Occupation-Based Hand Therapy!

The KAWA Model

All information adapted to case study was provided from: Iwama, Michael. (2006). The Kawa Model: Culturally Relative to Occupational Therapy. Retrieved April 30, 2008 from University of Toronto, Department of Occupational Science and Occupational Therapy: http://www.kawamodel.com/

           The Kawa Model is explained in detail on its own website and is a model of practice that accounts for culture in occupational therapy (http://www.kawamodel.com).  It is the first model to come out of somewhere other than the West that doesn’t focus on the familiar concepts of individual autonomy but instead takes into account a more collective-oriented, interdependent view of human occupation. The Kawa Model brings nature and ecology to occupational therapy.
           The Kawa (Japanese for river) model translates subjective views of self, life, well-being and the meanings of occupations into a nature-based, pictorial concept.  The river is the life force of the individual.  When an individual becomes injured or impaired, their life force becomes impeded.  Rocks represent certain circumstances, the walls and bottom of the river represent the environment (both social and physical contexts), and the driftwood account for the assets and liabilities.  All of these are inseparable parts of the river that determine the progress of its flow.

Occupational Therapy – Identification of Jim’s Current Issues Using the KAWA Model

Discrete circumstances that are considered to impede one’s water or life-flow. They are life circumstances perceived by the client to be problematic and difficult to remove.
- Pain & decreased dexterity of hand- Can not fix up his bike and play golf / basketball with friends
- Trouble filling his duties at his job as a prosector
- Trouble fulfilling his duties as a student when it comes to taking notes, transcribing, writing papers, etc.

River Walls & Bottom
The client’s environment, in the context of being inseparable from all of the other river structures- namely water and rocks.
Micro level:Living in 2-story house Lives with 3 friends / classmates
Macro level:Medical School Policies & Regulations
The client’s personal attributes and resources, that can positively or negatively affect the subject’s circumstance and life flow. They are transient in nature.
Frustration with his medical condition
Very independent – feels like he “should be able to do everything independently”

Perceives his injury as a sign of weakness

The subject’s life energy or life flow
Water continues to flow in substantial volume around his carpal tunnel syndrome and functional consequences, driftwood (see cell above), and his social and physical environment.  Water still flows, but to a lesser extent through seams and gaps bounded by the structures and components in Jim’s river diagram.
Spaces and Gaps Occupational Therapy
Potential occupational therapy treatment approaches and points of interventions are on the gaps and channels through which water (life energy) still flows and the specific structures that form the boundaries.
Occupational Therapy Actions Using the KAWA Model

Assess body mechanics as Jim performs tasks that generally cause him pain.  Provide tips on how to alter body mechanics and educate about when to rest. Provide night splints and additional assistive stabilizing wrist equipment for use during certain tasks.
Brain storm additional ideas concerning activities that Jim can do with his friends while he is healing.
Speak with Jim about recruiting others to help with difficulties he might be having around the house and at school.  Give Jim ideas of how to approach roommates with requests for help and role-play so Jim feels comfortable doing so.  Can someone take notes for him in class?  Can someone transcribe notes while he reads them out loud?
River Walls & Bottom
Explore relationships with roommates and friends.  Determine how he feels that his professors and other medical health professionals view him and his current condition.  Find ways to help him understand his condition and not feel that it is a personal weakness.
Examine ways and means to keep Jim involved with his friends, job, and hobbies.  Assistive technology provisions might come in handy here.  Additional temporary mobility might be useful if he feels that driving is too painful – bus routes, etc.
Discussion of main environments of school, home, and work to discuss barriers to his participation.
Jim has good health insurance from his school and so far his injury is not impeding with any medical school policies and regulations.
Provide information regarding his particular medical injury and see how much of it he already understands.  Be aware that he is a medical student and probably understands much of this condition already but highlight this injury in relation to HIM.
Discuss going to the school counselor if his feelings of shame and weakness begin to feel like a burden to him.
Provide information on different ways he might carry out tasks so he can still perform certain acts independently.
Make sure to let Jim use his current abilities to help him when he is performing tasks.  Try not to provide too much in the way of support but not too little so that he continues to feel frustrated with his injury.
Encourage Jim and give him positive feedback in regards to carrying out tasks and the improvement of his condition over time.
Try to involve members of his social support network (with client’s consent) whenever possible. 

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