OT Assessment and Interventions in Adult and Geriatric Populations

Common Frames of Reference (FOR)

Frame of Reference:
Contemporary Task-Oriented Approach / Occupational Therapy Task-Oriented Approach (OT-TOA)
Major Concepts Concept Example Application Scholarly Evidence
(Evaluation or Intervention)
Key Concepts: Preissner (2004) offers a case-study • Almhdawi et al.’s (2017)
• Based on behavioral neuroscience and recent models of motor learning (Rowe & example of the use of OT-TOA with a article Efficacy of
Neville, 2008) geriatric client with cognitive involvement. Occupational Therapy Task-
• Underpinnings of theory of occupational adaptation (Rowe & Neville, 2008) Helen was an 83-year-old woman with a oriented Approach in Upper
• Strong focus on involving clients in goal setting and decision making to increase
history of dementia, myocardial infarction, Extremity Post-stroke
motivation and promote commitment to recovery
and hypertension. She was referred to Rehabilitation was a
• Contemporary motor learning approach evaluates learning not only after
acquisition phase, but also after retention phase and after task generalization inpatient rehab OT after a CVA that randomized control trial
(Gillen & Nilsen, 2020). resulted in reduced performance of ADL (RCT) that followed two
• Random practice is more effective than blocked practice (Gillen & Nilsen, 2020). skills. groups of 10 participants in
• Commonly utilized in clients with neurological disorders (CVA, TBI, CP) (Bass- the chronic phase of stroke
Haugen et al., 2008) The therapist utilized the evaluation through an OT-TOA
• Training programs tailored to the patient’s ability framework provided by Mathipwetz rehabilitation program.
• Tasks are modified continually to increase difficulty; promote adaptation of skills;
(2004) to assess Helen’s performance and • In this study, task-oriented
promote independence (Schaechter, 2004).
contacted her daughter for information approaches were found to
• Tasks targeted during early rehab include BADLs, functional mobility skills and
transfers, use of AE and DME to increase safety and I (Schaechter, 2004). because of the client being a poor lead to enhanced
• Tasks targeted during later rehab dependent on client and may include IADLs, historian. Supporting and limiting factors occupational performance in
community mobility, work/employment tasks (Schaechter, 2004). were reported after evaluation. activities of daily living,
functional movements of the
Focus: Supporting factors: functional use of left upper extremity, self-care
• Goal is to retrain clients with movement disorders (Preissner, 2004) arm and leg, ability to follow simple independence, postural
• Utilizes training programs focused on specific functional tasks to promote/restore
commands, procedural memory for basic stability, and mobility.
occupational performance
tasks, social support. • Participants reported
• Focus is on the transactional relationship between client, task, and environment
factors and how they impact motor performance (Bass-Haugen et al., 2008) Limiting factors: right-sided hemiplegia, significant improvement in
• Motor learning principles inform methods in this FOR but the client’s desire to poor attention to tasks, impaired their top-priority functional
engage in meaningful occupations drives task adaptation (Rowe and Neville, 2028). initiation/continuation of steps of tasks, self-perceived
Documentation Integration: activities, apraxia, disorientation, performance, and
• Evaluation: problem-solving deficits, balance deficits, satisfaction levels as
o Involves interviews, skilled observation, and the use of standardized assessments impaired trunk control, limited activity measured by the COPM –
o Client = primary source of information
tolerance. Client perception of
o Evaluation begins with assessment of role performance and role changes, and use of
the Role Checklist is advised (Gillen & Nilsen, 2020). performance skills improved
 o Second step in evaluation is assessment of occupational performance, with the use Helen received OT services 6 days a week by an average of 2.71 and
of standardized assessments such as the COPM (Gillen & Nilsen, 2020). for 90-minutes per day. Treatment client satisfaction with their
o Therapist assists client to self-identify tasks that are meaningful to them followed by principles from the OT-TOA were selected performance of meaningful
assessment of task performance (Gillen & Nilsen, 2020)
to minimize the need for new learning tasks improved by an
o Assessment of client factors (performance skills and performance patterns) to
include cognitive, psychosocial, and sensorimotor function) (Gillen & Nilsen, 2020). while also supporting Helen’s engagement average of 3.24.
o Assessment of environmental context and demands (physical, social, cultural) in the OT-TOA approach. • After intervention,
(Gillen & Nilsen, 2020) participants demonstrated
• Intervention Plan: (Rowe & Neville, 2019). Treatment principles were as follows: clinically significant
o Goals are set collaboratively with high level of importance on patient desires and - help the client adjust to role/task improvements in scores on
preferences performance limitation the Motor Activity Log (MAL)
o Interventions focus on meaningful specific tasks to the client to be completed in
- create an environment that , the Wolf Motor Function
their primary environment or in simulated settings
o Clients are encouraged to engage in personal practice outside of skilled therapy promotes everyday life Test (WMFT), and Canadian
sessions; research suggests that the high value placed on client-directed goals challenges Occupational Performance
improves HEP adherence - practice of functional tasks in a Measure (COPM).
• Progress Updates: (Gillen & Nilsen, 2020) closely simulated environment to
o Progress is reported first by the client promote identification of • Implications for practice:
o Re-administering motor skills standardized assessments assists to quantify progress effective strategies o Review suggested that
o Documentation throughout POC should include changes made to the duration,
- minimization of the OT-TOA was more
difficulty, or intensity of the program that also then facilitate more detailed progress
notes ineffective/inefficient client-centered, used
o Progression of goals as client meets short-term objectives movements patterns more meaningful
- use of contemporary motor activities, and
Approach: learning principles such as fading appropriate for a wider
• Top-down, client-centered, occupation-focused restorative approach with of cueing and assistance audience of clients than
components of task-oriented approaches from physical therapy and exercise throughout constraint-induced
science (Bass-Haugen et al., 2008)
movement therapy
• Approach assumes the following
At the time of discharge, all of Helen’s FIM (CIMT)
o Functional tasks organize motor behavior
o Motor behavior results from interaction of a person with their environment scores had improved compared to the o OT-TOA was found to be
o Occupational performance observed after central nervous system (CNS) time of admission. She was discharged an effective post-stroke
damage reflects attempts to achieve tasks home with her daughter and home health rehabilitation approach
o Exploration and practice are how clients problem solve to engage in PT, OT, and nursing services. The therapist for the upper extremity
occupations in this situation was able to utilize the OT- that was accessible to a
(Bass-Haugen et al., 2008; Mathiowetz, 2004)
TOA with Helen to capitalize on the use of larger audience than
• Progressively increase difficulty of tasks to increase challenge as patient masters
procedural memory and familiar tasks to CIMT protocols
the skills (Mathiowetz, 2004)
• Feedback is immediate and specific, fading as client progresses; less feedback is promote motor organization and
preferred over more feedback as it promotes problem solving, long-term skill functional recovery.
retention, and self-efficacy (Gillen & Nilsen, 2020)
• Small improvements are recognized/celebrated
Avoid excessive effort that reduces functional performance and decreases client
motivation (Muratori et al., 2013)
 References

Almhdawi, K. A., Mathiowetz, V. G., White, M., & delMas, R. C. (2016). Efficacy of occupational therapy task-

oriented approach in upper extremity post-stroke Rehabilitation. Occupational therapy international,

23(4), 444–456. https://doi.org/10.1002/oti.1447

Bass-Haugen, J., Mathiowetz, V., & Flinn, N. (2002). Optimizing motor behavior using the occupational therapy

task-oriented approach. In C. A. Trombly, Radomski, M. V. (Eds.), Occupational therapy for physical

dysfunction (5th ed., pp. 31–45). Philadelphia: Lippincott Williams & Wilkins.

Gillen, G., & Nilsen, D. M. (2020). Stroke Rehabilitation E-Book: A Function-Based Approach. Elsevier.

Hosseini, S., Ghamari, N., Hayati zadeh, Z. (2017). Review of task-oriented interventions in occupational therapy.

The Scientific Journal of Rehabilitation Medicine, 6(3), 239-248. doi: 10.22037/jrm.2017.1100362

Mathiowetz, V. (2004). Task-oriented approach to stroke rehabilitation. In G. Gillen, & A. Burkhardt (Eds.), Stroke

rehabilitation: A function-based approach (pp. 59–74). St. Louis, MO: Mosby.

Muratori, L. M., Lamberg, E. M., Quinn, L., & Duff, S. V. (2013). Applying principles of motor learning and control to

upper extremity rehabilitation. Journal of hand therapy: official journal of the American Society of Hand

Therapists, 26(2), 94–103. https://doi.org/10.1016/j.jht.2012.12.007

Preissner K. (2010). Use of the occupational therapy task-oriented approach to optimize the motor performance of

a client with cognitive limitations. The American journal of occupational therapy : official publication of

the American Occupational Therapy Association, 64(5), 727–734.

https://doi.org/10.5014/ajot.2010.08026

Rowe, V. T., & Neville, M. (2018). Client perceptions of task-oriented training at home: "i forgot i was sick". OTJR :

occupation, participation and health, 38(3), 190–195. https://doi.org/10.1177/1539449218762729

Rowe, V. T., & Neville, M. (2019). The feasibility of conducting task-oriented training at home for patients with

stroke. The Open Journal of Occupational Therapy, 7(1). https://doi.org/10.15453/ 2168-6408.1514

Schaechter, J. (2004) Motor rehabilitation and brain plasticity after hemiparetic stroke. ProgNeurobiol 73: 61-72.