Occupational Therapy

  The practice of occupational therapy means __________.

Occupations

“everyday life activities given value and meaning by individuals and a culture. … Occupations are central to a person’s identity and competence, and they influence how one spends time and makes decisions” (AOTA, 2002, p. 610).

 Functioning within one’s role

OT

  “Occupational therapy focuses on...

OT Practitioners are

  experts in understanding...

the multidimensional nature of occupations and activities and their effect on the health and wellness of the individual, organization, or population.

  To fully understand the complexity of occupational performance, occupational therapy practitioners engage in a critical reasoning process involving general and specific activity analyses and activity synthesis (Crepeau, 2003; Kramer & Hinojosa, 2000)

Goal

The overarching goal of occupational therapy is supporting....

What is Health ?

n  According to WHO (1986), health is

“the extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs, and, on the other hand, to change or cope with the environment” (p. 74).

What is Participation ?

What is Engagement ?

Occupational therapy services achieve outcomes that are important to individuals, organizations, and populations (AOTA, 2002

•   Occupational performance, or the ability to carry out life activities in organizations or the community

• Personal satisfaction

•   Role competence

• Adaptation

•  Health and wellness

• Quality of life

client 

is used broadly to refer to a person, group, program, population, organization, or community for whom the occupational therapy practitioner is providing services (AOTA, 2002; Moyers, 1999).

•   actual term used for the person receiving occupational therapy will vary by practice setting (patient, student)

• Motor Skills
• Process Skills
• Communication/Interaction Skills

• Habits
• Routines
• Rituals
• Roles

·         Client Factors

• Body Functions (e.g., neuromuscular, sensory, visual, perceptual, cognitive, mental)
• Body Structures (e.g., cardiovascular, digestive, integumentary systems)
• Spirituality
• Values and Beliefs

·         Areas of Occupation

·         Bathing, showering

·         Bowel and bladder management

·         Dressing

·         Eating

·         Feeding

·         Functional mobility

·         Personal device care

·         Personal hygiene and grooming

·         Sexual activity

·         Sleep/rest

·         Toilet hygiene

·         Care of others

·         Care of pets

·         Child rearing

·         Communication device use

·         Community mobility

·         Financial management

·         Health management and maintenance

·         Home establishment and management

·         Meal preparation and cleanup

·         Safety procedures and emergency responses

·         Shopping

·         Areas of Occupation:  Education

·         Formal educational participation

·         Exploration of informal personal educational needs or interests

·         Informal personal education

·    

    Employment interests and pursuits

·         Employment seeking and acquisition

·         Job performance

·         Retirement preparation and adjustment

·         Volunteer exploration

·         Volunteer participation

·         Play exploration

·         Play participation

·         Leisure exploration

·         Leisure participation

•        Community

•        Family

•        Peer, friend

• Objects Used and Their Properties
• Space Demands
• Social Demands
• Sequencing and Timing
• Required Actions
• Required Body Functions
• Required Body Structures
• Other Client Factors

• Mental functions (affective, cognitive, perceptual)

–        Structures of the nervous system

• Sensory functions and pain

–        The eye, ear, and related structures

• The eye, ear, and related structures

–        Structures related to movement

• Cardiovascular, hematological, immunological, and respiratory systems

–        Structures of the cardiovascular, immunological, and respiratory systems

• Voice and speech

–        Structures involved in voice and speech

• Digestive, metabolic, and endocrine systems

–        Structures related to the digestive, metabolic, and endocrine systems

• Genitourinary and reproductive systems

–        Structures related to the genitourinary and reproductive systems

• Skin and related structures

Skin and related structures

• Cultural
• Physical
• Social
• Personal
• Temporal
• Virtual

·         Cultural Environment and Context

• (external features that have been internalized)
• Customs, beliefs, activity patterns, behavior standards, and expectations accepted by the society of which the client is a member; includes political aspects, such as laws that affect access to resources and affirm personal rights. Also includes opportunities for education, employment, and economic support.

·         Physical Environment and Context

• (external to the person)
• Nonhuman aspects of contexts. Includes the accessibility to and performance within environments having natural terrain, plants, animals, buildings, furniture, objects, tools, or devices.

·         Social Environment and Context

• (external to the person)
• Availability and expectations of significant individuals, such as spouse, friends, and caregivers. Includes larger social groups that are influential in establishing norms, role expectations, and social routines.

Personal Environment and Context

• (external or internal to the person)
• “Features of the individual that are not part of a health condition or health status” WHO, 2001, p. 17). Personal context includes age, gender, socioeconomic status, and educational status.

·         Temporal Environment and Context

• (external or internal to the person)
• “Location of occupational performance in time” (Neistadt & Crepeau, 1998, p. 292).

·         Virtual Environment and Context

• (external to the person)
• Environment in which communication occurs by means of airwaves or computers and an absence of physical contact.

·         Performance Skills         

• are the features of action, which includes motor, cognitive, and communication and interaction skills

·         Motor Skills

• Posture
• Mobility
• Coordination
• Strength and effort
• Energy

• Posture

• Mobility

• Coordination

• Strength and effort

• Energy

·         Cognitive Skills

·   

•      Energy
• ·         Knowledge
• ·         Temporal organization
• ·         Organizing space and objects
• ·         Adaptation

     Energy

·       

—sustained cognitive effort over the course of occupational performance while using process skills

·         Knowledge—the ability to seek, discover, learn, and use activity related information

Temporal organization

·     

   Organizing space and objects

·       

·         Communication & Interaction Skills

·      

•   Physicality
• ·         Information exchange
• ·         Relations

  Physicality

·     

   Information exchange

·     

·         Performance Patterns  

·         Contexts

·         General Activity Demands

• Free-standing rehabilitation
• hospital or center
• Inpatient hospitals
• Inpatient mental health
• Inpatient rehabilitation
• Nursing facilities
• Prisons
• Research facilities

·         Driver’s rehabilitation programs

·         Hospital outpatient

·         Low vision clinics

·         Outpatient clinics

·         Outpatient office

·         Outpatient rehabilitation

·         Partial hospitalization

·         Research facilities

·         Principle 1) Code Of Ethics

Principle 1

·         OT personnel shall:

• Provide services in a fair and equitable manner.  They shall recognize and appreciate the cultural components of economics, geography, race, ethnicity, religious and political factors, marital status, age, sexual orientation, gender identity, and disability of all recipients of their services.

·         Strive to ensure that fees are fair and reasonable and commensurate with services performed. When occupational therapy practitioners set fees, they shall set fees considering institutional, local, state, and federal requirements, and with due regard for the service recipient’s ability to pay.

·         Make every effort to advocate for recipients to obtain needed services through available means.

·         Recognize the responsibility to promote public health and the safety and well-being of individuals, groups, and/or communities.

·         Principle 2)

·         Principle 2)

OT personnel shall

• Maintain therapeutic relationships that shall not exploit the recipient of services sexually, physically, emotionally, psychologically, financially, socially, or in any other manner.

·         Avoid relationships or activities that conflict or interfere with therapeutic professional judgment and objectivity.

·         Refrain from any undue influences that may compromise provision of service.

·         Exercise professional judgment and critically analyze directives that could result in potential harm before implementation.

·         Identify and address personal problems that may adversely impact professional judgment and duties.

·         Bring concerns regarding impairment of professional skills of a colleague to the attention of the appropriate authority when or if attempts to address concerns are unsuccessful.

·         Principle 3) 

     Principle 3) 

 OT personnel shall

·     

   Collaborate with recipients, and if they desire, families, significant others, and/ or caregivers in setting goals and priorities throughout the intervention process, including full disclosure of the nature, risk, and potential outcomes of any interventions.

·         Obtain informed consent from participants involved in research activities and ensure that they understand potential risks and outcomes.

·         Respect the individual’s right to refuse professional services or involvement in research or educational activities.

·         Protect all privileged confidential forms of written, verbal, and electronic communication gained from educational, practice, research, and investigational activities unless otherwise mandated by local, state, or federal regulations.

·         Principle 4)

         Principle 4)

   OT personnel shall

·         Hold the appropriate national, state, or any other requisite credentials for the services they provide.

·         Conform to AOTA standards of practice and official documents.

·         Take responsibility for maintaining and documenting competence in practice, education, and research by participating in professional development and educational activities.

·         Be competent in all topic areas in which they provide instruction to consumers, peers, and/or students.

·         Critically examine available evidence so they may perform their duties on the basis of current information.

·         Protect service recipients by ensuring that duties assumed by or assigned to other occupational therapy personnel match credentials, qualifications, experience, and scope of practice.

·         Provide appropriate supervision to individuals for whom they have supervisory responsibility in accordance with Association official documents; local, state, and federal or national laws and regulations; and institutional policies and procedures.

·         Refer to or consult with other service providers whenever such a referral or consultation would be helpful to the care of the recipient of service. The referral or consultation process shall be done in collaboration with the recipient of service.

·         Principle 5) 

Occupational therapy personnel shall comply with laws and Association policies guiding the profession of occupational therapy.  (Procedural Justice)

·         Principle 5) 

·         OT personnel shall

Familiarize themselves with and seek to understand and abide by institutional rules; applicable Association policies; and local, state, and federal/national/international laws.

·         Be familiar with revisions in those laws and Association policies that apply to the profession of occupational therapy and shall inform employers, employees, and colleagues of those changes.

·         Encourage those they supervise in occupational therapy–related activities to adhere to the Code.

·         Take reasonable steps to ensure employers are aware of occupational therapy’s ethical obligations, as set forth in this Code, and of the implications of those obligations for occupational therapy practice, education, and research.

·         Record and report in an accurate and timely manner all information related to professional activities.

·         Principle 6) 

·         Principle 6) 

    OT personnel shall

• Represent their credentials, qualifications, education, experience, training, and competence accurately. This is of particular importance for those to whom occupational therapy personnel provide their services or with whom occupational therapy personnel have a professional relationship.

·         Disclose any professional, personal, financial, business, or volunteer affiliations that may pose a conflict of interest to those with whom they may establish a professional, contractual, or other working relationship.

·         Refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, or unfair statements or claims.

·         Identify and fully disclose to all appropriate persons errors that compromise recipients’ safety.

·         Accept responsibility for their professional actions that reduce the public’s trust in occupational therapy services and those that perform those services.

·         Principle 7) 

·         Principle 7) 

   OT personnel shall

• Preserve, respect, and safeguard confidential information about colleagues and staff, unless otherwise mandated by national, state, or local laws.

·         Accurately represent the qualifications, views, contributions, and findings of colleagues.

·         Take adequate measures to discourage, prevent, expose, and correct any breaches of the Code and report any breaches of the Code to the appropriate authority.

·         Avoid conflicts of interest and conflicts of commitment in employment and volunteer roles.

·         Use conflict resolution and/or alternative dispute resolution resources to resolve organizational and interpersonal conflicts.

·         Familiarize themselves with established policies and procedures for handling concerns about this Code, including familiarity with national, state, local, district, and territorial procedures for handling ethics complaints. These include policies and procedures created by AOTA, licensing and regulatory bodies, employers, agencies, certification boards, and other organizations having jurisdiction over occupational therapy practice.

• Autonomy  

• Beneficence  

• Confidentiality 

• Dilemma  

• Duty  

• Ethics  

• Fidelity 

·         Justice:  Three types of justice are:

·         

Compensatory justice

·         Distributive justice

·         Procedural justice

Compensatory justice:  

·

        Distributive justice: 

·         

·         Morality:  

• Nonmaleficence:  

When was the Occupational Therapy Code of Ethics last updated?

·         : The Code was reviewed and updated in 2005 and approved by the AOTA Representative Assembly in May 2005.

Where can I find a copy of the Code?

·         The Code is available in several places on the AOTA Web site at www. aota.org. You can download and print it from the “About AOTA” section. The Code is posted in the “Practice and Ethics” section (under “Ethics Resources”) and in the “Consumer” section, which makes it available to nonmembers as well. It also is available through the AOTA Fax-on- Request line (800-701-7735, Document 914). It is contained within the Reference Guide to the Occupational Therapy Code of Ethics (this publication), which is available through the “Books, Products, & CE” section of the AOTA Web site or from 1-877- 404-AOTA.

·         Are any resources available to explain the Code of Ethics in greater detail?

·         Can I file a complaint against any occupational therapist or occupational therapy assistant?

·         Ethics Complaints and Process

  Yes. However, AOTA is a membership organization and is permitted to handle only ethics complaints against occupational therapists and occupational therapy assistants who were AOTA members at the time of the alleged misconduct. The Enforcement Procedures for the Occupational Therapy Code of Ethics (2005) outline the jurisdiction of AOTA’s Ethics Commission and are available at http://www.aota.

·         What is the process for filing a complaint?

·         : What are the differences among AOTA, NBCOT, and SRBs?

·         What should I do if my clinical judgment indicates a different plan of care than what is supported by the client’s insurance plan?

·          I am applying for admission to an occupational therapy/occupational therapy assistant program. Several years ago I was involved in a legal incident that resulted in a criminal record against me. Can I now become an occupational therapy practitioner?

·         I would like to file a legal complaint (e.g., noncompete clause, prices for contract work, canceling or changing terms of a contract). What is the process?

·This area is not in the jurisdiction of the Ethics Commission. You may wish to contact your SRB. You also may wish to seek the advice of an attorney who is knowledgeable in this subject.

·        How long should I keep records in home care or at an outpatient treatment facility?

·

    There may be both legal and ethical responsibilities related to medical records. The employer usually determines the length of time for records management. If you are dealing with the Centers for Medicare and Medicaid (CMS) or any other accrediting agency (e.g., JCAHO), you should check the standards of these organizations. You usually can find copies of records management procedures in the medical records/health records office of any facility. Code of Ethics principles to consider: Principles 3D, 5A, and 5B.

·         Can a skilled-nursing facility under the prospective payment system refuse to provide needed equipment to a patient?

·         I am an occupational therapy assistant, and my supervisor is requiring me to write initial evaluations. Will I get into trouble? Is this legal or ethical?

·   

·         While working in the office of another discipline (e.g., psychologist, physical therapist), an occupational therapist is providing biofeedback services or other similar nontraditional service. Is it ethical to bill under the license of another professional?

·         My supervisor has been promoted, and I have taken over her caseload.  I have discovered that she has been billing for patients when she has been sitting in her office all day. What should I do?

·         I am new to my facility, and I have been asked to recreate notes on a patient of another occupational therapy practitioner. Is this ok?

·         My supervisor has asked me to go back and recreate my notes/records on a patient/client I saw more than 2 months ago. I do not have copies of my notes. Can I do this?

The Code states that you should not use any form of communication that is false, fraudulent, or deceptive. If you have billing records or notes that explain the dates and times you saw a particular patient, you can write a note stating that information. If you do not have notes and cannot remember what you did and what type of progress an individual made, then it is unethical to make something up. Code of Ethics principle to consider: Principles 6C.

·         I am an academic fieldwork coordinator. During Level II fieldwork, a fieldwork educator reported to me that one of my students attempted to convert both patients and other students to his religious belief system. The fieldwork educator has spoken to the student about respect for cultural and religious differences. This conversation has not changed his behavior. What do you suggest?

·        

First, you should gather more information. Ask the student to provide a first-hand account of what transpired. Assuming his account includes proselytizing, you should talk about the potential harm his actions could cause to patients who are in a vulnerable situation (Principle 2, nonmaleficence). Bring to the student’s attention Principle 1A, which states “recognize and appreciate cultural components . . . religious and political factors of all recipients of their services.” If you have access to a hospital chaplain, he or she might be able to contribute to this conversation by emphasizing the need to show respect to others’ choices of religious beliefs. If the student still does not see the need to change his behavior, you should document the situation, for example, with a professional behavior citation, with clearly stated consequences (including removal from the fieldwork site if necessary). You also should investigate university policies for nonacademic misconduct. If the student is a member of AOTA, you could consider contacting the AOTA Ethics Commission, as the Code of Ethics applies to students as well as practitioners. Code of Ethics principles to consider: Principles 1A and 2.

·         Are there any resources about the ADA that I could review to help me ensure that my practice and facility are in compliance?

·         You are working with a client who is deaf and uses the services of an American Sign Language interpreter to communicate. The interpreter regularly talks with you about the client during the treatment session when no communication is being shared between you and the patient. Is it ethical practice for you to participate in that communication?

·         Self-assessment questionnaires

·         Environmental assessments

·         Checklists and rankings

·         Occupational histories

·         Occupational narratives

·         Skilled observation of occupational performance

·         Performance skill ratings

·         Activity simulations

·         Standardized tests

·         Nonstandardized tests

·         Data obtained from evaluations

·         

Pre-morbid or self-perception of current functioning level in activities of daily living, instrumental activities of daily living, work, education, play, leisure, and social participation

·         Interests, meanings, values, and beliefs regarding occupations and activities

·         Participation levels in the community

·         Health status

·         Potential therapeutic occupations and activities

·         Abilities and limitations in occupational performance

·         Possible goals for future occupational performance

·         Contexts and environments that support or interfere with occupational performance

·         Performance skill abilities and inabilities

·         Inappropriate or appropriate performance patterns

·         Body structure and function capacities and impairments

·         Intervention Plan.

• developed in collaboration with the client, reflects the client’s goals and priorities
• is based on the results of the evaluation process, particularly the occupational performance problem statement.
• Ultimately, the plan describes the specific occupational therapy approaches and types of interventions that will accomplish the client's targeted outcomes (AOTA, 2002, p. 617)

• The occupational therapist develops the intervention plan; the occupational therapy assistant may contribute to its development. The steps are as follows:

–        Establish objective and measurable goals with time frames.

–        Identify the approaches for the occupational therapy intervention on the basis of theory and evidence.

–        Establish the mechanisms for service delivery (e.g., provider of the intervention; type of intervention; frequency, intensity, and duration of service).

• In addition, the occupational therapist considers potential discharge needs and plans, selects outcome measures, and makes recommendations or referrals to others as needed.

• Health promotion 

·         Occupational therapy practitioners use three main approaches to promote health and well-being (Wilcock, 2003, 2005):

·         

1. Enable “all people to achieve their fullest health potential”          (Wilcock, 2003, p. 42):
2. ·         Mediate “among differing interests in society toward the pursuitof health” (Wilcock, 2003,p. 42):
3. Advocate with the belief that “health is a major resource for social and economic development, and personal quality of life”    (Wilcock, 2003,p. 42):

·         Establishment or restoration 

·         Criteria for Remediation and Restoration Approach:

·         An expectation for

·         Significantly reducing impairments of body structure and function to:

–        Prevent further activity limitations and participation restrictions and

–        Resolve activity limitations or increase participation in occupations and activities;

·         Learning new performance skills and patterns;

·         Slowing declines in impairments of body structure and function and in occupational performance;

·         Maintaining or improving quality of life; and

·         Having a context or environment supportive of the time needed for this approach

Maintain is

·         A need to: 

(Maintain)

–        Ensure that the client does not lose current levels of occupational performance;

–        Ensure that improvements in occupational performance remain once therapy is withdrawn;

–        Slow the anticipated loss of occupational performance with a progressive condition;

–        Hold the client accountable for following therapeutic recommendations;

–        Train the client how to use therapeutic strategies targeting impairments (e.g., exercise routines or splinting schedules) or how to make activity and environmental modifications (e.g., simplifying activity procedures or adding safety devices in the kitchen and bathroom); and

–        Retrain the client with “booster sessions” because of gradual degradation of body functioning, performance skills, and performance patterns.

·         The intervention approach of modification and compensation focuses on...

·         Modify/compensate

·  

      Expectation for little change in impairments and in performance skills and patterns

·         Limited time for intervention

·         Preference of person and family, relevant others, or caregivers

·         Residual impairments in body structure and function, and performance skills and patterns

·         Need for immediate success in occupational performance to sustain motivation for remediation

·         Activity limitations and participation restrictions interfere with occupational performance

·         Problems of safety, adequacy, and quality during occupational performance

·         Existence of remaining occupational performance capabilities that can be enhanced

·         Psychological acceptance of the modification.

disability prevention

·         Therapeutic Teaching Process

·       

Determine the characteristics of the learner

·         Identify learning needs.

·         Set learning goals.

·         Select methods for teaching based on learning styles, such as auditory, visual, or kinesthetic ways to facilitate learning.

·         Assess the learning environment.

·         Apply evidence-based learning tools unique to the situation, such as

–        Motor learning (organization of practice and feedback to enhance the learning of motor tasks),

–        Errorless learning (use of cues and direction to prevent errors in novel tasks for those with significant cognitive deficits),

–        Attentional focusing (use of externally focused information vs. internally focused information to learn motor tasks),

–        Scaffolding (breaking tasks down into a hierarchy of skills), and

–        Self-monitoring (metacognitive skills to enhance self-awareness).

–        Evaluate learning.

–        Examine instructor characteristics and style.

• Match training strategies with the learning capacity of the person.
• Grade the complexity of what is to be learned.
• Integrate new learning with previous knowledge.
• Incorporate practice of activities chosen by the person, repetition, and methods for transfer to a variety of occupations within multiple contexts.
• Provide training in the use of activity, activity objects, and contextual and environmental modifications.
• Provide feedback for altering performance.
• Reinforce correct performance.
• Incorporate new learning into habits.

·         Intervention Implementation

• This puts the intervention plan into action,
• a process that involves a skilled occupational therapy process for effecting change in the client’s occupational performance and participation in community.
• “Intervention implementation is a collaborative process between the person and the occupational therapist and the occupational therapy assistant” (AOTA, 2002, p. 618).
• The focus of intervention is on changing the interrelated and dynamic factors of contexts and environment, activity demands, client factors, performance skills, and performance patterns.
• Determining how the client’s occupational performance responds to changes in those factors is a necessary aspect of intervention implementation.

    Determine and carry out the type of occupational therapy intervention or interventions to be used.

·         Therapeutic use of self

·         Therapeutic use of occupations or activities

·         Consultation process

·         Education process.

·          Therapeutic Use of Self

• Occupation-based activities

• Purposeful activities 

• Preparatory methods,

·         Types of OT Intervention: Consultation process

·         Types of OT Intervention: Consultation process

·   

     Types of OT Intervention: Education process

·         Steps of Intervention Implementation

·     

   Monitor the client’s response to interventions using ongoing assessment & reassessment.

·         Measurement of Outcomes

• Begins with the evaluation of the client when outcomes are determined and intervention is implemented, so as to achieve those outcomes.
• During the intervention, periodic review of progress toward the outcomes may require modification of the types of intervention or the targeted outcomes. Occupational therapy services are no longer needed when outcomes have been achieved.

• occupational performance,
• client satisfaction
• role competence
• adaptation,
• Health and wellness
• quality of life (AOTA, 2002).

·         Outcome Measures

·         To discern the effects of the occupational therapy intervention

·         To select the occupational performance problems conducive to intervention

·         To choose the best approaches to and types of intervention

·         To make decisions about frequency, intensity, and duration of intervention

·         To determine the client’s progress and results

·         To change the therapeutic approach

·         To communicate intervention progress

·         To ascertain the effectiveness of an intervention program offered to a group of clients

To determine sites of future intervention

·         Several key critical reasoning questions are answered with outcomes measures:

• What is the client’s level of activity and participation?
• Are there any remaining occupational performance problems?
• Has the client’s activity and participation truly changed?
• Has the client’s activity and participation changed significantly?

·         Attention Deficit/Hyperactivity Disorder

·         Brain Injury

·         Cerebral Palsy

·         Children With Behavioral and Psychosocial Needs

·         Chronic Pain

·         Developmental Delay in Young Children

·         Multiple Sclerosis

·         Older Adults

·         Parkinson’s Disease

·         School-Based Interventions

·         Stroke

·         Stroke: Focused Questions

·         Substance Use Disorders

·         AOTA’s Evidence-Based Practice
Resource Directory (www.aota.org)

• Databases and Internet sites in occupational therapy, rehabilitation, and health outcomes

·         Tutorials for acquiring basic and intermediate level skills to search and interpret the literature relevant to occupational therapy

·         National and international evidence-oriented Internet sites posted by universities, government agencies, and private organizations.

• Evidence-Based Practice
• Outcomes and Effectiveness
• Technology Assessments
• Preventive Services
• Clinical Practice Guidelines.

·         Termination of occupational therapy services may include:

• referral to community resources or other professionals, such as other occupational therapy practitioners with specific expertise
• Assisted-living facility, home care, or outpatient rehabilitation services.
• a referral for vocational assessment
• participation in a community self-help program, (such as Alcoholics Anonymous)

·         Further/Continued OT

• planned medical interventions that occur in stages (e.g., a series of plastic surgeries after a severe burn; a two stage tendon repair)
• The client may need to perform new tasks because of changes in the context and environment, such as a new living situation, workplace, caregiver, or teacher.
• Changes in client factors may provide opportunities to move the client to a higher level of occupational performance (e.g., going from reliance on assistive technology to conventional use of everyday equipment),
• from one life or developmental stage to another (e.g., from preschool to school, from work to retirement),
• from one program to another (e.g., from hospital inpatient to home health), or
• From one physical context to another (e.g., from a job in one part of a building to one in another part of the building).
• Finally, new technology may enhance the client's ability to engage in desired occupations; its implementation may require intervention to effect modifications in performance patterns and skills