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Functional

Interventions
Edith Feld
Fieldwork Presentation
Sunrise Hospital

Functional Interventions
Functional, occupation-based activities are known to be
the keystone of an occupational therapy practitioners
skilled treatment and intervention services.
When used correctly, functional activities can address
the same problem areas and impairments as more
commonly used tools, such as therapy balls, exercise
equipment, or cones, but with added benefits.

Davis, 2009

Why Functional Interventions?


Functional activities are most commonly used by
occupational therapy practitioners in one of three ways:
Assess the level of independence and safety
Practice a skill needed to improve a specific functional activity
Therapeutic tool to maximize overall function

Davis, 2009

Environment & Context


Evaluation of the patients natural setting
Environments are the external physical and social aspects
that surround clients while they engage in occupations
Contexts are the cultural, personal, temporal, and virtual
aspects of this engagement

Occupational therapy practitioners analyze the


environment and context to understand how these
elements can best support learning and performance.
Solutions are then generated to reduce identified barriers
or build supports through modifications and adaptations.
Cohn & Lew,

Treatment Ideas and Strategies in


Stroke Rehabilitation
Tips for selecting activities related to impairment of movement:
Select activities that require the same (or similar) movement that you are trying
to facilitate or encourage
Select activities that require repetition of movement
Select activities that have light, easy movements
Select activities that dont require precision

Tips for selecting activities related to impairments of cognition


and perception:
Select activities requiring problem-solving skills that are appropriate to the
cognitive level of the patient
Select activities that require repetition of the entire activity
Select activities that are familiar and meaningful
Select activities from real life that use real objects
Davis, 2009

Effect of Occupation and Activity-Based


Interventions on IADL Performance
Among Community-Dwelling Older
Adults: Systematic Review
Types of Interventions:

Multicomponent Interventions

Occupational Therapy Interventions

Functional Activities Interventions

Functional Task Exercise Programs


Simulated IADL Programs

Performance Skills Interventions

Physical Activity Interventions


Cognitive Activity Interventions

Home Modifications and Assistive


Technologies

Strong evidence indicates that


client-centered and activityspecific interventions in
collaboration with other
disciplines help improve and
maintain IADL performance in
older adults
Improvement in physical
performance does not always
translate to improvement in
IADLs
More need to develop evidence
for the use of assistive
technologies,Orellano,
environmental
Coln, & Arbesman
modifications, and occupation-

Occupation-Based
Activities

Laundry Hanging clothes


Motor deficits:
Gross/Fine motor skills
Functional reach
Grasp and pinch
Dynamic sitting/standing balance
Endurance
Strengthening
Cognitive deficits:
Problem solving
Attention
Decision making
Memory

Cleaning - Sweeping
Motor deficits:
Gross/Fine motor skills
Dynamic sitting/standing balance
Endurance
Strengthening
Coordination

Kitchen - Setting the table


Cognitive deficits:
Executive functioning
Following directions
Attention
Motor deficits:
Gross/Fine motor skill
Dynamic sitting/standing balance
Endurance
Strengthening

IADL Pet care


Motor deficits:
Gross/Fine motor skills
Dynamic sitting/standing balance
Endurance
Strengthening
Cognitive deficits:
Sequencing
Problem solving
Attention
Decision making
Memory

Behavioral, Neurophysiological, and Descriptive


Changes After Occupation-Based Intervention
55 year old male who experienced a chronic stroke;
moderately impaired UE motor function
Focused on the effects of occupation-based interventions on
post- stroke UE motor recovery, neuroplastic changes, and
occupational performance in 1 research patient
Intervention:
Received 15-sessions of OT based intervention in a hospital setting
designed to simulate home environment
Consisted primarily of occupation-based interventions with use of
preparatory methods (weight bearing or stretching) and purposeful
activities (turning keys to increase functional pinch for dressing)
Skubik-Peplaski, Carrico, Nichols, Chelette, &

Skubik-Peplaski et al., 2012

Conclusion of study
Considerably enhanced affected UE motor recovery,
neuroplastic change, and occupational performance for 1
participant with chronic stroke (Skubik-Peplaski, Carrico,
Nichols, Chelette, & Sawaki, 2012, e110).
As intervention progressed, Will reported several changes
taking place:
increased motivation, increased confidence, increased component
factors of affected UE function (including improved proprioceptive
awareness), improved self-management of health routines (e.g.,
knowledge of effective stretching, pain management, and self-cueing
supporting bilateral UE use), increased role competence, and
increased self-direction in occupational performance

Skubik-Peplaski et al., 2012

Questions?

References

Cohn, E. S., & Lew, C. (2010). Occupational therapys perspective on the use of
environments and contexts to support health and participation in occupations.Am J
Occup Ther,64(6), S57-69.
Davis, J. (2009). Treatment ideas and strategies in stroke rehabilitation.OT Practice, 1318.
Doig, E., Kuipers, P., Prescott, S., Cornwell, P., & Fleming, J. (2014). Development of selfawareness after severe traumatic brain injury through participation in occupationbased rehabilitation: Mixed-methods analysis of a case series.American Journal of
Occupational Therapy,68(5), 578-588.
Skubik-Peplaski, C., Carrico, C., Nichols, L., Chelette, K., & Sawaki, L. (2012).
Behavioral, neurophysiological, and descriptive changes after occupation-based
intervention.American journal of occupational therapy,66(6), e107-e113.
Orellano, E., Coln, W. I., & Arbesman, M. (2012). Effect of occupation-and activitybased interventions on instrumental activities of daily living performance among
community-dwelling older adults: A systematic review.American Journal of Occupational
Therapy,66(3), 292-300.
Teasell, R. W., Foley, N.C., Sanjit, K. B., & Speechley, M. R. (2003). An evidence-based
review of stroke rehabilitation. Topics in Stroke Rehabilitation, 10(1), 29-58.