activity analysis in occupational therapy

Department of Occupational Therapy, Bangladesh Health Professions Institute

1. ACTIVITY ANALYSIS

2. ACTIVITY ANALYSIS Shamima Akter B. Sc (Honors) in Occupational Therapy & M. Sc in Rehabilitation Science Assistant Professor , Department of Occupational Therapy Bangladesh Health Professions Institute (BHPI) Centre for the Rehabilitation of the Paralysed (CRP) Chapain , Savar

3. Activity Analysis Activity analysis is a fundamental skill of occupational therapists. A process used to identify the inherent properties is a given occupation, task, or activity as well as skills, abilities or capacities required to complete it. ( Trombly , 5 th ed.). There are three different perspectives of activity analysis: Activity- Focused Analysis Client-Focused Activity Analysis Environment-Client-Focused Activity Analysis TS1_Shamima_2018

4. Task- focused activity analysis/ Activity- focused analysis- Deconstruction of activity itself outside of the client-specific application to build student’s or clinician’s repertoire of therapeutic occupations. Client- focused activity analysis- Description of the reasoning used in the therapeutic use of occupation-as-means for a particular therapeutic goal for a particular person. Client-environment fit analysis- Deconstruction of the specific activity-environment-person fit to determine and/or optimize the likelihood of successful performance of occupation-as-end. TS1_Shamima_2018

5.   REASON OF USING ACTIVITY ANALYSIS To contribute to the clinical reasoning of Occupational Therapy practitioner. To break the activity down to small steps. To whether or not a person can perform an activity. Therapist analyses the activity to understand the functional requirements (performance components are needed to perform the activity). Then compares the requirements of the activity and tries to find out the answer of – Does the client has the necessary performance components to perform this activity? TS1_Shamima_2018

6. Continue To determine the appropriateness of activity for a particular client in terms of developmental needs, age, personal interests, gender, cultural relevance. To determine the potential use of activity as a treatment tool. To identify required resources, both intrinsic (related to person’s abilities) and extrinsic (cost, space, environment, time, skills, staffs). To identify an activity potential for modification. To identify risk, hazards and precautions. TS1_Shamima_2018

7. GUIDELINE FOR ACTIVITY- FOCUSED ANALYSIS According to Radomoski and Latham 2014, the steps of activity focused analysis are following: Describe the activity Describe the task demands Objects used: What are the properties of the utensils, tools, and materials and their locations relative to the person? Environmental Demands: What are the characteristics of the environment in which the activity is usually performed, including possible environmental barriers and enablers? TS1_Shamima_2018

8. Continue… Social Demands: What is the nature of and extent to which the activity involves others and /or holds particular meaning associated with social roles? Contextual demands Sequencing and timing Required actions: What are the steps of activity? Prerequisite capabilities, abilities, and skills ( sensorimotor , visual-perceptual, cognitive, or psychosocial) Safety Precautions TS1_Shamima_2018

9. Identify the primary therapeutic aspects of the activity/ adapt activity demands to align with therapy goals Sensorimotor (ROM, strength, motor control, postural control, endurance, or coordination/dexterity). If analysis of specific muscular requirements is required, complete a biomechanical activity- focused analysis. TS1_Shamima_2018 Motions ROM Primary Muscles Gravity Assists, Resists, No Effect Minimal Strength Required Type of Contraction

10. Visual-perceptual (visual scanning, perception of objects in space, and awareness of extrapersonal space) Cognitive (attention, memory, executive functioning, problem solving, and awareness) Emotional/relational (mood, engagement, and interactions with others) Modify the activity demands to calibrate level Object used Space demands Contextual demands Sequencing and timing TS1_Shamima_2018

11. Name of activity: Vacuuming the Halfway Carpet TS1_Shamima_2018

12. Task Analysis Process Example Describe the task demands Object Used Light weight upright vacuum cleaner with 25- foot cord Stored in closet next to the area to be cleaned TS1_Shamima_2018

13. Task Analysis Process Example Describe the task demands Environmental Demands The halfway is 30 feet long and 3 feet wide The electrical outlet is halfway between the two ends of the halfway, 5 inches from the floor No furniture is in the way The carpet is a low pile type TS1_Shamima_2018

14. Task Analysis Process Example Describe the task demands Social Demands Does not require the participation of others Vacuuming may fulfill a valued role TS1_Shamima_2018

15. Task Analysis Process Example Describe the task demands Contextual Demands The person takes pride in a clean, well vacuumed home The person is not willing to switch to a lighter, nonmotorized carpet sweeper because of the belief that it does not do a thorough job TS1_Shamima_2018

16. Task Analysis Process Example Describe the task demands Sequencing and timing Monological - there are not many alternative approaches or sequences that will satisfy the task requirements Can be completed in one therapy session There is no limiting time factor involved in the activity under normal circumstances. TS1_Shamima_2018

17. Analysis Process Example Describe the task demands Required actions Steps that comprise the activity Retrieve the vacuum cleaner from the closet Unwind the electric cord Plug cord into wall outlet Adjust height of vacuum cleaner for carpet use Turn on vacuum cleaner Push vacuum cleaner back and forth Move vacuum on carpet to complete entire carpet Unplug cord from outlet Wind cord on vacuum cleaner Place vacuum cleaner in closet

18. Identify the primary therapeutic aspects of the activity/ adapt activity demands to align with therapy goals TS1_Shamima_2018

19. Motions ROM Primary Muscles Gravity Assists, Resists, No Effect Minimal Strength Required Type of Contraction Volitional function of at least one upper extremity to move against gravity with moderate resistance shoulder flexion/extension, scapular protraction/ retraction, cylindrical grasp, a nd wrist stabilization Trunk flexion/ extension

20. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Prerequisite Capacities Sensorimotor : range of motion, strength, motor control, postural control, endurance and coordination/dexterity Volitional function of at least one upper extremity to move against gravity with moderate resistance; shoulder flexion/extension, scapular protraction/ retraction, cylindrical grasp, and wrist stabilization Trunk flexion/ extension Ambulation forward/ backward Estimated required 2-3 MET level

21. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Prerequisite Capacities Vision- perception: visual acuity, visual scanning, visual perception, and awareness of extrapersonal space Visual proficiency in acuity, scanning, and perception (figure ground, spatial relations)

22. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Prerequisite Capacities Cognitive: attention, memory, executive functioning, problem solving and self awareness Procedural memory of how to use vacuum cleaner Ability to sustain attention for 10-15 minutes Ability to complete multistep activity Ability to problem solve

23. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Prerequisite Capacities Cognitive: attention, memory, executive functioning, problem solving and self awareness Procedural memory of how to use vacuum cleaner Ability to sustain attention for 10-15 minutes Ability to complete multistep activity Ability to problem solve

24. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Prerequisite Capacities Emotional, rational The person takes pride in a clean, well vacuumed home Performed without social interaction

25. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Safety Precaution Nature of safety considerations if performed in a therapy context Patient may need guarding/ supervision and rest periods related to balance and/or endurance Patient may need cueing related to cognition Patient my need adaptations because of low back pain

26. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Sensorimotor Refer to the biomechanical activity- focused analysis mentioned later in this table for specific muscular requirements Range of motion Upper extremity is moved to its limit while vacuuming Strength, motor control Use a heavier vacuum cleaner Vacuum a thicker pile carpet Lift objects out of the way to vacuum Postural control, endurance Bend to reach outlet and behind furniture Increase the time spent vacuuming Coordination, dexterity Place furniture in the area so patient has to change directions of the vacuum to go around obstacles Larger or smaller handled vacuum cleaner Type of on/off switch

27. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Visual- perception Visual scanning Find vacuum cleaner in cluttered closet Items that need to be picked up before vacuuming are placed on the carpet Spread “dirt” that is in contrast or similar to the color of the carpet Place objects that cannot be moved on the carpet so the patient must move around them Visual perception, extrapersonal space

28. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Cognition Attention, memory Add distractions during the vacuuming activity, e.g., additional noise in the room Interrupt the patient during the activity, e.g. someone asks the patient a question Executive functioning, problem solving, awareness Use an unfamiliar vacuum cleaner so patient must figure out how to use it Have the patient predict performance before task performance and analyze the performance and analyze the performance after completion of task

29. Example Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Emotional- rational Mood, engagement, interactions with others Patient expresses pride in accomplishment

30. Identify the primary therapeutic aspect of the task; adapt task demands to align with therapy goals Object used Weight and size of vacuum cleaner Type of vacuum cleaner handle and control switches Low or high pile carpet Space demands Size of space to be vacuumed, e.g. halfway and living room Social demands NA Contextual demands Set personal goal to complete vacuuming activity by a certain time Sequencing and timing Set specific time parameters to vacuum a certain amount of carpet in a designated amount of time

31. Therapeutic goal for the activity Strengthening of upper extremity musculature Developing dynamic standing balance Improving grip strength Improving endurance Learning proper back mechanics TS1_Shamima_2018

32. GUIDELINE FOR CLIENT- FOCUSED ACTIVITY ANALYSIS 1. Specify the primary goal that this task is intended to advance through client performance 2. Specify which primary ability and/or capacity the task is intended to challenge: ROM Strength Motor behavior Praxis Sensation Vision-visual perception Cognition TS1_Shamima_2018

33. Continue… 3. Evaluate the therapeutic value of activity based on these characteristics: Inherently evoke desired response Be gradable to progress the patient to higher function Be within patient’s capabilities Be meaningful Be repetitive TS1_Shamima_2018

34. Continue… 4. Specify task parameters to calibrate difficulty level of the task: Method of instruction Nature and level of cueing Objects and their properties (materials and equipment) Environment Demands Sequence and timing Required actions and performance skills Required body functions Required body structures Context or environment TS1_Shamima_2018

35. GUIDELINES FOR ENVIRONMENT-CLIENT-FOCUSED ANALYSIS 1. Specify the task that the person wants or needs to perform in a given environment 2. Specify the performance environments (e.g., environment in which the client will perform the desired activity or environment in which the therapy session with occur). 3. Evaluate the barriers or enablers to performance of this activity in this environment: Task Environment Person 4. Determine solutions that will enable performance: Person Environment Task TS1_Shamima_2018

36. Continue… 5. Specify task and environmental parameters to calibrate difficulty level Method of instruction Nature and level of cueing Objects and their properties (materials, equipment) Space demands Sequence and timing Required actions and performance skills Required body functions Familiar or novel task or environment Known adaptations or specifics to design & build the needed adaptation TS1_Shamima_2018

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38. REFERENCE Trombly CA 1996, Occupational Therapy for Physical Dysfunction , 5 th ed, Mosby Company, Philadelphia Radomski and Trombly-Latham 2008, Occupational Therapy for Physical Dysfunction (6 th Ed).  Philadelphia: Lippincott, Williams and Wilkins. Radomski and Trombly-Latham 2014, Occupational Therapy for Physical Dysfunction (7 th Ed).  Philadelphia: Lippincott, Williams and Wilkins. TS1_Shamima_2018