model of human occupation, cole & tuffano (2007)

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

MODEL OF HUMAN OCCUPATION

Cole & Tufano (2007), Chapter 7


THE BEGINNING… (MOHO) is a conceptual model of

practice that evolved from Reilly’s Occupational Behavior Model and General System Theory.

Gary Kielhofner was a student of Mary Reilly who originally created this model as a Master’s thesis in 1975. Within five years, Kielhofner and his colleagues published MOHO for the first time


WHAT IS IT?The Model of Human Occupation is a conceptual practice model which is defined as “ …a set of evolving theoretical arguments that are translated into a specific technology for practice and are refined and tested through research” (Kielhofner, 2002, p. 3).


FOCUS Systemic, holistic approach for persons of varying

needs and populations across the lifespan Stresses the importance of the mind/body connection

in its depiction of how motivation (internal) and performance of occupations (external) are interconnected

Human occupation is described as the “doing” of work, play, or activities of daily living within a temporal, physical, and sociocultural context.

Interactive nature between the person and his environment and how this relationship contributes to one’s source of motivation, patterns of behavior, and performance.


PERSON – redefined for practice Kielhofner’s theoretical view of the person

is very comprehensive. Variables include one’s motivation,

behaviors, and performance All 3 inter-relate to form a person’s identity. Kielhofner has specifically grouped these

variables into 3 subsystems that he calls 1) volition, 2) habituation, and 3) performance capacity.


Volition Subsystem Volition is the source of motivation for

occupation.


Habituation Subsystem Habituation refers to the process by

which occupation is organized into patterns or routines


Performance Subsystem Performance capacity refers to the

physical and mental abilities that underlie skilled occupational performance. This subsystem is also called the mind-brain-body performance.


Assumptions Humans are biologically mandated to be

active. Spontaneous action is the most fundamental characteristic of all living things (Boulder, 1968; von Bertalanffy, 1968).

Practice Application: Persons have a fundamental and neurologically based need for action and doing. This innate need is the dominant source of motivation for participation in occupation.


Assumptions, cont. Thinking, feeling, and doing are influenced by a

dynamic interaction between one’s internal components and the environment. Situations and conditions within the environment will influence a person’s motivation.

Practice Application: Systems theory helps the practitioner to understand that there are multiple factors within the person and the environment that influence each other. A change (positive or negative) in any one variable will automatically result in a change in one’s motivation, behavior, and/or performance.


Assumptions, cont. Man is an open system that can change and develop

through interaction with the environment. The parts of the open system cycle include input, throughput, output, and feedback.

Practice Application: Persons are continuously impacted by input from one’s environment and feedback from one’s environment. Clients learn about themselves by experimenting with behaviors and receiving feedback about this behavior (output). Some cycles are positive and some are negative in outcome.


Assumptions, cont. Heterarchy is the principle that the demands of a

context or situation will determine how human variables will organize themselves to achieve a sense of order. In a heterarchy, each component contributes something to the total outcome but the arrangement or order of these variables is changeable due to the conditions of the context and/or environment.

Practice Application: The client’s environment, context, and/or situation greatly influence how the person variables identified as volition (motivation), habituation, (habits and routines) and performance capacity (mind/body skills) will inter-relate with each other.


Assumptions, cont. Participation in occupations helps to create

our occupational identity, which is formed by the person’s internal structures defined by volition, habituation, and performance capacity. It is a subjective construct.

Practice Application: Clients develop an identity over time. It is believed that this identity begins with self-appraisal and extends toward more challenging dynamics such as accepting responsibility for and knowing what one wants in life.


Assumptions, cont. Occupational competence is the degree to

which one sustains a pattern of occupational participation that represents one’s occupational identity. Competence is the ability to put into action what a person internally regards as meaningful.

Practice Application: Clients demonstrate competency when they can organize their life to meet the basic responsibilities to themselves and the role obligations of society in satisfying and meaningful ways.


Assumptions, cont. Occupational adaptation is the outcome of a positive

occupational identity and achievement of occupational competence. It is dynamic and context dependent (refer to concept of heterarchy). Occupational therapy can promote change in clients. The parts within the person (throughput) that include motivation, life patterns, and performance lead to behaviors in work, play, and self care.

Practice Application: The internal parts of the person are responsible for one’s occupational performance and adaptation. Occupational therapy acts as a form of feedback within one’s environment that can ultimately impact how one changes and alters behaviors


ORDER Kielhofner defined function as order (a

status of health and competent performance of daily living, work, and play). A person displays function when he is able to choose, organize, and perform occupations that are personally meaningful. It is a process whereby a person continuously learns how to balance his own expectations with those of society. A person who demonstrates order in daily living, work, and play experiences a sense of competence and role fulfillment


DISORDER Kielhofner termed dysfunction as disorder The inability to perform occupations An interruption in role performance An inability to meet role responsibilities)

(Barris, Kielhofner, & Watts, 1983). A person with dysfunctional behavior

patterns does not experience a basic quality of life nor can he meet personal and societal expectations.


ORDER vs DISORDER Exploration, competence, and

achievement = ORDER Helplessness, incompetence, and

inefficacy = DISORDER


MAN AS AN OPEN SYSTEM Input - Person - Occupational Performance -> Environmental Feedback


3 PARTS OF A VOLITIONAL SUBSYSTEM Volitional Subsystem – source of motivation that guides

individuals to anticipate, choose, experience and interpret what they do; thoughts and feelings about doing occupations that reflect a sense of mastery, enjoyment and value judgments. Composed of three smaller parts.

Personal Causation – refers to one’s sense of competence and effectiveness; what a person feels capable of; a person’s awareness of his abilities; includes feelings of self efficacy (perception of control over one’s own behavior, thoughts, and emotions including a sense of control in achieving desired outcomes). Example: “I am an intelligent person who can succeed in occupational therapy”.

Values – beliefs about what is right, important, and good to do that influences one’s goals; include personal convictions, principles, and a sense of obligation. Example: “I value helping others and therefore my goal is to become an occupational therapist”.

Interests – what a person finds enjoyable, pleasing, and satisfying. Example: “I enjoy studying the arts and science that underlie occupational therapy as a profession.”


2 PARTS OF THE HABITUATION SUBSYSTEM Habituation Subsystem – made up of the

behaviors and roles that help persons to organize their daily life. Composed of two smaller parts.

Habits – automatic and repetitive behaviors that influence how persons perform routine activities, use time, and behave on a daily basis.

Internalized Roles – a source of identity with inherent obligations and expectations; also referred to as scripts or ideas of what is expected of oneself in a particular situation; enable individuals to fulfill needs for self and society.


PARTS OF THE PERFORMANCE CAPACITY SUBSYTEM Mind-Brain-Body Subsystem – composed of

four constituents that represent one’s capacity for occupational performance; one’s underlying natural ability

Musculoskeletal – bones, muscles, joints comprising one’s biomechanical structure

Neurological – central and peripheral nervous systems

Cardiopulmonary – cardiovascular and pulmonary systems

Symbolic – abstract images that guide and give meaning


Occupational Performance or Skilled Actions(output) Goal directed actions (output) that make

up occupational performance. 3 categories.

Motor Skills – used to move one’s self or objects Process Skills – thinking and planning actions

used to help one organize and adapt Communication and Interaction Skills –

observable operations used to verbalize needs and intentions that are part of social behaviors


Person + Occupational Performance Person constructs (volitional,

habituation, and mind-brain-body subsystems) plus one’s occupational performance contribute to the development of occupational identity, occupational competence and occupational adaptation.


ENVIRONMENTPhysical and social places in which a

person performs occupations Shaped by culture Provides opportunities and resources

(positive) as well as demands and constraints (negative)

A significant source of feedback that can maintain or extinguish one’s occupational performance.


CHANGE As a person experiments with novel

behaviors and repeats them over time, these behaviors will become more automatic and habitual.

Persons create a sense of occupational competence when they are capable of engaging in productive and meaningful actions

Sufficient repetition and environmental feedback is required to assimilate new performance patterns


MOTIVATION Motivation is influenced by a

person’s interests, values, and a sense of personal causation, all aspects of the volitional subsystem. Therefore, the volitional subsystem becomes a significant focus area for motivation and change.


EVALUATION PROCESS Kielhofner calls this a data gathering

process.1. Use the data to find out about a client from the

viewpoint of an outsider looking in.2. Collect and use data to help clients understand

how their personal perceptions and subjective views lead to occupational performance actions and patterns.


ASSESSMENTS MOHO assessment instruments are both

structured and unstructured. Structured assessments typically include observational measures, self report questionnaires and checklists, and structured interviews. Unstructured assessments allow the therapist to be more informal and spontaneous in response to a client’s needs


INTERVENTION GUIDELINES Interventions should be focused on changing

one’s occupational performance (skilled action process). Adaptive solutions should be offered in substitution for maladaptive ones.

Interventions may be aimed at modifying or altering one’s environment to promote opportunities for change.


INTERVENTION GUIDELINES Interventions that are aimed at skilled

performance are more efficient than those aimed at a client’s underlying personal structure.

Interventions that take place in one’s natural environment are more likely to be assimilated by the client. Therapists should be ready to alter or modify the client’s environment to increase occupational performance

Interventions that relate to one’s volitional subsystem provide the most meaning and impact for the client. Occupations must be relevant to the client to be effective.


RESEARCH Since 1980, over 80 studies have

been conducted and published Kielhofner and his constituents have

offered major contributions to the field including a wide variety of assessments and extensive research concerning the impact of therapy and the positive outcomes achieved from this therapeutic approach.

model of human occupation, cole & tuffano (2007)

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