Therapeutic media: activity with purpose
NADINE K. HANNER, ANGELA CHINNERS MARSH and RANDI CARLSON NEIDEFFER
After studying this chapter, the reader will be able to accomplish the following:
• Describe considerations necessary when selecting media
• Describe the role of the occupational therapy assistant in choosing therapeutic media
• Select developmentally appropriate therapeutic media for different age groups
• Describe gradation of therapeutic activities based on client factors and activity demands
• Explain the importance of the impact of context and environment (e.g., cultural, physical, social, personal, temporal, and virtual) conditions when choosing therapeutic media
This chapter serves to introduce the entry-level occupational therapy assistant (OTA) to the definition, background, and application of therapeutic media.
The term media (plural of medium) is defined as “an intervening substance through which something else is transmitted or carried on. An agency by which something is accomplished, conveyed or transferred.”1 Method refers to “a means or manner of procedure, especially a regular and systematic way of accomplishing something.”1
Background and rationale of therapuetic media
In the early days of OT, arts and crafts were the primary therapeutic activities utilized by occupational therapists and OTAs. As social and economic times changed and technology grew rapidly, the repertoire of media used in the OT profession expanded and evolved to meet the changing needs of clients. However, craft activities continue to be used in various practice settings and are of particular value in the treatment of the pediatric population. Children can acquire and practice skills necessary to function in their occupations through the use of crafts as therapeutic media. Furthermore, engagement in crafts is typically an occupation of childhood. This chapter describes the selection and use of traditional and nontraditional therapeutic media as an intervention for children.
Selection of therapeutic media
OTAs use clinical reasoning skills when choosing therapeutic media for their clients. Specifically, activities that are meaningful and motivating to clients and address these client’s goals are deemed therapeutic. The OTA considers the client’s interests, therapy goals, client factors, performance skills, performance patterns, and contexts. For example, the OTA considers and respects the beliefs and traditions of the client’s culture when planning activities. Gradability of the media as well as activity demands are important aspects to be reviewed before selecting media. Activities carried out in group settings must be easily graded and adapted to meet the “just right” challenge for individual members. The following will help facilitate the thought process necessary in successful media selection for intervention planning and implementation.
Occupation/interests
The following questions may help the OT practitioner select meaningful, motivating, and age-appropriate media for children and adolescents.
1. Are the media relevant to the client’s age and occupational role (e.g., student, sibling, worker)?
2. Are the media related to the client’s current interests and/or hobbies? Can they possibly spark their interest to pursue a new leisure activity (e.g., drawing, computers, photography, needlecraft)?
Client factors and performance skills
The goal of OT intervention is to enable the client work toward his or her goals while feeling successful and safe. The OTA analyzes activities in terms of body functions (i.e., mental functions; sensory function and pain; neuromusculoskeletal, cardiovascular, hematologic, immunologic, and respiratory system functions; voice and speech functions; skin and skin-related functions; and structural functions of the body) to design interventions to meet the client’s goals. The following questions may be useful in guiding the OT practitioner:
1. What physical requirements (e.g., neuromusculoskeletal and movement-related functions) are needed to complete the activity or use the media (e.g., range of motion [ROM], strength, bilateral integration)?
2. What global or specific mental functions (e.g., level of arousal, motivation, attention, awareness, memory, perception, emotional, experience of self and time) must the client possess to successfully work with the selected media?
3. What performance skills (e.g., motor and praxis, communication and social skills) are required to successfully complete this activity?
4. What are the safety issues surrounding the use of the media? Does the client possess the safety awareness to handle the media or participate in the activity without risk (e.g., impulsivity, allergies)?
5. What sensory functions are required for the client to participate in the activity or with the media (i.e., vision, hearing, vestibular, taste, smell, proprioceptive, touch functions)?
Contexts and environments
“The term context refers to a variety of interrelated conditions that are within and surrounding the client. Context includes cultural, personal, temporal, virtual, physical and social. The term environment refers to the external, physical, and social environments that surround the client and in which the client’s daily life occupations occur” (p. 645).2 OT practitioners consider the clients’ contexts when selecting intervention activities. The OT practitioner should consider the following questions with regard to contextual and environmental influence in activity selection:
1. Is the therapeutic activity consistent with the client’s cultural, social, and personal background?
2. What social conditions (e.g., expectations of significant others, relationships with systems such as economic and institutional) surround the activity?
3. What are the personal characteristics of the client, and how will these affect activity selection (e.g., age, gender, socioeconomic status, educational status)?
4. Does this activity have any spiritual aspects that must be considered?
5. What are the temporal aspects (e.g., stage of life, time of day, time of year, amount of time needed for the activity) of the activity? How will this influence the selection of media?
6. What are the physical characteristics of the activity? In what environment will it take place (e.g., classroom, home, playground)?
Grading and adapting
OT practitioners may need to change therapeutic activities to promote success. The following questions may assist the OT practitioner in grading (i.e., changing the degree of difficulty of the activity) activities and adapting (i.e., changing how the activity is performed) activities:
1. Can the level of complexity of the activity be increased or decreased according to the client’s thought processing level (e.g., decreasing steps, taught by backward chaining, fading assistance)?
2. Can the provided media be modified, if necessary, for the client’s physical skills (e.g., less or more resistance, larger or smaller objects)?
3. Can the media be changed for the client’s sensory function requirements (e.g., placing media on bright background to increase contrast for a client with low vision or using a material with a different texture to accommodate a client’s tactile needs)?
4. Are the media versatile enough to be individualized within a group activity?
5. Is adaptive equipment needed to enhance the client’s performance? Is it available?
Activity demands
Successful planning of an activity requires the OT practitioner analyze the aspects of the activity. Activity demands refers to the objects and their properties, space demands, social demands, sequence and timing, required actions and skills, and required underlying body functions and body structures.2 Analyses of activity demands help the OT practitioner select appropriate activities and media. The following questions may guide the OT practitioner:
1. Are the tools and equipment necessary to use the media available and in good repair?
2. Are there adequate tools and materials for all of the clients?
3. Is there an adequate working surface, open space, and lighting for the activity?
4. What social and communication skills are needed to participate in the activity?
5. What are the steps, sequence, and timing of the activity? Will there be enough time to complete the activity?
6. What skills are required to successfully complete the activity?
7. What body structures are needed to complete the activity?
8. How can the activity be changed for clients who have deficits?
9. What are the safety precautions?
10. What is the cost of the activity?
Role of the occupational therapy assistant and the occupational therapist in selecting therapeutic media
Collaboration refers to “working cooperatively with others to achieve a mutual goal.”3 OTAs deliver OT services under the supervision of and in collaboration with occupational therapists. It is the legal and ethical responsibility of both the occupational therapist and the OTA to ensure that the OTA has the established service competency to choose media that are relevant to the client’s occupational goals.
OTAs who do not practice within close proximity to other therapists (such as those working in some school systems or home health care) can establish service competency and expand her or his skills by seeking an experienced mentor. Pediatric focus groups provide opportunities to collaborate with other OT practitioners and discuss intervention strategies. Furthermore, OTAs may discover new intervention strategies and use of media by attending professional conferences and continuing education. Commercial companies offer online resources for media projects and supplies which may prove helpful to OT practitioners.
Use of therapuetic media
The OT practitioner uses therapeutic media during the intervention process. The media may be used within the context of a purposeful activity; one that directly relates to the client’s goals and occupational role or as a preparatory activity to address client factors and the underlying skills necessary to achieve the client’s goal.
In this scenario, painting is the goal (fine motor skills to participate in a school activity) and is also the medium (to work on increasing fine motor skills). The OTA is able to help Kevin achieve a meaningful activity, which is part of his occupational role as a student. The preparatory activity, in this case, is the stretching and exercising prior to beginning the painting. The OTA provides the child with adaptations (built-up paint brush) to ensure success in art class. The child is invested in the painting and motivated to continue the activity in art class later. The OTA recognizes the importance of utilizing media and activities that are occupation based and meaningful to the child.
Activities
The following section provides examples of how the OTA chooses meaningful and therapeutic activities. Each scenario provides a client’s occupational profile, a description of the chosen media and method, suggestions for grading and adapting the activity, and an overview of the required client factors specific to the case. Tables 22-1 through 22-4 provide commonly used therapeutic media for each age group.
TABLE 22-1
Examples of Activities for Infancy
| ACTIVITY | BRIEF DESCRIPTION OF ACTIVITY OR PRODUCT |
| Handprint wreath | Arrange cut-out or painted handprints in wreath pattern |
| Body awareness dressing/bathing games | Use lotion, soap, powder, and movements while naming body parts during bathing and dressing. |
| Bubbles | Adult blows bubbles while cuing infant to visually track, reach, and pop. |
| Multi-texture mat | Can be purchased or homemade for infant to crawl over, walk on, or explore textures. |
| Cardboard box play | Push/pull infant across floor for vestibular input. |
| Hand/foot games | Examples are Peek-A-Boo, Patty Cake, and This Little Piggy. |
| Scooping/Pouring activities | Use various media: water, sand, dirt, rice. |
| Pots and pan music | Use various-sized pots, pans, plastic bowls, and wooden spoons. |
| Commercially available developmental toys | Examples are cause-and-effect, sequencing, push/pull toys, stuffed animals, and texture books.Examples are nesting toys, push lawnmower toy, and See and Say. |
TABLE 22-2
Examples of Activities for Early Childhood
| ACTIVITY | BRIEF DESCRIPTION OF ACTIVITY OR PRODUCT |
| Paper bag puppets | Use paper lunch bags. Cut, glue, or color puppet features onto bag. |
| Marshmallow people | Use pretzel stick to connect marshmallow body parts. |
| Birdfeeder | Roll pinecone in peanut butter and birdseed. |
| Sorting games | Use pincer grasp or tweezers/tongs to pick up small manipulatives for sorting. |
| Tissue paper collage | Have child crumple up with fingers precut squares of tissue paper and place on glue dots within a defined space. |
| Parachute | Great group activity! Incorporate with songs. Emphasize up, down, around. Toss items on parachute. |
| Loop cereal or noodle jewelry | String items on curling ribbon, plastic craft lace, pipe cleaners, etc. |
| Painting | Examples are finger painting, sponge painting |
| Body movement games | Examples are I’m a Little Teapot; Head and Shoulders, Knees and Toes; and Row, Row, Row Your Boat. |
| Commercial games/toys | Examples are Don’t Spill the Beans, Barrel of Monkeys, Candy Land, Hi Ho Cheerio, Memory, Ants in the Pants, Don’t Break the Ice, Mr. Potato Head, Shape Sorter, nesting items, and Counting Bears. |
TABLE 22-3
Examples of Activities for Middle Childhood
| ACTIVITY | BRIEF DESCRIPTION OF ACTIVITY OR PRODUCT |
| Paper chains | Have child cut strips of paper or use precut strips and attach them with various means such as paperclip, staples, glue. Vary colors. Consider cultural differences. |
| Windsocks | Have child roll construction paper to form cylinder and secure with staples or tape; attach crepe paper streamers along bottom edge; punch holes and thread yarn for hanger; and use markers, stickers, etc. to decorate. |
| Gingerbread house | Buy a ready-made kit, or provide pint-sized milk carton, graham crackers, stiff icing, and candies to decorate. |
| Sun catchers | Melt crayon shavings between two pieces of wax paper using iron. Have child make a frame out of popsicle sticks, construction paper, etc. |
| Paper mache piñata | Provide a thin box. Have child dip tissue or newspaper strips into a flour-and-water mixture (consistency of thin white glue), lay them over box in layers, and allow them to dry completely. Adult slits a hole in the box to fill with candy. Child decorates with paint, stickers, etc. |
| Body movement games | Examples are Red Light/Green Light, Simon Says, Hopscotch, Animal walks, and Twister. |
| Commercial games/toys | Examples are Bop It, Hungry Hippo, Connect Four, Tidily Winks, Leggos, Mega Links, Uno, Go Fish, Barrel of Monkeys, and Pick-up-Sticks. |
TABLE 22-4
Examples of Activities for Adolescence
| ACTIVITY | BRIEF DESCRIPTION OF ACTIVITY OR PRODUCT |
| Origami | Fold paper to form 3-D shapes. May use purchased kits or craft book. |
| Flowerpot découpage | Cut out pictures in magazines, greeting cards, old books. Have child brush découpage glue on back of picture, apply picture to flowerpot, and apply additional découpage glue covering picture and surface completely until entire area is smooth and uniform. |
| Picture frame | Have child decorate an old picture frame using various media (seashells, puzzle pieces, twigs, gemstones) |
| T-shirt painting/tie-dye | Provide various fabric paints, stencils, sponges, or brushes to be used on T-shirt. Buy commercial tie-dye kits, or use instructions available in craft books (see references). |
| Collage | Have child cut out pictures from magazines or catalogs of interest to him or her and glue them onto poster board and add decorative accents as desired (glitter bows, stickers). |
| CD mobile | Have child decorate and hang promotional or unwanted CDs from fishing line, coat hanger, drift wood, etc. |
| Rubbings | Have child rub crayons, charcoal pencils, pastels, etc. on thin paper placed over embossed surfaces (building cornerstones, carved wood, coins). |
| Commercial games | Examples are Dominoes, Mancala, Pictionary, Jenga, card games, Backgammon, Simon, and Perfection. |
| Rubber stamping | Have child create cards, gift tags, and stationary by using commercial rubber stamps and stamp pads. |
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