Therapeutic media: activity with purpose

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Therapeutic media: activity with purpose


NADINE K. HANNER, ANGELA CHINNERS MARSH and RANDI CARLSON NEIDEFFER



Chapter objectives


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



Key terms



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


To further clarify these terms in the context of the OT profession, a purposeful activity is chosen to produce desired outcomes for a client and carried out with the use of selected therapeutic media. The media and method are chosen for their therapeutic value and individualized for each client’s specific needs.




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.



CLINICAL Pearl


As defined by the Occupational Therapy Practice Framework, 2nd Edition, activity demands are “the aspects of an activity, which include the objects and their properties, space, social demands, sequencing or timing, required actions and skills, and required underlying body functions and body structure needed to carry out the activity.”2






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:




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:




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.



CLINICAL Pearl


Service competency ensures that one occupational therapist is able to obtain the same results from a procedure or activity as another. Some ways of establishing service competency are videotaping treatment techniques to be critiqued by an experienced occupational therapist and review of standardized test results to ensure correct administration procedures and accurate scoring. Another method is using competency check-offs for skills such as measuring range of motion with the goniometer, manual muscle testing, and safe transfer techniques.



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.



CASE Study


Kevin, a 7-year-old boy with juvenile rheumatoid arthritis, is in Grade 2. Kevin enjoys art class but has difficulty painting when his joints are inflamed. He also has difficulty holding the paint brush. The OTA has decided to work on Kevin’s goal to improve fine motor skills for academic work by using a painting activity. As a preparatory activity, Kevin and the OTA complete some stretching exercises (both passive and active). The OTA sets up a painting activity, similar to the one that will be conducted in art class later that week. Since Kevin takes longer than the other children to complete his work, the art teacher is very pleased that the OTA is able to break down the steps and allow Kevin to get a head start. Furthermore, this allows the OTA to determine what types of adaptations work best for Kevin. She provides Kevin with a built-up handled paintbrush and an easel positioned close to him and at a lower level (so that he does not have to raise his arm as high as the other children). Kevin enjoys painting and is looking forward to finishing his project in art class later in the week.



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.







Infancy: birth through 18 months



CASE Study


Miguel’s water play session. Miguel is a 12-month-old boy with a diagnosis of Down syndrome. He receives outpatient occupational and physical therapy services once a week. The goals for OT include improving Miguel’s physical endurance and hand skills for play. During the OT sessions, the OTA works on increasing postural stability for independent sitting as well as improving reaching and grasping skills. This week, the OTA and the physical therapy assistant (PTA) collaborate and plan activities to address Miguel’s OT and PT goals in the clinic’s pool. The OTA discusses this upcoming session with Miguel’s parents who report that he loves to play in the water and that they would like him to develop preswimming skills. Miguel will wear a swimsuit with an attached floatation device for safety while in the pool. To prepare Miguel for the water and increase body awareness, the OTA will rub Miguel’s arms, legs, and back with water while naming each body part.

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Related posts:

  1. Scope of practice
  2. Applying the model of human occupation* to pediatric practice
  3. Development of occupational performance skills
  4. Functional task at school: handwriting

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Jul 24, 2016 | Posted by in PEDIATRICS | Comments Off on Therapeutic media: activity with purpose

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