OCCUPATIONAL THERAPY

Assesses what muscles need strengthening and coordination to enable ADL and recommends practical activities to improve strength Improves basic self care skills, such as dressing, eating, and personal hygiene Recommends adaptive equipment and upper extremity orthoses to facilitate ADL and trains patient in use of upper extremity orthoses and protheses Teaches homemaking skills and determines at what level the patient can participate Teaches energy conservation and work simplification methods to improve work tolerance Improves communication skills, such as reading, writing, and using telephone Redirects vocational, avocational, recreational interests, and social activities to accommodate disability To acquire objective evidence of the patients functional capacity, ask him or her to demonstrate activities such as dressing, feeding, and attending to personal hygiene. Record any assistance required, the ability to perform the task independently, or the necessity for another person to perform the activity Also record any adaptive equipment and assistive devices needed and the time required to complete the task Test balance in both the sitting and the standing positions. The

Occupational Therapist

Dr. Lanny Indriastuti, SpRM

Occupational Therapist

Occupational Therapist

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Activities of Daily Living

Balance

normal person is able to remain stationary in the sitting and standing positions unsupported and does not fall when nudged from side to side. Record any deviations from normal balance, as these may impair ambulation. Also a prerequisite for ambulation, transfer ability involves turning in bed, sitting up, and standing up. If the patient can perform these maneuvers, evaluate the ability to move to a chair or mat.

Transfers

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Evaluation of ambulation consists of the ability to propel a wheelchair or walk using a functional and efficient gait pattern. As the patient ambulates, observe coordination, and speed and record any deviations from a smooth, rhythmic pattern. Changes in muscle strength or the skeletal structure produce abnormal shifts in the center of gravity, leading to abnormal gait patterns and additional energy requirements.
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Ambulation

Independent: Patient can perform activities without verbal or physical assistance. Supervision needed: Patient may require verbal instruction or standby assistance to perform functional activity. Assistance needed: Patient requires assistance of another person at minimal, moderate, or maximal level to perform the functional activity. Dependent: Patient cannot perform the activity even with the assistance of adaptive equipment or another person and the functional activity must be performed totally by someone other than the patient.

Level of dependence

Level of dependence

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Occupational Performance Areaa

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Grooming Oral hygiene Bathing Toilet hygiene Dressing Feeding and eating Medication routine Socialization Functional communication Functional mobility Sexual expression

Work Activities
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Occupational Performance Areas

Play or leisure activities

l Exploration l Performance

Home management Care of others Educational activities Vocational activities

l Sensory integration l Sensory awareness l Sensory processing (tactile, visual,etc.) l Perceptual skills l Neuromuscular l Reflex l Range of motion l Muscle tone l Strength l Endurance l Postural control l Soft tissue integrity l Cognitive integration and components l Level of arousal l Orientation l Recognition l Attention span l Memory (short-term, long-term,etc)

Sensory motor components

Performance Components

Performance Components

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Sequencing Categorization Concept formation Intellectual operations in space Problem solving Generalization of learning Synthesis of learning

Motor
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Performance Components

Activity tolerance Gross motor coordination Crossing the midline Laterality Bilateral integration Praxis Fine motor coordination/ dexterity Visual motor integration Oral motor control

Psychosocial skills and psychological components

l Psychological l Social l Self management

Performance Components

Physical Disability & Serious Illness pose a major threat to an individual precipitate a life crisis
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Before The patient could love & work The patient was unrestricted & could move about freely The patient had outlets for physical tension, aggression and creativity After His family life & his future plans were disrupted His body image was altered His work roles was terminated His self-esteem, security, independence, opportunities were reduced His psychological integrity was threatened His control over intimate physical functions were lost

PSYCHOLOGY

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The Perfectionist personality The Authoritative personality The Sociopathic & impulsive personality The passive aggressive personality The paranoid personality

Premorbid Personality

The perfectionist personality : l The perfectionist has internalized high standards for maintenance of self-esteem. l The criteria by which he judges himself may be inflexible l Slow and less-than-perfect achievement and a reduction in the ability to maintained valued by standards will be threatening The authorative personality : l The authorative personality needs to be in control. l They want things done a certain way and have rigid perceptions about rules, values and the way people should live and behave. They tend to be judgemental, concerned with status, limited ability to develop insight or to empathized with others. l Adaptation to disability requires compromise and acceptance which will be difficult for him The sociopathic and impulsive personality : l They cannot tolerate the restrictions of hospitalization and the rules & procedures of medical treatment such as costs, turning frames, or even splints. l They fail to exercise good medical judgement l They often exacerbate their dysfunctions by failure to comply with self-care procedures. l Acting out behaviours are disruptive on the ward and in treatment The passive-aggressive personality : l They are defensive and aggressive, expressing hostility passively through stubborness, procrastination, obstructiveness and intended inefficiency. l They work poorly with others and may have a demoralizing influence on the staff and in therapy groups The paranoid personality : l They are hypersensitive, jealous, envious and self important. l Such a patient is alert in collecting clues through staff behaviours or medical procedures which he interprets as a plan to harm him l Such a patient is unwarrantedly suspicious of the intentions of

others The narcissistic personality : l They feel superior l They are threatened by reduction of this image. l They need to know that they are still acceptable. l Sometimes, they have a history of withdrawal and poor interpersonal skills. l So, they will find the closeness of the rehabilitation environment anxiety provoking.
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Denial Depression Grief & Mourning Regression Anxiety Anger Compensation Overcompensation Repression Daydreaming & Fantasy Dependency

frequently seen in reaction to injury & chronic illness

Defenses & Emotional Reactions

The disabling Sx The painful Sx The decrease funct-ional ability The resulting deform-ed physical appear-ance Anxiety Fear Depression Shame
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Rheumatoid Arthritis ( RA )

Genetic Autoimmune Infection Pyschological

The hypothesis of RA etiologies

Overreaction to illness

Secondary responses to the RA

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Masochism Rigidity Confirmity Perfectionism Difficulty in dealing with hostility & aggression Be very sensitive Be vulnerable to stress Have diminished body image related to crippling deformity Have difficulty in : a. flexible management of their lives and b. seeing alternative ways of problem solving

In turn RA patient are seen to :

Psychological treatment Suggestion : l A good relationship with a kind but firm therapist who provides a consistent, stress-free structure in which the pt can learn l Treatment activities designed to meet special lerning needs l Clarity and repetition for reinforcement l Feedback to benchmark even small gains

Cerebral Vascular Accident

Organic denial. * Un awareness of ability of the inability to read or neglect of the affected side Psychological denial * Belief in a complete recovery and high interpretation of the slightest change or spasm
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Cerebral Vascular Accident

Rehabilitation Potential

of the patient. Helping the patient to reach one goal at a time keeps him from being overwhelmed with the enormity of his task. The therapist should be clear on when to support, when to give more responsibility for self, when to be the patients advocate and when to encourage him to solve his own problems and initiate his own planning.

l The therapist can assist the patient in his accomodation to disability

Rehabilitation Potential

by provision of experiences where the patient feel more in control of

his life and more aware of his competencies toward the development of mastery of environment. Integration and permanence of the new skills and attitudes will depend on the presence and quality of transitional and community treatment and follow-up programs
l Can be increased by involving the patient in a partnership of choice

Rehabilitation Potential

with the therapist in the development of treatment objectives. l If the patients goals are initially too ambitious, the therapist should remember that these are not necessarily the final choice. Patients, like the rest of us, are capable of experiencing failure and of reassessing and thinking through the need to change direction. The therapist can guide treatment by sequencing achievable short-term goals to support the patients long-term objectives.