All right people, we’ve arrived at Tuesday’s lectures– the final day of the IV Step conference. Hold on to your seats, we’re coming in for a landing!
First up on Tuesday we had Lisa Chiarello present Excellence in Promoting Participation: Striving for the 10 Cs– Client Centered Care, Consideration of Complexity, Collaboration, Coaching, Capacity Building, Contextualization, Creativity, Community, Curricular Changes and Curiosity.
There were a lot of good graphs/charts in this lecture, so I’ll be putting those here too, because I like graphs and charts. They will make the concepts make way more sense that I can ever explain.
So we began with looking at this model of motor control. Lisa wanted us to see how all these things are interconnected and effect each other in a big way. To effect change on motor control to improve participation, we first defined participation as: “the extent to which people with disabilities are participating in the community in a manner that is meaningful to them.” (Rehabilitation Act of 1970) How about another graph? Because those words really sound muddy to me.
So with that, participation is very personalized and complex. Lisa described the “self” circle as “thinking and feeling.” That one was a little abstract. So, because of that, in order to effect it, we therapists need to do 3 things: set equally individualized and complex goals; take those from a participation analysis and provide participation focused interventions. Here’s that in another graph:
We therapists also have a special role in collaborating between others on the patient’s medical team to make sure everyone’s on the same page in supporting their participation goals. We also need to work with the community to make eliminate as many barriers to participation in the community setting as much as possible. Like those terrible public restrooms I spoke on here. We also need to be our patients’ biggest cheerleaders and coach them on to their goals. In assessing participation, we should be looking at 4 things: the time it takes for the person to participate; how independent they are in participating in their chosen activity; the quality of their performance in said activity; how frequent are they participating. Try not to get bogged down on the quality. As movement chauvinists, it is easy for us to get bogged down in that, but that may not be your patients’ goal. It will probably be useful to actually visualize your patient participating in their activity. You could ask them to have someone else video them, or maybe even do a live Skype/FaceTime into the activity. If there is an instructor/trainer/coach at the activity, collaborate with them about the patient, with the patient’s permission of course. Lisa also mentioned using the Canadian Occupation Performance Measure as your participation level outcome measure. (I honestly know nothing about it, except what I see on that website. The main thing for me being that it’s not free. Womp, womp.) Just remember to assess everything in that Framework for Optimal Participation graph up there when you’re assessing to get the whole picture.
Lisa had a few other good nuggets to pass on; however, I think they will be better addressed in the closing post. So I’ll save those bits until then.