Model of Human Occupation

Transcription

1 Model of Human Occupation Archived List Serv Discussion Remotivation process October 27, 2010 HI there Does anyone have experience of using the remotivation process and manual with adults with aquired brain injury, in the community? I'm afraid I'm a defected OT who has just become a case manager and am working with adults with ABI - motivation issues are a big part of the problem so if anyone has any evidence of the effectiveness of the process with this client group I'd be grateful to hear it. Thanks Jill Blount October 27, 2010 YES!!! I do have experience with people who ha brain injury in the community!! Good results...it is a longer time taken in Exploration process, but yes, please contact me... Let me know what are the occupational needs of the gorup you work with.. Carmen Gloria de las Heras, MS, OTR Chile October 28, 2010 Carmen, I am most interested in that information as well! (I am looking at a sticky note on my desk that I recently wrote it says remotivation process how to use?) I work with a mild TBI and PTSD population who are frequently overwhelmed with attempts to reintegrate into their relationships and society after deployment, in addition to struggling with the effects of their psychological issues and mtbi. These individuals often have

2 difficulty organizing themselves, planning, remembering, and in short, envisioning their future. Thanks so much for any suggestions you might have would be most welcome! Chris Wallace Colorado USA October 28, 2010 Dear Chritine, Jill and all: The remotivation process offers a protocol of intervention for people who present severe volitional challenges, no matter what type of mental or physical problems they maight have, if they have such problems. There are people who have developed a negative volitional process through life because other circumstances (environmental for example). Based on this reality I will try to give some orientation: 1. The Remotivation Manual has different sections in which you can answer a lot of questions regarding its use. One of the important premises is that the process is dynamic and it is guided with the regular use of the Volitional Questionnaire. This means that the lenght of the process in each stage of volitional change will vary from person to person and the time spend working in each step will depend also on different variables. All MOHO components are to be considered to be able to reason and make decisions on interventions to follow. 2. The evaluation process is important: Not only the evaluation of the status of occupational participation in the present but also applying the OPHI-II with the person if possible or family/significant others if neccsary to look for their occupational history being very specific in people s volitional process and construction of their identity. In the manual you can also find the importance of the evaluation of people s microreality considerered as their own reality of performance capacities, environmental circumstances and expectations, which gives you guidelines to relate to the volitional process and ways people coyuld live it. 3. The Remotivation Process looks for facilitating the optimal development of the volitional process in a normalized way, offering a continuum of intervention through different Modules of Exploration, Competence and Achievement.

3 4. One important key is to evaluate in which way the person can live the volitional process. When we work with people with problems on attention, memory, organization skills, and other alike, we find that most of the time people can experience volition and make choices, and have difficulties interpreting and anticipating due to their cognitive problems. Experience volition when doing or being part of their occupational context constitutes the strongest fase of the volitional process for them, and in action they make choices of activities. Many of these people are confronted to big changes in their occupational lives and have the need to reconstruct their narratives.. We may ask ourselves, how can they reconstruct their narratives if they can t remember well what they have experienced or they get disorganmized in their performance. The fact of my experiences is that the exploratory phase takes longer time, specially on giving opportunities of significant participation within the range of their past interests and values and the current range of their abilities, consistently enough for them to experience "sense of pleasure and efficacy in action", the fourth phase of exploratory module. This is a period of exploring in action the real current capacities, in no other type of therapy they can experience this, therefore the OT needs to expect possible frustrations, that in the run will be necessary for the person to get to accept their reality. The important aspect here is continously thinking about, in addition to past values, the characteristics of atraction and pattern of interests to guide which kind of different opportunities within that spectrum of atraction and patterns can fit the skills the person has in the present (ie: a young man used to love music participating with friends in dicos, dancing; after a abrupt and tragic brain damage, he could not longer participate of dancing and going to discos, knowing what aspects attracted him to music: following the rythm of music, the feeling of sensing his voice accompanying music, within a social and physical pattern. Opportunities were given to explore playing the drums and other percusion instruments in a musical group who gave shows at different community organizations, new activity for him that gave him sense of pleasure and connected him to his interests, and others. In this way, discovering with the person routines which gives these new opportunities of experiencing themselves, and within these opportunities facilitating decision making and initiative when doing and participating. Patterns of feelings thinking and doing are developed thanks to the repetition of the succesful experiences on time and on consistent environments. This principle of occupational participation is crucial. Another young man with these characteristics after a time exploring new options (respecting his volitional process and identity), had been an extraordinary student at University and he could not accept his life without participating in his role of student and being the best. We offered him to explore this alternative participating first at a program in

4 Reencuentros (Community Integration Program) to help to enter and participate in educational programs at the comunity. This program allowed people to evaluate community options, own skills, environmental impact and their own interests and goals, through group discussions, revision of resourses, self assessments, exploring alternatives in the Community, and participating in educational group activities such us preparing topics and presenting to the group, then self assessment and evaluation form others. The goal set with him was to explore his skills and see by himself if he could continue his studies. Despite seeing his difficulties through experience and discover his skils in other types of occupation, he could not accept to pursue another goal. Results of VQ were low, his personal causation specially. We taked and decided to go to his University with him and ask the Dean and Director of Ingeneering (?) to open the opportunity for him to attend and participate in two classes of his choice during a semester. In constant communication with his professors, we had information of his process. He showed an strong commitment in all activities despite all attentional and learning problems. The moment he accepted his difficulties was at the end of the semester when he wrote in his final test "I can t do it".. Exploration can take a long time living the experince of volition through real and significant experiences. During that time we continued working togueter participating in other new options of leisure time and volunteering in tasks he valued and were suitable to complete by him directed to help with administration of the Center. After that moment, he shifted his goals into other productive roles, the volunteer and worker role at the School where he had studied. 5. Having a solid exploratory process, and observing carefully the appearance of some competence level of VQ indicators in conditions are shown in the manual, you can offer more challenge on developing new skills. The feelings of success in some areas of participation could give the strenght to explore other more challenging for the person. KEY : What is the maximum level of satisfaction people can get within his own reality of performance and environmental conditions (including adaptive resources). The aspects of relationship with others beging go in a progress as volition shows some indicators of competence level. If you review the manual, it guides you on how this aspect is facilitated as personal causation grows. Review also expectations about people relating to others according to volitional process development. The envisioning of the future is facilitated through the process. You can integrate evaluating communication interaction skills with ACIS to help you processing which strenghts people begin to develop as volition develops, and also when appropriate begin integrating goals in this area.

5 I think I will finish this message for now. From this, please ask me more specific questions, so I can be more specific.. BIG HUG Carmen Gloria de las Heras, MS, OTR Chile