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Planning Process for Occupational Therapy Treatment Continuum

The planning process for building an adult occupational therapy treatment continuum is essentaial to the existence of the profession as well as imperative to protecting your reputation as a competent medical professional. You don’t just do self-care activities and IADLs!!! Remember that your job is to take all of the human anatomy, physiology, neurology, and medical diagnoses that you have learned and created a realistic and evidence-based treatment plan that will last 8-12 weeks (or however long your plan is). It is not treatment to treatment – you must be always moving toward the big picture! 

Edema and Swelling - Planning Occupational Therapy Treatment

FIRST

Swelling and Pain

Remember that swelling is not always a bad thing though this physiological response can lead to very uncomfortable fall out! As a practitioner, your job is to support this crucial stage in the healing process. Allow the body to do what it needs to do while minimizing unnecessary discomfort and increasing efficient return to ‘typical’ function.

      1. Decreasing pain and Promoting swelling Absorption 
      2. How?
          • Therapeutic modalities
          • Manual techniques
          • Therapeutic exercises and Movement
Range of Motion - Planning Occupational Therapy Treatment

Second

Range of Motion

First, address arthrokinematic movement which occurs between joint surfaces and consists of three different patterns

      1. Roll – “rocking” motion
      2. Glide– Movement of a rigid object across another rigid and stationary surface
      3.  Spin

**During joint movement, these arthrokinematic movements occur simultaneously with the express purpose of maintaining joint congruency**

**You can only move on to addressing  osteokinematic movement when arthrokinematic movement is restored or maximized

Second, address osteokinematic movement which are body structures that form angles can be measured for quantitative measures

Types of Osteokinematic Movements

Osteokinematic movements:

    1.  Flexion and Extension
    2.  Abduction and Adduction
    3.  internal and external rotation
    4.  protraction and retraction
    5.  plantarflexion and dorsiflexion
    6.  inversion and eversion
    7.  Opposition
    8.   lateral deviation
    9.  elevation and depression
    10.  upward rotation and downward rotation
    11.  lateral flexion
    12.  right rotation and left rotation
    13.  pronation and supination
    14.  ulnar deviation and Radial deviation
Strength and Endurance - Planning Occupational Therapy Treatment

THIRD

Strength and Endurance

    1. As a result of decreased muscle elasticity and lack of strength, ROM may be affected. Although the joint integrity is fine, lack of strength and elasticity may be affecting ROM which will require you to work on BOTH ROM and strength simultaneously
    2. In order to increase muscle FUNCTION, you must design a plan of care that increases strength, endurance, and power 
      1. Muscular strength –  the ability of a muscle to produce Force against resistance
      2. Muscular endurance-  requires different physiological characteristics in the muscle and refers to the ability of the muscle to produce force over time
      3. Power-  the ability of the muscle to produce Force quickly and because it requires a foundation of muscular strength, it should not be directly addressed until that Foundation has been established
Neuromuscular and Balance - Planning Occupational Therapy Treatment

FOURTH

Neuromuscular and Balance

    1. Both neuromuscular control and the client’s ability to balance require integration of multiple body systems across several regions, and are more functional
      1. Neuromuscular control is the unconscious efferent response to an afferent signal
        1. More information on neuromuscular re-education  
      2. Balance is the ability to maintain a center of gravity within a base of support; that is the ability not to fall
        1. More information on Occupational Therapy Balance treatments on Balance treatments  
Functional Progression - Planning Occupational Therapy Treatment

FIFTH

Functional Progression 

This step is what you have been taught as “occupation-based activity”.

You can NOT give someone an occupation-based activity to do as ‘rehabilitation in any capacity until you ensure they have the adequate functions, structures, and performance skills and tools to perform that particular activity. This is not an evidence-based practice. What is evidence-based is ensuring every treatment is meaningful to the client and works toward goals set through a collaboration between client and practitioner. But this does not mean perform self-care, wash windows, fold clothing, and put simulated groceries away over and over and over again until your patient is magically healed. This is not occupational therapy. Be better than this. 

    1. Functional Progression moves the client from the basic ability to function towards the ability to complete all desired occupations to the desired standard.
    2. You can’t just jump to this step without risking injury for your client, exemplifying questionable clinical practices, and risking long-term dysfunctional movement patterns for your client. 

Listen to this episode of the Re-Think OT Podcast on Building an Occupation Therapy Treatment