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Slagle
Lecture
Uni2ng
Prac2ce
and
Theory
in
an
Occupa2onal
Framework
Summary
Jiayong
(Vanessa)
Li
Main
Purpose
The
main
purposes
of
this
1998
lecture
is
to
conceptualize
the
unique
contribu2on
of
occupa2onal
therapy
within
the
health
care
arena
and
to
ar2culate
the
important
role
of
occupa2on
as
a
therapeu2c
agent.
According
to
the
author,
the
roots
of
this
lecture
dates
back
from
the
period
when
she
was
in
school
pursuing
her
occupa2onal
therapy
degree.
During
those
2me
and
during
her
early
prac2ce,
she
feels
a
heavy
focus
on
exercise
and
the
neurophysiologic
approaches
dilu2ng
the
uniqueness
of
occupa2onal
therapy
and
blurring
the
line
between
occupa2onal
therapy
and
other
health
care
service,
for
example,
physical
therapy.
The
author,
using
this
lecture,
advocates
the
philosophical
shiN
to
its
historical
meaning:
trea2ng
pa2ents
holis2cally
by
using
a
top-down
approach
to
improve
pa2ents
occupa2onal
performance.
Important
Concepts
There
are
two
concepts
we
need
to
understand
in
this
lecture.
The
rst
one
is
mechanis2c
paradigm.
This
term
is
coined
by
Kielhofne
(Kielhofne,
1997)
to
describe
the
occupa2onal
therapy
prac22oners
using
scien2c
and
medical
theory
to
treat
the
clients
underlying
impairment.
Although
such
method
shows
some
of
its
eec2ve-
ness,
the
author
sees
mechanis2c
paradigm
as
reduc2onis2c,
diver2ng
the
profession
from
its
original
philosophical
base:
trea2ng
pa2ent
holis2cally.
Moreover,
the
author
sees
mech-
anis2c
paradigm
blurs
the
line
that
separate
occupa2onal
therapy
from
other
profession,
threatening
the
uniqueness
of
occupa2onal
therapy.
The
author
comes
to
realize
mechanis2c
paradigm
is
denitely
not
the
answer
of
eec-
2ve
occupa2onal
therapy.
Later,
the
author
started
to
specialize
in
sensory
integra2on,
and
she
also
get
to
know
and
get
immersed
in
Kielhofners
Model
of
Human
Occupa2on,
and
MOHO
is
the
second
concept
we
have
to
know
in
this
lecture.
reason,
or
goal,
also
organizing
performance.
According
to
the
author,
meaning
and
pur-
pose,
when
considered
in
rela2on
to
occupa2on,
are
inextricably
interrelated.
Purposeful-
ness
is
important,
but
it
is
not
enough.
Occupa2on
is
both
purposeful
and
meaningful.
If
we
can
pick
the
meaningful
occupa2on
for
our
client,
we
can
use
occupa2on
to
increase
mo2-
va2on
and
a
sense
of
purpose.
Addi2onally,
as
occupa2onal
therapy
prac22oners,
we
can-
not
confuse
our
purposes
or
meaning
with
those
of
our
client.
How
to
successfully
choosing
the
right
occupa2on
is
the
one
of
the
two
keys
to
unveil
the
richer
view
of
occupa2onal
therapy;
another
key
is
how
can
occupa2onal
therapy
prac2-
2oner
make
the
philosophical
founda2ons
of
our
profession
a
reality
of
everyday
prac2ce.
The
author
believes
we
do
that
by
uni2ng
prac2ce
and
theory
in
an
occupa2onal
framework.
Important
Informa5on
Two
models
are
introduced
in
this
lecture
in
order
to
answer
two
key
ques2on
men-
2oned
in
the
previous
part.
In
order
to
answer
the
ques2on
how
to
choosing
the
right
occupa2on
for
clients,
the
au-
thor
introduces
Four
Con2nua
of
Ac2vi2es.
This
four
con2nua
can
be
used
to
evaluate
the
characteris2cs
of
any
ac2vity
we
might
use
as
interven2on.
The
rst
group
of
ac2vi2es
is
exercise,
the
most
salient
features
of
this
group
of
ac2vi2es
is
clients
is
engaged
in
rote
exercise
or
prac2ce.
This
kind
of
ac2ves
usually
lacks
a
purpose,
even
when
it
does,
the
purpose
more
oNen
than
not,
originated
from
the
prac22oners
more
than
from
the
clients.
Addi2onally,
the
ac2vi2es
have
liale
or
no
meaning
to
the
clients
and
the
focus
on
of
the
exercise
on
the
remedia2on
of
impairments.
Examples
of
such
ac2vi2es
are
liNing
weights
to
develop
strength,
or
stack
cones
to
develop
reach.
The
second
group
of
ac2vi2es
is
contrived
occupa2on,
such
occupa2on
is
designed
with
added
purpose
and
with
a
contrived
component.
However,
such
purpose
most
likely
originated
from
the
prac22oners
not
the
clients,
hence
the
meaning
of
such
ac2vi2es
remains
minimals.
This
kind
of
ac2vi2es
aims
to
remediate
the
underlying
impairments
more
than
to
improve
occupa2onal
performance.
The
third
group
of
ac2vi2es
is
therapeu2c
occupa2on.
A
cri2cal
characteris2c
of
this
kind
of
occupa2on
is
that
the
client
ac2vely
par2cipate
in
occupa2on.
This
kind
of
ac2vi2es
are
considered
purposeful
and
meaningful
by
the
clients.
Also
to
the
greatest
extent
possible,
the
environment
of
the
ac2vity
is
naturalis2c
and
contextual,
the
client
while
doing
the
ac-
2vity
is
using
real
objects
in
the
natural
environments.
Example
of
such
ac2vi2es
are
using
graded
occupa2on
to
treat
balance
or
reach
using
clients
hobbit.
Another
example
of
ther-
apeu2c
occupa2on
is
direct
interven2on
of
impairments,
for
example,
in
order
to
improve
the
clients
social
skill,
the
prac22oner
ask
the
client
to
do
her
favor
ac2vity
for
other
peo-
ple.
The
nal
group
of
ac2vi2es
is
adap2ve
or
compensatory
occupa2on.
This
group
of
ac2vi-
2es
share
the
essen2al
characteris2c
with
the
therapeu2c
occupa2on:
the
client
ac2vely
par2cipate
in
the
occupa2on
the
client
chosen
for
themselves.
Also
like
the
therapeu2c
oc-
cupa2on,
adap2ve
or
compensatory
occupa2on
are
meaningful
and
purposeful
ac2vi2es
to
the
client,
and
ac2vi2es
happen
in
the
natural
and
contextual
environment.
The
dis2nc2on
between
therapeu2c
occupa2on
and
adap2ve
or
compensatory
occupa2on
is
that
the
for-
mer
may
aims
to
remediate
the
underlying
impairment,
the
laaer
makes
no
aaempt
to
re-
mediate
the
underlying
impairment,
only
focus
on
improving
occupa2onal
performance.
Providing
assis2ve
devices,
teaching
alterna2ve
or
compensatory
strategies
or
modify
physi-
cal
or
social
environments
are
some
of
the
methods
used
while
prac22oner
using
adap2ve
or
compensatory
occupa2on
to
improve
clients
occupa2on
performance.
ANer
clarifying
dierent
group
of
ac2vi2es,
the
author
asks
the
ques2on,
what
is
the
le-
gi2mate
ac2vi2es
for
occupa2onal
therapy.
The
author
acknowledges
that
the
necessity
of
appropriate
use
of
the
rst
and
second
group
of
ac2vi2es,
however,
she
strong
believes
that
if
occupa2onal
therapy
prac22oner
truly
want
to
2e
their
prac2ce
to
our
philosophical
base,
prac22oners
must
put
clear
emphasis
on
therapeu2c
occupa2on
and
adap2ve
occupa2on.
She
also
ques2ons
overusing
the
rst
and
second
group
ac2vi2es
by
a
lot
of
prac22oners,
she
ques2ons
the
validity
of
the
jus2ca2on
from
this
prac22oners
that
such
excess
use
of
the
rst
and
the
second
group
ac2vi2es
will
ul2mately
lead
to
improved
occupa2onal
per-
formance.
ANer
answering
the
rst
ques2on
about
choosing
the
right
occupa2on
for
the
clients.
The
author
proposes
another
model,
Occupa2onal
Therapy
Interven2on
Process
Model
to
answer
the
second
ques2on:
how
do
we
2e
our
daily
prac2ce
to
our
philosophical
base.
Ac-
cording
to
the
author
such
uni2ng
is
crucial
for
us
as
occupa2onal
therapy
prac22oners
to
remain
a
viable
profession
and
avoid
the
risk
of
being
viewed
as
redundant.
Occupa2onal
Therapy
Interven2on
Process
Model
stresses
the
use
of
a
top-down
ap-
proach
to
evalua2on,
it
also
provides
a
framework
to
guide
professional
reasoning
that
leads
to
implementa2on
of
adap2ve
occupa2on
for
purposes
of
compensa2on
as
well
as
thera-
peu2c
occupa2on
for
purposes
of
remedia2on.
The
rst
step
of
the
model
is
establish
client-center
performance
context.
Such
step
is
important
because
it
provides
framework
for
understanding,
evalua2ng,
and
interpre2ng
a
persons
occupa2onal
performance.
Context
is
not
only
dened
everything
that
is
external
to
the
client,
context
should
be
boarder
dened
as
the
transac2on
between
the
person
and
the
environment,
hence
the
clients
mo2va2onal
characteris2cs,
roles
and
capaci2es
are
just
as
cri2cal
as
are
the
task
and
the
features
of
the
environment
of
the
occupa2on.
Therefore,
we
need
to
fully
understand
each
of
these
elements
and
the
transac2on
between
these
el-
ements
to
understand
why
and
how
a
person
perform
the
task,
and
why
he
or
she
may
have
dicul2es
or
dissa2sfac2on
while
performing
such
task.
There
are
nine
dimensions
of
client-
centers
performance
context,
all
of
these
dimensions
are
interrelated,
these
dimensions
in-
cludes:
temporal,
environmental,
cultural,
societal
(ins2tu2onal),
social,
role,
mo2va2onal,
capacity,
and
task.
Normally
a
prac22oner
establishs
client-centered
context
through
ini2al
referral,
chart
review
and
interview,
the
author
suggests
this
step
is
worth
extra
2me
and
nding
out
what
task
or
ac2vity
is
purposeful
and
meaningful
is
crucial
in
this
step,
the
au-
thor
also
advices
against
to
assess
the
person
underlying
capaci2es
on
this
stage.
The
second
stage
of
the
Interven2on
Model
is
iden2fy
strengths
and
problems
of
occu-
pa2onal
performance.
The
author
stresses
the
cau2on
to
nd
problem
the
client
may
have,
but
may
not
realize.
The
third
stage
of
the
Model
is
to
implement
performance
analysis.
The
purpose
of
such
analysis
is
to
iden2fy
the
discrepancy
between
the
demand
of
the
task
and
the
skill
of
the
client.
She
stresses
the
clients
problem
and
strengths
are
described
in
terms
of
quality
of
the
goal-directed
ac2on
that
comprise
the
occupa2onal
performance,
not
the
underlying
capaci2es
and
impairments.
In
fact,
too
much
focus
on
the
underlying
capaci2es
and
im-
pairments
may
aect
the
scoring,
because
during
this
stage
what
is
being
scored
is
clients
occupa2onal
performance
in
his
or
her
chosen
task
and
in
the
natural
environment,
the
transac2on
between
the
client
and
the
chosen
task
and
environment
can
be
more
eec2ve
than
what
the
underlying
capaci2es
and
impairments
suggests.
The
fourth
stage
of
the
Model
is
to
dene
ac2on
of
performance
the
client
cannot
per-
form
eec2vely.
The
Nh
stage
is
to
clarify
and
interpret
cause.
Constraints
can
be
think
in
terms
of
im-
pairment,
also
can
be
think
in
terms
of
physical
environment,
social
environment,societal
constraints
and
societal
expecta2on.
The
sixth
stage
to
choose
between
compensatory
model
or
remedial
model.
For
a
good
candidate
for
remedia2on,
prac22oners
can
choose
remedial
model
and
use
therapeu2c
tools
to
remediate
the
underlying
impairment.
But
if
the
remedia2on
is
not
eec2ve
or
if
recovery
plateau,
the
prac22oners
can
go
back
to
choose
the
compensatory
model.
The
next
stage
aNer
closing
the
compensatory
model
is
to
plan
and
implement
adap2ve
occupa2on
to
compensate
for
ineec2ve
ac2on.
The
desired
outcome
is
the
design
of
adap-
2ve
occupa2on
to
compensate
for
the
clients
ineec2ve
ac2on.
There
are
three
compo-
nents
of
this
stage:
expand
consulta2ve
partnership,
collabora2ve
consulta2on,
educa2on
and
adapta2on,
adapta2on
strategies.
Finally
reevalua2on
for
enhanced
occupa2onal
performance
is
crucial
in
the
model.
Us-
ing
performance
analyses
to
verify
whether
the
client
has
met
his
or
her
goals,
and
docu-
menta2on
of
the
eec2veness
of
our
occupa2onal
therapy
is
a
cri2cal
step
toward
commu-
nica2ng
the
unique
roles
of
occupa2onal
therapy
as
well
as
jus2fying
payment
of
occupa-
2onal
therapy
services
by
health
care
payer.
Reevalua2on
is
also
important
for
us
to
iden2fy
further
problem,
redene
new
goal,
and
if
the
circumstances
change,
to
revisit
the
previous
steps.
Also,
dont
forget
to
develop
therapeu2c
rapport
during
the
whole
interven2on
process.
References
Fisher,
A.
(1998).
Uni2ng
Prac2ce
and
Theory
in
an
Occupa2onal
Framework.
American
Journal
of
Occupa2onal
Therapy,
509-521.
Kielhofner,
G.
(1997).
Conceptual
founda.ons
of
occupa.onal
therapy
(2nd
ed.).
Phil-
adelphia:
F.A.
Davis
Company.