Canadian Model of Occupational Performance and Engagement

Mrs. R.P &

Overview of the CMOP – E adapted (Turpin and Iwama, 2011)

Canadian Model of Occupational Performance and Engagement CMOP-E

About Mrs. R.P

Mrs. R.P is a 62 year old retired teacher who was working in a high school for the last 32 years.

She was diagnosed with Osteo – arthritis in the left knee joint seven

years ago. She has developed a partially stretchable contracture in the same joint. Later she started developing mild osteo – artritic changes in the right knee too.

She underwent different types of medical and therapeutic treatment since then but the degenerative nature of the disease did not produce remarkable progress in her condition.

She underwent radical nephrectomy due to nephritis as she was diabetic in August 2010.

Reasons for using CMOP – E

Assumptions underpinning CMOP – E presented by Townsend and Polatajko (2007) (cited in Turpin and Iwama, 2011):

1. Humans are occupational beings.2. Occupation has therapeutic potential.Occupation3. Affects health and well – being.4. Organizes time and brings structure to living.5. Brings meaning to life through combination of cultural and

individual influences on creation of meaning.6. Occupations are idiosyncratic, in that the specific occupations

that a person might engage in will vary from person to person.

Core inner aspect – spirituality

Spirituality provides structure to our lives. It is seeded through our culture, philosophy and our world views. This provides a deeply ingrained meaning to our lives.

It is described as a ‘dynamic, patterned process’ (Hasselkus,2011) which has deep personal significance.

Mrs. R identifies herself with her religion by visiting the temple every week, praying at home and attending group prayer sessions with her friends. She performs sacred offerings in the form of milk and flowers to the temple.

She finds a purpose to life with this as she feels it ‘gives a structure to her otherwise mundane day’.

She believes that it is this ‘connection with God’ that gives her peace of mind and satisfaction and happiness in life.

She is unable to undertake these visits altogether after her nephectomy. This has caused adverse effects on her behaviour as she feels guilty and punished.

She has also affected her social meetings with friends which has altered her mood as she has changed from her friendly , sociable self to an irate and moody person.

Person (Mrs. R)

The person, according to CMOP – E is made of three components Turpin and Iwama, 2011):

Physical which is made up of the motor, sensory and the sensorimotor components. The client has limitations in each of these areas –

Mrs. R’s motor component is affected as she experiences decreased ranges, muscle strength which directly affects her movement and actions. Reduced physical capacity is also a direct result of increased pain and decreased threshold for the same.

She experiences sensory deficits as she is diabetic. She experiences loss of sensations in her toes which further incapacitates her as she gets bruises which take longer time to heal.

Her sensorimotor system is affected and due to this she experiences bladder incontinence. This embarrasses her and she claims this to be one of the major barriers to socialising.

Occupation Occupation can be described as clusters of actions and activities which are a part of

daily life, providing structure to the day and which are labelled. These tasks have individualized importance and belong to a culture.(CAOT, 1997 cited in Turpin and Iwama, 2011).

Occupation are all the things that people do to absorb themselves through the day. These include self – care, productivity and leisure.

Mrs. R’s self – care activities are affected as she has restricted ranges in her knee joints. Therefore, she finds it difficult to squat during toileting.

Prolonged standing causes severe pain and hence she experiences difficulty to shower. Due to the suture wounds she is presently unable to don a saree. She is apathetic

because of her present condition and therefore is totally disinterested in grooming activities which she used to perform with great interest before.

Meal preparation is demanding as she is unable to stand continuously for a long duration. She took great interest in cooking her own meals and was a perfectionist in her actions.

She is unable to walk or climb beyond a few paces/ steps respectively due to severe gripping pain ; as a result of which she avoids venturing out of her residence.

Occupation (contd.)

Productivity for Mrs. R who is retired included volunteering for an orphanage and a poor people’s home.

The restriction to her mobility has not discouraged her from undertaking these ventures.

She continues to carry on with the volunteering through telephone and the internet facilities from her residence.

But due to her present condition, she has ceased to undertake almost all the volunteering ventures which she used to before.

She enjoyed family excursions to hill stations and family gatherings and functions. But her present has restricted her participation in these events.(leisure) (Turpin and Iwama, 2011).

Occupation and engagement

CMOP – E describes two inter – related concepts:

Occupational performance and enablement through occupation.

Both these concepts are essential for successful participation by individuals in their immediate environments.

Occupational performance can be described as ‘dynamic interaction of the person, occupation and the environment.’ (Polatakjo et al., 2007 cited in Turpin and Iwama, 2011).

Enablement through occupation is described by Townsend et al. (2007) (cited in Turpin and Iwama, 2011) as ‘enabling people to choose, organize and perform those occupations they find useful and meaningful in their environment’.

Thus the importance of environment is stressed.

Environment can be classified as: physical, cultural, institutional and social.

Environment Mrs. R’s physical environment is made up of her residence. She

is in her bedroom almost all day which is equipped with a double bed, a raised plastic chair for sitting, a television, her closets, medical cabinets, a small praying chamber, large windows, air conditioner and a small table. There is an adjoining bathroom and toilet. The kitchen is few steps away where she seldom prepares tea and snacks. She uses the car to visit places occasionally.

She is culturally motivated and tends to follow it. She dresses and grooms according to it, her eating patterns are strongly influenced by it and she is highly dedicated to her religion and its religious practices. (Turpin and Iwama, 2011).

Environment (contd.)

Institutional environment related to Mrs. R are the medical dispensaries that she frequents, clinics of doctors and specialists, bank, and the volunteering setups that she is involved with. Most of her visits to the voluntary setup is replaced with telephonic conversations.

Mrs. R’s social life was very active. She was an enthusiastic participant in family trips, functions, ceremonies. She regularly visited the temple and attended group prayer sessions. She also joined her friends for shopping, parties and gatherings. (Turpin and Iwama, 2011).

Concluding statement

From the above discussion it is evident that conceptualising a patient using a model aids in providing an explanation to the individual’s actions in relation to their circumstances and condition. It provides a holistic way of approaching a patient rather than viewing them from a single angle.

As occupation underpins the realm of Occupational Therapy, it is vital to focus on the same and understanding its implications on a client.

This lays the foundation for a client centred approach and therefore improves the quality of treatment package provided.

References

Hasselkus, B. R. 2011. Occupation as a source of spirituality: The meaning of everyday occupation. 2nd ed. Thorofare: Slack Incorporated, pp.143-161.

Turpin, M. and Iwama, M.K.2011. Canadian model of occupational performance and engagement: Using occupational therapy models in practice: a field guide. Edinburgh: Churchill Livingstone Elsevier, pp. 117 – 135.