Occupation-Based Hand Therapy!

The field of occupational therapy has long since begun in it’s move away from a medical model approach to treatment and care and now embraces a more client-centered stance when it comes to treatment.   The 4 levels of intervention provided by Pedretti and Early (2005) are a useful way to address treatment in a way that involves the client and produces meaningful therapeutic activity. The 4 intervention levels do not necessarily follow each other on a continuum; some can occur simultaneously and it is worthwhile to note that they do not need to be followed on a strict step-by-step progression either.

1. Adjunctive Methods—
are used to prepare the client for occupational performance and include but are not limited to exercise, facilitation and inhibition techniques, positioning, splinting, sensory stimulation, and application of certain physical modalities.  At this level, the OT should be assessing and remediating performance components.  These methods are often used to prepare the client for purposeful activity and are often seen, though not limited, in the acute care setting.
2. Enabling Activities—are the steps toward the ability to perform purposeful activities.  Purposeful activity has goals beyond just being able to perform the motor components of the task and some clients aren’t ready for this yet.  Therefore devices and methods that simulate the activity are used at this level, such as work simulators, driving simulators, tabletop practice activities, practice boards and hooks for mastering dressing, etc. Equipment can also be enabling such as wheelchairs and other ambulatory aids, communication devices, and environmental control objects.  The OT continues to assess and remediate but also begins to teach in performance areas.
3. Purposeful Activity—
includes activities that have a relevant goal and that are meaningful to the client.  The client determines the purposefulness of the activity  because such activities are part of their life roles and/or daily routines.  Such activities, like feeding, dressing, mobility, communication, art, sports, work, etc., are examples.  Purposeful activity enhances functioning in performance areas and at this stage, the OT is concerned with assessing and remediating deficits in those performance areas. 
4. Occupation-Based Activity—
engages the client in occupation in her or her own environment and in the community setting.  The OT’s involvement should begin to decrease as the client performs ADLs, IADLs, play, and leisure to his or her own maximum capacity.

How can I start to integrate some occupation-based treatment into my clinical practice?

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