Occupational Performance - Essay Example

Occupational Performance It describes the Basic understanding of the nature and purpose of occupational performance according to Occupational Therapy practice framework (AOTA2002) and the International classification of functions; its relevance to the human health and function. With case study analysis of Manual Material Handling activity. The analysis is done on the performance skills, performance pattern, Required Body function and Body structure. It tries to identify one impairment of Body structure or function, which could create difficulties in carrying out the activities. It also tries to explain why the impairment could cause difficulties and the consequences for the individuals of these difficulties and finds ways in which these difficulties might be reduced or overcome. (No. of words used - 3074) Occupational Performance Part One Nature and Purpose Occupational performance can be defined as the ability of a person to perform tasks for the purpose of carrying out her/his occupational roles in a satisfying manner. The importance of analyzing functional performance is of crucial importance to occupational therapy. The assessment of an individual's / group or populations' level of functioning is very important in planning an occupational therapy for an individual. Occupational therapists take into account the many types of occupations humans might engage, sort them into categories called 'areas of occupation' Let's look at the various performance roles first: Occupational performance roles are patterns of behavior in different kinds of occupation in ones daily life i.e. self-maintenance, productivity, leisure and rest. The roles are determined by individual's physical, mental and spiritual conditions and her/his relationship with external environment. The components of occupational performance are classified as biomechanical components, sensory-motor components, cognitive components, intrapersonal components and interpersonal components. Biomechanical components refer to the operation and interaction of and between physical structures of the body during task performance. This can include range of motion, muscle strength, grasp, muscular and cardiovascular endurance, circulation, elimination of body waste. From the perspective of the task or sub-task, this component refers to the biomechanical attributes of the task; for example, size, weight, dimension and location of objects. Sensory-Motor Performance Component refers to the operation and interaction of and between sensory input and motor responses of the body during task performance. Cognitive Performance Component: refers to the operation and interaction of and between mental processes used during task performance. Intrapersonal Performance Component: refers to the operation and interaction of and between internal psychological processes used during task performance. Interpersonal Performance Component refers to the continuing and changing interaction between a person and others during task performance that contributes to the development of the individual as a participant in society. Elements of Occupational Performance are the body, mind and spirit. The Occupational Performance Model (Australia) acknowledges that together these core elements of human existence form the human body, the human brain, the human mind, the human consciousness of self and the human awareness of the universe (Popper, 1981) Body Element: The tangible physical components of human structure consists the body element. Mind Element: the basic intellectual component of an individual is called the Mind element Spirit Element: is defined loosely as that aspect of humans which seeks a sense of harmony within self and between self, nature, others and in some cases an ultimate other; seeks an existing mystery to life; inner conviction; hope and meaning. As stated earlier the areas on which occupational performances are observed are Self-maintenance, productivity, leisure and rest. Self-Maintenance Occupations are regular tasks and sub-tasks done by an individual to maintain her/his health and well being in the environment (Reed, 1986, p.499). These regular tasks and sub-tasks can be in the form of habit (reading, eating, cooking) that is necessitated by demands of life. Productivity occupations are regular tasks and sub-tasks, which are done to enable a person to provide support for self, family or community through the production of goods or provision of services (Reed, 1986, p.499). Leisure/Play Occupations: are those regular tasks and sub-tasks for purposes of entertainment, creativity and celebration, for example gardening, singing, dancing, sewing, games. Rest Occupations: are those tasks for the purposeful pursuit of non-activity. This can include time devoted to sleep (Meyer, 1922), as well as tasks, sub-tasks and rituals undertaken in order to relax like meditation etc. External Environment: is an interactive sensory-physical-socio-cultural phenomenon within which occupational performance occurs. The interaction of these four dimensions creates further sub-dimensions such as political and economic environments that profoundly affect occupational performance. The occupational performance environment shapes the nature of occupational performance and is also modified by it. Space: refers to compositions of physical matter (Physical Space) and a person's view of the experience of space (Felt Space). The space at which a MMH is asked to do his work plays a very important role in the performance. The space is dictated by the management, co-workers, customers etc. etc. Time: refers to the temporal ordering of physical events (Physical Time) as well as a person's understanding of time based on the meaning that is attributed to it (Felt Time). Contextual Influences Context is the varieties of interrelated conditions that influence activity performance. The contexts are internal as well as external. Occupational therapists need to consider the specific contexts that surround the performance to understand performance skills and patterns. The Occupational therapists consider all the relevant contexts, keeping in mind that some of them may not be influencing the particular skills and patterns being addressed. Physical context: refers to the natural and constructed surroundings of a person, which form physical boundaries and contribute to shaping behavior. Tall and fat people are not recommended for Manual Materials handlers because their physical structure is an impediment for the job. The therapist has to look for prior history of back injury, poor physical fitness level, second Jobs, recreational activities, hobbies, smoking, aging process and psychological issues like family, financial or other personal problems, Job dissatisfaction, lack of Job Control, work related stress are some of the physical Social context: refers to an organized structure created by the patterns of relationships between people who function in a group, which in turn contributes to establishing the boundaries of behavior. The occupational performance has considerable dependence on the social context. The family background of a MMH is a very important factor to be considered by a therapist. The acceptance of the society in which a MMH lives of the kind of job involved is another major factor. The influence of co-workers, management and customers relates to Social context. Part 2 Activity for Analysis Manual Material Handling is the activity we have taken for study. Manual materials handling (MMH) is a component of many jobs and activities undertaken in life. Generally it involves lifting, carrying, pushing, pulling, lowering of loads manually. The job profile includes loading and unloading of trucks, moving parts, assemblies, sub-assemblies in work place, lifting patients from a bed or transporting them in a wheelchair etc. Performance Skills: "Skills are observable elements of action that have implicit functional purposes" (Fisher & Kielhofner, 1995, p. 113). The job of Manual Materials Handling (MMH) requires heavy lifting, frequent bending, twisting of body, whole body vibration and other risk factors. The task is repetitive in nature and normally done over an extended period of time, little rest in between. We need to use Biomechanical approach, Psychophysical approach, Psychosocial approach for understanding the skills required. In Biomechanical approach it is necessary to use the principles of physics to the human body to determine the mechanical stresses that affect it and the resultant muscular forces needed to counteract the stresses. Many Mathematical models are available to help determine the forces and torques acting on different parts of the body, such as the upper and lower back, arms, shoulder, torso and legs. We follow the physiological approach for analyzing the energy consumption and the stresses acting on the cardiovascular system. The repetitive job profile for longer duration requires higher intake of oxygen resulting in faster heartbeats. This is the physiological cost associated with the activities we perform. The underlying premise of the psychophysical approach is that when people perform a lifting task, they intuitively combine both biomechanical and physiological stresses in their subjective perception of the demands placed on them. In other words, people adjust their workload to the maximum amount they feel they can sustain without undue strain or discomfort, and without becoming unusually tired, weakened, overheated, or out of breath. Psychosocial factors: Low job satisfaction, monotonous nature of work, work space, interpersonal relationship, worker's perception about their abilities, work demand stress are the psychosocial factors affecting the workers. Lifting from knee height is easier than lifting from floor level. The workspace also imposes restriction on the posture. If there are space restrictions as inside a container or inside a truck, the body twist is inevitable. As posture plays very important role, use of extreme postures adversely impacts energy expenditure and the strength needed to accomplish a task The floor and the shoes worn play an important role in carrying out this activity. In a container, or inside a truck where space is limited extra demand is exerted. The space at which work is done plays an important factor. Interpersonal relation with the co-workers plays another important role. It requires sustained strength and endurance from body and mind. The MMH worker needs to understand the following basics of material handling: 1. Test the weight of the load and its weight distribution before lifting. 2. Heavy loads needs assistance from others or mechanical handler 3. The path should be clear on the way while delivering the load. 4. The load should be as close to the body as possible so the center of gravity remains close to the spine. 5. Grasp the object with the whole hand using a power grip whenever possible. 6. Movement should be natural, smooth, continuous, and balanced. Movement of the feet should avoid twisting of the torso and should maintain stability during the lift. 7. Minimizing twisting, bending, stretching, and reaching with the trunk during the lift. 8. Lifting the head before lifting the back. Body functions: While manually handling loads, the forces have to be exerted on those objects may result in direct damage to the spine, and to the intervertebral discs in particular. It needs to be determined the forces and torques acting on various systems of the body, such as the back, arms, or legs As the task is repetitive in nature and takes place over an extended period of time, it requires sustained strength and endurance. The body requires more oxygen resulting in increased heartbeats. The muscles become fatigue. Body structures: In lifting the load the person also need to lift his upper body weight. And hence obesity becomes a hindrance for material handling job. Tall people are relatively unsuitable for lifting weight as the center of gravity shifts away from the body, putting more strain. The manual materials handlers has to stand on their legs most of the time. Hence the strong lower limb is an essential requirement. "Aging leads to reductions in physical work capacity, range of lumbar spinal motion, muscle strength, muscle contraction speed, shock absorbing characteristics of the lumbar discs, intraabdominal pressure, load supporting capacity of the spine, and aerobic capacity." Hence age also plays a big factor. Performance Patterns Patterns of behavior related to daily life activities that are habitual or routine. Behavioral Patterns of MMH, which result in Declining Performance: Increased, Repeated, unexpected and on the Job Absenteeism from excuses like minor illnesses or improbable excuses. Excessive tardiness and disability, Concentration Problems, Greater effort to finish work, Jobs and projects take longer, Erratic Work Pattern, Physical illness on the job (headaches, stomach aches, etc.) Increased number and length of coffee breaks, increasingly long lunches; increased number of trips to rest room Complaints from co-workers Difficulty in recalling instructions and details, in handling and completing assignments Difficulty in recalling own mistakes Extremes of high or low productivity and in quality of work Poor decision-making, Friction with Other Employees, Overreaction to real or imagined criticism, Wide swings in mood, Unreasonable resentments, Avoidance of associates, Irritability, Unusual Behavior, Temper tantrums, Physical violence, Emotional outbursts The pace at which we work carries some physiological cost, but there is a personal work rate at which each of us can safely work without deleterious physical effects. This is most often the case when work is "self paced" -when the individual establishes a personally comfortable work rate; however, work rates are often established by machines and equipment, standards, management, or co-workers. Increasing the work rate, or task frequency, increases the body's physiological response. The postures we assume while working may be self or workplace-imposed. A person may (inappropriately) choose an extreme posture on his or her own to perform a task. Work piece positioning, equipment orientation, and workstation layout may also compel the use of extreme postures. PART -3 Activity limitations and participative restrictions: Chosen impairment of body structure for the study under consideration: Injury to the L5/S1 Spinal disc of the lower back. L5/S1 disc is the low back spinal disc most frequently injured in the performance of materials handling tasks. There is a relative agreement on the mechanisms, which can injure the lower back. If extremely heavy weights must be handled, the forces we have to exert on those objects may result in direct damage to the spine, and to the intervertebral discs in particular. The workplace risk factors typically associated with low back pain include handling heavy loads, task repetitiveness, extreme postures of the back (twisting, bending, stretching, and reaching), static postures, whole body vibration, prolonged sitting, direct trauma to the back (striking or being struck by an object), slips, trips and falls. Extreme postures of the back, which is also of particular concern. A) Twisting the back without moving the feet. B) Lateral bending. C) Back flexion; associated with picking up objects below knuckle height. D) Back extension. A variety of personal qualities and traits, which the worker may bring to a manual materials handling job, have also been identified as potential risk factors in the development of low back pain. These include a prior history of back injury, poor personal fitness levels, second jobs, recreational activities, hobbies, smoking, the aging process, gender, obesity, physical stature, and psychosocial issues (including family, financial or other personal difficulties, job or management dissatisfaction, a lack of job control, and work-related stress among other factors). A prior history of back injury is one of the few personal risk factors that probably have some positive correlation as a predictor of future LBP. Persons who have had an injury are more prone to re-injure that body part. With regard to personal fitness levels, the better condition we are in the better we are able to tolerate and recuperate from the stressors we place on our body. Second jobs, recreational activities, and hobbies, especially those that closely mimic the physical demands of our work, can add to the wear and tear on the systems being taxed on the job. As important, they reduce our opportunity for rest and recuperation, which we must have if we are to protect our health and well being. Consequences: Unattended rise in the incidence and severity of back injuries result in the associated medical costs, workers' compensation, man-hours lost and restricted activity time Reduction in productivity and quality are added disadvantages usually accrued over time. Methods to overcome the problem: 1. Education and Training: The primary means of reducing the risk of musculoskeletal disorders among materials handlers is to provide engineering solutions to workplace risk factors. A comprehensive low back pain prevention initiative will include a multi-tiered education and training program. Management and supervisory training should include positive acceptance of employee reports of low back pain, promoting the early reporting of pain, follow-up and communication, and early return to work. 2. Worker Selection/Characteristics One purpose of worker selection is to prevent people with a history of low back musculoskeletal disorders from being placed in what, for them, would be a high risk job. A second purpose is to make sure that people who are assigned to a strenuous job have the physical attributes of strength or endurance necessary to safely perform it. 3. Medical Management According to the federal Occupational Safety and Health Administration (OSHA), the goals of a medical management program are to reduce the duration and severity of symptoms and conditions associated with musculoskeletal disorders. Further, its purpose is to prevent, eliminate, or significantly reduce the duration and severity of functional impairment and disability associated with these symptoms or conditions. In order to have an effective medical management Program, employers must provide employees who experience pain on the job with prompt access to a health care provider for medical assessment and treatment. The ergonomic approach: It is meant to ensure that worker capabilities and limitations are taken into account, and ergonomic risk factors are minimized. This means the job and work environment are more acceptable to a wider range of people. BIBIOGRAPHY Christiansen, C. & Baum C. M. (Eds.) (1997). Occupational therapy: Enabling function and well-being (2nd Ed.). Thorofare, NJ: Slack. Christiansen, C. & Baum, C. M. (1997). The occupational therapy context: Philosophy-principles-practice. In C. Christiansen & C. Baum (Eds.), Occupational therapy: Enabling function and well-being (2nd Ed.). Thorofare, NJ:Slack. Christiansen, C. & Baum, C. M. (1997). Person-environment occupational performance: A conceptual model for practice. In C. Christiansen & C. Baum (Eds.), Occupational therapy: Enabling function and well-being (2nd Ed.). Thorofare, NJ:Slack. Christiansen, C. & Baum, C. M. (1997). Understanding occupation: Definitions and concepts. In C. Christiansen & C. M. Baum (Eds.), Occupational therapy: Enabling function and well-being (2nd Ed.). Thorofare, NJ:Slack. Fisher, A., & Kielhofner, G. (1995). Skill in occupational performance. In G. Kielhofner (Ed.), A model of human occupation: Theory and application (2nd ed., pp. 113-137). Baltimore: Williams & Wilkins. Meyer, A. (1922). The philosophy of occupational therapy. New York: Ravens Press Occupational Performance Model -Australia, http://www.occupationalperformance.com/oldsite/index.html Occupational Therapy Practice Framework: Domain and Process, American Journal of Occupation Therapy, 56, 609 -639. Popper, K. (1981). Part 1, in K. Popper, & J. Eccles, The self and its brain: an argument for interactionism (pp. 3-211). Berlin: Springer International Practice Frame Work: Domain and Process, AOTA Continuing Education Article. Randall B. Stephan, Jeter George (Editor), A Guide to Manual Material Handling & Back Safety, N. C. Department of Labor, Occupational Safety and Health Program Reed, K. (1984). Models of practice in occupational therapy. Baltimore: Williams & Wilkins Yungstor, Mary Jane, September 2002, Introduction to the Occupational Therapy. Read More