Occupational therapy programs tables of content

References
Bottomley, J.M. (1994). Principles and practice in geriatric rehabilitation. In. D.G. Satin (Ed.), The clinical care of the aged person (pp 230-280). New York: Oxford University Press*
Caplan, LR, Dyken, ML & Easton JD (1994). American Heart Association family guide to stroke treatment, recovery, and prevention. New York: Times Books*
Coni, N, Davidson, W, & Webster, S (1992). Aging. The facts (2^nd ed.). New York: Oxford University Press*
Craik, RL, (1993). Sensorimotor changes and adaptation in the older adult. In A.A. Guccione (Ed.), Geriatric Physical Therapy (pp 71-98) Boston: Mosby*
Ellul, J., Watkins, C., Ferguson, N, Barer, D, & Rowe, J (1993). Increasing patient engagement in rehabilitation activities. Clinical Rehabilitation, 7, 297-302.
Hasselkus, BR (1989). Occupational and physical therapy in geriatrics. Physical & Occupational Therapy in Geriatrics, 7 (3), 3-20.
Hasselkus, BR (1993). Functional disability in older adults. In HL Hopkins & HD Smith (Eds.), Willard and Spackman’s Occupational Therapy (8^th ed.) (pp 742-752). Philadelphia: JB Lippincott.
Hergenhahn, BR (1976). An introduction to theories of learning. Englewood Cliffs NJ: Prentice-Hall, Inc.
Hintzman, DL (1978). The psychology of learning and memory. San Francisco: WH Freeman and Company.
Isaacs, B. (1992). The challenge of geriatric medicine. New York: Oxford University Press*
Johnson Allinder, JE (1993) Sensory loss: Deafness and blindness. In HL Hopkins & HD Smith (Eds) Willard and Spackman’s Occupational Therapy (8^th ed) (pp 706-715). Philadelphia: JB Lippincott*
Kantowitz, BH & Roediger III, HL Gazda (1980). Memory and information processing. In GM Gazda & RJ Corsini (Eds) Theories of learning (pp 332-369). Itasca, IL: FE Peacock Publishers, Inc.
Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., & Pollack, N (1990). The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57 82-87.
Levine, RE & Gitlin, LN (1993). A model to promote activity competence in elders. American Journal of Occupational Therapy, 47 147-153.
Lezak, MD (1983). Neuropsychological assessment. New York: Oxford University Press.
Levy, LL (1993). Late adulthood. In HL Hopkins & HD Smith (Eds), Willard and Spackman’s Occupational Therapy (8^th ed). (pp 130-136). Philadelphia: JB Lippincott*
Lovett, SB & Rose, JM (1993). Low vision rehabilitation with older adults. NeruoRehabilitation, 1 (3). 26-33*

Neistadt, ME (1994). The neurobiology of learning: Implications for treatment of adults with brain injury.  American Journal of Occupational Therapy, 48 421-430.

Neistadt, ME (in press). Assessing learning capabilities during cognitive and perceptual evaluations for adults with traumatic brain injury. Occupational Therapy in Health Care.
Ormrod, JE (1990). Human Learning. Principles, theories, and educational applications. New York: Maxwell Macmillan International Publishing Group.
Pollock, N (1993). Client-centered assessment. American Journal of Occupational Therapy, 47. 298-302.
Rob, D. (1991). The caregivers guide. Helping elderly relatives cope with health and safety problems. Boston: Houghton Mifflin Co. *
Rogers, JC (1993). Geriatric psychiatry. In HL Hopkins & HD Smith (Eds), Willard and Spackman’s Occupational Therapy (8^th ed) (pp 753-764). Philadelphia: JB Lippincott.
Satin, DG (1994). Emotional and cognitive issues in the care of the aged. In DG Satin (Ed), The clinical care of the aged person (pp 62-107). New York: Oxford University Press*
Schunk, C. (1993). Cognitive impairment. In AA Guccione (Ed), Geriatric Physical Therapy (pp 139-148). Boston: Mosby.
Smith, CA (1988). Sensory stimulation and ADL performance: A single case study approach. Physical & Occupational Therapy in Geriatrics, 6 (3), 43-57.
Tappen, RM (1994). The effect of skill training on functional abilities of nursing home residents with dementia. Research in Nursing and Health, 17 159-165.
Tideikssar, R (1993). Falls and instability in elderly. NeuroRehab8ilitation, 1 (3), 51-61*
Toglia, J (1991). Generalization of treatment: A multicontext approach to cognitive perceptual impairment in adults with brain injury. American Journal of Occupational Therapy, 45, 505-516.
Wharton, MA (1993). Environmental design: Accommodating sensory changes in the elderly. In AA Guccione (Ed), Geriatric Physical Therapy (pp 125-138). Boston: Mosby*

WORK SIMPLIFICATION HANDOUT, CONTINUED

Rate of Work - If you double your work speed, you will use two or three times the energy each minute. You may find that you can safely do a job that would usually be too hard on your simply by doing it at a slower pace.
A slow, steady rate of work with short rest periods, will get the job done without doing you

in. Remember that fast walking takes 1 ½ times as much energy as slow walking; walking

up stairs takes 7 times as much as walking on level ground.
Rest - Frequent short rest periods are a must whether at home or work. Short rest periods are of more benefit than fewer long rests.
Distribution of Work Load - Peak loads for short periods may call for more energy at one time than you can afford. Avoid straining yourself in emergencies. Don’t try to do a two-man job yourself.
Weather - You cannot do as much work safely on a hot, humid day as on a cool one. In addition to supplying the working muscles with blood, the head must also supply a great flow of blood to the skin to keep the body cool. In hot weather direct sunlight increases strain on the body, so keep in the shade. Also be well dressed and don’t over do it when out in the cold winter weather.
Physical Conditioning - It pays to keep in good physical condition through regular, moderate activity.
Weight - keep your weight normal; excess weight overworks the heart and lungs.
Age - An older person cannot work as hard as he did when he was young. Generally speaking, at age fifty, your capacity, assuming good health will be about 70% of what it was at age twenty-five; at age seventy it will be about 50%.
Emotions - Worries, fears and tension will prevent you from relaxing during rest. These emotional stresses place an extra burden on the heart.
In order to protect yourself and avoid endangering others, ask your doctor to tell you if

certain activities should be avoided.

Table 1: Sensory Detection Errors/Visual Deficits and Treatment Strategies.

VISUAL DEFICITS (Characteristic Behavior)	Treatment/Training Strategies
DECREASED ACUITY (Groping, squinting, complaints of inability to see)	Clean eyeglasses Better lighting Larger Print Magnifying lens Organized environment (easier to find objects)
DECREASED ABILITY TO SCREEN OUT GLARE (Shields eyes, squints, reports sharp pains in eyes in bright light)	Indirect flourescent lights Task lighting Minimal use of shiny surfaces (glass, vinyl) No glare wax on floors No wax on furniture Sheer curtains, blinds, drapes Position chairs so not facing direct sunlight
DECREASED COLOR DISCRIMINATION (Difficulty seeing blues, greens)	Use red-yellow end of color spectrum as much as possible (signs, furniture, wall coverings
DECREASED ABILITY TO DISTINGUISH CONTRAST (Groping for objects, reports not seeing objects in low contrast situations)	Create high contrast for functional activities (dark background with light objects) Mark edges of stairs Large print, high contrast dials for appliances Furniture distinct from floor coverings
DECREASED ABILITY TO ACCOMMODATE TO LIGHT CHANGES (Night blindness)	Night lights (red) Light switches, lamps at entrances to rooms Pause before entering a room

Information derived from sources with asterisks in reference list

Table 2: Sensory Detection Errors/Auditory Deficits and Treatment Strategies.

AUDITORY DEFICITS (Characteristic Behavior)	Treatment/Training Strategies
DECREASED ABILITY TO HEAR HIGH FREQUENCY SOUNDS (Misses high pitched sounds like consonants, timer bells)	Alarms at a lower frequency Flashing lights for some alarms Speak in lower voice registers Use gesture, facial expressions to augment communication
DECREASED DISCRIMINATION OF SOUNDS (Asks for repetition)	Speak slowly and clearly Decrease background noise Use gesture, facial expressions to augment communication
DECREASED ABILITY TO SEPARATE ONE SOUND OR VOICE FROM BACKGROUND NOISE (Asks for repetition) (Difficulty seeing blues, greens)	Decrease background noise Use gesture, facial expression to augment communication
MUFFLED SOUNDS (Asks you to speak up; speaks softly)	Increase voice volume Hearing aid Use gesture, facial expressions to augment communication
SLOWED PROCESSING (Looks puzzled)	Speak slowly, with pauses between sentences Use demonstration Use gesture, facial expressions to augment communication

Information derived from sources with asterisks in reference list

Table 3: Sensory Detection Errors/Proprioceptive and Tactile Deficits and Treatment Strategies

PROPRIOCEPTION DEFICITS (Characteristic Behavior)	Treatment/Training Strategies
DECREASED ABILITY TO JUDGE POSITION OF LEGS AND TRUNK (Increased postural sway)	Teach increased use of vision to compensate for proprioception loss Good lighting Mirrors for movement training
TACTILE DEFICIT (Characteristic Behavior)	Treatment/Training Strategies
DECREASED ABILITY TO DETECT NOXIOUS STIMULI (Prone to minor burns, abrasions)	Textured surfaces on walls Textured doorknobs, railings

Information derived from sources with asterisks in reference list

Table 4: Central Nervous System Processing Deficits and Treatment Strategies

CENTRAL NERVOUS SYSTEM PROCESSING DEFICIT (Characteristic Behavior)	Treatment/Training Strategies
SLOWED PROCESSING (Slowed performance)	Give directions slowly Give one or two steps at a time in directions Decreased distractions in performance environment (uncluttered room) Allow increased time for task completion
DIFFICULTY WITH LEARNING (Difficulty transferring learning from one situation to another)	Use familiar, overlearned activities Stick to regular routines as closely as possible Repetition & practice Simplify tasks (preprogrammed phones) Familiar environments Use whole, not part activity practice
MISINTERPRETS INCOMING DATA & OVER RELIANCE ON PREVIOUSLY LEARNED CONCEPTS (Unsafe task performance)	Find out more about misinterpretation Explore emotional need connected to misinterpretation Clarify the data Ask the person if his/her interpretation matches the data
POOR DECISIONS BASED ON MISMATCH BETWEEN CURRENT ABILITIES & TASK REQUIREMENTS (Unsafe task performance)	Simplify task/environment Clarify person’s concept of abilities Explore emotional issues related to concepts of ability Ask person if his/her interpretations matches Support groups Social support network
DECREASED MEMORY RE: SEQUENCE (Leave tasks unfinished, may leave water boiling)	Picture cards posted on bathroom mirror, refrigerator, etc. re: activity steps Tape recorders re: sequence of steps Smoke alarms Low pitched timers Appliances that shut off automatically Microwave oven Consistent routines
FAULTY MOTOR PROGRAMS (Awkward, inappropriate movements)	Hand over hand Repetition Simplify movement requirements of task

Information derived from sources with asterisks in reference list

Table 5: Motor Execution Deficits and Treatment Strategies

MOTOR EXECUTION DEFICITS (Characteristic Behavior)	Treatment/Training Strategies
MUSCLE WEAKNESS (Difficulty lifting self and objects)	Weight lifting programs
DECREASED FLEXIBILITY (Difficulty moving joints)	Range of motion exercises Long handles reachers, sponges, shoehorns, sock aides, elastic shoe laces
DECREASED COORDINATION (Awkward movement)	Modify activities to reduce coordination demands (pullovers) Practice coordination in functional tasks
TREMORS (Shaky movements)	Modify activities for safety (sliding, not lifting pots)
DECREASED ENDURANCE (Fatigues easily)	Increase activity during day Organize daily tasks more efficiently Aerobic exercise programs
INSTABILITY (Tends to lose balance easily)	Modify activities for safety (tub seats) Increase activity levels

insert functional expectations for spinal cord injured patients here!


OCCUPATIONAL THERAPY

PROGRAMS

Section 26

Occupational Therapy Services for Alzheimer’s Disease and Related Disorders (Position Paper)

The American Occupational Therapy Association submits this paper to identify and illustrate occupational therapy services used in managing irreversible dementing illnesses such as Alzheimer’s disease.
Occupational therapy is a health care profession that trains individuals with mental, emotional, and physical impairments to be as self-sufficient in self-care, work and leisure occupations as their capabilities allow. The philosophy of occupational therapy rests on the belief that purposeful activity is needed to promote wellness and to prevent the debilitating effects of inactivity, such as muscle atrophy, contractures, constipation, depression, and confusion.
In regard to individuals with dementia, occupational therapy focuses on personal self-care and independent living skills. In the early stages of cognitive decline, attention may be directed toward the continued capacity for work (Snow & Rogers, 1985: Wilson, Grant, Witney, & Kerridge, 1973).
Irreversible dementia is a chronic disease accompanied by a progressive loss of cognitive and motoric ability that results in severe incapacity. Occupational therapy involves a continuous simplification of tasks and the task environment so that the tasks remain within the individual’s decreasing capabilities. These simplifications help the person to retain as much control as possible over his or her own life and to maintain a sense of personal dignity. The realization of maximal self-care capacity at each stage of impairment assists in projecting positive, yet realistic, expectations of the individual to care givers. In view of the multiple incapacities resulting from cognitive impairment, teaching care givers how to manage these incapacities is a salient component of the occupational therapy process.
Occupational Therapy Assessment

Occupational Therapy begins with a comprehensive assessment of the patient’s functional capabilities and limitations. The assessment focuses on personal self-care, home management, and leisure activities. Self-care may include feeding, food ingestion (swallowing), dressing, using the commode, hair and nail care, bathing, mobility skills, and shaving and putting on makeup if appropriate. Home management encompasses a wide range of skills needed to maintain independent living, such as telephoning, shopping, preparing meals, washing clothes, cleaning house, managing finances, doing home repairs, and gardening. Leisure activities are appraised to determine interest, skill, and level of participation. If dementia is recognized early, an evaluation of work skills may be indicated. Consideration is also given to finding an acceptable substitute for work when employment becomes infeasible (Olin. 1985: Snow & Rogers, 1985). Because the performance of self-care, work, and leisure tasks requires the use of objects, equipment, and space, an evaluation of the environmental factors that promote and hinder function is a critical component of the assessment (Kiernal, 1982: Skolaski-Pellitteri, 1983: Skolaski-Perllitteri, 1984).

The assessment considers the patient’s daily or routine involvement in activities of daily living and the patient’s actual ability to initiate and complete these tasks. Data on daily habits are obtained by interviewing the patient, family members, and other care givers. Information on the patient’s performance

is obtained by observing the patient doing activities at home, at work or in the occupational therapy clinic. The assessment gives a description of the tasks that the patient can do independently, easily, and safely; the tasks that are accomplished only with difficulty; and those tasks for which physical assistance, supervision, verbal prompts, or demonstration is required (Skurla, 1984).

By observing the patient’s task performance, the occupational therapist also obtains information on the factors causing performance dysfunctions. For example, a patient may be unable to put on shoes because of joint restrictions at the hip, a deficit in the visual-spatial skills needed to place the shoe on the foot, or an inability to remember the location of the shoes. As this example suggests, the functional disabilities of cognitively impaired patients may be due to physical as well as mental factors. The occupational therapist would evaluate these inhibiting factors further (i.e., range of motion restrictions, visual-spatial skills, and functional memory) to obtain more precise understanding of the nature of the patient’s occupational performance dysfunction.
The evaluation of task performance takes into account the balance of activity and inactivity in the patient’s daily life. While too little activity during a given time period can induce lethargy, too much activity can precipitate confusion and catastrophic reactions. To minimize these adverse behaviors, the occupational therapist seeks to determine what constitutes a healthy balance of activity and inactivity for each patient.
Uses for the Assessment

In addition to serving as a guide for selecting the appropriate kind of occupational therapy intervention and as a baseline for such intervention, the assessment may be used for several other purposes. First, it may be used to facilitate decisions about level of care, placement, and guardianship. The patient’s functional status provides a basis for determining the continued feasibility of independent living, the need for supportive services in the home, or at least restrictive living situation if residential care is indicated. Similarly, work evaluation contributes to decisions concerning continued employment, job redesign, and job reassignment.

Secod, in acute medical or psychiatric facilities, the initial occupational therapy assessment may be used in conjunction with periodic reassessments to ascertain the effects of medical treatment on daily living skills. For example, a medication given to control combative behavior may precipitate rigidity and adversely affect the patient’s ability to carry out skilled activities. A reduced dose or a different drug may control psychiatric symptoms and not influence functional capacity adversely. Thus, the behavioral observations made under the controlled conditions of the occupational therapy assessment may be useful in monitoring drug management regimens.
Third, the assessment may make a significant contribution to the differential diagnosis of dementia and pseudodementia. Typically, patients with dementia exhibit a breakdown in task performance skills. Those patients with depression retain these skills but demonstrate a breakdown in daily living routines. By observing the patient’s task performance, evidence of the nature of the impairment is obtained.
Fourth, because of its reliance on observation, the occupational therapy assessment can provide useful information about patients with severe cognitive impairment. For such patients, the usefulness of interviewing and standardized testing is restricted because these methods generally fail to provide meaningful information.