A Task Oriented Approach to Upper Extremity Rehabilitation in a Developing Country

1. A Task Oriented Approach to Upper Extremity Rehabilitation in a Developing Country Jenica Domanico, OTR/L Saint Catherine University, MN & Fundación Hermano Miguel: el Centro de Atención Integral al Discapacitado (CAID) in Quito, Ecuador Discussion Abstract Conclusion The task-oriented approach is an evidence-based approach to motor recovery (Bass-Haugen, Mathiowetz, & Flinn, 2008). Occupational therapists in developing countries are challenged because of limited access to materials and supplies. Given the world-wide priority of advancing evidence-based practice in occupational therapy (DeWalt, et. al., 2010, Iwama, 2003; Pearson, & Jordan, 2010), resource- and culturally-sensitive tools are needed. These are the results of collaboration with Ecuadorian occupational therapists to create a clinical tool supporting a task oriented approach. Preparatory activities are concrete, measurable activities. Research provides evidence for preparatory activities, however, practitioners are encouraged to develop a holistic treatment (von der Heyde, 2011). Holistic treatments that focus on the client appear to be effective (Amini, 2011). The AMPS, a task-oriented assessment based in MOHO theory, uses instrumental ADL’s to assess function. The IADL tasks meaningful and relevant to the participant’s culture are performed (Dickerson & Fisher, 1995). • There is moderate but influential supporting evidence for a task-oriented tool for rehabilitation of the upper extremity in a developing country. • Evidence based treatments using minimal resources and low levels of specialized education are a good fit for a developing country. • The task-oriented approach can inspire an evidenced based tool that works cross-culturally and is very amenable to a culturally oriented approach. • Tools created at the literacy level of the clients, with the use of pictures, ensure universal precautions of providing client-centered care. The task-oriented approach: a highly individualized, client-centered, occupational therapy, functional-based intervention compatible with motor learning and motor control principles such as intensive motor training, variable practice, and intermittent feedback. The intensive practice of functional activities (self-care, work, and leisure) aims to enable the client with opportunities to discover the most optimal strategies (i.e., the most efficient and effective) to enable optimal functional performance. Almhdawi & Mathiowetz, 2011, p.112. References Almhdawi, K., & Mathiowetz, V. (2011). Effects of occupational therapy task-oriented approach in upper extremity post-stroke rehabilitation. (doctoral dissertation) Retrieved from MNCAT http://purl.umn.edu/116102 Amini, D. (2011). Occupational therapy interventions for work-related injuries and conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 65, 29 - 36. doi:10.5014/ajot.2011.09186 Bass-Haugen, J., Mathiowetz, V., & Flinn, N. (2008). Optimizing motor behavior using the occupational therapy task-oriented approach. In Radomski, M.V. & Trombly Latham, C.A. (2008). Occupational Therapy for Physical Dysfunction, 599-641 Baltimore, MD: Lippincott Williams &Wilkins. DeWalt, D.A., Callahan, L.F., Hawk, V.H., Broucksou, K.A., Hink, A., Rudd, R., & Brach, C. (2010). Health literacy universal precautions toolkit. (Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality. Iwama, M. (2003). Toward culturally relevant epistemologies in occupational therapy. American Journal of Occupational Therapy, 57 (5), 582 – 588. Maslowski, J. & Armando Hernandez, J. (2008). Assessing community needs and resources in Quito, Ecuador: Report on the Quito project’s 2008 community survey. Retrieved from http://thequito project.org/?q=research_0 Pearson, A. & Jordan, Z. (2010). Evidence-based healthcare in developing countries. International Journal of Evidence-Based Healthcare, 8, 97 - 100. doi: 10.111/ j.1744-1609.2010.00164.x von der Heyde, R. (2011). Occupational therapy interventions for shoulder conditions: A systematic review. American Journal of Occupational Therapy, 65, 16-23. doi: 10.5014/ajot.2011.09184 The highest skills endorsed (more than 50%) by Ecuadorians: sewing clothing, raising animals, cleaning houses and offices, painting, using the computer, construction work, managing a business, selling things, plumbing/electrical, maintaining documents, teaching children, making food for large groups of people, and growing fruits and vegetables (Maslowski & Armando Hernandez, 2008). Introduction Methods & Materials The development of an evidence based, culturally relevant ‘tool for therapy’ required consideration of: • Cultural context; • Research evidence of best practices in upper extremity intervention; • Clients’ cultural connection with the tools used; “We have not fully considered whether the rest of the world shares our values about what constitutes well-being and the centrality of meaningful action to it” (Iwama, 2003, pp. 582). • Literacy level of the clients; “Health literacy is the ability to obtain, process, and understand health information to make informed decisions about health care” (Dewalt, et. al., 2010, p. 1). US students traveled to Ecuador to observe, collaborate, and work with students and therapists at CAID. • Observation: Preparatory activities, strong therapist-client relationship, unspecified goals for therapy; • Developing an understanding of the: ● clinic’s theoretical perspective: Traditional neurodevelopmental approach; ● the therapists’ educational system: Biomechanical medical model, no national journal; ● supply availability: Limited supplies and financial resources; • Exploration of values: Preparatory method to activity versus value of goal directed, client-centered task; • Collaboration with the therapists: Asking questions and demonstrating new ideas for therapy together; • Tool creation: The US student created a tool based on collaboration experience, clinic interest, and evidence. AMPS is a method that requires training, but few tools and resources. Above skills were analyzed for their task properties using language from the AMPS and for the tools and materials most likely incorporated into those occupations. The final product were multiple two-sided brightly colored 5” by 7” cards with culturally relevant images. The cards were sent to be trialed and reviewed in Ecuador. Considerations for future use of this tool could include incorporating the cards into clinics in the United States to support therapy with non-English speaking clients. Acknowledgements Thank you to Saint Catherine University for the amazing experience and to Ecuador for sharing her wonderful people!