1
Q
What paradigms have influenced the practice of OT in the past few decades
A
Medical model
Social model
really an interaction between all components PEO
2
Q
What are the main differences between the medical and social model of health in relation to the environment
A
Social model
- world as disabling
- society is the problem
Medical model
- -> person as disabled
- ->problem within the person
3
Q
OT specific CMOP-E
A
PEO was the initial idea behind COMP here environment surrounds the person physical social cultural institutional
4
Q
PEO Model environment
A
- one piece of the puzzle of occupational health
- cross sectional but the degree can change over time
5
Q
OT specific EHP model : what distinguishes environment in EHP?
A
Environment is part of a larger context, which isn’t static, it can change
- The context gives a person cues and the output is the performance of a task
- All activities occur in a context, there is NO activity analysis without a specific context
- In this framework doing an analysis of activity without qualification of the context would be a problem
6
Q
What aspects of the environment do you think are the most amenable
A
Physical:
- not always the easiest
- societal perception
- funding
Institutional:
- policy change
- can be very slow
- People don’t always want change
Individuals (social):
- advocacy
- raising awareness
- Knowledge
- Attitudes
7
Q
Flow - Csikszentmihalyi
A
-Important concept to positive psychology
-an action or occupation is done for its own sake
-You are totally engaged and unaware of yourself, the ego is gone
-Autotelic personality is a person who performs acts because they are intrinsically rewarding, rather than to achieve external goals ( combination of humility, curiosity and persistence)
-People are the most “existentially satisfied” during flow
LOOK AT GRAPH of mental state
Y axis Challenge level
X Skill level
8
Q
Disable AND implicit
A
- enforcing negative societal views (obvious telling people they can’t)
- focus on impairment
9
Q
The international classification of Disability Functioning Health
A
- the environment in which the person lives is important and needs to be considered in the course of planning and delivering interventions
- This orientation is consistent with models that consider “person” and “environment” as dynamic and interactive dimensions of an individual’s situation
- Contexts in which people live their lives play a central role in the expression of their capacity to function.
10
Q
Environment is a contextual factor that can influence or be influenced by a person’s functioning
A
- Products and technology
- Natural Environment and Humans Made Changes to Environment
- Support and Relationships
- Attitudes
- Services Systems and Policies
11
Q
Universal Design
A
Universal design: products and environment to be usable by all people to the greatest extent possible without the need adaptation or specialized design.
12
Q
Principle 1: Equitable Use
A
The design is useful and marketable to people with diverse abilities
-Guidelines:
same means of use for all users, Identical when possible, equivalent when not
avoid segregation or stigma
-needs to be appealing to all users
13
Q
Principle 2: Flexible in Use
A
The design accommodates a wide variety of individual preferences and abilities
- guidelines: provide choice of methods of use
- right/left handed
- facilitate accuracy and precision
- adaptability to pace
14
Q
Principle 3: Simple and Intuitive Use
A
-use of the design to easy understand, regardless of the user’s knowledge, language, skills, or current concentration level
Guidelines:
-eliminate unnecessary complexity
-be consistent with user expectations and intuition
-accommodate a wide range of literacy and language skills
arrange information consistent with its importance
-provide effective promoting during and after task completion
15
Q
Principle 4: Perceptible Information
A
The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities
Guidelines:
use different modes, (pectoral, tackle) for redundant presentation of essential information
-provide adequate contrast between essential information and its surrounding
maximize legibility of essential information
differentiate elements in ways it can be described
Provide compatibility with a variety of techniques or devices used by people with sensory limitations
16
Q
Principle 5: Tolerance for Error:
A
The design minimizes hazards and the adverse consequence of accidental or unintended actions
Guidelines:
-arranging elements to minimize hazards and errors
-providing warnings of hazards and errors
-providing a fail safe feature built into the design
-and to discourage unconscious action in tasks that require vigilance
17
Q
Principle 6: Low Physical Effort
A
The design can be used efficiently and comfortably and with a minimum of fatigue
Guidelines:
allowing user to maintain a neutral body position
using reasonable operating forces
minimizing repetitive actions
minimizing sustain physical effort
18
Q
Principle 7: Size and Space for approach
A
Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user’s body size, posture, or mobility
Guidelines:
Providing a clear line of sight to important elements for any seated or standing user
make reach to all components comfortable to any seat or standing user
accommodate variation in hand and grip size
providing adequate space for the use assistive devices or personal assistance
19
Q
Universal designs for new homes:
A
housing that can work for everyone. It makes housing accessible to those with disabilities. It also lets people stay in their homes as their circumstances change, without expensive renovations
-a well-designed accessible unit doesn’t look different from a standard unit, it appeals to those who need special features - and those who don’t
20
Q
What is accessible house design: Visitable
A
easy for anyone to visit your home
21
Q
What is accessible house design: Adaptable
A
easy to adapt your home to changing family need
22
Q
What is accessible house design: Accessible
A
Fully wheelchair accessible home
23
Q
Throughout the home: universal design features (7 points)
A
- Allow space for wheelchairs and walkers to move freely
- install lever-style door handles and faucets
- Use non-slip flooring
- Install smooth, low thresholds
- include good, non-glare lighting
- install windows with low sills
- Insulate exposed pipes
24
Q
Entry Universal Design (4 points)
A
- Position the entry near parking
- use ramps and landings, or well-designed steps
- Install a bench or ledge to set things down while opening the door.
- Add a covered sitting porch, canopy or overhang
25
Living room and dining room universal design (3 points)
- Design the space for a range of activities, such as watching television, reading, entertaining, playing table games and dining.
- allow for flexible furniture layouts
- Make the most of natural light and outdoor views
26
Kitchen Universal Design ( 6 points)
- Install removable lower cupboards
- Use adjustable-height counters with rounded corners
- Place cabinets, appliances, switches and outlets within easy reach
- Create adjustable storage and place short-term storage between knee and shoulder heights
- Use color contrast on outlets, cabinets and counters
- install hand-free faucets
27
Bedrooms: Universal Design (3 points)
- Design the space for varied uses, such as crafts, hobbies and reading
- Provide bedside storage
- Place controls for lights, television and telephone within reach of bed
28
Bathrooms: Universal Design (6 points)
Locate the full bathroom on the ground floor
- install an adjustable-height vanity and removable lower cabinets
- use a step-in tub with a seat and a roll-in shower with an adjustable-height shower head
- Install temperature-limiting controls and make them accessible from both inside and outside the tub and shower
- Reinforce walls to support grab bars
- Add closet or cabinets that can be later to expand the room
29
What is an Age-Friendly Community
“…encourages active aging by optimizing opportunities for health, participation and security in order to enhance quality of life as people age”
30
Person-Environment Fit
-Older people strive to maintain independence, self-esteem, well-being and identity by actively or passively adapting to the demands of their environment
31
Competence
The physical, cognitive and sensory abilities that an individual possesses
32
Environmental Press
The characteristics of the physical and social environment, which place demands on an individual
33
Person-Environment Fit Universal Design: (6 points)
- Simple and intuitive use
- Perceptible Information
- Low Physical effort
- Equitable Use
- Tolerance for Error
- Space for approach and use
34
Flexibility in use
The design accommodates a wide range of individual preferences and abilities
35
1. What kind of challenges people may experience in this place
2. who may post a challenge
3. Who can benefit
4. What about other adults
LOOK AT PICTURES AND ANSWER THESE QUESTIONS Built Spaces and Aging slides
curb design
road design
patterns in the road
side resting area, parking, crossing the road, outdoor washrooms like in france
36
How physical and social environments are connected ? \
| Environment vs. Social Press
Environmental presses are tachable- The built environment can be redesigned, people can adapt their routines/behaviours to cope
Social Presses are much less tractable- it is a greater challenge to change or anticipate troublesome attitudes and behaviours from others
37
Cultural Shift in post-industrial society
In "traditional" societies, older adults are respected as source of local knowledge and experiences.
- there is a deeper, moral commitment to elders as sources of social capital and to whom society owes respect and material reciprocity
- Paramount value is placed on the individual- career success, delayed child bearing, "self-actualization"...
38
-In contemporary, "western" culture, aging:
is a debilitating, problem-ridden phase of like that is fraught with medical problems that necessitates specialized care and intervention
39
Could adequate policies affecting older adults result in conditions that decrease the risk of ageist behaviour?
fill in when I know the answer
40
From the Royal Town Planning Institute (RTPI)
| Planning involves twin activities:
- the management of the competing uses for space, and
| - the making of places that are valued and have identity
41
From the Canadian Institute of Planners (CIP)
| Planning means:
- The scientific, aesthetic, and orderly disposition of land, resources, facilities and services with a view to
- securing the physical, economic and social efficiency, health and well-being of urban and rural communities
42
The planning Professions Origins:
| Community
- A local group based on spatial/geographic proximity,
- Shared interests as in political or business community, or characteristics as in an ethnic community,
- Quality of relationships sharing of common goals, values or identities and, associated with these, emotional or moral commitment,
43
Neighbour unit Six essential Characteristics
- Population - 1000 to 5000
- Boundaries - arterial roads,
- Open space - Pedestrian paths linking a connected open space system
- Centre - Public institutions such as a school, church, library
- Shopping districts -located at the periphery
- Compact - maximum 1/4 mile walking distance (402m)
44
Post war Suburban Development
1953 - toronto's mother of all suburbs
-entire neighbourhood blocked into 4 quadrants each with an elementary school, church and small retail plaza,
-Discontinuous and curvilinear road system
-multiple housing types - single and semi-detached homes, three-storey apartments
130 hec set aside for light industry and a commercial mall
45
Suburb to Sprawl Technology change:
Automobile dominated culture
- power instrument of convenience
- Commercial buildings with large setbacks to make space for large parking lots
- Houses reoriented to face the street, dominated by a garage and driveway
- Street layouts and length based on speed of the car
46
Suburb to Sprawl Economic change:
Municipal financing is locally based rather than transferred from a higher level of government
--> creates competition between municipalities to attract new (taxable) development
47
Suburb to Sprawl Mass (housing) production:
Fueled by the post-war population explosion and standardization of building codes,
--> inventive designers turned to more lucrative commercial building market
48
Charter of the 20th century Modernism:
| Goal:
Breaking down social (cultural) divisions and distinctions through the development of "universal" standards of design and aesthetics
-Purity of rational, geometric forms' through mass produced industrial technology
49
Charter of New Urbanism: (5 points)
- Neighbourhoods should be compact, pedestrian-friendly and mixed-use,
- Many activities of daily living should occur within walkable distance,
- Within neighbourhoods, a broad range of housing types and price levels can bring people of diverse ages, races, and incomes into daily interaction
- Transit corridors, when properly planned and coordinated, can help organize metropolitan structure
- Appropriate building densities and land uses should be within walking distance of transit stops
50
Transit Oriented Development (TOD) Definition:
A cluster of housing, retail space and offices within a quarter mile of a transit station
51
Transit Oriented Development (TOD) Characteristics:
- Mix of 2 to 3 storey walk-up apartments
- mixed use "main street"
- Integrated open space,
- Regional shopping mall
- Focused around transit nodes
52
Small Growth
- Strongly predicated on an environmental ethic,
| - Foundation for conservation/cluster subdivision planning
53
Small Growth Principles:
- Preservation-open space, farmland and critical environmental areas,
- Mixed land uses
- Strengthen and direct development towards existing communities
- Provide a variety of transportation choices,
- Create a range of housing opportunities and choices,
- Create walkable neighbourhoods
- Foster distinctive, attractive communities with a strong sense of place.....
54
Community vs neighbourhood
fill in once I know
55
Spaces fill by humans enabling and disabling
fill in once I know
56
Bronfenbrenner's ecological Systems theory
Inner Circle: the individual
Microsystem: school peers, church group , family
Mesosystem
Exosystem: friends of family neighbours, mass media,
Macrosystem: attitudes and ideologies
Chronosystem: patterning of environmental events and transitions over the life source
Time: Sociohistorical conditions and time since life events
57
The ICF and Environment
Natural and Built environment
Products and Technology
Supports and Relationships Attitudes
Services, System and Policies
58
Supports And Relationships
Perceptions that one is cared or and loved, valued and esteemed, and able to count on others should the need arise
59
Attitudes
Demeanors or dispositions or dispositions of individuals, or groups toward a person, an action and or idea
60
Services, Systems and Policies
Structures in the macro-enviornment that are designed to serve people"
61
Implications for practice
Removing barriers from environment
- Changing attitudes within societal environment
- Developing policies within political-economic environment
62
Implications for practice Strategies community
```
Environmental/adaptations
Ergonomics/Universal Design
Awareness generation
Advocacy for equal rights, services
Occupational justice
Accommodations/assistive technology
-Person-level advocacy
```
63
Importance of Social Contact:
| Six F words that should be focus in childhood disabilities
-Function
-Family
-Fitness
-Fun
-Friends
-Future
Providing disabled children with the opportunity to socialise with other children and young people puts many of these "F-Words" into action and improves quality of life
64
Disabled children and young people have the same needs as other children:
- They want to play laugh, pick on each other and get into mischief
- They want to have something interesting to say and friends to say it to
- They want to hide in "magic " places, to be liked and loved, understood by others and included
- They want to be accepted and appreciated by others for what they can do
65
A range of barriers can prevent disabled children and young people from socialising and making friends
These can be classed as:
Access barriers
Communication barriers
-Opportunity barriers
66
Access Barriers
-Children and young people spend 40-50% of their waking hours engaged in out-of-school activities --> physical barriers can make it difficult for disabled children and young person to access the places where these activities take place
ex playgrounds, theatres, libraries, music studios, dance studios, sports fields
67
Communication Barriers
Everyday communication is fast and complex -depends on speech and language combined with gestures and facial expressions
disabled children may not be able to talk or may take more time gesture or have difficulties with changing facial expression
68
Alternative or Augmentative Communication (AAC)
number of integrated components, such as symbols, strategies and techniques to enhance communication
-simple picture communication
or enhance communication programs
specialized speech or picture output
ACC systems also need to be updated and need to be charged
69
Limitations of ACC
much more slowly than our thoughts
- words or symbols might not be exactly right
- could be corrected or finished by and adult (sentence)
- Lack of vocabulary
- asked yes or no questions
70
Barriers - Opportunity Barriers
- lack opportunity to mix with other children and young people
- might find it difficult to fit in
- children might feel more free to express themselves when there is not always an adult around
71
Social Anxiety
- Children feel socially awkward or excluded they are less likely to have a positive experience
- child will decide if it is worth participating based on previous experience
- child who will be laughed at or isolated will not want to put themselves in same situation
72
Solutions to barriers for children with disabilities:
| Assessment tools
MEQAS and SEAS: tools that can be used to assess the qualities of an environment and experiences of children and young people
73
Self-reported Experiences of Activity Settings) (SEAS) tool
- provides a way for children and young people to record their experiences in recreational and leisure activity settings
- rate their engagement, belonging, meaningful interactions, choice and control and personal growth
- Children express the extent to which they got along with others,had good conversations, shared ideas about things important to them, tried something new, became better at something and had fun
74
Solutions --> Enabling Access
-community facilities that are accessible
-offer activities that support building relationships
-activities may need to be adapted
-Assistive tech can help
signs, symbols and words in the public space help disabled to gain access and participate more fully
75
Solutions - Encouraging Communication
-Ensure communication aids are fully operational
-help overcome social anxiety
adapt situation, setting and nature of planned activity if appropriate
-identify child's interests and preferred communication style
76
Solutions-Providing Opportunities
-open up new opportunities and also identity ways to make better use of existing opportunities
-disabled children can benefit from being engaged in a shared activity
allowed to make choices and be in control
-need to feel comfortable in the social environment and physical space respected
77
Key Points from Disabled Children Module (6 points)
- Being able to interact socially with others is vitally important to a child's learning, sense of belonging and their ability to form lasting friendships
- Disabled children can find it difficult to mix with other children and to engaged in social activities
- Many disabled children use AAC aids but they have limitations
- A range of barriers (access, communication, Opportunity) can prevent disabled children from socialising and making friends
- it is possible to overcome these barriers by thinking creatively and making certain adaptations
- The best way to engage disabled children in this process to ask them about their interests and references and listen to their views
78
Institutional Environment Breakdown
Economic
Legal
Political
79
Economic
Directly impacted by populations
80
Aging Population
with an aging population that continues to grow, our healthcare system will be changed forever
81
Legal Environment
- Legislation affecting the Canadian Population
- Practice guidelines
- Impact of legislation of our clients
- Impact upon occupational performance and OT practice
82
Federal and Provincial legislation have impact on your practice context. Funding can change and impact caseloads and available services:
```
Hospital-Acute Care and Rehab
Home and Community CAre
Mental Health
School Health
LTC
Corrections
Insurance
```
83
The Home Model Modification Process
```
Receive a referral
arrange home visit
Prepare Travel to meet the client
-Interview client on their needs
-Complete a home safety assessment
-Measure/consider home setup
Prioritize goals/innervations
-Report writing/send referrals/contact vendors or contractors
-Follow up -educate on use of modification
```
84
Types of Modifications
Home Safety Equipment
- Raised toilet seats/ Toilets seat elevators, Commondes, Bath seats/Tub transfer benches, Bed assist bars, floor ceiling poles.)
- These are typically non-permanent equipment that can be easily put in pace from client use
Home Modifications
- Basic modification (eg. Grab bars, changing door handles, removing doors from hinges for extra clearance
- Major Home modifications (ramp, walk in showers, stair glides, porch lifts, ceiling lifts, kitchen modifications
85
Assessment Measures
Person
-Consider the person's height width, weight and reach
Equipment
-Wheelchair or walker, turning radius, width, clearance
Environment
-Toilet height, door widths, tub clearance, bed height couch height
86
Measuring Tips
Door widths consider the most narrow point
-Measuring ceiling heights if the ceiling/floor is even when selecting the best place to measure
easiest against the wall but may not be ideal if the ceiling is uneven or it changes
87
Kitchen and living room modifications
- Layout-everything within reaching distance
- Move furniture so there is clear maneuvering space
- Remove rugs
88
Threshold ramp
Threshold ramp can be either rubber or metal and are made to butt up against the lip of a door threshold or a curb
they are typically 6 inches in height or less, very lightweight, and can be used on both the insider and outside of a doorway
-These ramps are simple, cost-effective solutions for people using a wheelchair, waler or scooter to maintain small barrier
89
Portable Ramps
- most versatile of all wheel chair ramps, come in several designs and many sizes
- Portable ramps offer many advantages over permanent ramps, not the least of which is lower cost. Portable wheelchair ramps are great for people who are out in the community on a regular basis as they can be used as needed with little exertion by a care giver or attendant. That said, a person who is confined to a wheelchair will find it difficult, if not impossible to carry and set up a portable ramp
90
Folding Ramp
Folding Ramp consist of either bi-fold (two panels) or tri-Fold (four panels). The bi fold ramps fold over once while the tri-fold ramps has three folds. The folding ramp should only be used for personal use. It can be used for access into wheelchair-accessible vans, or it can be placed over a small set of stairs that lead into a home
91
Modular ramps
- A modular ramp is typically a larger, more permanent fixture but it doesnt require a building permit becuase it can be disaassembled and reassembled at another location
- They are constructed out of ramp sections that are built off-site for speedy assembly. Aluminum is typically the best material to use for outdoor, commercial wheelchair ramp applications because it does not rust or warp and it is the most cost effective option
92
Permanent Ramp
Made from wood or concrete and cannot be moved or adjusted once they are set in pace so a building permit is required. Unlike modular ramps they are built completely on-site, so the installation and construction time is much longer. These types of ramps are typically used for aesthetics are more important than longevity and code compliance.
93
Environmental Control Units (ECUs)
devices that allow people to operate electronic devices, including televisions, computers, lights, appliances, and more.
There are many commercially available ECU devices, however they typically fall into two broad categories - stand-alone and computer-based
94
Stand-alone ECUs
contain their own electronics and do not utilize a computer to function. Many of these units can be activated by a switch, which acts as the interface between the user and the unit.
95
Computer-based ECU
consists of a software program and the necessary peripherals that allow a computer to function as an ECU
96
AC Powered
this type of system uses the electrical wiring already in your home. Each item to be controled (lamp, radio, etc) is plugged into a control box via the existing wiring system. A different contorl box is needed for each application. These systems are inexpensive and easy to instal
97
Infrared
These ECU devices send an infrared signal to the control unit, which in turn sends another infrared signal to the appliance. This type of ECU is seen in most of our TV and VCR remote controls. In order for the device to work, the remote must be aimed directly at the control bow with nothing blocking its path
98
Radio Control
With this type of device, the remote sends radio waves to the control unit which sends the messages to the appliance. This is the same technology that powers garage door openers. The remote and control box can be in different rooms and still work, but the system have a range limit of 50-200mm feet. Interference from another nearby control unit is also possible 1
99
Ultrasound
This type of ECU uses high frequency sound waves as the input and output signal. The sound wave will bounce around the room until it reaches the control box and delivers its message. The control box then sends a command signal to the application being controlled. The input device and the control box must be in the same room to work
100
Application ECU
Voice or touch control
Heating (thermostat), lighting, external sensors, (e.g nest guard, detect, doorbell, smart cameras)
-Entertainment/leisure
-Computers
-Security - smart locks
Communication
Access to external world - news events elerts
101
Devices
iphones, android, iPad
smart fridge, smart speakers, mesh wifi routers
Google nest hub, smart plugs, smart garage openers
-Robot lawn mower
102
Challenges. ECU
Cognitive demands, physical access if touch, privacy, security, activation by voice (voice recognition is not alway perfect)
103
OT Role. EUCs
Knowledge of purpose/functional application; set-up for acess and operation; exploring funding options; ssupport for functional use/application or participation; collaboration with technicians engineers or other professionals as necessary
104
Historical Perspective
occupation is necessary to life as food and drink
Even human being should have both physical and mental occupations
-All should have occupations which they enjoy, or hobbies
Sick minds, sick bodies and sick souls may be healed through occupation
-The therapist should help their patient to participate more effectively in our society
105
occupation as a key concept
Occupation is everything people do to occupy themselves, including looking after themselves (self-care), Enjoying life (leisure) and contributing to the social and economic fabric of their communities (productivity)
106
World Federation of Occupational Therapy
| Primary goal of occupational therapy:
enable people to participate successfully in the activities of everyday life through:
-enabling people to do things that will enhance their ability to live meaningful lives
Enabling engagement:
107
Enabling engagement:
- modifying the environment to better support participation
| - Enabling a just and inclusive society so that all people may participate to their potential
108
Essential role of what we do everyday- with whom, where, how and why
Doing: meaningful engagement
Belonging: relationships with the external world
Becoming: a sense of future
Being: here and now
109
Community and Occupation
occupation and affordance
urban vs rural and also location and place specific
Examples: access to transportation; access to recreation and leisure opportunities
110
Recreation and play
how does environemnt /your community/neighbourhood det3ermined your play oppertunities
111
Community OT
Person focused AND/OR community focused
- Three spheres of direct nfocues services
- Individual
- Interpersonal
- Community - capacity building
112
Summary
entry to the space, place – to allow the physical presence:
Physical space accessible for all potential users: those who work there, visit, etc. – as relevant; universal design. Examples: transportation, doors, railings, elevators, signs, brail, light, fees to enter? (financial), etc..
Characteristics of space, place that support health and engagement in what is going on (activities, programs in that space, place):
Consider physical, sensory, institutional, cultural aspects of the place
Examples: place for restoration (plan walls, waterfall, etc.), spirituality, physical exercise (accessible gym equipment), light, benches, etc•Technology and strategies supporting participation face to face; remote and virtual options
Participatory design – involving ALL end users of the space, place (people with disability, parents, children
113
OT role community
Think both functionally AND developmentally
Advise, consult, collaborate with other key professionals: engineers, technology experts, IT, city planners, politicians, etc.
Advocate for change to make communities more welcoming for all and inclusive
Work for the city planning office
Work for the municipality – to bring broad expertise as to accessibility & inclusion
114
International Classification of Functioning, Disability and health ICF framework
Activity
(environmental factors and personal factors)
-Body functions and structures
-Participation
Health condition or disease
115
Perspectives on Partcipation
Sociocultural theories : Participation as a requirement for human development
Health promotion: Creating healthy environments
Critical disabilities approach
Social Justice and human rights approach
116
How to understand partcipation
- Attribute of health (ICF)
- Goal of rehabilitation and outcome
- Process of engagement in activity
- Experience - meaningfu partcipation
117
Meaningful Participation Experiences
-Sense of control and autonomy
-Psychological engagement
-Sense of belonging
-Sense of accomplishment and learning
-Identity exploration
Postive emotions
118
Measuring Participation
Children's assessment of Partcipation and enjoyment (CAPE)
-Participation and environment measure for children and youth
-Environments and experiences (SEAS and MEQAS)
SEAS: youth self-reported experiences of activity settings
MEQAS: observer rated measure of environmental qualities of activity settings
119
Understanding Environmental Influences
Differences in the quality of children environments produce important variations in life experiences - in turn these influence children's physical and mental health, well-being and competence
120
Influences of the environment, Family and child
Environment:
physical accessibility, perceptions of environments as welcoming or not, support from friends, classmates
Family:
-Family cohesion, preferences for activities, supportive relationships for child
Child
-Functional ability (i.e. cognitive, communicative, and physical functioning), preferences for activities
121
Activity settings as context of participation
places and spaces where we do things
-Conceptual unit of analysis the combines location and activity, allowing to link participation opportunities with particular experiences
122
Kid in wheelchair diagram
```
People
Activity
Place
Objects
Time
```
123
What matters for children and youth
-Need to understand what is important for children and youth in order to help the reach their goals
- Having choice
- Playing with peers
- Belonging and self-efficacy
- Supportive relationships, friendships
124
Long term-developmental Benefits
Competency related benefits
- Skill development
- Physical benefits
- academic benefits
Psychological and emotional benefits
- self-efficacy and self-confidence
- Self-worth
- Sense of identity/self-concept
Social benefits
- Relationships
- Civic
125
Spectrum of services
Individual
- assistive technology helping a child to access a library computer
- facilitating interaction with peers
Community:
providing activity settings that offer certain opportunities
-building partnerships with community agencies to offer and support inclusive program
126
Transdisipinary Collaboration
-only multiple professional working together cna respond to complexity recognized by ICF and beyond
-Parents and children are active members of the transdisciplinary team; child is included in decision making as appropriate
-Flexible services delivery models
-Collaboration is essential
to build child, family and community capacity
127
family, child therapy
- Functional relationships focused interventions
- Think about needs for belongings, cometency, autonomy, Choice and fun/entertainment
- Think about long term developmental benefits
128
Students at the center of Design
Pyramid
self-actualization: achieving one's full potential, including creative activities
Esteem needs; prestige and feeling of accomplishment
Belonging and love Needs: intimate relationship friends
Safety needs: security and safety
Physiological needs:
food water, warmth, rest
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Majority of children referred to school-based OT:
Fine motor challenges (e.g. printing/handwriting)
Gross motor challenges (e.g. ADL tasks)
-Sensory challenges (e.g. problematic behaviors
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Physical, Sensory, and Sociocultual Settings
Physical
- influence engagement in self-care, academics, and social roles
- Barriers to physical activity contribute to reduced well-being and role performance
Sensory
Sensory input from environment provides children with important cures about what is expected
-sensory perception challenges, sensory modulation challenges
Sociocultural
- Development of sociocultural roles, skills and understand norms
- Regulations of behaviour based on school rules and norms set out by the environment
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Phsyical Supports
- Preferential seating in a classroom
- Lists and schedules that make expectations explicit
- Imposing structure and routine to support transitions from one task to another and increase independence
- Areas available outside of work area for break, expression, play
- Areas available that offer alternative work positions (eg, flexible seating options
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Visual Acuity
Ability to see detail
Notation:
6/6, 6/60; viewing distance (m)/letter size (M-units)
CF (counting fingers), LP (light perception) or NLP (No light perception)
OD = right eye; OS = left eye; OU = both eyes together▫c: with glasses; c without glass
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Contrast Sensitivity
trast: light-dark transition of a border that delineates the existence of a pattern/object•Contrast sensitivity: how much contrast a person requires to perceive a pattern or object
Increasing contrast supports clients with poor contrast sensitivity
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Light and glare
Individuals with ocular disease often need more time adapting to changing light conditions
Glare refers scattered or stray light that diminishes our perception of contras
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Other components of visual function
Oculomotor function
| Visual perception
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Vision Loss
Vision Loss is an inclusive term that covers all people who are blind or partially sighted. •
Vision loss can occur at any stage in a person’s life.
▫Congenital blindness or visual impairment
▫Age-related ocular conditions
▫Vision loss related to a disease or medical condition
▫Vision loss due to an accident or trauma
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Legal Blindness
visual acuity <6/20 (20/200) with correction
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Total blindness vs legal blindness
Less than 10% of clients known to us are totally blind
| Legally blind does not mean total blindness
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Low Vision
Low vision is vision that cannot be corrected by medication, surgery, or conventional eye glasses
- Individual has some residual vision
- Defined differently depending on the source
- ->e.g., for billing of low vision assessments by ophthalmologists, OHIP defines low vision as visual acuity ≤ 20/50 or visual field ≤ 20
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(functional) low function
oadly, low vision is “Any reduction in visual function that is not correctable with standard prescription glasses or contact lenses, medications or surgical treatment NOT limited to a reduction in visual acuity”
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Functional low function includes `
Loss of visual acuity•Loss of peripheral vision/visual field•Loss of contrast sensitivity (inability to discern faded print/details)•Altered colour perception•Difficulty in adapting to different light levels
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Functional vision loss
ion loss can make reading a challenge, while others may have extreme light sensitivity or issues with depth perception. •Approximately half a million Canadians are estimated to be living with significant vision loss that impacts their quality of life
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Types of vision loss
```
Age-related Macular Degeneration
Retinitis pigmentosa
-Glaucoma
-Diabetic Retinopathy
-Acquired brain Injury
Location and extent of damage may impact
-Field loss
-Perception
Processing
-Oculomotor control
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Refractive errors
myopia -short sighted
hyperopia -far sighted
astigmatism
-Presbyopia
potential for correction in most cases
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General Principles and Strategies
| interventions for low vision
- Size
- Contrast
- Colour
- Lighting
- Organization
- Substitution
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Other considerations for intervention
- ensure training and intervention is based on client identified goals and safety concerns
- Assess level of adjustment to vision loss (which will impact readiness for different types of vision rehabilitation
- Collaborate with other teams to ensure continuity of care
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The role of occupational therapy in Driving
- Occupational therapists assess the individual's strengths and abilities related to the skill of driving. We then consider the context in which the individual is required to perform the occupation of driving. From the assessment findings the occupational therapist may recommend:
- interventions and training to help facilitate access to the vechile, driving or delay driving cessation
- Further assessment to clarify level of risk and ability to drive or to continue driving
- Driving cessation
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Tier 1 - Generalist
Tier 1 occupational therapist is able to explore the client's goals related to driving: helping to determine if it is a valued occupation
-Tier 1 occupational therapist have the ability to provide information on driving with specific medical conditions and healthy aging and driving
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Generalist
- Tier 1 occupational therapist often has the knowledge and skils to identify clients who may have difficulty learning to drive or who may be at risk to continue or resume driving
- In conjunction with their knowledge of client performance in complex IADLs, their screening may warrant a recommendation of driving cessation or that a novice is not yet ready to learn to drive. In the latter case, intervention may be offered to remediate challenge areas.
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Tier 2 - Advancement
- The occupational therapist at this level has expertise in assessing physical, cognitive, visual-perceptual, and behavioural skills specifically related to safe driving
- At the tier 2a level, occupational therapists administer clinical evaluations using both standardized and non-standardized assessment
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Advanced
At the tier 2b level, occupational therapists incorporate an on-road evaluation when deemed appropriate. The on-road component is available when feasible from an operational program perspective and when the therapists have the appropriate knowledge, skills and abilities to perform comprehensive driving evaluations
-This assessment consists of clinical and on-road evaluation (cognitive road test) and may include provision of basic adaptive equipment (cognitive road test) and may include provision for basic adaptive equipment (eg. spinner knob, signal extender, adapted mirrors)
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Tier 3 - Advanced Specialist
- At this level, the occupational therapist completes a complex CDE and has highly specialized expertise in clinical assessment, training and or/retraining of driving skills, vehicle modifications and use of assistive technology for driving
- Tier 3 occupational therapists complete assessments with clients with visual impairments (eg. Hemianosia) in which the client does not meet the minimum visual standard for driving but demonstrates potential to drive
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Advanced Specialist
- The client physician/ophthalmologist may refer the client for Tier 3 evaluation and are usually required to submit documentation to driver fitness and monitoring supporting the client's potential to drive
- Other indications for complex assessment at Tier 3 level includes clients who demonstrate impairments across multiple domains (visual and physical and cognitive/perceptual) and clients who require specialized technology, such as electronic gas/brake
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Assessments for driving
- requires advanced skills in perception, analysis, and decision making on a continual basis, often without conscious effort
- Screening and assessments of skills related to driving is multifactorial with evaluation of psychomotor; cognitive and visuo-perceptual components providing information on impairments that may impact an individual's ability to drive
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Occupational Therapy Intervention for driving
-Education of client and or family (generalist)
-Domain specific training (g and A)
-Access/transfer equipment (G and A)
Adaptive equipment (A and Advanced specialist
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Access Equipment
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Swivel seats
Transfer board
Ramps
Lifts
Accelerator
Combined Brake and Accelerators
Break level
Long arm Break level
Spinner knob and handles
-Left foot accelerator
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Legislation
| Occupational therapy Act
contains a scope of practice statement, as well as provisions and regulations specific to the occupational therapy profession. It includes entry-to-practice and title protection regulation
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Federal legislation
| Canadian Health Act
Canada’s federal health insurance legislation and defines the national principles that govern the Canadian health insurance system, namely, public administration, comprehensiveness, universality, portability and accessibility
on an annual basis, the federal Minister of Health is required to report to Parliament on the administration and operation of the Canada Health Act, as set out in section 23 of the Act
Minister is responsible to identify any areas of non-compliance with the Act
-prominent concerns with respect to compliance under the Canada Health Act remained patient charges and queue jumping for medically necessary health services at private clinics
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Funding
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ADP
Ontario March of Dimes
Direct funding
Special services at home
ODSP
-Icome support
-Employment support
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Trillium Drug plan
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Elements of a funding Letter
Elements of the letter:
◦Be specific on the request, how funding will impact the individual(s) and indicate the timeframe(s) of the need
Link the request to the service(s) provided by the funder
Include any relevant assessment information (without getting into too much ‘jargon’)
Include any information required by the funder (e.g. quotes, tax information, script from MD)
Include relevant pricing information
OT 886 - Environmental Determinants
flashcards
Decks in class (1)
# Cards
