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Environmental Contexts: Considerations for Therapy

1 January 2012


In addition to structuring intervention plans to ensure optimal therapy outcomes, occupational therapists have the power to help determine living arrangements of clients based on assessments and observations of performance in daily living skills. Performance on assessments administered in an unfamiliar, clinical setting may prove to be quite different than performance in a familiar, home setting, as an unfamiliar setting demands new learning that may not be necessary for independence in daily living skills. For this reason, consideration of contexts for assessments and therapeutic interventions is imperative, as environmental factors can directly impact the client’s ability to perform daily living activities.
Does environmental context (naturalistic vs. clinical settings) affect client’s performance during occupational therapy rehabilitation/assessments?
The role of occupational therapy in making recommendations for living arrangements for clients with physical and/or cognitive impairments sheds light on the topic of accuracy of assessment of daily living skills in familiar vs. unfamiliar settings. In a sample scenario, a female client, age 71, was diagnosed with dementia two years prior. She was recently referred to OT services for safety concerns in the home, particularly with meal preparation activities. The client had left the stove on several times over the past few months. She has lived with her husband for the past 60 years. She is typically left alone in the home during the weekdays, as her husband works and attends to errands. While clinical assessments led therapy staff to recommend that this client receive 24-hour assistance to ensure safety in the home, the OT made a home visit and observed the client’s performance level home to be significantly higher than her performance in the clinic in several areas. This scenario leads the authors to wonder if assessment of daily living skills provides occupational therapists with more accurate information about client performance if administered in a familiar setting as opposed to an unfamiliar, clinical setting.


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