OPM Book

Occupational Performance Model (Australia) Monograph1, April, 1997

This aim of this paper is to present an example of how the Occupational Performance Model (Australia) (Chapparo & Ranka, 1996) can be used to guide occupational therapists in their prescription of upper limb orthotics with clients whose hand function has been compromised by spinal cord injury. The example presented is an extension of an action research project originally completed by Ranka, Colyer, Dickson and Chow (1994) in which an earlier version of Occupational Performance (Chapparo & Ranka, 1992) was used as the foundation for an upper limb orthotic program.

Nine normal male subjects, between 60-79 years old participated in a study designed to determine the effect of wrist immobilisation on upper limb occupational performance. An upper limb measurement system using the Motion Analysis System, ExpertvisionTM was developed and this was used to quantify and describe the three dimensional movement of the subjects during performance on the Jebsen Hand Function test. Comparisons of the time, and range of the upper limb movement between the free and immobilised wrist condition were made. Results revealed statistically significant increases in the time taken and the total degree of shoulder motion used, as well as significant decreases in the total elbow motion during the immobilised condition. Results also showed great variation in the effect of wrist immobilisation on upper limb joints. These reinforce the need for occupational therapists to evaluate the upper limb as an entity and to evaluate each client on an individual basis when immobilising the wrist. The upper limb measurement system in this study provides future direction for research methodology that can analyze the effects of orthotic intervention on everyday occupational performance.

Combinations of spasticity, dyskinesis and reduced isolated control are found in almost every child with cerebral palsy. This abnormal tone and movement can seriously interfere with upper limb motor performance in young children. The resulting malalignment of joints and abnormal pattern of muscle action affect the quality of fine motor control required for prehension and bilateral use. This in turn reduces the repertoire of reach, grasp and release patterns available to the child for everyday occupational performance tasks.

Occupational therapists who provide direct service to young children with cerebral palsy seek to improve the quality of upper limb movements during the performance of occupational tasks. As an adjunct to play and work related modes of intervention, therapists often apply various upper limb orthotic systems to encourage the carryover of gains made in therapy.

Controversy has existed for many years over the use of casting as an orthotic system to manage young children with cerebral palsy. Therapy literature reveals little support for upper limb casting, reflecting instead, occupational therapists preference for the use of thermoplastic orthoses. Few articles exist to support the clinical impression that casting of the wrist improves active wrist and hand control in children who demonstrate active and functional motion.

The purpose of this paper is to present case studies that illustrate the results of a serial inhibitory casting program for two preschool children with cerebral palsy.

In 1995, the Occupational Therapy Department at Westmead Hospital had an extensive waiting list for children with Perceptual Motor Dysfunction. Perceptual Motor Dysfunction is a term used to describe preschool and school-aged children of normal intelligence, with no identifiable neurological pathology, who may have difficulties in fine motor skills, general coordination, handwriting, perception and learning (Wallen & Walker, 1995).

Strategies were implemented to reduce the waiting time for intervention. One such strategy, group intervention, was trialled for children with handwriting difficulties as an alternate approach to traditional individual intervention. Handwriting was chosen as the focus for a group intervention because handwriting difficulty was one of the most frequent reasons that school-aged children were being referred to occupational therapy.

Children with learning disabilities form a large portion of most general paediatric occupational therapy practices. The children are referred for assessment and intervention for difficulties with writing, coordination, perception, perceptual motor and self help skill development. For most of these children, the level of ability, independence and organisation in many areas of their life is effected by the pervasive nature of the disability.

Over the last twenty years, sensory integration theory and practice (Ayres, 1972a, 1972b; Fisher, Murray & Bundy, 1991) has been a major and evolving form of intervention used by occupational therapists for children with learning disabilities who also have sensory integrative dysfunction. Research investigating the effectiveness of therapy using sensory integrative procedures has concentrated on the gains made in coordination, learning and behaviour (see for example, Ayres, 1972a, l977, l985; Ayres & Mailloux, 1981; Ayres & Tickle, 1980; Grimwood & Rutherford, 1980; Humphries et al, 1990; Parham, 1990). There has been little documentation of research that measures the change to the overall adjustment in the day to day life of the child who is receiving sensory integrative intervention. It is well recognised clinically, however, that "sensory integration and the corresponding adaptive behaviours lead to organised and appropriate occupational behaviour, including self-care and self-management, play and academic skills" (Fisher, Murray & Bundy, 1991.p.22).

Children with severe and multiple disabilities "constitute a substantial portion of the total occupational therapy population" (Clancy & Clarke, 1990,p.162). As members of most therapy and educational service delivery teams, occupational therapists are often asked to assume prominent roles in designing and implementing therapeutic programs for these children. Although they are often classified according to their sensory, motor or intellectual impairment, they are regarded by occupational therapists as first and foremost whole, multifaceted individuals with unique existence in the social and physical world (Nelson, 1984). Each child's developmental needs are broad, deep and complex, radiating into all aspects of occupational performance. While improving performance of occupational tasks in areas of self-maintenance, school, play and rest are important concerns, establishing an occupational identity through occupational roles, is considered fundamental to occupational therapy intervention for children with multiple disability.

The purpose of this paper is to demonstrate how the Occupational Performance Model (Australia) (Chapparo & Ranka, 1996) has been applied within this setting to guide the scope and the focus of planned intervention.

This will be accomplished through examination of one case study. Using selected constructs within the model, discussion of the case will include an outline of:

In practice, the majority of occupational therapists concern themselves with activities of daily living and productivity-related issues (Graham, 1990; Gregory, Fairgrieve, Anderson & Hammond, 1992; Powell, 1994). Occupational performance is often viewed in limited terms of self-maintenance and productivity. Additionally, therapists place emphasis on: a) the biomechanical, sensory motor and cognitive components of performance; and b) the physical environment. Less emphasis is placed on: a) leisure and rest aspects of performance; b) the interpersonal and intrapersonal components of performance; c) the social, sensory and cultural environments; and d) the body/mind/spirit core elements of human existance, all of which, at least theoretically, influence a person’s occupational performance (Chapparo & Ranka, 1993). These restricted views of occupational performance do not mirror the profession’s holistic theoretical and philosophical foundations (See for example, Meyer, 1922).

This paper is an introduction to research which investigates the occupational role performance of men who have had a stroke and are living at home. It contains a discussion of the nature of life roles and of their occupational roles in particular. The conceptual framework for this research is a person centred occupational performance model. The rationale for using this approach is given and the data collection methods are briefly described. Preliminary findings are presented, together with a case history to illustrate these findings