology in practice	333
Working as consultants	334
Focusing on elderly people	335
Reaching people through the use of tele-health	335
Disaster preparedness and response	336
Conclusion	337
References	338
Five Working with the individual	339
Twenty-Four Enabling engagement in self-care occupations	341
CHAPTER CONTENTs	355
SUMMARY	341
KEY POINTS	341
Defining self-care	342
Who one is	343
Identity	343
Independence	343
Values and beliefs	344
Self-efficacy	344
Motivation	344
Choice	345
Meaning	345
Environment	346
Assessment	346
Purpose of assessment	346
Assessment decisions	347
Assessment approaches to self-care	347
Developing an occupational profile	348
Interpreting assessment data	349
Establishing goals for engagement in self-care	350
Strategies for enabling engagement in self-care occupations	351
Conclusion	351
References	353
Further reading	355
Twenty-Five Leisure	357
CHAPTER CONTENTS	357
SUMMARY	357
KEY POINTS	357
Introduction	358
What is leisure?	358
Leisure as residual time	358
Leisure as activity	359
Leisure as experience	359
The leisure experience	360
Perceived freedom	360
A sense of intrinsic reward	360
Enjoyment or pleasure	360
Relaxation	360
Temporality and flow	360
Leisure and recreation	361
Relationship to health	361
Application to practice	362
Leisure assessment tools	364
Measurement of time	364
Leisure as activity	365
Critique of tools	365
Leisure as experience	366
Ways of enabling participation in leisure	366
Temporal aspects	367
Adaptation of the environment and/or occupation	367
Occupational substitution	367
Leisure as means	367
Conclusion	368
References	368
Twenty-Six Play	371
CHAPTER CONTENTS	371
SUMMARY	371
KEY POINTS	371
What is play?	372
Theories of play	372
Play development	373
Types of play	373
An occupational perspective on play	373
The value of play	377
Long-term health and well-being	377
Pretend play and language	378
Literacy and learning	378
Pretend play and narrative competence	378
Social interaction and competence	379
Creativity and problem-solving	379
‘Play as means’ or ‘play as ends’ in occupational therapy	379
‘Play as a means’ in therapy	379
‘Play as an ends’ in therapy	383
Conclusion	387
References	388
Twenty-Seven Work rehabilitation	391
CHAPTER CONTENTS	391
SUMMARY	391
KEY POINTS	391
Introduction	392
Work occupations	392
The meaning of work	392
Occupational therapy and work	393
Work rehabilitation	394
The work rehabilitation process	395
Phase one: assessment	401
Assessment of the worker	401
Diagnostic and prognostic information	401
Interview with the worker	401
Assessment of the worker’s capacity	401
Assessment of the workplace	402
Manager/supervisor interviews	402
Workplace assessment – job analysis	403
Phase two: professional reasoning – matching worker and work tasks	403
Phase three: goal setting and outcome measurement	403
Phase four: therapeutic interventions	404
Return-to-work programme	404
Modifications of the environment, tasks, tools or equipment	405
Education or training	405
Other interventions	405
Phase five: implement interventions, monitor and review	407
Conclusion	407
References	407
Twenty-Eight Home modification: occupation as the basis for an effective practice	409
CHAPTER CONTENTS	409
SUMMARY	409
KEY POINTS	409
Introduction	410
Home as a design product for purchase or rental	410
Home affordability and home-modification funding	411
Home as an emotional place	412
Legislation relevant to home-modification practice	413
Occupational basis for modification reasoning	414
Occupational basis for modification knowledge	415
Home-modification assessment	416
Home visiting and clarity of assessment purpose	417
Home-modification intervention	420
Communication skills in home-modification practice	423
Modification recommendations	426
Conclusion	427
References	427
Twenty-Nine Toward universal design	431
CHAPTER CONTENTS	431
SUMMARY	431
KEY POINTS	432
Introduction	432
Principles of universal design	433
Design of entrances, kitchens and bathrooms	434
Universal entrances	434
Ramps	435
Platform lifts	435
Site conditions	436
Universal kitchens	437
Refrigerated storage	441
Lowered work surfaces	441
Controls	443
Universal bathrooms	444
Lavatories	444
Toilets	444
Bathing fixtures	445
Offset controls	445
Reinforcing for grab bars	446
Additional universal features	447
Water controls in the kitchen and bathroom	447
Widening doors with swing-away hinges	448
Washing-machine height	448
Closet storage	448
Application to practice	448
Conclusion	450
Additional resources	451
Thirty Assistive devices for enabling occupations	453
CHAPTER CONTENTS	453
SUMMARY	453
KEY POINTS	453
Introduction	454
Enabling occupations with assistive devices	454
Design of assistive devices	455
Policy context	456
History of assistive device provision in occupational therapy	456
Problem solving and reasoning	457
Problem-solving process	459
Step 1: Assessment	459
Step 2: Planning	460
Step 3: Intervention	464
Step 4: Evaluation	465
Conclusion	466
References	466
Resources	468
Internet resources	468
Thirty-One Wheelchairs: posture and mobility	469
CHAPTER CONTENTS	469
SUMMARY	469
KEY POINTS	470
Introduction	470
Occupation, person and environmental factors	470
Health conditions of wheelchair users	471
Wheelchair prescription	473
Enablement of mobility interventions	474
Self-propelling wheelchairs or independent manual mobility systems	474
Attendant-propelled wheelchairs or dependent mobility system	474
Powered wheelchairs	475
Children’s wheelchairs and buggies	475
High-performance sports wheelchairs	476
Bariatric wheelchairs	476
Stand-up wheelchairs	476
Elevating wheelchairs	476
Assessment for wheeled mobility systems	476
Seating interventions	476
Biomechanics and seating	478
Effect of force on seating	478
Centre of mass	478
Why is it important to know about forces acting on the body of someone in a wheelchair?	479
Tissue integrity and pressure ulcers	479
Physical assessment and interventions for postural management	480
Postural control	480
Orthopaedic factors	482
Cushioning within wheelchairs	482
Adaptive seating systems	482
Pressure cushions	482
Conclusion	485
Acknowledgements	485
References	486
Thirty-Two Driver assessment and rehabilitation within the context of community mobility	489
CHAPTER CONTENTS	489
SUMMARY	489
KEY POINTS	489
Introduction	490
Driving, community mobility and health	490
Balancing road safety and an individual’s mobility needs	491
Reporting of health and/or impairment-related conditions that may impair driving	492
Driving as an information-processing task	493
Role of non-driving-trained occupational therapists in relation to driving	494
Occupational therapy driving specialist: assessment and intervention	495
The practice context	495
Referral systems for specialist mobility and driver assessment services	495
Characteristics of individuals referred for driver assessment	496
Driving-related assessments	496
Off-road screening	497
On-road assessment	498
Possible driver evaluation outcomes	499
Emerging issues related to occupational therapy driver assessment and rehabilitation	503
Conclusion	503
References	503
Thirty-Three Orthotics for occupational outcomes	507
CHAPTER CONTENTS	507
SUMMARY	507
KEY POINTS	508
Introduction	508
What are orthoses?	508
Who needs orthoses?	509
The condition	510
The occupational goals of the person	510
The structural properties of the upper limb and hand	510
Types of orthoses	511
Static orthoses	511
Semi-dynamic orthoses	512
Dynamic orthoses	512
How to design orthoses	513
When to use orthoses	513
Immobilisation	513
Joint protection	513
Immobilisation for rest	513
Immobilisation for wound healing	513
Correcting deformities and preventing contractures	515
Correcting deformities and preventing scarring	516
Improving use of the hand	518
Reducing pain	521
Decreasing oedema	522
Conclusion	523
References	523
Further reading	526
Thirty-Four Biomechanical strategies	527
CHAPTER CONTENTS	527
SUMMARY	527
KEY POINTS	527
Introduction	527
Defining terms	528
Kinesiology	528
Biomechanics	528
Kinematics and kinetics	528
Rationale for biomechanical strategies	529
Professional reasoning	535
Assessment	535
Assessment of meaning	535
Assessment of function	535
Assessment of form	536
Implementing strategies	536
Overall aims	538
Strength	538
Endurance	539
Enhancing voluntary movements	539
Conclusion	540
References	540
Thirty-Five Skills for addressing sensory impairments	543
CHAPTER CONTENTS	543
SUMMARY	543
KEY POINTS	543
Introduction	543
Index	653

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