Welcome back to my column. This month as mentioned I will head into the next subject of the OTA education process. This next course is Media, or the arts and crafts used by OT's in the clinic. If you are unaware, arts and crafts have been the basis of occupational therapy treatment since the beginning of the profession. Early OTs used crafts to help people with mental health deficits develop work skills.

However, making crafts and doing art projects are the least of this course. As much as students are introduced to new arts and crafts, the main focus in this course is learning to lead groups, understand differences in cultural and habitual routines and the ability to grade and adapt the crafts.

Leading groups is an important skill every OTA must learn. Being the leader of a group takes confidence and the knowledge of craft making geared towards the patient's interest. The arts or crafts used must also be directed to accomplish a goal of the patient as well. Merely having a patient make a craft does not necessarily address a deficit that needs improvement. First off, the craft must be somewhat challenging to the person but also address an area the patient needs to become more independent in.

Leading a group of patients in an arts and crafts activity has several challenges. Those are: 1) addressing goals of the patients, 2) learning the patient's interests, and 3) grading and/or adapting the activity towards the skill level and capability of each patient.

Patient goals are the most important item here. These are the deficits identified by the evaluating therapist, who then develops goals to have the patient address to improve their ability in specific areas. For instance, if the patient needs to improve fine motor skills then a craft that incorporates small details or objects would be used. Without addressing the goals of the patient there is no therapeutic value to any craft the patient works on.

Learning the interests of the patient is important because if the patient does not see any significance in the craft being done they will not give their best effort. If you try to make a person do a woodworking craft, and there is no awareness of why they are doing it or they have no interest in woodworking, then the gains will be minimal. This is one of the hardest pieces of the OT puzzle to grasp, because as humans we tend to believe that everyone else does things the same way we do and has the same values and knowledge we do.

Grading an activity is an important skill needed to be able to use a similar craft with several patients. To grade a craft is simply learning to change parts of the activity to make the craft easier or more difficult for the person. One example is if the craft contains many small parts and the person has decreased fine motor skills, the small parts would be exchanged for larger objects to complete the same project. At times grading an activity is as simple as changing one part of the craft, but can be as complicated as having to change several parts of the entire activity to address the groups' abilities.

Adaptions to the craft are used to help people with physical deficits be able to complete the activity. Adapting the activity can be as simple as the use of a clamp to hold the project for someone who lacks the use of one upper extremity (arm) to complete the craft. It can also involve the use of built-up handles, holders for small objects, a universal cuff, or other devices to enable the person to complete the activity very much like other group members.

As much as grading and adapting of an activity seem similar, there are differences. Simply put, grading is changing one or more objects of the craft to make it easier or harder, and adapting is the use of special devices to enable a person with physical and/or mental limitations to complete the craft.

As mentioned, the most important skill that the OTA needs to take out of this class is the knowledge of how different people think, react, and believe. We need to take into account that every person has different values, cultural differences, and beliefs. We all learn in our early years the things our parents or caregivers want us to know, however different cultures or religions may learn in different ways or with different values. This is the human factor in OT, as we make every attempt to understand another's perspective on things in order to make OT treatment as holistic as possible.

As an OTA, we will treat many people with different ways of doing things than we learned to do them. Learning to adapt our behavior/methods to the patient's needs, while addressing their goals and making them more Independent in their daily living skills is what OT is all about. In order to do this it is important to have good communication skills so we can listen to the patient, learn their interests, and then direct therapy to make them improve in a method they accept.  This is basic people skills, but as an OTA we incorporate psychological intervention skills as well. Simply put, as an OTA we try to put ourselves in the patient's shoes.

Next month I will discuss Functional Anatomy. This course has so much information to learn it spans two separate classes.  

Thanks again for stopping by to read my column. As always I invite comments which you can post here or send to my personal email address.

Timothy P. Banish, Sr., COTA, has more than 20 years of experience in home health and long term care facilities. He is currently teaching OTA courses at a community college. Tim can be reached at TBANISHSR@cinci.rr.com.