In this essay I am going to critically reflect on how an Occupational Therapist (OT) would use grading and adapting to increase the therapeutic gain for clients when using groups and creative activities. I am going look at these two skills as they focus on client centeredness and intervention. College of Occupational Therapist (COT 2010; Atkinson and Wells 2003) stated that as a therapist one has to have a continuing duty to respect and hold the autonomy of a client, encouraging and enabling choice in the occupational therapy process and do things that are meaningful.
During my placement I participated in an activity based social group of elderly people with dementia. A Group is defined by Jacobs and Jacobs (2004) as individuals who are in contact with each other and are aware of some common goal. One particular activity that I can reflect on was the Parachuting exercise. According to Willet (2006), parachute games encourage cooperative, non-competitive play and reinforce turn-taking and sharing. This activity was to enable social interaction among members of the group who were lacking in confidence.
It involved the sending of a ball from one client to another by raising and lowering the parachute. The therapist leading this session was the facilitator who put the environment into consideration by choosing a well-lit and spacious room where all chairs and tables were put to one side to facilitate participation. This can be identified as adaptation. Crepeau et al (2009) defined adaptation as changing tasks demands so they are consistent with the individual’s ability level either by modification, use of devices or changes in physical or social environment.
The ability to grade and adapt is one core skill unique to the occupational therapist with the purpose of changing the environment of an activity for a therapeutic gain (Duncan 2006). During this task, one ball was initially used raising and lowering the parachute. The activity was then graded by adding more balls on to the parachute hence changing the demands of the same activity. Crepeau et al (2009) defined grading as increasing demands of occupation to stimulate improved function or reducing the demands to respond to client difficulties in performance. Also read luma reflection paper
By having more balls the activity was made difficult and there was an increase in momentum to keep the balls on the parachute. As the session went on I began to see some cohesion in the group and this made me begin to see the value of the activity. However when we did the same activity in the seminar it gave me an opportunity to see other activity demands that were associated with this exercise that I had not realised on my placement.
For example the underlying body functions like raising the parachute, head movements, flexing and extending the arms, pass the ball, initiating eye contact with group members etc. Again the activity was graded and adapted by reducing the number of group members to about three. This was in order to increase participants’ confidence and interaction. As the time went on more participants were added to the group. By the end of the session I could see improvements in moods and interaction among the participants in the seminar group. However not everyone was finding this enjoyable and beneficial.
Some people in the group thought this was childish and a waste of time and there are people who naturally do not like group involvement as highlighted by Benson (2010), who identified sources of anti-group phenomenon as resistance to participation in groups stemming from distrust, fear, anxiety and dislike of groups. On my placements I did not take part in any creative activity but did in the skills seminar. According to Atkinson and Wells (2003) cited (Jones 1972), creativity is defined as a uniquely human characteristic which everyone possesses to some extent.
My task was to draw a hand on plain white paper. The environment fitted the task as there was good constant lighting and the tables and chairs were spaciously arranged. Using the Occupational Therapy Practice Framework (Creek 2010), I was able to identify some skills critical to this activity performance that is, grading the activity by first choosing a simple picture that I copied using a template and drawing it on a smooth table. I then adapted the activity by putting a paper grip to hold the paper in position and referring to the instruction manual.
I noticed that the activity became flexible after the adaptations hence promoting my participation. Atkinson and Wells (2003) revealed that creativity exists within us in managing well- being at the same time enjoying it. However Leckey (2011) disagrees in stating that there is no clear evidence that supports creativity improves well-being but does suggest that participation may contribute to improving one’s social network and that more research is needed. Holford (2011) highlighted the advantages of creative activities and mentioned that tapping into people’s individual creative interests can ncourage them to participate and connect with family and friends. As a result of this experience I have managed to realise the positive effects of group and creativity approaches on clients and how I can incorporate them into my practice. My preconceptions about groups and creative activities helping patients’ to improve their wellbeing were altered by the evidence in practice I experienced during placement. I have also understood the use of grading and adapting in activities to increase a client’s therapeutic gain.
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