1). Domain and Process 2).

Evaluation is broken down into 6 areas: Performance: It’s observing how the person performs the tasks he needs to do the occupation he chooses. Is the person able to walk at all, does she need assistance to brush her hair? Is she able to read her books? How high does her arm reach, etc. Context: This includes socio-economic factors (the kids come from an un-wed 13-year-old mother or a middle-class, suburban home); client is of another country or religion, or can’t speak the language, has a different value-system (don’t look at his wife in the face!); personal, as in his individual experiences and home life; the ability with which he socializes, where the occupation takes place, etc. Performance patterns: the person’s habitual routines and activities, which I assume also means in attitudes and other psychological terms, as well as in the facility and manner of movement and types of activities the person gravitates toward. They are probably the occupations they’ll want to recover. This might include swimming every other day, or walking the dog or chopping onions for the evening meal. It could also mean habitually thinking of the past, worrying, or the way they like to dress, etc. Activity demands: what tools and skills the occupation will require the client to achieve his goals. This could be anything from physical materials, location and space, sequencing, motor skills of many kinds, etc. A person needs healthy shoulders to swim, and a jeweler needs good eye-sight and flexible, strong hands. Performance skills: these are physical (range of motion, for example), cognitive (developmental disabilities, psychological disorders); social (speech or language problems, Asberger’s). Client factors: The client’s physical characteristics: musculoskeletal, sensorimotor, neuromuscular, eye site, hearing, impairments, illness, etc. 3). They refer to them as clients. 4). Context is everything that the person has been influenced by in his life. The OTPF only stated culture, religion, spirituality, personal experiences, what it going on at THIS point in his life (temporal) and virtual (his relationships on-line, I take this to mean?). I would add country-of-origin, family or origin, the school he attends. Pretty much anything at all in this person’s life is the context in which he lives and works and practices his occupation. 5). Context matters because you need to know as much as you can about the client before you can create an effective therapy. Every person is a unique individual, shaped by his own particular and unique experiences and if we’re not sensitive or knowledgeable about the context of their lives, we could insult them, miscommunicate, hurt their feelings, make them withdrawn, anger them, and make them unable to trust us. Also, we can’t fully understand their issues unless we know their whole picture.

6). Activity demands are exactly what the word says: what actions the client will need to engage in to perform the occupation: body functions and structures, where they will perform and what materials they’ll need to do their activity, social context, sequencing and timing of activities. Client factors are the things we’d need to know about his physical condition to better plan the therapy: his body structure and function, neuromuscular, musculoskeletal and sensorimotor system, whatever illness or injury or disability he has, etc. a) What the therapy will demand of the client: to throw a ball the client will need to reach for it, pick it up; use his shoulder, elbow, wrist and fingers to throw it. This occupation is usually done at school, but since I’d like to avoid any social embarrassment (kids are so sensitive to being observed by their peers), so we’ll do it at the baseball field across the street from the clinic, since its large enough. We’ll need a ball that he can hold with some comfort, and perhaps his family can watch and give him encouragement. Perhaps the client’s father would like to play with the client, too. b) Client factor: The client, a little league baseball player, is recovering from a torn rotator cuff. He experiences tingling in his fingers due to pinched nerves, and he is still in a little pain, so he still has a hard time throwing effectively. 7). Participation is key to effective service, since no one person can observe as well as several people working together. Also, the OT doesn’t actually deliver the therapies, so the OTA will be the person with more access to the patient. Without both people participating (indeed, ALL the members of the team), the client doesn’t get as good a service as he could, since OTAs is the one who observes his activities and progress. The AOTA uses the word so much because it’s trying to emphasize that this is a team endeavor. And of course, if the families, teachers and other care-givers are included in the process, it can help the client’s progress and help the families understand how to help. 8). In order to provide effective therapy, we have to look ahead to see what the outcomes of the therapy might be: teaching to throw a ball would give the client the ability to play ball again, enhance self-esteem and bring him out of his depression. Outcomes are also important as they allow the OT and OTA to see if the therapy is working, needs adjustments or be dropped.

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