Therapeutic Reason (Week 11) Flashcards
Intervention Process
Consists of the skilled services provided by
occupational therapy practitioners in collaboration with clients facilitate
engagement in occupations related to health, well-being, and participation.
Bottom-up or top-down approach
Bottom-up approach: Involves community members in dealing with issues that affect people in closer proximity.
Top-down approach: Interventions will be most effective when coordinated and implemented through centralized agencies or individuals.
TUS
Describe a therapist’s planned use of their own personality, insights, perceptions, and judgments as part of the therapeutic process.
Therapeutic Reasoning
Reflect on providing the “rationale” for your choices and/or the reflective process that takes place after service has been delivered
Process
Involves thinking and feeling
Decisions about evaluation and intervention
Based on evidence-based practice
Foundation skill
Elements of Therapeutic Reasoning
-Scientific
-Ethical
-Artistic
Thought Process
- Formation of pre-assessment image
- Cue acquisition
- Hypothesis generation
- Cue interpretation
- Hypothesis evaluation
Therapeutic Reasoning Strategies
Procedural, Interactive, Conditional, Narrative, Pragmatic
Procedural
Reviewing conditions to see what will work best for that condition.
Interactive
Understanding the person by gathering data from their point of view, their goals, and the environment -TUS
Conditional
Considering the condition of the person, and the environment, applying the results to implement change when the client requires it.
Narrative
Storytelling/story creation (using other client’s stories to help them reframe their own story.
Pragmatic
Considering outside factors that may impact the therapy process such as reimbursement, space, and equipment, plus the therapist’s own skills and expertise.
Development of Therapeutic Reasoning Skills
- Novice
- Advanced Beginner
- Competent
- Proficinet
- Expert
Techniques to Improve Therapeutic Reasoning
- Chunking
- Supervision
- Coaching
- Role Modeling
- Self-Awareness
- Observation
- Setting Personal Goals
Theory
A set of ideas to explain things or the analysis of a set of facts in relation to each
other.
-Enough evidence to support a hypothesis
-Observation and research lead to the hypothesis
-Concepts, and principles, provide a basis for practice
Models of Practice
Philosophical base
Organize one’s thoughts
Occupation
Describe practice
Overall view of profession
Model of Human Occupations (MOHO)
Garyu Kelihofner and colleagues
Volition: motivation, interests, values, and belief in their skills
Habituation: habits/daily patterns of behaviors, roles and routines
Performance: capacity for doing: motor, cognition, and emotional aspects required
of the task
Environment: Context and environment aspects
Canadian Model of Occupational Performance (CMOP)
Canadian OTs
Lots of research to support
Spirituality as core: motivation or inspiration
Client-centered
Person, environment, occupations
Semi-structured interview (COPM)
PEO FOR comes from this model
Person-Environment - Occupation - Performance (PEOP)
Charles Christiansen and Carolyn Baum
Person—physical, social, psychological
Environment—supports
Occupation—everyday things people do
Outcome
Performance
Occupational Adaption (OA)
Schkade and Schultz
Change person, environment, or task for success
This model supports adaptation and compensatory techniques
Frame of Reference
Is a guideline for practice that provides direction for the evalution and treatment of particular deficits in the OT domain of concern.
-Tool to guide one’s intervention
-Has research to support evaluation and intervention
-Guide one’s practice is an essential part of evidence-based practice.
Identifies a population or condition (Frame of Reference)
Age, condition, or type of deficit
Continuum of function/dysfunction (Frame of Reference)
What they can or cannot do
Theory regarding change (Frame of Reference)
How the brain may change or how muscles may work
Principles of intervention (Frame of Reference)
We know there are certain developmental milestones that most children go through in order to develop normally
Role of the practitioner (Frame of Reference)
What to do, what not to do, how to respond, facilitation, inhibition
Evaluation instruments (Frame of Reference)
What tools to use to assess the client
Deciding on a FOR
Population, definition of function/dysfunction, setting, evidence supporting FOR, match client to FOR
Physical/motor control/motor learning function
- Biomechanical
- Neurodevelopmental Treatment (NDT)
- Motor Control
Pediatric - Focused
- Developmental
- Sensory Integration
