PUTTING THE ‘FUN’ IN ‘FUNCTIONAL’ Mackenzie Schumacher, OTS

THE IMPORTANCE OF OCCUPATION-BASED TREATMENT

OBJECTIVES
•Define and classify the 8 areas of occupation
•Discuss the importance of occupation and using
meaningful interventions during treatment
•Review of current literature: Using occupation in treatment
•Provide real-life examples of occupation-based
treatment
WHAT IS AN
OCCUPATION?
In occupational therapy,
occupations are the
everyday activities that
people do to occupy their
time. These everyday
activities bring meaning
and purpose to an
individual's
life. Occupations include
things people need to,
want to, and are expected
to do (WFOT 2012).
 Activities of
Daily Living
(ADLs) Instrumental
Sleep/Rest activities of
daily living
(IADLs)

Social Areas of Education

Participation
occupation

Leisure Work

Play
Credit: https://www.youtube.com/watch?v=Ud5Fp279g4Y
WHY ARE OCCUPATIONS IMPORTANT?
•People want and need to be active.
When an individual engages in
satisfactory, meaningful occupations, they
are promoting their health and wellbeing
(Wilcock, 1998).

•Occupations help develop our personal

and social identity (Yerxa et al, 1989), as well as
give an individual a sense of purpose
(Christiansen and Townsend, 2004).
MEANINGFUL OCCUPATIONS IMPROVE LIVES!
•Occupations that keep older adults active lower the incidence
of depression (Vance, Wadley, Ball, Roenker, Rizzo, 2005).
•Jacob, Guptill, and Sumsion (2009) reported that participants
who sang in a choir reported a sense of community and
accomplishment, stress reduction, and an improved mood.
•Inmates at Fulton County in Atlanta were matched up with
dogs from a local shelter for 2 months. Inmates reported
feeling a sense of responsibility and purpose (Liebson, 2017).
•Participants in a dance class for individuals with Parkinson’s
disease reported improvements in mood, balance, and ability
to complete tasks around the house (Beauchamp, Heinkele, Hoogstra, &
Schumacher, 2018).
OCCUPATION AS A MEANS
•Trombly (1995) defines occupation-as-means as
“a specific occupation, determined by the client’s
choice or interests, is used as a means in therapy
to bring about a change in a person’s
performance”.
• Must be: purposeful, include client-centered
goals, and involve active and voluntary
participant by the client
• Using occupation-as-means is only successful if
the activity is meaningful to the client (Hinojosa,
Kramer, Royeen, and Leubben, 2003).
 “To improve the
satisfaction and capacity
of individuals, groups, and
society, for engaging in
desired occupations where
and when they naturally
occur. Such engagement
enhances values and roles,
positively influences
overall health and quality
of life, and assists in
developing and
reaffirming the identify of
individuals or groups”
(UNH, College of health and human
OCCUPATION BASED PRACTICE services, 2012, para. 2).
CURRENT LITERATURE
• A case study by Jack and Estes (2010) highlighted a shift
from a biomechanical frame to an occupational
adaptation frame. The participant reported
improvements in self-ratings of occupational performance,
including tasks that involved supination, holding a book,
manipulating window controls, and static grasp of a cup
(p. 86)
• Ma and Trombly (2002) found that homemaking tasks
resulted in greater improvement of cognitive ability when
compared to paper-and-pencil drills for individuals after
a stroke.
• Individuals who have experienced a stroke showed
improvements in ADL performance and a reduced risk of
deterioration after receiving occupational therapy that
focused specifically on ADLs (Legg et al., 2007).
CURRENT LITERATURE
•Earley and Shannon (2006) conducted a case study with an individual
with shoulder adhesive capsulitis and concluded that occupation-
based interventions should be initiated as soon as a diagnosis is
identified.
• Decreased pain, improved range and quality of motion, and
enhanced occupational performance
•Colaianni and Provident (2010) reported that participants felt
occupation-based treatments were effective because they were more
motivating and gave “a sense of ownership, if not expertise, in the
activity with which they are familiar” (p. 138).
 COMPARISON OF THERAPEUTIC ACTIVITIES WITH
THERAPEUTIC EXERCISES IN THE REHABILITATION OF YOUNG
ADULT PATIENTS WITH HAND INJURIES
Umet Guzelkucuk, Iltekin Duman, Mehmet Ali Taskaynatan, and Kemal Dincer
•Purpose was to compare the efficiency of therapeutic activities that mimic ADLs with
that of traditionally used therapeutic exercises in the management of injured hands in
young adults.
•36 participants having functional loss due to hand injury
• Control group: exercise program including passive, active assistive, and active range
of motion, strengthening exercises, physical modalities, 2x daily
• Study group: 1 session of the exercise program daily combined with 1 session of
therapeutic exercises
•Results showed that both groups improved in each parameter, but the study group
showed better results in all parameters. They concluded that these results showed that
the therapeutic activities mimicking the ADLs might improve hand function more
effectively.
EXAMPLES OF OCCUPATION-BASED ACTIVITIES

•Reaching to put dishes

in a cabinet
•Preparing a meal
•Climbing up and down
stairs while carrying •Lifting a box
laundry •Sweeping, mopping, or
•Carrying a bag of vacuuming
groceries •Getting dressed
•Bending down to pick •Gardening
up a child
•Feeding a pet
•Folding laundry
WHICH PATIENT IS PERFORMING A MORE
FUNCTIONAL TASK?
WHICH PATIENT IS PERFORMING A MORE
FUNCTIONAL TASK?
REAL-LIFE EXAMPLES
•Addressing standing balance while cutting
brownies
•Putting together a puzzle to work on problem
solving and fine motor coordination
•LSVT Loud and Big incorporated into a dance
program
•Work hardening activities
•Working on activity endurance during ADLs

Does anyone have any other examples of

occupation-based treatment that they have used
or observed?
IN SUMMARY, OCCUPATION-BASED THERAPY…
•Is client centered and individualized
•Encompasses any area of life that is meaningful to an
individual (i.e. cooking, dancing, walking outside,
taking care of a child or pet, etc.)
•Uses functional interventions rather than impairment
based interventions
•Is easily graded up or down
•Addresses different client and environmental factors

And can be used for everyone!!

ARE THERE ANY
QUESTIONS OR
COMMENTS?
REFERENCES
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal
of Occupational Therapy, 68(Suppl. 1), S1– S48. http://dx.doi.org/10.5014/ajot.2014.682006

Bedard, L., & Micko, K. (2013). Fun in Functional: Functional Tool Kits for the Individual Resident in the Nursing Home and ALF [PowerPoint slides].
Retrieved from http://www.hcanj.org/files/2013/10/seminars-convention2012-5.pdf.

Beauchamp, G., Heinkele, I., Hoogstra, E., & Schumacher, M. (2018). Perceived Effects of Ballet and Movement-Based Interventions for
Parkinson's Disease. Manuscript in preparation.

Christiansen, CH, Townsend, EA (2004) Introduction to occupation: the art and science of living. Upper Saddle River, NJ: Prentice Hall.

Colaianni, D., & Provident, I. (2010). The benefits of and challenges to the use of occupation in hand therapy. Occupational Therapy in Health
Care, 24(2), 130-146.

Definition of Occupational Therapy (2016). In World Federation of Occupational Therapists. Retrieved March 23, 2018, from
http://www.wfot.org/aboutus/aboutoccupationaltherapy/definitionofoccupationaltherapy.aspx

Earley, D., & Shannon, M. (2006). The use of occupation-based treatment with a person who has shoulder adhesive capsulitis: a case
report. American Journal of Occupational Therapy, 60(4), 397-403.

Guzelkucuk, U., Duman, I., Taskaynatan, M. A., & Dincer, K. (2007). Comparison of therapeutic activities with therapeutic exercises in the
rehabilitation of young adult patients with hand injuries. Journal of Hand Surgery, 32(9), 1429-1435.

Hinojosa, J., Kramer, P., Royeen, C. B., & Luebben, A. (2003). Core concept of occupation. Perspectives in human occupation: Participation in life, 1-
17.
REFERENCES
Jack, J., & Estes, R. I. (2010). Documenting progress: Hand therapy treatment shift from biomechanical to occupational adaptation. American
Journal of Occupational Therapy, 64(1), 82-87.
Jacob, C., Guptill, C., & Sumsion, T. (2009). Motivation for continuing involvement in a leisure‐based choir: The lived experiences of university choir
members. Journal of Occupational Science, 16(3), 187-193.

Legg, L., Drummond, A., Leonardi-Bee, J., Gladman, J. R. F., Corr, S., Donkervoort, M., . . . Langhorne, P. (2007). Occupational therapy for patients with
problems in personal activities of daily living after stroke: Systematic review of randomised trials. Bmj, 335(7626), 922-925.
10.1136/bmj.39343.466863.55

Ma, H. I., & Trombly, C. A. (2002). A synthesis of the effects of occupational therapy for persons with stroke, Part II: Remediation of impairments. American
Journal of Occupational Therapy, 56(3), 260-274.

Trombly, C. A. (1995). Occupation: Purposefulness and meaningfulness as therapeutic mechanisms. American Journal of Occupational Therapy, 49(10), 960-
972.

University of New Hampshire, College of Health and Human Services. (2012). Occupation-based practice. Retrieved from
http://www.chhs.unh.edu/ot/occupation-based-practice

Vance, D. E., Moore, B. S., Farr, K. F., & Struzick, T. (2008). Procedural memory and emotional attachment in Alzheimer disease: implications for meaningful
and engaging activities. Journal of Neuroscience Nursing, 40(2), 96-102.

Wilcock, A. A. (1998). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65(5), 248-256.

Yerxa, EJ, Clark, F, Frank, G, Jackson, J, Parham, D, Pierce, D, Stein, C, Zemke, R (1989) An introduction to occupational science, a foundation for occupational
therapyinthe 21st century. Occupational Therapy in Health Care, 6 (1),1–17.