Ch 2- Theories and Practice Models for OT with Children

How do models of practice help therapists engage in sound therapeutic reasoning?

• They provide structure to guide thinking.

• They address theory but not practice.

• They predict the outcome of intervention.

• They examine physical characteristics of child.

Answer explanation

An occupation-centered practice model addresses the uniqueness of human occupation (i.e. those things that children and youth do that provide them meaning and give them identity).  The models provide terminology, principles, assessment and intervention methods that occupational therapists can use to help children and youth regain their roles and occupations for improved life satisfaction and quality of life (Fisher, 2013). Occupation-centered practice models provide structure to guide one’s thinking and subsequent intervention planning to enable children and youth to engage in those things that are important to them. The models assist occupational therapists in understanding the child’s strengths, challenges and goals that can be addressed in therapy (O’Brien, Stoffel, Fisher, & Iwama, in press).  Models also encourage occupational therapists to examine the broader picture when considering occupational performance.  At times, the most important barriers or facilitators of performance are external to the person.  Contextual factors may be critical.

Which of the following statements best describes the benefit of using an occupation-centered practice model?

• Addresses the unique value of occupation

• Provides intervention protocols

• Provides specific intervention activities

• Addresses child’s limitations in skills

Answer explanation

Using an occupation-centered practice model allows occupational therapists to address the unique value of occupation during evaluation and intervention while also addressing broader contextual or societal conditions that may support occupation.  Models of practice provide the overarching framework and structure, while a frame of reference serves to provide specific intervention activities or techniques for specific populations or conditions.

Which model of practice emphasizes the child’s subjective experience of his/her abilities?

• Occupational Adaptation

• Model of Human Occupation

• Person-Environment-Occupation-Performance Model

• Canadian Model of Occupational Performance and Engagement

Answer explanation

According to Model of Human Occupation, performance capacity refers to the person’s mental and physical abilities required to participate in daily activities as well as the person’s subjective experience and view of their occupational performance (Taylor & Kielhofner, 2017). MOHO expands performance capacity to include the child’s personal experience and viewpoint of his/her abilities.  The child’s subjective experience of his/her performance is important to the child’s occupational identity.  For example, a child may perceive that he is not a “good student” because he struggles with writing.  These feelings may cause him to feel anxious and unsuccessful in his student role and cause him to dislike school.  He may doubt his academic abilities, when in fact handwriting is only a part of education.  Because he feels like he does not adequately fulfill his student role, he may develop feelings of occupational incompetence leading to decreased performance in many areas of school.  Occupational therapists using MOHO as their model of practice examine both the objective (physical and mental abilities) and the child’s subjective experiences.

Which frame of reference provides an environment in which the child decides to select activities that require responses to movement, balance, weight bearing, and tactile activities?

• Motor control/motor learning

• Ayres’ sensory integration

• Neurodevelopmental treatment

• Developmental

Answer explanation

Occupational therapy intervention using the SI FOR includes the use of controlled multi-sensory activities that require the child make an adaptive response.  Intervention is child-directed, fun, and includes vestibular, proprioceptive and/or tactile input (See Figure 2-10). Children are engaged in activities for which they must respond and adapt.  SI intervention focuses on creating opportunities for children to develop improved movement (praxis), body awareness, and overall sensory processing to allow for improved participation and success in daily occupations (such as academic, self-care, and play).  Children who receive SI intervention may also develop improved self-efficacy and self-confidence as they master new tasks and are successful completing novel movement experiences and activities.  Table 2 -3 outlines the principles of ASI.

Which frame of reference emphasizes techniques to teach children movement that resemble coaching?

• Motor control/motor learning

• Rehabilitation

• Biomechanical

• Ayres’ sensory integration

Answer explanation

Occupational therapists promote motor learning by using feedback (knowledge of results and knowledge of performance), practice (blocked, random, or variable), demonstration and mental imagery to promote movement.  They examine the task and activity demands to determine which motor learning strategies to use to improve performance.Some of the key techniques that occupational therapists use in this FOR are giving verbal instructions and demonstrating movement strategies. Verbal instructions focus on the relationship between the child and the objects in the environment and emphasize key movement features directly related to achievement of the functional goal (Figure 2-7) (Gentile, 1998). Physical or manual guidance can be helpful during the initial teaching of a movement because it may clarify the goal, guide selective attention, and help the child organize and plan the movement. Researchers stress that guidance or facilitation of movement should be removed as soon as possible, arguing that the occupational therapist rapidly becomes part of the environment, which alters the performance context and the intrinsic feedback available to the child (Gentile, 1998).