Occupational Therapy for Physical Dysfunction - Assignment Example

Occupational Therapy for Physical Dysfunction Part A: Describe the occupation Step 1: “The client wants to mop the floor”. Step2: Meaning: The client perceives that working is vital to human survival The client believes that getting a mop job could offer unique chances to utilize her vigour despite her physical disability The client views being employed as a way to free her mind from stress and the problem she suffers while eking out livelihood for herself Values, interests and personal causation The clients understands the importance of work, and would like to give this cleaning job using a mop a shot The client duly hopes he could mop without letting her physical problem come in the way of the job The client views employment as a gateway into self-discovery and freedom The client values staying in the workplace environment and contributing her quota without being necessarily undermined The client is currently jobless, and she will be happy to put all her optimism into the cleaning job if she is lucky to be hired The client sees mopping job as a creative assignment she could accomplish with the help of her left hand and personal determination to succeed Roles and habits Even though the client moves around by a powered wheelchair, it is practically possible to annex a mop to his wheelchair The client’s left arm is functional and unaffected by the disease that has crippled her right arm The client, at the moment, is ready and willing to look for a cleaning job: her industriousness would not permit her to relax until she has got the job Environment The client sits on wheelchair that could move from one place to the other, so moving around shouldn’t be a problem The client’s left hand is not incapacitated; so, she could raise a mop with it. The client looks forward to working for a company where her mobility is encouraged, and she will be able to discharge her duties without any hassles It is possible that the client may have had some experiences in cleaning job, which will be helpful to successfully execute future job The client receives continuous medical attention from her doctors to stay fit and healthy for the mopping task Step 3: Summary The client wants to mop the floor. The client realises that working is significant to human survival. The client hopes that getting a cleaning job could give unique chances to use her energy despite her physical disability. The client views employment as a way to free her mind from stress and the problem she suffers while working hard to make livelihood for herself. The clients understands the significance of being employed, and would like to give this cleaning job using a mop all her best. The client values staying in the workplace environment and contributing her quota without being necessarily undermined. The client sees mopping job as a creative assignment she could accomplish with the help of her left hand and personal determination to succeed. Even though the client moves around by a powered wheelchair, it is practically possible to annex a mop to his wheelchair. The client’s left arm is functional and unaffected by the disease that has crippled her right arm. The client sits on wheelchair that could move from one place to the other, so moving around shouldn’t be a problem. The client looks forward to working for a company where her mobility is encouraged, and she will be able to discharge her duties without any hassles. The client receives continuous medical attention from her doctors to stay fit and healthy for the mopping task Part B: Occupational analysis (The client will mop the floor when she finally gets a cleaning job). Step 1: Tools and materials needed to complete the occupation The client could use any of the following tools and materials to mop the floor. A mopping system: she can particularly use a ROBOMOP, which is an automated, double bucket system designed for small offices, restaurants and coffee shops and restaurant areas. Traditional mopping tools: these include brooms and mops. Floor machines and vacuum cleaners (automated) Trolleys and Signage. Step 2: Sequence of major steps and time required to complete occupation Step Sequence Time required 1. Gather the supplies (tools & materials) 5 mins 2. Prepare the floor by wetting or pre-washing sticky floors 3 mins 3. Waiting after floor preparation 2 mins 4. Fill the bucket or sink with mopping solution 4 mins 5. Open all windows and/or maintain good ventilation 1 min 6. Dip and wring out the mops (remove excess water/liquid) 3 mins 7. Mop (using different tools) 10 mins /area 8. Change mopping styles periodically 2 min 9. Rinse and Ring out liquid/water 4 mins 10. Floor drying 10 mins 11. Tools and materials drying 5 mins 12. Put away supplies (tools and materials) 5 mins 13. Washing of hands 3 mins 14. Hand drying with towels 2 mins Step 3: Indicators that the occupation has been successfully completed 1. The occupation has been successfully carried out within the set timeline 2. Appropriate steps required are dully followed without missing a step 3. The floor looks cleaner and in better conditions that could not hamper the health of human occupiers of the office 4. Health rules and standards are completely obeyed and stuck to. 5. The customer (office owners, coffee shop owners etc ) are satisfied with the overall performance. Step 4: Occupational performance components required to complete the occupation PERFORMANCE SKILLS MOTOR SKILLS Positions: Body / upper limbs will have to bend downward in order to be at the right level for cleaning floors Reaches: Automated tools do not necessarily need firm reaches: however, traditional mops and brooms require firm grasp. Bends: Both the upper limb and upper part of the body must bend to a certain degree. Automated tools or systems do not require extensive bending. Coordinates: The body must be positioned in a way that the wheel chair moves smoothly across the floor, and either the automated or manual tools are aligned horizontally for better performance. Manipulates: Automated mopping systems require firm and speedy use of fingers, while the other parts of the body (the lower part, precisely) stay firmly on the floor or the wheel chair. Flows: Liquids, water and other solutions must flow smoothly in order to achieve optimum success, or else they may have been contaminated. Calibrates: It is imperative to regulate the time, speed, swirl angle of the automated mopping systems: manual tools do not require any calibration. Grips: Both the manual and automated tools must be held firmly to prevent unexpected dropping and accident. Endures: Mopping requires concentration and timeliness: special attention must be placed on following all the appropriate steps, which could exert pressure on a person’s mind. Endurance is highly needed. PROCESS SKILLS Attends: Special attention must be placed on the mopping process, because the bad-smelling solutions could cause some distraction. Chooses: To be successful, the right mopping tools and materials must be selected. Uses: The mopping tools and materials must be used according to their specifications. Most especially the solutions. Handles: Requires proper handling, usage and maintenance of tools and materials for mopping. Heeds: It is important that the mopping procedures must be strictly adhered to: health standards and systems’ operations instructions can never be undermined. Inquires: It requires getting the complete information from the office owners about their floors before any success could be achieved in the occupation. Initiates: Avoid leaving any important step undone, which could cause unforeseeable problem in the entire mopping process. Continues: It is nice to follow every step to completion once started in order to achieve optimum success. Sequences: Must follow each step in mopping operation, failure of which would end the whole job in a big mess. Terminates: Stops any activity that may be unnecessary and time consuming (for example, cleaning and wiping one’s hands for minutes before starting the next mopping exercise). Gathers: Will meticulously gather all the required tools and materials for the mopping operations. Organises: Has the capacity to follow each step with a great deal of self-control and work organization.. Notices/ Responds: Able to respond or notify the office owners in case of any faulty (depressed) floors and other irregularities that may destroy the overall success of the mopping operations. Accommodates: In case of unanticipated problems, accept suggestions and modifications from the office owners. Adjusts: Has to adjust to changes or modifications offered in order to be able to have a satisfactory occupational performance. COMMUNICATION / INTERACTION SKILLS Gestures: Necessary to communicate with gestures as bad-smelling mopping solutions may be difficult to breathe in or swallow down the guts. Articulates: Communicates pro-actively with the office owners etc. Asserts: Confident to state the requirements while paying attention to views held by the others involved in the occupation. Asks: Quick at requesting for appropriate information needed to make the operation successful.. Engages: Has the unique ability to fully grasp demands and requirements while carrying out mopping activities. Modulates: Has the capability to regulate factors of operations in a way that nothing seems to contradict the others. Speaks: Should use the right dictions, phrases and words to express emotion. Collaborates: Must demonstrate reasonable ability to heed the others’ views and be able to work in a cooperative environment. Conforms: should follow the laid-down procedures and rules while carrying out the mopping tasks. Respects: Be able to show recognition and respect for the right authority, be it office owners etc. Part C: Observe your clients’ performance of the occupation and document your findings Step 1. * Below are the outcomes of assessing the client based on the skills described in section B. Attempts are made not to repeat the skills unnecessarily. Process Skill Level of difficulty Comment/ Example MOTOR SKILLS Positions Moderate -Crippled right upper limb reduces the client’s ability to maintain a balanced position Reaches None -Can firmly hold a remote control for automated tools and/or the edge of a manual mop or broom. Bends None - Easily flexed the leg joints, waist muscle and lower part of the body. Coordinates Moderate - Difficulty in staying in the same position for a long time, owning to the disability on the right arm. Manipulates Moderate-extreme -Cannot hold the tools or materials for a long time due to sprain and pain in the arm muscle. Flows Moderate -Irregular movements caused spilling of mopping solutions and other liquids. Calibrates Moderate -Made the automated mopping system ran faster or slower than expected, then causing a little accident. Grips None - Able to grip tools and materials during the course of use Endures Moderate -Ill-health and body pain reduce the client’s level of endurance. Fatigue from mopping worsens this situation PROCESS SKILLS Attends Moderate -Handled all mopping tools and materials carefully. Engaged with the office owners meanigfully. Chooses Extreme -Sometimes chose improper mopping tool for a floor cleaning (the tools work differently depending on the kind of floors). Uses Extreme -Couldn’t use tools and equipment to their full capacity owning to physical disability Handles Moderate -Hand-held devices sometimes slipped from her grips Heeds Moderate - Personal sympathy sometimes obstruct the willingness to follow laid-down instructions Inquires Moderate Shyness and self-pity sometimes prevent her from talking directly with the office owners etc. Initiates Moderate Dogmatically followed the mopping procedures, but sometimes forgot which step came next. Continues Moderate Fatigue and absentmindedness sometimes came in to distract on-going task or activity. Sequences Moderate Missed some procedural steps at times due to forgetfulness or mere distraction. Terminates Moderate Sometimes mopped longer than necessary: a symptom of occupational fatigue Gathers None -Worked hard to gather the required tools and materials before mopping without forgetting to get the first thing first. Organises Extreme Threw mopping equipment around after work; sometimes forgot to dry her hands after mopping operations. Notices/ Responds Extreme - Mostly unmoved to inform the office owners of her discoveries, due to self-effacement and possibly, fear of being rejected Accommodates Extreme -Accidentally destroyed a mopping system against the advice of a supervisor at the workplace Adjusts None -Easily agreed to use either automated or manual mopping tools, depending on the officer owner’s demands. COMMUNICATION/ INTERACTION SKILLS Gestures None -Encountered no problem using gestures, body movement and fingers for communication Articulates Moderate -Sometimes could not understand office jargons used by the office owners. Asserts None -Had fruitful communication with the cleaning supervisors of the offices where she worked Asks None -Didn’t hesitate to ask appropriate and useful questions Engages None -Easily asked for the office owners’ opinions and recommendations Modulates None -Had a clear voice while expressing her opinions Speaks Mild -Experienced a little speech impediment due to her health problems. Collaborates Moderate -On most occasion, preferred to follow her own instinct while mopping the floor. Conforms None - Showed good-natured lifestyle, gentleness and communicability Respects None -Revealed no pride or annoying stubbornness to mopping supervisors at the offices. Step 2: Summary of Strengths and Weaknesses Strengths Moderate level of communication skills; Encountered no problem using gestures, body movement and fingers for communication. Had fruitful communication with the cleaning supervisors of the offices where she work. Worked hard to gather the required tools and materials before mopping without forgetting to get the first thing first. Showed good-natured lifestyle, gentleness and communicability. Weaknesses Physically disabled with an almost paralysed upper right arm. Accidentally destroyed a mopping system against the advice of a supervisor at the workplace. Mostly unmoved to inform the office owners of her discoveries, due to self-effacement and possibly, fear of being rejected. Difficulty in staying in the same position for a long time, owning to the disability on the right arm. Sometimes mopped longer than necessary: a symptom of occupational fatigue Step 3. 2x Assessments chosen and clinical reasoning Assessment Clinical Reasoning 1. Canadian Occupational Performance Measure (COPM) -Encourages client-centred activity; client measures own satisfaction levels and the significance of occupations through a designed interview with ordinal scale. Client’s main objectives become basis for goal setting/ intervention. -Discovering problems in occupational performance in self care, productivity, leisure -Not -change resistant -Quick to practicalise (30mins) -Well established dependability and genuineness -Highly recommendable for mental health 2. Assessment of Motor and Process Skills (AMPS) - Of good standard, delicate, popularly applied in mental health -Objectively assesses motor and process skills, applicable to the client’s difficulties, concentrates on skills rather than disabilities. -Discover if the person that had undergone assessment can complete the selected task safely, with/without assistance, efficiently and in the absence of much physical effort. -Consist of 100 assessments (promoting client centred practice- client can pick the assessment criteria commensurable with the level of challenge) -needs no extraordinary equipment and can be applied in any applicable environment within 30-40 minutes. Part D: Setting priorities for intervention-developing goals and behavioural objectives, grading and adaption Step 1: One long term goal “I want to earn a living working as a cleaner (mopping worker) for a long time.” Step 2: Three relevant short term goals 1. Earn enough to be able to take care of personal needs including medical expenses for hospital visits 2. Need to exercise the whole body in order to make it receptive to the rigor of the new job 3. Attend conferences/workshops for disable workers and learning a new lifestyle. Step 3: One applicable behavioural objective 1. Who: Client Does what: Attends 2x conferences/workshops for disabled workers Given what: -2x phone call reminders before class 2x OT session to explain how to use private transport in order to get to the conference hall Access to private transport (eg a taxi) Easy admission to group Support, praise and encouragement Practice using private transport How well: Attends 2x sessions over four weeks for full class duration. Be teachable and fully participates in the workshop activities to an appreciable level. By when: Four weeks Step 4 a) Adaption of occupation PERSON Permit the client to continue to use automated mopping system which seems to make the task of mopping a push over for her. The client needs more training in the area of handling and operating the automated system Educate the client about the possibility of improving her body position while mopping Inform the client about the necessity of working by standards and occupational requirements.. ENVIRONMENT The client’s should be allowed to work only in offices or places that support wheel chair’s mobility. Encourage other workers in the offices to be friendly and helpful to the client so as to reduce the extent of self-pity and inaction. Make available accessories or instructional materials that would make job of mopping quite easy for the client. OCCUPATION Use automated mopping systems Provision of the tools at the appropriate time Removing of hindrances to the occupation Adoption of cooperative communication processes that would make the client feel appreciated and duly praised. b) Grading occupation 1. Both automated and manual mopping tools and materials would be arranged by the OT before the first session. The client would be asked to do the same by herself (Scaffolding). 2. An instructional manual would be presented to the client so that she can follow the step-by-step procedures necessary for successfully mopping the floor (faded). 3. The OT will model the use of mopping tools and materials. This modelling will be faded as the client summons up courage to use the same tools and materials confidently by herself. 4. At the beginning, the OT will help the client get acclimatized to the procedures, and as soon she can carry out the mopping operations by herself, this assistance will be faded. 5. Mopping requires several stages: the OT will first of all helps the client to select the appropriate tool for a stage or step in the mopping operation. This assistance will be faded as the client demonstrates the capability to do the same. 6. From the onset, the OT will give plenty of support, encouragement and praise. This feedback will be faded as the client reaches a seemingly maturity level. 7. In the course of the first OT session, the client would have scheduled breaks (4 x 3 minutes). However, these breaks will be faded while the therapy is on as soon as the client manifests certain confidence in the processes and having no fatigue. 8. The OT will provide series of instructions on how to be a successful cleaner (mopping worker). These ideas would be removed when the client has mastered them all (Scaffolding). References AMPS. (2009). AMPS assessment: clinical reasoning. Retrieved on 18/10/09 from www.ampsintl.com/ Blesedell Crepeau, E., Cohn, E.S., & Boyt Schell, B.A. (2009). Willard & Spackman’s Occupational Therapy (11th edn), Lippincott Williams & Wilkins. Kielhofner, G. (2008). Model Of Human Occupation (4th edn), Lippincott Williams & Wilkins, US. Vining Radomski, M.V., & Trombly Latham, C.A. (2008). Occupational Therapy for Physical Dysfunction (6th edn), Lippincott Williams & Wilkins, US. Read More