Occupational Therapy for Physical Dysfunction Seventh Edition RRaaddoommsskkii__FFMM..iinndddd ii 88//2266//1133 88::3311 PPMM This page intentionally left blank. RRaaddoommsskkii__FFMM..iinndddd iiii 88//2266//1133 88::3311 PPMM Occupational Therapy for Physical Dysfunction Seventh Edition EDITORS Mary Vining Radomski, PhD, OTR/ L, FAOTA Clinical Scientist, Occupational Therapist Courage Kenny Research Center Occupational Therapist Courage Kenny Rehabilitation Institute Minneapolis, Minnesota Catherine A. Trombly Latham, ScD, OTR/L, FAOTA Professor Emerita Department of Occupational Therapy College of Health and Rehabilitation Sciences: Sargent College Boston University Boston, Massachusetts RRaaddoommsskkii__FFMM..iinndddd iiiiii 88//2266//1133 88::3311 PPMM Senior Editor: Michael Noble Product Manager: John Larkin, Heather Rybacki Development Editor : Kelly Horvath Marketing Manager : Shauna Kelley Designer: Teresa Mallon Compositor: Absolute Service, Inc. Seventh Edition Copyright © 2014 Lippincott Williams & Wilkins, a Wolters Kluwer business 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Printed in China Sixth Edition, 2008; Fifth Edition, 2002 NOTICE TO READER: This publication contains information relating to general principles of medical care that should not be construed as specifi c instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages, and precautions. It remains the responsibility of the practitioner to evaluate the appropriateness of a particular opinion or therapy in the context of the actual clinical situation and with due consideration of any new developments in the fi eld and current drug information. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at per- [email protected], or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Occupational therapy for physical dysfunction / editors, Mary Vining Radomski, Catherine A. Trombly Latham. -- Seventh edition. p.; cm. Includes bibliographical references and index. ISBN 978-1-4511-2746-1 (hardback : alk. paper) I. Radomski, Mary Vining, editor of compilation. II. Latham, Catherine A. Trombly editor of compilation. [DNLM: 1. Occupational Therapy. 2. Disabled Persons--rehabilitation. WB 555] RM735 615.8’515--dc23 2013029668 DISCLAIMER Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any conse- quences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clear- ance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at ( 800) 638-3030 or fax orders to (301) 223-2320 . International customers should call ( 301) 223-2300 . Visit Lippincott Williams & Wilkins on the Internet : http://www.lww.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. RRaaddoommsskkii__FFMM..iinndddd iivv 88//2266//1133 88::3311 PPMM Dedication To the profession’s authors—past, present, and future. RRaaddoommsskkii__FFMM..iinndddd vv 88//2266//1133 88::3311 PPMM Preface The seventh edition of O ccupational Therapy for Physical Section V elucidates intervention principles and prac- Dysfunction emphasizes four key themes that are essential tices for persons with physical dysfunction. As in earlier to the best possible occupational therapy for adults with editions, this section does not provide recipes for the physical disabilities and to the future of the profession: treatment of people with particular diagnoses but rather descriptions of best practice. The professional occupa- ● Reliance on evidence/research to inform occupational tional therapist can choose from these for a particular therapy assessment and intervention patient who has his or her own particular goals and mani- ● Occupation as the central intervention and outcome of festation of a diagnosis. occupational therapy services Section VI includes discussions of the practice of ● Importance of expert activity analysis that synthesizes occupational therapy for particular major diagnostic theoretical knowledge, clinical skills, and awareness of categories, each written by a specialist in that area. These person and contextual factors to occupational therapy experts alert therapists who are beginning to practice practice with one of these populations to various commonly ● Appreciation for the individuality, unique circum- encountered impairments that affect occupational func- stances, and priorities of each patient/client. tioning and to the specialized assessments and treat- These themes are evident in the book’s organization, ments that have been developed for persons carrying the features, ancillaries, terminology, and authorship. diagnosis. In addition to the textbook, the following three chap- ters from the sixth edition are now available to readers ORGANIZATION on thePoint, the book’s website (thepoint.lww.com): Optimizing Motor Behavior Using the Bobath Approach, Similar to the previous edition, the seventh edition is Optimizing Motor Behavior Using the Brunnstrom composed of six sections with 45 chapters. Movement Therapy Approach, and Managing Defi cit of Section I lays the foundation for the rest of the text- First-Level Motor Control Capacities Using Rood and book. Chapter 1 addresses theoretical foundations (with Proprioceptive Neuromuscular Facilitation Techniques. emphasis on the Model of Occupational Functioning), The intervention techniques described in these chapters and Chapter 2 addresses practical foundations of occupa- are not adequately supported by current evidence, and to tional therapy for adults with physical dysfunction. remain consistent with the key themes described above, Section II presents the areas of assessment in which we did not include them in the book. However, because an occupational therapist working in acute medical, in- many practitioners continue to refer to these approaches patient/outpatient rehabilitation, and community-based and related concepts, these chapters are preserved to serve rehabilitation settings should be competent. The chapter as important resources. sequence generally represents the order in which occupa- tional therapists might conduct assessment, beginning with appraisal of the specifi c context and evaluating the FEATURES person’s occupational roles and competence, followed by assessment of the person’s abilities and capacities This edition also has a number of features that emphasize that support role performance and fi nally assessment of the scientifi c and refl ective foundations of clinical practice. the relevant environmental constraints and enablers of The chapters in Section II (Assessment of Occupational performance. Function) include Assessment Tables that summarize Section III presents three mechanisms of therapeutic the psychometric properties, strengths, and weaknesses of change: occupation and occupation as therapy, learning, the assessment methods described in the chapter. and therapeutic rapport. Evidence Tables (where evidence exists) are included Section IV presents therapeutic technologies that in chapters in Section III (Therapeutic Mechanisms), Sec- enable and support occupational functioning: splinting, tion IV (Therapeutic Technologies), Section V (Interven- wheelchairs, adapted or assistive devices, and physical tion for Occupational Function), and Section VI (Reha- agent modalities. bilitation to Promote Occupational Function for Selected vi RRaaddoommsskkii__FFMM..iinndddd vvii 88//2266//1133 88::3311 PPMM Preface vii Diagnostic Categories). These tables summarize research of research, including that from other disciplines, to studies that address the interventions mentioned in the practice), Safety Notes (precautions to be observed), and chapters and/or Case Examples. They are not exhaustive Resources (where to fi nd information and equipment) compendia of all research but represent the current best are included throughout the chapters to showcase and evidence for the effectiveness of the interventions and emphasize key concepts. serve as examples of culling critical information from research articles. Readers will fi nd information pertain- ANCILLARIES ing to these tables and other features in this volume’s User’s Guide . As indicated above, a website is available at thepoint.lww The Case Examples in this edition continue to high- .com. Students can go to the site to see how an expert light the “whys” of the assessment and intervention would answer the questions posed in Clinical Reasoning process. In general, Case Examples are designed to help Boxes throughout the text. Clinical Reasoning Boxes students appreciate how various topics described in the (questions and answers) from the sixth edition are also chapter relate to and inform occupational therapy prac- available on the site. Instructors’ Resources have been tice. Readers will fi nd that the Case Example format in this posted, including PowerPoint slides that provide lecture edition describes the actions of therapy (“ Occupational outlines for each chapter and an image bank containing Therapy Process”) along with the therapist’s internal all images and tables from the book. dialogue to explain why he or she approached occupa- Also at thePoint, students can access audiovisual con- tional therapy assessment and/or intervention as he or she tent in which core techniques are demonstrated. Brief did (“Clinical Reasoning Process”). video clips help learners visualize and review key aspects of New to this edition are three A ctivity Analysis Case practice, including the measurement of upper extremity Examples, the goal of which is to explicate the clinical range of motion and hand strength, upper and lower reasoning that occupational therapists use in selecting extremity dressing techniques for individuals with hemi- and modifying activities to meet patients’ therapeutic plegia and paraplegia (new to this edition), how to fabri- goals. Three types of activity analyses are introduced in cate a splint, and how to assist clients as they transfer into Chapter 12 by Catherine Verrier Piersol, PhD, OTR/L, and out of a wheelchair. and modeled in later chapters by other authors. In Chapter 27 ( Restoring Competence for Homemaker TERMINOLOGY and Parent Roles), Susan Fasoli, ScD, OTR/L, developed an Activity-Focused Analysis Case Example . This Throughout this book, readers will note an amalgam is a deconstruction of the activity itself outside of the of occupational therapy terminology, derived from client-specifi c application or context. This type of activity the Occupational Therapy Practice Framework: Domain & analysis is intended to provide a schema that readers may Process, Second Edition (American Occupational Therapy use to build a repertoire of therapeutic occupations and Association, 2008), I nternational Classifi cation of Func- emphasizes occupation-as-means. In Chapter 37 (Hand tioning (World Health Organization, 2001), O ccupational Impairments), Cynthia Cooper, MFA, MA, OTR/L, CHT, Functioning Model , and generic “OT speak.” This supports developed a C lient-Focused Activity Analysis Case our aim to develop multilingual practitioners. The use Example . This is a description of the reasoning involved of various terms and frameworks in the textbook refl ects in the therapeutic use of occupation-as-means for a partic- the different ways in which practicing occupational ther- ular therapeutic goal for a specifi c person. In Chapter 25 apists and occupational therapy scholars talk about the (Restoring the Role of Independent Person), Anne Birge work we do each day. If you fi nd yourself needing to think James, PhD, OTR/L, developed an Environment-Client twice to do some translation, get used to it. In practice, Focused Activity Analysis Case Example . This is a de- we must be profi cient at adapting our language based construction of the specifi c activity-environment- person on the needs of those with whom we communicate, un- fi t to determine and/or optimize the likelihood of suc- derstanding that most of us spend our day with people cessful performance of occupation-as-end. Activity Analy- who have never heard of occupational therapy, much sis Case Example templates are also available on thePoint less our professional vocabulary. Similarly, some authors ( thepoint.lww.com) should readers choose to use them to elected to refer to recipients of occupational therapy ser- develop activity analyses on their own. vices as clients, others as patients. This too refl ects ways As in the previous edition, a Glossary and boxes in which appropriate terminology varies based on the highlighting C linical Reasoning (opportunities to de- context of the situation. In general, the term “patient” velop clinical reasoning skills that go beyond the material is most often used in acute medical and inpatient reha- that can be looked up in the chapter), Procedures for bilitation settings; it refl ects a more passive role of the Practice (how to do a particular assessment or treatment), person receiving care and is the term used by other pro- Defi nitions, R esearch Notes (examples of application fessionals on the health care team. The term “client” is RRaaddoommsskkii__FFMM..iinndddd vviiii 88//2266//1133 88::3311 PPMM viii Preface used in reference to a person living in the community sharing their knowledge and skills with occupational who is receiving outpatient, home-based, or community- therapists preparing to enter the fi eld. based services. It refl ects the assumption that the person Mary Vining Radomski receiving services is ready to assume a more directive role Catherine A. Trombly Latham in organizing his or her care. REFERENCES AUTHORS American Occupational Therapy Association. (2008). Occupational Sixty-eight outstanding clinical and academic occupa- therapy practice framework: Domain & process (2nd ed.). A merican Journal of Occupational Therapy, 62, 625–683. tional therapists and experienced lay persons contrib- World Health Organization. (2001). I nternational Classifi cation of Function- uted to this edition. They each did so with the desire to ing, Disability and Health–Short version. Geneva, Switzerland: World contribute to the profession of occupational therapy by Health Organization. RRaaddoommsskkii__FFMM..iinndddd vviiiiii 88//2266//1133 88::3311 PPMM Acknowledgments We gratefully acknowledge the many individuals who ing space for our photography and videography sessions have helped us with the seventh edition of O ccupational and to Cheryl Smith and Matthew White, OTR/L of the Therapy for Physical Dysfunction . As always, we relied on Courage Kenny Research Center. We are especially grate- the accommodation, practical assistance, and occasional ful to Elizabeth Plummer, who allowed us to use her beau- indulgence of our friends and loved ones, most notably tiful photograph on the cover of the book. our husbands, Jim Radomski and John Latham; we thank As mentioned in the Preface, we recognize the con- them for their help with this work. Heather Rybacki, Man- tribution, commitment, and hard work of this edition’s aging Editor at Lippincott Williams & Wilkins, worked authors. In this edition, we are particularly grateful to with us throughout the planning and editing of the the authors who are also members of the U.S. Army seventh edition. John Larkin, Product Manager, and Russ Medical Specialists Corps including MAJ Charles Quick, Hall (Absolute Service, Inc.) orchestrated and prepared the MAJ Priscillia Bejarano, LTC Andrew Fabrizio, MAJ Jose production of the book. We appreciate their expertise, pro- Rafols, MAJ Sarah Mitsch, MAJ(P) Kathleen Yancosek, fessionalism, and the continuity that they brought to this and those with recent military service (Valerie Rice, Lisa project. Smurr Walters, and Lynsay Whelan). We recognize the Many others were quick to agree to our requests for historically important ways that military clinicians have assistance with photographs, videography, and ancil- infl uenced our profession and their service to our country. laries. Emily Eastman, occupational therapy student at All of these authors stand on the shoulders of 51 previ- St. Catherine University, was an exceptional model for the ous authors who have shaped the textbook’s content since new range of motion and manual muscle testing photo- the fi rst edition was published in 1977 (see the list that graphs. We appreciate Jennifer Theis, MS, OTR/L, who follows). Past and present authors have taken on this work developed the storyboards for the new video on car trans- with a desire to advance the profession by sharing their fers and dressing techniques, and Kelly Tollefson (and expertise with you and for that, we are most grateful. her sister/driver, Amy) and Susan Hagel, MS CTRS, who demonstrated these techniques in the videos. Thanks too Mary Vining Radomski to the Courage Kenny Rehabilitation Institute for provid- Catherine Trombly Latham ix RRaaddoommsskkii__FFMM..iinndddd iixx 88//2266//1133 88::3311 PPMM