An Occupation-Based Approachin Postacute Care
to Support Productive Aging
Lesson 2
Occupational Therapy Practice Models
Used in Postacute Care
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Which Way Do I Go?
Models of Practice
Intervention
Outcomes
Occupation
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Why Use Practice Models?
A direction for therapy
A rationale for interventions
A foundation for articulating the process.
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Models Used in Postacute Care
Occupation-based models
Cognitive disability model
Biomechanical model
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Occupation-Based Models
Model of Human Occupation (MOHO)
Person–Environment–Occupation–Performance (PEOP) Model
Occupational Adaptation (OA) Model
Ecology of Human Performance (EHP) Model
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(Kielhofner, 2008)
(Christiansen & Baum, 2005)
(Schkade & Schultz, 1992a)
(Dunn, Brown, & McGuigan, 1994)
Model Similarities
Developed by occupational therapists
Includes the person, the environment or context, and occupation
Client-centered (Cole & Tufano, 2008)
Addresses the transactional relationship between the person, the environment or context, and occupation, resulting in occupational performance (Rogers & Holm, 2009).
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Focusing on Occupational Performance
PersonPhysical skillsCognitive skillsSocial skills
EnvironmentWhereWhenWith whom
OccupationCharacteristicsSequenceTools of task
Occupational Performance
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MOHO
Volition: Motivation for and choices of occupations
Habituation: Organization of occupations into patterns and routines
Performance capacity: Mental and physical capabilities
Environment: Physical and social features
(Kielhofner, 2008)
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MOHO (cont.)
Assessments:
The Volitional Questionnaire (de las Heras, Geist, Kielhofner, & Li,
2003)
Assessment of Communication and Interaction Skills (Forsyth, Salamy, Simon, & Kielhofner, 1998)
Work Environment Impact Scale (Moore-Corner, Kielhofner, &
Olson, 1998)
Occupational Performance History Interview (Kielhofner,
Mallinson, Crawford, Nowak, Rigby, Henry, & Walens, 2004)
Occupational Self-Assessment (Baron, Kielhofner, Iyenger,
Goldhammer, & Wolenski, 2006).
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PEOP
Person: Physical, mental, cognitive, and psychosocial factors
Environment: Influences of physical, social, and cultural contexts
Occupation: Daily life activities
Performance: Actual “doing” of occupation.
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(Christiansen & Baum, 2005)
PEOP (cont.)
Assessments:
Canadian Occupational Performance Measure(Law, Baptiste, Carswell, McColl, Polatajko, & Pollock, 2005)
Activity Card Sort (Baum & Edwards, 2008)
Interest Checklist (Matsutsuyu, 1969)
Role Checklist (Oakley, Kielhofner, Barris, & Richler, 1986)
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(Schkade & Schultz, 1992a)
OA
Person: Physical, cognitive, and psychosocial systems and the desire for occupational mastery
Occupational environment: Demand for mastery
Interaction: Creates a press for mastery
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OA (cont.)
Assessment:
What are the patient’s occupational environments and roles?
Which role is of primary concern to the patient and family?
What is the patient’s sensorimotor, cognitive, and psychosocial status?
What is facilitating or limiting relative mastery in the primary occupational environment and role?
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(Dunn, Brown, & McGuigan, 1994)
EHP
Person: Physical, psychosocial, and cognitive skills and abilities
Task: Occupations
Context: Surroundings
Person–context–task interaction: Performance
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(Dunn, Brown, & Youngstrom, 2003)
EHP (cont.)
Assessments:
Temporal Environment Checklist
Physical Environment Checklist
Cultural Environment Checklist
Social Environment Checklist
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Review of Occupation-Based Models
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More Model Similarities
Occupational performance is the primary outcome.
Each is a client-centered process.
Each promotes a top-down approach to evaluation and intervention.
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Models Used in Postacute Care
Occupation-Based Models
Cognitive Disability Model
Biomechanical Model
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Cognitive Disability Model
This model is based on a performance approach and focuses on
Maximizing residual performance capabilities and
Modifying the occupation and environment to match performance capacity.
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Cognitive Disability Model (cont.)
A performance approach supports an occupation-based approach.
Use is restricted to clients with cognitive impairments.
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Review of Models Used inPostacute Care
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Biomechanical Model
Targets remediation of physical impairment
Focuses on client factors
Takes a bottom-up approach.
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Biomechanical Model (cont.)
Should not be used to the exclusion of occupation-based models
Does not reflect a focus on occupational performance
May be considered service duplication
Has interventions that are considered preparatory methods.
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Complete Review of Models Used in Postacute Care
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Clinical Reasoning
Practice
Models
Clinical Reasoning
Occupational Therapy Process
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Clinical Reasoning:Biomechanical Model
Focused on scientific, diagnostic, and procedural clinical reasoning
Primarily based on impersonal information related to science-based information (diagnosis, research evidence, clinical protocols).
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Clinical Reasoning: Occupation-Based Models
Use narrative, interactive, and conditional clinical reasoning
Incorporate personal information (client narrative; likes and dislikes; and past, present, and future performance concerns).
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Your Clinical Practice
Consider two key questions:
What occupation-based model(s) do I use in my current clinical practice?
How does my clinical practice reflect the use of an occupation-based model?
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Models of Practice
Practice that is grounded in theory differentiates professional practice from technical disciplines (Ikiugu et al.,
2009).
Models of practice provide Structure, organization, and direction to the
occupational therapy process; A mechanism for evaluating and integrating research
evidence into practice (Reed, 1984); and “Explanatory power” (Ikiugu et al., 2009, p. 163).
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Your Occupation-Based Toolbox
Occupation-based approach
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