Occupational Therapy Interventions

Occupational therapy treatment interventions may be classified into three broad categories: preparatory methods, purposeful activity, and occupation-based interventions (The American Occupational Therapy Association 2008b) (Table 15.3). Preparatory methods include interventions intended to prepare the client for engaging in activity and may include splinting, edema management, physical agent modality application, and therapeutic exercise (The American Occupational Therapy Association 2008b). Purposeful activity includes interventions designed to remediate specific mental or physical skills to allow the client to engage in his/her occupation (The American Occupational Therapy Association 2008b). For example, a client may have a goal of independently caring for his grandchildren with controlled pain. To reach this goal, the client may engage in specific education, cooking, or dressing activities designed to increase range of motion and strength; provide an opportunity for feedback regarding pacing or ergonomics; and provide a platform for client-therapist discussion focused on educating and empowering the client as an agent of change. Occupation-based interventions are treatment methods that include the client's participation in occupations that he/she finds meaningful, preferably in the environment in which the client would normally

Table 15.3 Common occupational therapy intervention strategies addressing physical, psychosocial, and environmental aspects of pain.

Preparatory techniques

Purposeful activity

Occupation-based activity

Physical management

Physical agent modalities Therapeutic exercise Joint mobilization Nerve gliding exercises Wound care Trigger point release

Functional activities designed to address the client's physical dysfunction. For example, client may wipe off a table to address shoulder range of motion Work conditioning includes

Occupations such as gardening may address balance, proprioception, range of motion, strength but are intended to accomplish a client-centered goal (i.e., the client needs to

work-simulated tasks wash laundry at home)

Perform work hardening in the client's actual environment

Psychosocial Ideally, psychosocial management techniques (cognitive behavioral interventions, assertiveness management training, relaxation, guided imagery, yoga, tai chi, etc.) should be used in all activity categories.

As the activities progress from preparatory to occupation-based activity, the occupational therapist must encourage the client to integrate those interventions into his/her lifestyle to establish a habit or routine

Environmental/contextual Ergonomic modification Work simplification principle Work simplification principle adaptations Work simplification application in a simulated application in a client's education work environment actual work environment

Energy conservation education

Adaptive technology education complete the occupation (The American Occupational Therapy Association 2008b). For instance, a client with chronic pain who engages in work conditioning tasks at his/her place of employment with an occupational therapist would be engaging in an occupation-based intervention (Fig. 15.2). The intervention occurs not only as the client is completing tasks required for his/her position but also as the therapist provides feedback and direction, analyzes the client's posture, implements workstation modifications, and provides educational experiences. During the process of occupational therapy pain management intervention, the client's occupational performance is a central focus.

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