Occupation-Based Hand Therapy!


All information provided from: Christiansen, C. H. & Baum C. M. (2005). Occupational Therapy: Enabling Function and Well-Being 2nd Edition. Thorofare: Slack, Inc.  Picture re-created with graphics by the author of this site.

Environmental features can either enable or serve as a barrier to performance.  What makes an environmental feature supportive or not depends on the skills of the individual AND the characteristics of the environment.  This model clarifies the relationship between impairment and the current environmental factors.  It reminds us that a person with a disability is not a “disabled” person but rather has a set of abilities that are impacted by the environment.  The Enabler can be an excellent model to use for people with mobility impairments as well.

Competence can be defined as abilities and skills that the individual possess, not by impairments.  To understand the relationship between these and the environment, task analysis is often used.  This model is based on the actual performance of what an individual can or can not achieve in real time and place.  A task such as bathing can be broken down to assess for things like location of the tub relative to other areas in the house, type and location of fixtures such as faucet handles, forces necessary to turn them, etc.  Major environmental features can be explored such as spaces, products used in them, hardware/controls, other individuals in these spaces, and how these affect occupational performance.

The Enabler highlights difficulties that an individual is having performing certain occupations and diagram what physical or physiological symptoms might be involved.  It then requests that the treating health professional assess factors in the environment that might also impede the performance of said occupations.  Instruments based on the Enabler Concept renders predictive, objective, and norm-based assessments and analyses of accessibility problems in physical environments possible (Iwarsson, Jensen, & Ståhl, 2000). The methodology allows analyses from individual perspectives.

Jim has trouble with: fixing up his motorbike, prosecting the cadavers for his part-time job, lifting weights, playing golf, playing basketball, typing on his computer, and holding books and magazines to read them.

Jim’s environments to explore: his home environment, his school environment, his work environment, and his leisure environment.

  The Housing Enabler is an assessment that explores the accessibility of the home.  It is frequently used when the Enabler model is applied.  It might provide good baselines on which to consider assessing additional features of other environments in which Jim interacts.

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