Clinical Reasoning

The process used by practioners to plan,

direct, perform and reflect

on patient care.

Scientific reasoning

Focuses on diagnosis, condition, theory,

what typically happens.

Diagnostic reasoning

Cause or nature of condition,

attempts to explain why the

client is experiencing problems.

Procedural reasoning

Intervention routines thought to

be effective, scientific based or

reflect habits of the setting.

Narrative reasoning

Personal, impact of illness, disability,

or occupational performance on a

person's daily life,

"the so what of the condition"

Pragmatic reasoning

Practical, scheduling options, equipment

available, management directives,

skills

What therapist is capable of...

Ethical reasoning

What is the right thing to do,

competing principles, risks, benefits

Interactive reasoning

Thinking directed towards building

positive interpersonal

realtionships with patients.

Conditional reasoning

Blending of all forms of reasoning,

seen in experienced therapists.

The main steps in the process

of clinical reasoning...

1.Formation of preassessment image

2.  Cue Aquistion

3.  Hypothesis generation

4.  Cue Interpretation

5.  Hypothesis evaluation

Formation of

preassessment image

Diagnosis, age, prior

level of functioning,

what do I know about the condition

and how it impacts the person?

Cue acquisition

Gather data about person's

futional status and

occupational roles.

Hypothesis generation

Look at evaluation data and

make tenative assumptions-

basis for theraputic action.

Cue Interpretaion

What do you find out from

your observations? 

Continually gathering data...

Am I on the right track with this person?

Hypothesis evaluation

Examine data collected...

Hypothesis with most supporting

evidence forms the basis

for intervention

How do Clinical Reasoning

skills develop?

1.  Develops over time- experience

2.  Cannot be taught

3.  Case studies

Stages of development of

clinical reasoning skills?

1.  Novice

2.  Advanced Beginner

3.  Competent

4.  proficient

5.  Expert

Novice

Procedural or scientic reasoning,

use what is learned in courses

Advanced Beginner

recongnize and pick up on

additonal cues (body language),

begins to see client as individual

Competent

determine importance of facts,

more likely to individualize treatment.

(may lack creatvity and flexibility)

Proficient

Sees the whole or big picture,

flexable, able to see where

client is going

Expert

Understands rules of practice,

uses intuition, picks up on subtle

cues and able t consider multiple

factors, conditional reasoning

Chunking

Strategy used by experts. 

Chunk info into categories

as to how it applies to practice

Ideal self

Perfect self, unrealistic

Perceived self

Aspect others see, defined only

by outward behavior

People sometimes only see your

behavior vs. thoughts & reasoning

Real self

Intention and action, environment,

open up to the real self

(All of us have strengths & weakness)

Therapeutic Qualities

1.  Empathy-ability to understand how they feel.

2.  Sensitivity-alertness to patients needs

3.  Respect-recognize unique indv. w/person values

4.  Warmth-sense of friendliness,interest &ethusiasm

5.  Gunuineness-ability to be ones sel openly

6.  Self diclosure-practive of revealing things

7.  Specificity-art of stating things

Communication Techniques

when dev. therapuetic qualities

1. Make inital contact brief

2. Choose wors carefully

3.  Be comfortable with silence

4.  Encouage minimal response

5.  Listen & observe

6.  Summarize & focus

7.  Ask for clarification

8.  Follow through on promises

Issues that impact therapist/patient

relationships

Tranference- Patient relates to other person as if was somone else(mother, father, wife or husband)

Countertransference- Therapist falls into that role

Dependence(3 types)

1.Detrimental-patient capable of doing more

2.  Constructive-relies on health prof. to do something they cannot do. Approp. of clothing

3.  Self- help increase realistic awareness of abilities

Why should OTs learn about

theories, models and frame of reference?

1. Backbone of OT 

2. See what would be appropriate 

3. Having a broader knowledge to choose better treatment.

4. Structure for organizing your thoughts

5. Identifies areas where you should/could focus

6. Concepts to help organize and understand problems

Three subsystems on

MOHO?

Volition

Habituation

Performance Capacity

Volition

Personal causation-effectivness

Values- important and meaningful

Interests-  What you enjoy doing

Habituation

Roles- internalized roles, consists of habits,

routines, and skills, role

change or transition

Habits- automatic routines, patterns

of activity, help

conserve energy

Performance Capacity

Objective componets- body structure and function

Subjective experience- finger stinffness

experienced differently

Biomechanical approach is most

common is which practice setting?

Physical disability

Most appropriate for people who have intact

CNS, but lower motor neuron or

orthopedic disorders.

Biomechanical approach

is based on what?

Kinetics- science of motion of objects and

forced acting on them

Principles of Physics included in the

Biomechanical Approach

1. Forced

2. Levers

3. torque

OT intervention in the

Biomechanical approach

includes:

Range of Motion-(eval. specific physical limitaions- strength & endurance)

Muscle strengthening- Restore these functions

Therapeutic exercise & orthotics- prevent or reduce deformity