Intervention Approaches

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Table reference: Pendleton, Heidi McHugh. Pedretti’s Occupational Therapy – E-Book (Occupational Therapy Skills for Physical Dysfunction (Pedretti)) (p. 125). Elsevier Health Sciences. Kindle Edition.

The unique role of the OT is to contribute to the patient’s care plan and the rehabilitation process, by establishing a method that assists the patient to reach a state of physical, mental, and social wellbeing, to identify and attain their aspirations, to satisfy their personal needs, and to change or cope with their environment.
Each patient’s intervention plan is formulated using selected theories, frames of reference, practice models, and evidence. This process is directed by the patient’s goals, values, beliefs, and occupational needs, and is based on the patient’s goals and priorities. Establishment of the intervention plan is a collaborative effort between the therapist and the patient or, if the patient is unable to collaborate, the patient’s family or caregivers.

Summary of Intervention Approaches
1. Health promotion and wellness to enable or enhance performance in everyday life activities.
2. Establishment, remediation, or restoration of a skill or ability that has not yet developed or is impaired.
3. Maintenance and enhancement of capabilities without which performance in everyday life activities would decline.
4. Compensation, modification, or adaptation of activity or environment to enhance performance.
5. Prevention of barriers to performance, including disability prevention.

Focus on the Intervention Approach of Modification, Adaptation and Compensation
In a remediation approach, intervention is targeted towards improving performance components, with the assumption that such improvements will lead to enhanced occupational performance.

If a patient’s previous abilities cannot be restored, utilizing an adaptive or compensatory approach can promote participation in occupations. This approach focuses on the patient’s remaining abilities and aims to improve function by compensating for deficits in performance components. Ultimately, optimal occupational performance is achieved through successful adaptation.

OTs view individuals to be independent whether they perform the component activities by themselves, perform the occupation in an adapted or modified environment, use various devices or alternative strategies. The OT facilitates the achievement of occupational performance goals by finding ways to revise the current context or activity demands to support performance.
Including:
• Modifying or adapting tasks, activities and environments
• Using assistive devices to maximize function and compensate for lost function
• Using compensatory strategies

Adaptations
In simple terms, an adaptation makes performing an activity easier. An adaptation is a change in the structure, function, or form of the activity to promote a better adjustment to the environment in which the patient lives. Adaptation may involve changing the tool or the technique used to complete a task. It is important to note that, although adapting may involve making changes to an activity to make the task possible for a patient according to their abilities, adaptation does not change the outcome of the activity. The manner of how the activity is accomplished, is purposefully altered to make it achievable for the patient. 

Adaptations may require:
– Restructuring of the physical environment to assist occupational performance.
– Changing the technique used to perform an activity.
– Modifying or substituting objects used in performing an activity to make it easier to complete.

Examples of Adaptations:
• Applying Velcro to replace shoelaces
• Listening to music to filter out certain stimuli while working
• Putting different textured surfaces onto individual keys to aid in finding the correct one
• Adapting working conditions- physical space and lighting to maximize productivity
• Adjusting the height of the table to improve posture
• Assistive devices such as basic a long-handled sponge for bathing.
• Adapting a wheelchair for a respiratory unit
• Recommending environmental adaptations to assist with physical, perceptual, and cognitive functioning, such as labeling cupboards and drawers, or using lighting to improve vision and/or attention to task

Modifications

Types of Environmental Modifications

1. Changes to the Physical Environment
• Modify the layout (remove a door to make the opening wider)
• Provide adaptive equipment (a tub bench)
• Architectural modifications (provide a ramp, bathroom modifications)

2. Modification of the Occupation (modify behavior)
• Education about how to use the environment in a different way (always turn on lights before entering a room for an individual who has low vision)
• Use everyday items to achieve goals (always carry a mobile phone to call for help if needed)

Examples of Modifications 
• In a work environment, the OT can modify the way that the worker performs the work or modify the work environment to allow the worker to perform optimally.
• Home Modifications: The main goal of home modifications is maximizing safety and independence in the home. This involves reviewing aspects of the home that may require modification to facilitate performance and making changes to adapt living spaces to increase usage, safety, security, and independence. It includes recommendations for alterations, adjustments, or additions to the home environment through the use of specialized, customized, off-the-shelf, or universally designed technologies; low- or high-tech equipment, furnishings; and other features that affect the layout and structure of the home. Common home modifications include increasing lighting with nightlights or increased light bulb wattage, replacing faucets and door knobs with levers, installing non-skid materials in bathing areas and on stairs, adding handrails or grab bars, widening doorways, and adding ramps.
• To make a bathroom accessible for a patient in a wheelchair, the bathroom can be modified to allow independence with BADLs.
• A patient who has been diagnosed with a progressive disease will experience a decline in their ability to function independently. As the disease progresses, there is a greater need for environmental support such as durable medical equipment, modifications to the home, and adaptive equipment.
• Recommending modifying a patient’s diet in terms of changing the texture if they have difficulty swallowing thin liquids.

Compensation

Determining new ways of accomplishing an activity. Finding strategies/techniques or using specially adapted tools that work around the patient’s limitations. In comparison to adaptation which involves altering the setting or demands of a task to facilitate performance.

Examples of Compensatory Techniques/Strategies
• Teaching a patient who presents with muscle weakness in their shoulders how to use a compensatory technique of propping their elbows and bringing their hand to their mouth when eating.
•  Fatigue management or energy conservation techniques for COPD
• Teaching hemi-dressing techniques (dressing affected side of body first, using adaptive dressing aids such as a button hook)
• Techniques for completing tasks with functional use of one hand (for example, using a dycem mat to stabilize a mixing bowl while breaking an egg into the bowl with one hand)
• Using a daily planner or reminder functions on mobile phones to compensate for poor memory
• Shopping during quieter supermarket hours to manage social anxiety
• A plate guard to prevent food slipping off the plate while eating with functional use of one hand

Providing assistive devices is an important element of OT intervention to support the patient’s performance and increase their participation in their occupations. Assistive devices are classified as adaptive equipment as the patient requires the assistance of an external device (assistive device or aid) to be independent in their occupations. I.e.: The patient is Modified Independent. If the assistive technology acquired does not match the skills and abilities of the patient, the OT then adapts them accordingly.