This chapter is written from the perspective of the practicing occupational therapist and addresses how impairment of the upper extremity (UE) is treated within the context of daily living skills. The chapter is designed to provide the physical therapist with information to (1) provide effective interventions to improve UE function, (2) understand the unique contributions of the occupational therapist in UE functional skill training, and (3) communicate with occupational therapy colleagues about comprehensive interdisciplinary patient management.
Before planning treatment, the therapist performs a task or activity analysis. Task analysis is the breakdown of activities into their component parts to understand the demands of the activity and identify patient deficits that hinder successful participation in the activity (Box 11.1). Therapists consider three primary components in the activity analysis process: patient body function performance skills, activity demands, and environmental factors. Patient body function performance skills refers to the anatomical and physiological components necessary to participate in the activity; the skills are further broken down into the following skill categories: sensory, perceptual, neurological, musculoskeletal, cognitive, and psychosocial. This chapter focuses on the neurological and musculoskeletal skills needed to perform activities of daily living (ADL).
Activity demands refers to the requirements embedded in each step of the activity. Environmental factors are the physical characteristics of the environment that may impede or promote performance and the social and/or cultural values and beliefs that may influence a patient's ability and desire to perform specific ADL. Once an analysis of all three areas is complete, the therapist can modify the activity and/or the environment to enhance the patient's ability to participate. To improve patient performance, therapists can also use specific interventions designed to enhance the patient's neurological and/or musculoskeletal function.
BOX 11.1 The Process of Activity Analysis Patient Case Sample
The patient is a 72-year-old woman status post cerebrovascular accident (CVA) with a right parietal lobe lesion and resultant underlying impairments in sensation, visual perception, motor functioning, cognition, and psychosocial skills. The following are specific underlying body function performance skill impairments.
Sensory: impaired proprioception, kinesthesia, and stereognosis in left UE
Perceptual: left visual and somatosensory neglect noted; exhibits extinction upon double simultaneous stimulation to both UEs
Musculoskeletal: moderate left shoulder weakness; moderate flexor synergy elicited with left UE overhead and side reach; minimal gross grasp and weak trunk control when seated
Cognitive: decreased attention and concentration, able to follow two- to three-step commands, has moderate difficulty with judgment, awareness, and insight; requires frequent prompts to initiate activities
Psychosocial: appears depressed and demonstrates emotional lability; appears to lack motivation to participate in treatment
The therapist considers the following questions:
How will the above impairments affect or limit the patient's performance during each ADL task?
How will each component of a given ADL task be affected by a combination of impaired performance skill areas?
For example, while engaged in functional activities the ...