Updated Activity Analysis Using the Occupational Therapy Practice Framework III: Paralleling Craft Activity Skills to Everyday Occupations

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Updated Activity Analysis Using

the Occupational Therapy Practice

Framework III:

Paralleling Craft Activity Skills

to Everyday Occupations

Cynthia Evetts, Ph.D., OTR

Emily Leenerts, B.S., OTS

Emily Miller, B.S., OTS

With Dr. Suzanne Peloquin, UTMB Professor Emerita

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Outline and Objectives of Workshop

Outline

1. Orient you to updates in the new OTPF-III

2. Analyze your own meaningful occupations and discuss what other craft

activities help to build related skills.

3. Analyze a patient’s meaningful occupations and discuss what craft

interventions help to reach functional outcomes.

Craft

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4. Explore the research with Emily Leenerts.

Craft

5. Discuss tips to successful therapeutic use of craft.

Craft

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Outline and Objectives of Workshop

Objectives

• Demonstrate activity analysis of craft activities and parallel skills to

everyday occupations

• Get you updated on current OT terminology

• Collaborate on ADL analysis

• Demonstrate documentation of craft intervention

• Build confidence to use therapeutic craft activities as an intervention

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Orientation to the Updated OTPF-III

• The purpose of the OTPF-III is to “describe central concepts that

ground occupational therapy practice and build a common

understanding of the basic tenets and vision of the profession”.

• Two parts: Domain and Process

– Domain: OT body of knowledge and expertise.

• The “what”

– Process: Client-centered evaluation and intervention.

• The “how”

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OTPF-III

Domain

– Occupations

– Client Factors

– Performance Skills

– Performance Patterns

– Contexts & Environments

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OTPF-III

Process

School of Occupational Therapy

• Evaluation

• Intervention

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OTPF-III

Terminology: Important for Today’s Workshop

• Activity Analysis: Analysis of “the typical demands of an activity,

the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it”.

– Activity analysis is a distinguishing skill of occupational therapists that sets us apart from every other profession in the health industry.

– We do activity analysis on a regular basis and we are good at it! – It includes knowing our client’s limitations and strengths, using

skill-building interventions that are geared to reaching functional outcomes, and grading the activity to meet a just-right challenge. – We do this whole process within a reflective thought process

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OTPF-III

Terminology: Components of Activity Analysis

• Activity Demand: Aspects of an activity or occupation needed to

carry it out, including:

– relevance and importance to the client – objects used and their properties

– space demands – social demands

– sequencing and timing

– required actions and performance skills

– required underlying body functions and body structures

• Performance Skill: Goal-directed actions that are observable as small

units of engagement in daily life occupations. They are learned and developed over time and are situated in specific contexts and

environment.

– Motor skills – Process skills

– Social interaction skills

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OTPF-III

Terminology: Components of Activity Analysis

• Activity and Occupational Demands

• Relevance and importance to client

• Objects used and their properties

• Space demands

• Social demands

• Sequencing and timing

• Required actions and performance skills

• Required body functions

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OTPF-III

Terminology: Related to Craft Interventions

• Preparatory Tasks: Actions selected and provided to the client to target

specific client factors or performance skills. Tasks involve active

participation of the client and sometimes compromise engagements that use various materials to simulate activities or components of occupations. Preparatory tasks themselves may not hold inherent meaning, relevance, or perceived utility as stand-alone entities.

Examples include:

- Assertiveness training to prepare for self-advocacy

- Hand strengthening exercises with therapy putty, exercise bands, and

grippers.

- Craft activities can be an example of preparatory task

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OTPF-III

Therapeutic Use of Craft

Occupation is both a means and an end!

Therapeutic use of craft is more than just doing crafts. Crafts have preparatory elements, building proficiency in specific skills that directly relate to

functional goals and outcomes.

(Usually more engaging for the client than rote practice of ADLs.) Craft can be included in all five approaches to intervention: - Create, Promote

- Establish, Restore - Maintain

- Modify - Prevent

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OTPF-III

What’s New?

- Sensory - Emotional - Relevance

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Self-Assessment of Meaningful Occupations

Occupational needs

12 things I like to do

every day accompl

ishme nt af fir m at io n ag ency co he re nce co mpa ni ons hi p pl ea sur e re ne w al Shower X Take the dogs for a walk X X Cook breakfast X Email friends and family X

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Worksheet:

Activity Analysis of Everyday Occupations

Activity Analysis: Analysis of “the typical demands of an activity, the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it”.

Step 1: Activity analysis of the everyday occupation. What is required to do the task? Fill in the first column.

Step 2: Select and analyze a craft activity that helps to build competency in the skills of everyday occupation. Fill in the second column.

Pick one important everyday occupation: Driving to work (IADL)

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Worksheet:

Activity Analysis of Everyday Occupations

Components of Analysis Everyday Occupation

Driving to work

Relevance/Meaning Exercise independence. Important for community mobility.

Objects/Tools Car: Steering wheel, foot pedals for braking and accelerating, rear view and side mirrors, blinker signal to turn, chair

Space Moderate room in cabin of car to move arms and feet. Everything in about arm’s reach.

Social Rules of the road, respecting the space and signals of other drivers, respect speed limit.

Sequencing Turning on the car, checking mirrors, buckle seat belt, change gears. Sequence changing lanes or turning.

Required Actions/ Performance Skills - Motor - Process - Social

- Grip the steering wheel, coordination of motor skills to move the steering wheel, keep body and head upright.

- Scan the road for potholes and other drivers, plan your navigation or route, attention to the road and task, respond to unexpected traffic or car

- Takes turns at a stop sign, socializes with passenger while not maintaining consistent eye contact

Body Functions/ Body Structures - Mental - Sensory - Musculoskeletal - Speech - Cardiovascular - Other

- Alert and conscious, ability to focus for prolonged periods - Sensation of the wheel, proprioception, visual acuity

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Worksheet:

Activity Analysis of Everyday Occupations

Components of Analysis Craft Activity

Knitting

Relevance/Meaning Interest or hobby. Expression of creativity. Make gift for another person.

Objects/Tools Yarn, knitting needles or loom.

Space Moderately small space to work on project in lap or on table. Everything is within arms reach.

Social Sharing supplies if in a group and cleaning up after you are done.

Sequencing Steps to position hand, yarn, and knitting needles. Turning needle and manipulating the yarn.

- Fine motor manipulation, movement of the shoulder, elbow, and fingers. Coordination of upper extremity.

- Scan for knots or tangles in the yarn. Plan steps to finished product. Respond to unexpected mistakes. Attention to task.

- Alert and focused on sequence of task. Image the finished product. - Sensation of the yarn and needle, proprioception, visual acuity. - Upper extremity strength and ROM. Gross and fine movement

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Tips for craft:

- Craft activity should be meaningful

- Grade the craft for a just-right challenge

- Outcomes of craft activity should be directly related to your

goals

Worksheet:

Activity Analysis of Everyday Occupations

http://dianne-jones.blogspot.com/2011_11_01_archive.html

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Activity Analysis of Everyday Occupations:

Group Work!

Activity Analysis: Analysis of “the typical demands of an activity, the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it”.

Step 1: Activity analysis of the everyday occupation. What is required to do the task? Fill in the first column.

Step 2: Select and analyze a craft activity that helps to build competency in the skills of everyday occupation. Fill in the second column.

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Worksheet:

Activity Analysis and Craft Intervention

Client: 54 yr-old female with left CVA

Occupation: Brushing teeth

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Activity Analysis and Craft Intervention

Components of Analysis Everyday Occupation

Brushing teeth

Relevance/Meaning Hygiene and self-care

Objects/Tools Tooth brush, tooth paste, water, sink

Space Good lighting, small work space

Social Expectation from others to have a clean mouth.

Sequencing Process of untwisting the cap of the tooth paste, applying tooth paste to brush, wetting tooth brush, back and forth motion in mouth to clean. Usually performed at morning and night.

- Grip the tooth brush, squeeze paste from the tube, gross and repetitive movements of the shoulder, spits out saliva

- Attends to task without distraction, uses tools for intended purpose

- Alert and oriented

- Sensation of saliva in mouth and need to spit, not swallow or choke. Proprioception. - Use of one or both hands, upper extremity. Upright position

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Activity Analysis and Craft Intervention

Components of Analysis Craft Activity

Paper Heart Basket

Relevance/Meaning Gift for another person, hold message, seasonal ornament

Objects/Tools Scissors, paper, table to work on

Space Good lighting, space for individual work area

Social Sharing supplies, following verbal directions or cues, cleaning up after done

Sequencing Follow sequence of steps, measuring, cutting and weaving.

- Manipulates tools, manipulates paper to weave.

- Uses tools appropriately, initiates step after reading instruction, finds mistakes - Asks questions when confused, asks to share supplies

- Orientation and attention to task

- Sensation of tools and supplies, proprioception - Upper extremity movement. Gross and fine motor - Ask for help or communicate

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Activity Analysis and Craft Intervention

Craft Intervention: Heart Basket

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• Occupational therapy is both art and science

• Heart enhances the art of therapy

– Values

– Passion

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Activity Analysis and Craft Intervention

Craft Intervention: Heart Basket

1. Cut construction paper into four even sections (hamburger style) 2. Cut the edges so each one is a long oval with rounded edges

3. Cut three parallel lines out of the oval shape, stopping an inch before the edge

4. Fold each oval shape in half and face the folds together so it resembles a heart shape

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Activity Analysis and Craft Intervention

5. Begin weaving with the top fold of the right oval. Thread it through the top folds of the left oval piece.

6. Make sure to weave the right fold you are working on through each left fold. This will help it look checkered, and also give the heart a basket shape. 7. Weave each right fold completely and move it up to begin the next.

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Activity Analysis and Craft Intervention

Grade the activity by:

- Using a different medium. Eg: felt, foam, or paper. - Precut the shapes, like we did for you today.

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Activity Analysis and Craft Intervention

Tips for documentation:

 Use language that illustrates specific skill building in progress note.  Track progress with measureable degree in mind (time, cues, etc.)

 LTG is related to occupation and function.

 STG is related to specific skill building (accomplished via craft).  When using electronic documentation, focus on documenting the skill.

Leisure activity or therapeutic exercise may be accurate categories, but may not give adequate credit to the skill building and functional

outcomes.

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Activity Analysis and Craft Intervention

Document Goals:

LTG: Client will perform morning teeth hygiene using both hands by end of two weeks.

STG: Client will demonstrate use of affected hand to stabilize and grasp objects during

skilled, purposeful task.

STG: Client will demonstrate reduced neglect of affected arm by using it in 40% of

activity with verbal cues.

Document Progress:

Subjective: “My bad side can help out a little bit more today”.

Objective: Client lifted affected forearm to table with use of unaffected hand with no

verbal cues. She held the paper heart with her affected hand and manipulated the paper weaving with her unaffected hand.

Assessment: Client recognized progress in use of affected hand. Client demonstrated

gross motor weakness in affected arm and functional use of fingers in affected hand.

Plan: Progress towards goals met through the use of crafting. Continue to use

skill-based craft modality for this client. OR … Progress towards goals not met through the use of crafting. Discontinue use of skill-based craft modality for this client.

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Activity Analysis and Craft Intervention:

Group Work

Client:

___________________________________________________________ Occupation:_________________________________________________

Step 1: Activity analysis of the client occupation. What is required to do the task? Fill in the first column.

Step 2: Select and analyze a craft activity that helps to build competency in the skills of this occupation. Fill in the second column.

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Research

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• Introduction

– Craft was part of occupation-based treatment in

early history of OT (Bathje, 2012)

– Craft fell out of favor during Reductionist

Movement (Christiansen & Haertl, 2014)

– Full-circle, are we returning to craft?

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• Social Media Research data

(Guistini, 2010; Lomborg, 2012; Wu, Sun, & Tan, 2013; Jacobson, 2011)

– Pinterest selected; craft is popular topic

http://pro.psychcentral.com/private-practice/wp-content/uploads/sites/2/2014/09/oa4qcmjpg_zpsf989836b.png

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• 6 weeks, 4 hrs/week on Pinterest

• Data gathered

– Crafts from commonly found materials in clinics,

inexpensive (<$1) materials at craft stores, or

recycled materials

– Other criteria

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www.buzzfeed.com www.babble.com www.craftgawker.com

Gender

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Age

www.babble.com

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Low Vision

www.indianainking.blogspot.ca marisa-ramirez.tumblr.com www.cfabridesigns.com

Decreased Memory

www.mysocalledgreenlife.com

Changing Laterality

_{Weak Pincer Grasp}

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www.embraceyourchaos.com

www.smcarney.blogspot.com http://www.pinterest.com/Patriciuca/

Holidays

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www.naturallife.com www.marthastewart.com www.marthastewart.com

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www.blog.honest.com www.playbasedlearning.com.au www.moonfrye.com

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www.redtedart.com www.homemadesimple.com

www.buzzfeed.com

www.pinterest.com/mobileprofessor www.craftsncoffee.com http://www.pinterest.com/Patriciuca/

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Using Craft

• Fortune Cookie Craft

– Many ways to adapt craft

– Portable, clean

• Instructions found in bag with

materials

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http://www.dumpaday.com/wp-content/uploads/2014/01/do-it-• Good fortune comes to those who….

• Pay it forward

– Write a piece of advice for good occupational

therapy

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Advocate and Promote Therapeutic Use of Craft in

Your Work Setting:

• Crafts don’t have to be a huge project. Try incorporating creativity into the intervention. Example: Have patient peel off own paraffin wax and create a figurine.

• Petition to your department director for basic supplies.

• Barriers to not using craft activities might include a personal lack of knowledge about craft. Therapists tend to use interventions that their facility endorses or that they are more familiar with. Be open- craft is simply creating.

• Understand your client. What craft activities are meaningful to them? • Use documentation to demonstrate the usefulness and efficacy of

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Butterfly or Moth

http://www.edupic.net/leps4.htm

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American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd_Ed.).

American Journal of Occupational Therapy, March/April 2014, Vol. 68, S1-S48. doi:10.5014/ajot.2014.682006

Bathje, M. (2012). Art in occupational therapy: An introduction to occupation and the artist. The Open Journal of Occupational

Therapy, 1(1).

Christiansen, C. H., & Haertle, K. (2014). A contextual history of occupational therapy. In B. A. B Schell, G. Gillen, & M. E. Scaffa (Eds.). Willard & Spackman’s Occupational Therapy (12th ed., pp. 9-34). Philadelphia: Lippincott Williams & Wilkins. Giustini, D. (2010). Building research capacity among a group of social media adopters in Canada: introducing the Social Media Research Team (SMeRT). Journal of the Canadian Health Libraries Association, 31, 119-121.

Jacobson, J. (2011). Leveling the research field through social media. American Journal of Nursing, 111(10), 14-15. Lomborg, S. (2012). Researching communicative practice: Web archiving in qualitative social media research. Journal of

Technology in Human Services, 30, 219-231.

Wu, J., Sun, H., & Tan, Y. (2013). Social media research: A review. Journal of Systems Science and Systems Engineering, 22(3), 257-282.