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History of Occupational Therapy
Nelson's Occupational Analysis
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The primary assumption of the compensatory approach is the belief that a patient can regain independence using compensation when underlying deficits cannot be remediated. While some patients may regain their independence they would not do so as they did before their illness. This approach uses both compensation and adaption. Adaption ensures that the environment will be appropriately modified to substitute for loss of function. Compensation teaches the patient to use adapted procedure, which substitute for loss of function and to use the modified environment.
Geiger (1989) found that 54% of dressing devices were not used by patients with orthopaedic conditions after they went home. Half of the patients in the survey said they no longer needed the device. Even patients with long term disabilities such as stroke patients, reported a 24% disuse rate for dressing aids. Yet Occupational Therapists said they thought only 16% of adaptive devices were discarded after discharge (Bynum and Rogers 1987). There is therefore a discrepancy between patients and therapists perception of how helpful adaptive devices are at home.
There are however positives to using adaptive devices within this approach:
Good face validity – the patient recognises their use immediately
Have a concrete immediate solution
Can be a rapid remedy in a high demand service
And there are disadvantages:
Some patients may feel they stigmatise them as “handicapped”
Require some cognitive reasoning to their purpose and use
May be used simply as a “quick fix” rather than solving the initial cause
Upper Extremity Orthotics
These orthotic devices can compensate for upper limb strength, such as mobile arm supports that attach to wheelchairs and flexor hinge splints.
These devices may compensate within activities of feeding, grooming and writing.
These are advantageous when a problem cannot be solved in another way, such as a wheelchair cannot achieve access to a particular room. Here, environmental modifications can make the difference between regaining or losing a valued role. Environmental modifications are often costly both in monetary and time. It is important to consider whether the dysfunction is temporary and therefore if the modification is justified.
This requires problem solving and then coaching the patient in adaptive procedures to enable task completion. Examples could be advising a person that has had hemiplegia to dress affected side first or a person with a spinal cord injury to apply trick motions. Other examples could be advising a person with ataxia to position their arm to improve stability when picking a glass or advising a person with hemianopia to do the majority of tasks to their visible side. A frequent application of adaptive techniques is during energy conservation tasks. Applying adaptive procedures is advantageous as they are less visible but a disadvantage may be that the patient does not wish to change a habit. Adaptive procedures may not be useful for patients with cognitive deficits (Carlton 1987).
In summary, the compensational approach is a valuable approach to apply to clients that are willing to consider alternative methods of functioning or need a rapid improvement in a specific task. Compensational strategies, although they may improve functioning of the task, do not necessary improve the impairment.
Critics state that occupational therapists risk over reliance on this approach due to time restraints and the pressure in considering that their time is more effective enabling a rapid achievement of functional tasks rather than improvement of the cause to the functional impairment (Zoltan 1996)
Bynum H, Rogers J (1987) The Use and Effectiveness of Assistive Devices Possessed by Patients Seen in home care. American Occupational Therapy Journal 7: 181-184
Carlton RS (1987) The effects of body mechanics instruction on work performance. American Journal of Occupational Therapy 41: 16-20
Geiger CM (1989) the utilisation of assistive devices by patients post discharges from an acute rehabilitation setting. Unpublished Masters Thesis. Temple University
Zoltan B (1996) Vision, perception and cognition – a manual for the evaluation and treatment of the neurologically impaired adult. Slack. Thorofare.
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