Put Down the Pegs: Function-Based in Treatments In Long-Term Care

Transcription

1 Put Down the Pegs: Function-Based in Treatments In Long-Term Care ANGIE REIMER MOT, OTR What is Occupational Therapy? In its simplest terms, occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities AOTA

2 Why Do We Choose Our Interventions? Previous Education Previous Experience Walker, Drummond, Gatt, Sackley, 2000 is Does Function Really Matter? Lin Wu & Trombly 1998 Adults had to either ring a bell or just touch the lever before completing a line bisection task Kinematics of the group that had rang the bell were better Does Function Really Matter? Volman et al, 2002 Participants reached for a marker (no object), toward a light switch with no light or reach for a light switch turning a light on Adding the object (the light) was associated with greater improvement in motor function than adding sensory cues 2

3 Does Function Really Matter? Bakshi, Bhambhani &Madill, 1991 Looked at the number of repetitions, increase in heart rate, increase in blood pressure and rating of perceived exertion in subjects performing the most-preferred and least-preferred tasks from a pre-determined list under purposeful and non-purposeful conditions Subjects experienced a significant increase in heart rate and rating of perceived exertion during non-purposeful activity during most-preferred and least-preferred tasks Does Function Really Matter? Wu, Trombly, Lin & Tickle-Degnen, 1998 Compared pushing on a food chopper to cut a mushroom to pushing on the same chopper covered with cardboard Reaching to chop the mushroom resulted in more efficient, direct, smooth and prepared movement than the simulation Importance of Client Centered Care and Functional Treatments Patient Understanding/Education Do they understand what you are addressing and why? Decreased patient satisfaction Dementia Care Going back to Rote Inability to learn new tasks Functional and Meaningful Treatment Drive Neuroplastocity 3

4 Barriers to Change Productivity Standards Lack of Supplies Lack of treatment ideas Lack of support/mentorship Task Oriented Approach Active, repetitive practice of functional activities in order to re-learn a motor skill Principles of Task Oriented Approach Practice of a movement results in improvement in that movement Large amounts of practice are required to truly master a motor skill Learning requires problem solving, not rote repetition Learning does not happen in the absence of feedback Optimal learning occurs with high levels of motivation and engagement Variable practice conditions are optimal for learning and generalization Mass practice promotes better learning than distributed practice Whole task practice is more effective than partial task practice 4

5 Where Do I Start? History is critical Know the plan what is my patient s goal? Activity Analysis Where are the deficits and what do I need to do about it? What function am I serving through use of cones/pegs etc.? What other activity could I use to address these deficits or facilitate desirable behavior? Involve your patient in the plan Life History and Occupational Profile Hobbies Career Family Values Habits Routines The more information you have the easier to plan treatments Intervention Ideas 5

6 Shoe Box Kits Wood working kits Fine Motor Boxes Laundry baskets of clothes Jewelry making supplies Socks to sort and fold Feather duster and cleaning supplies Grooming/ADL supplies Cards/Board Games Shoe Box Kits Pet Care Medication Management Child Care Items For More Ideas Occupation based kit ideas ADL Moments Toileting AM ADL routine Showers/bathing Self feeding Simple home management in the patient s room (making bed, hanging up clothing) 6

7 Join Activities Check the activities calendar for opportunity Bingo for cognition and visual scanning Balloon volleyball Crafts Therapy in this setting can provide not only intervention, but also social interaction Holidays Fill Easter eggs for the facility hunt (or help hide them) Decorate the Christmas tree or hang decorations Plan a holiday party Make gifts or cards for loved ones Involve Leisure Interests Putting for golfers Knitting/Crochet Card games Painting Models Puzzles Gardening 7

8 Homemaking Tasks Folding or sorting laundry Making the bed Cooking/baking tasks Sweeping Dusting Sorting silverware into dividers Put Them to Work Making copies or packets of papers Crushing aluminum cans Helping with inventory Clean out a closet or cupboard Wipe down therapy equipment Multiple errands tasks Ice Cream in a Bag Ice cubes (enough to fill each gallon-size bag about half full) 1 cup half and half 1/2 cup salt (The bigger the granules, the better. Kosher or rock salt works best, but table salt is fine.) 2 tablespoons sugar 1/2 teaspoon vanilla extract 1 pint-size ziplock bag 1 gallon-size ziplock bag 8

9 Online Bill Pay/Shopping Fine Motor Control Grip and Pinch Strength Make paper wads (and throw them into trash) Knead Dough Aggression Cookies cookies/ Pie Crust 9

10 Whatever you do with the patient make it meaningful! Questions? 10