Project or Presentation for Fieldwork

• Your name and name of the Fieldwork Placement:

Angela Blaser – Transitional Rehab, Aspen Ridge East

• Description of the clients served and the work that is carried out there, in your own
words. (2 pts)

Most of the clients were geriatric and all were transitioning from a hospital setting to
a long term living environment. They were either going home (possibly with home health
care), or to a long term care facility. The interventions were focused on improving
independence in ADLs and IADLs to return home safely, and/or training on AE to
improve their functional performance.

• How your project supports the work of the agency (3 pts)

I chose to fabricate and donate some items that would increase the facilities ability
to provide occupation-based interventions for their clients. They had a lot of orthopedic
rehabilitation and the OT was working on increasing standing (sometimes dynamic)
endurance, and after having the clients complete therapeutic exercises they were most
often brought to a table. They almost always had some sort of game for the client’s to
play when they raised the table, and justified it as distracting the patients while they
stood, while also engaging them in a cognitive exercise. The problem was that there
were a lot of clients (men in general) who refused to play games as they were not
preferred occupations. For those clients they spent most, if not all of their OT time
completing therapeutic exercises.

• A thorough description or picture or copy of the project itself, must use at least 2
resources for evidence (demonstrate that the presentation or project is based on
EBP). Be sure to give me enough information so I can grade it. (8 points)

I decided to make something to fill this gap that may provide an activity of interest for
this population. I wanted the activity to be purposeful and simulate an ADL or IADL, and
since my husband is a carpenter with the necessary tools handy, I chose to create a
home maintenance and hood working kit with hand tools.

I created a station of sorts that provided the opportunity to install and/or replace a
door hinge and a door knob. I also included a nail block with small nails for hammering
and removing nails if appropriate. I provided a small hammer, a traditional screwdriver,
an adjustable ratchet screw driver (to limit in-hand manipulation and provide the option
of moving in a variety of planes), nails and screws in a container, a measuring tape and
marking pencil, and a bag to hold all of the tools.

Lastly, I made a woodworking activity in the form of a birdhouse. I wanted this

activity to be accessible to individuals at varying functional levels, so I made it possible
to fully assemble the birdhouse will wooden dowels and/or screws. We color coded the
pre-drilled holes to avoid confusion, with the blue holes designating the use of a
screwdriver. As this activity also functioned as a 3D puzzle of sorts and could be used
to challenge problem solving and other cognitive skills, we chose to number the pieces
and include instructions for the OTs to use with clinical judgement to grade the activity
appropriately.

These activities were meant to provide a more client centered and occupation-based
option for some of the residents receiving treatment at this transitional rehab facility. I
used it with multiple clients during my stay and received comments like, “It feels good to
be able to do something real again”. I also observed an increase in social interaction
between men participating in these therapeutic activities discussing personal interests,
history, and employment. So, not only did it get them engaged physically and cognitively
with the activity, it improved social participation in some patients.
 Current evidence emphasizes the effective use of occupation-based
interventions. A recent randomized control trial (Daud, Yau, Barnett, Judd, & Jones,
2016) showed significant functional benefits to incorporating occupation-based activities
into intervention plans that utilized therapeutic exercise, as opposed to therapeutic
exercise alone. This was done with patients in a hand clinic who’s diagnoses apply
directly to some of the clients seen at my FW placement. A systematic review,
conducted in 2012, also provided research-based evidence to support the use of
therapeutic activities like the one I created (Orellano, Colon, & Arbesman). They found
that when interventions were interdisciplinary, which is how this transitional rehab facility
functioned, functional task exercise programs improved IADL performance of
community dwelling older adults. An IADL-based training program was shown to
improve their ability to perform IADLs as well as their physical fitness. Overall, this
systematic review provided strong evidence that activity-specific and client-centered
interdisciplinary interventions improve IADL function in community dwelling older adults.

• Comments from your fieldwork supervisor. Ask them to write a sentence or two
about the project and comment on its quality or usefulness or creativity, etc. Have
them handwrite it on the bottom of your one page summary, email the comments to
me at jeanette.koski@hsc.utah.edu or leave me a voice message at 585-3133. (2
pts)

My FW supervisor sent her comments to Jeanette directly.

• After you complete the project, what went well and what could be done even better
next time? (3 pts)

I felt that this was my most successful project yet. I saw it being used by multiple
OTR/Ls and COTAs, and felt that it truly promoted an occupation-based perspective in
a facility that may have gotten stuck in a rut with therapeutic exercises. Luckily, my
husband had extra unused tools to donate, but it is not a kit that I would be able to
produce regularly with ~$10 reimbursement budget. I cleared the idea past the
therapeutic director and made sure that the space it would take up would be acceptable.
At the facility they had a lot of space for storing therapeutic tools and materials. At other
facilities, this type of project could be considered cumbersome, which was something I
considered.

If I were to make this again I might make the roof of the birdhouse with a tapered
edge, instead of a square edge to make the pieces easier to assemble intuitively.

References

Daud, A. Z. C., Yau, M. K., Barnett, F., Judd, J., Jones, R. E., & Nawawi, R. F. M. (2016). Integration of
occupation based intervention in hand injury rehabilitation: a randomized controlled trial. Journal
of Hand Therapy, 29(1), 30-40.

Orellano, E., Colón, W. I., & Arbesman, M. (2012). Effect of occupation-and activity-based interventions
on instrumental activities of daily living performance among community-dwelling older adults: A
systematic review. American Journal of Occupational Therapy, 66(3), 292-300.