Focus: Creating an Occupational Profile
- Top-Down/Bottom-up Approach? Which to use? Why Use it?
- Through the lens of occupation theory
- Move to FORs:
- Biomechanical
- Behavioral
- Cognitive Behavioral
- Cognitive Disability
- Occupation FOR or Model
In order to create an occupation profile, we need to gain some insight into the client and/or their family and caregivers. The occupational profile is a way to understand your clients and their needs. Often therapists approach a client and want to understand things solely based on their range of motion, muscle strength or biomechanical components. This is only one aspect of function rather than a global perspective of what a person wants and needs to do.
There is also the idea of a bottom-up or top-down approach. If you employ a systematic approach to developing an occupational profile, you will have an enhanced insight and understanding of how to approach a client. You will have an idea of who they are as a person and what they hope to achieve in therapy and beyond therapy once they are discharged. This will be different for each person, and that is why a top-down approach is beneficial in guiding your overall approach to creating an intervention plan.
A top-down approach considers the roles, the habits, the routines, and desires of your client, while the bottom-up approach is primarily concerned with the very specific and discrete functions of a person such as range of motion, visual perception, strength, and those sorts of components. Using a broad perspective and understanding of your client allows you to more fully aid them in reaching their desired goals for occupational engagement by removing potential barriers either in their environment or physically aiding and supporting them in their performance. Using an occupation theory can aid in guiding and structuring your thinking around the needs of your patient. The use of an occupation theory does not mean to disregard all other theories or frames of references. However, you should be able to state at least one occupation theory that guides your thinking in the therapeutic or clinical reasoning process. I will go into the distinction between those two terms later on in the webinar.
How the MOHO Can Help in Development of an Occupational Profile
- Structured and systematic thinking
- Language of thinking
- Embraces distinct value and contributions
- Tools to aid in the process
How can the Model of Human Occupation (MOHO) help in the development of an occupational profile? MOHO is an occupational therapy theory. It has many tools to aid in developing your understanding of what your patients' occupational needs and desires are during their therapy sessions. When approaching assessment and treatment, having an occupation theory as an overarching framework provides a structured and systematic guide in thinking about your client. An occupation theory provides the language to name and frame what it is that you are doing. It also aids the patient and other disciplines with whom you are working to have a better understanding of the role of occupational therapy and the distinct value and contributions that our profession makes to the rehabilitation of our clients.
Focus: Using MOHO Concepts as a Tool to Develop an Occupational Profile
- Volition
- Habituation
- Performance Capacity
- Environment
With this in mind, I want to introduce or reintroduce you to the concepts that comprise MOHO. The MOHO is made up of four primary conceptual areas. They are volition, habituation, performance capacity, and the environment. Each of these primary conceptual areas has sub-areas that actually constitute the entire concept.
Volition
- Personal causation
- Sense of capacity
- Self-efficacy
- Values
- Important
- Meaningful
- Interests
- Enjoyable
- Satisfying
For volition, these sub-areas are personal causation, values, and interest. For personal causation, individuals have to have a sense of their ability to do and that they are competent at what they do. This is a sense of capacity and self-efficacy. For values, it is what is important and meaningful for a person to do. What are the things that they have to do each day that are the most meaningful to them? And then, what are their interests? What is enjoyable and satisfying for them to do?
Volitional process.
- Ongoing process:
- Experience
- Interpretation
- Anticipation
- Activity and occupational choices
Volition is an ongoing process that is comprised of experience, interpretation, anticipation, activity, and occupational choices. With experience, that is the immediate thoughts and feelings that occur as you are doing an activity or in response to how you performed that activity. The next piece is the interpretation. This is how a person reflects on and recalls the performance and activity and how significant it is for that person and in their world. Anticipation is noticing and reacting to the potential and the expectation for action, or the next time that you might engage in it. Activity and occupational choices are the deliberate commitments that someone makes to undertake a role, new habit, or undertake a new project. Volition is the pattern of thoughts and feelings a person has about themselves within their own world. So if someone is trying to figure out whether they want to try a new activity, this is when the volitional process kicks in. For example, if somebody decides that they want to take up gardening, they have to think about what skill sets they have. Initially, they have the thoughts and feelings of what they want to do. Then, they decide they are going to engage in a gardening activity. They have to gather all the tools and the things that they need such as seeds, the soil, and a pot. They engage in the activity and might feel really good about it when the seed turns into a flower. So, their interpretation of that activity is, "I did a really good job. I planted a seed and was able to grow a flower." The next time they will then anticipate having a good feeling towards it and decide to do it again. This is important to recognize when we are working with our patients to help them engage or re-engage in activities that maybe they do not feel motivated to do.
Next, I would like to do a learning activity. I want you to reflect on how you have personally experienced volition. What do you think you have the ability to do? Do you think you are good at this activity? Or, think of a time when you felt you had lost your volition. What happened? How did you lose it? What was going on in your life? Why did you not have the drive to engage in things that were important and meaningful to you? Was there a time when you did not find interest in any activity? Was there a time that nothing was enjoyable or satisfying to you? What was happening in your life? How did you move forward in your life? What happened to make the change in the positive? After you think about this, consider how you have seen volition or motivation in others. What did you observe? Perhaps think of a patient on your caseload. Have you had patients that you have thought they were not motivated to try anything even though you felt you had a good understanding of who they were and how they might want to engage in a particular occupational activity? What changed in that person if they did engage?
Habituation
- Habits (Routines)
- Roles
The next component of MOHO is habituation. Habituation is made up of habits or routines and roles that we engage in each day. These are the things that a lot of times people take for granted.
For habits, people tend to respond and perform in very consistent ways in familiar environments and situations. Routines form in seconds, minutes, hours, days, weeks, and years. For example, you can look at that patterning of a routine in how you get up in the morning and what is the first thing that you do. Do you get up each morning and brush your teeth and get dressed and then go and eat breakfast? It can be something as simple as how you approach brushing your teeth. You may squeeze a tube of toothpaste from the middle or from the bottom, and you consistently do that every single time. This is how routines are made up. Routines can influence roles.
Let's now talk about roles, and then I will go back and talk about how roles influence routines. A role is a pattern of action that reflects what we have internalized. It can be something that is our own personally defined status or something that is placed upon us by society. There is usually a related cluster of attitudes and behaviors that occur as a result of a specific role. There can be roles such as worker, student, parent, caregiver, and community volunteer. There are many different roles that people can engage in. The roles are influenced by our routines. For example, if we are a worker we have a certain pattern of activity during a week. Typically, we go to work Monday through Friday, from 8 am-5 pm. Then on the weekends, we might engage more in community and family roles. There is a patterning of our life that gives it structure. And, if there is disruption with that, there can be some issues.
For this next reflection, I would like for you to consider the impact of habits, roles, and routines on your own day-to-day life. What does it look like in your life? Has it ever been disrupted? If it has, how did you respond? It can be impacted in a positive or negative way. After reflecting on the importance and the impact of habits and roles on your life, consider how you have observed the impact of this in other people, in patients that you have worked with or in people that you know. And if it was disrupted, either for the positive or the negative, what did that look like? Positive disruption of a role can be the addition of another role. An example is somebody that becomes a new parent, or they get married and they are now in a spouse role. What does that look like? And, how did others around them react?
Performance Capacity
- Objective components
- Subjective experience
- Lived Body
Another major component of the model of human occupation is performance capacity. Within MOHO, performance capacity is taken into consideration in terms of facilitating or being a barrier to occupational engagement. There is not a specific measure for this. For the objective components, these are the things that we tend to measure biomechanically such as visual perception, range of motion, muscle strength, and so on. MOHO is concerned with how this impacts a person's ability to be motivated or volitionally driven for occupational engagement and doing what is desired, but we do not have a specific measure for it in terms of a goniometer or muscle testing.
How is this objective measured? How does it impact roles or routines? Within MOHO, it is important to know that each of these conceptual areas and the areas that are examined does not stand alone. There is an interaction that is occurring. This is particularly important because there is not an objective measure for performance capacity within MOHO. We need to understand that if there is a limitation in movement or limitation in strength this can impact a person's overall life and how they are going to engage in that life. We need to be mindful of that as we develop an occupational profile. Again, if there is a problem biomechanically, we do need to think about how that impacts all of the areas related to MOHO concepts.
The other concept or component to performance capacity is the subjective or lived body experience. This is how the client feels to be in their body now that they have a neurological issue? An example of this is a child who has a sensory issue. A child might have a huge fear of going down the slide and is hesitant to do it. The child is asked, "Why don't you want to go down the slide?" And the child says, "I'm afraid that I'm going to keep going and not stop and go down into the Earth." Other children who have sensory issues have described this feeling that anything that touches their skin is like glass cutting into them.
It is really important for us to understand that there is a lived body experience, and when people have an injury or an impairment illness disease, the way that they feel in their body is going to be different than maybe what it was prior. This can impact their performance capacity.
For this next learning activity, I want you to think about living in your own body. I am sure that all of us have had something, even if it is just a paper cut, that we can take an objective measure of how we think that is affecting us in our day to day ability. We will protect our hand and put a bandaid on it. In terms of living in your own body, was there ever a time when you became acutely aware of your body and the inability to do what you wanted? How did that feel to you? What did you do in terms of being able to feel motivated to engage in your life and do your daily roles, routines, and habits? And, if you think about an objective measure versus a subjective measure, how do you see that differently with performance capacity? Do you think that both are equally important? Consider this in your life, and then think about it in terms of your patients or others around you.
Environment
Environmental Impact reflected in:
- Physical
- Spaces
- Objects
- Social
- Temporal
- Occupational forms
- Culture
The next major component of MOHO is the environment. This is the idea of the environmental impact as it is reflected in physical, social, temporal, occupational forms, and the culture around us. We need to know what this means in terms of facilitating activity and occupational engagement or being a barrier to occupational engagement.
Levels of Environmental Influence.
•Social-economic aspects/attitudes/laws/policies
The levels of environmental impact or influence have immediate, local, and global contexts. An immediate context would be home, work, school, and the treatment facility where a patient might find themselves. The physical context is looking at the spaces and objects within that environment. What are the activities that somebody is engaging in and what are the properties that they are using to engage in those activities? Does the person live alone or do they live in a home with six people? What does that look like? You have to take that into consideration when you are thinking about somebody's ability to engage in their own life and as you are developing their occupational profile.
