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In the assignment, I have engaged in my chosen occupation which is swimming that I will be discussing in relation to meaning, form, purpose and performance components. Occupations are where individuals engage in activities that have meaning and purpose (World Federation of Occupational Therapists [WFOT], 2011). The chosen occupation will be explored in relation to individual meaning and socio-cultural meaning of how this could differ in other situations for others. The case study of Jessica, aged eight years old, female and has moderate cerebral palsy [CP] will be discussed in relation to my chosen occupation. The findings will also discuss how Jessica’s social-cultural and occupational dysfunction impacts on her occupational participation; especially using my occupation as a therapeutic application. Occupational dysfunction identifies any difficulties that clients may have when engaging or performing in occupations (Reed, 2015). Therapeutic application defined as the therapeutic use of self-associating the link between relationship, efficacy and individual’s involvement (Solman, & Clouston, 2016). In addition, it will also explore whether Jessica’s condition can have positive and negative effects on her health and well-being.
Although physical and built environments impact on what and how people do things, it is the cultural context through which people understand and ascribe meaning to what they do (Whiteford, 2010). Meaning is the entire interpretive experience engaged in by an individual encountering an occupational form (Kramer, Hinojosa, & Royeen, 2003). Cutchin & Dickie (2013) do specify that occupations are forms of activity that create and re-create a multitude of our relationship with the worlds we experience. In addition, the result of engaging in occupations is vital to understanding the experience, social development and relates to well-being. Occupational form guides, structures, or suggests what is to be done by the person (Kramer, Hinojosa, & Royeen, 2003; Nelson, 1994). Nelson (1988) stated that the form is observable and objective, but it can change, for example; completing an activity on your own and doing the activity with friends; the form may have an impact on meaning. The purpose is what it is experienced once an individual has engaged in the occupation, it provides meaning and motive for the individual (Kramer, Hinojosa, & Royeen, 2003).
My chosen occupation was swimming which I have engaged in individually. I see swimming as a leisure activity which means I engage in the activity in my free time within my own choice and it is fun (Poulsen, & Ziviani, 2010). The meaning of engaging in swimming for me is that it provides exercise, reduces stress and time to myself. Nelson (1988) argued that the meaning may not positive, but the purpose gives a reason for engaging with a form.
Culture provides scaffolding for informing and shaping an individual’s perception of the different roles and behaviours that are important in the social group (Burke, 2003). As occupations are culturally placed, individuals can be influenced by other causes, for example, choice, personal need, the level of skills and gender expectations (Wilcock, & Hocking, 2015).
Performance components, for example, sensori- motor, cognitive, psychosocial, and psychological aspects are the elements of performance that occupational therapists assess and, when needed, in which they intervene for improving occupational performance (Duncan, 2011). Performance components that I have used in my occupation are a range of motion, strength and muscle tone within the neuromusculoskeletal category.Â Performance components refer to what the person is thinking, feeling and doing, which leads to effective engagement in occupation (Strong, & Gruhl, 2010).
In relation to Jessica’s background, she was born in the United Kingdom and the parents are Chinese. There are specific values and beliefs within their culture which impact on how an occupational therapist is able to deliver a specific therapeutic program with the child. The Chinese community do not like their child to socialise with other cultures, especially receiving intervention from professionals and although education is an exception. The Home Affairs Committee (1985, p.14) stated that “The Chinese community is still fairly conservative in nature, sticking well within its own created socio-economic subculture” (Chau, 2013). The occupational therapist breaks down barriers and reassures parents. An occupational therapist creates an intervention when working with children, it is taken into consideration of the family and child’s interests, including gaining an analysis of the child’s behaviour and performance when engaging in occupations. It should be acknowledged that the family’s perspective may differ than the occupational therapist’s perception and to ensure what priorities are important to that particular child and family (Case-Smith, 2010). Jessica has moderate CP, she is quite an interactive child and has no language difficulties. Jessica’s occupation dysfunction is that she does not often attend school as she frequently loses her balance when walking and uses a stick occasionally as she has long term chronic pain. Jessica’s physical activity is minimal.
Swimming will be used as a therapeutic application for Jessica to improve her general fitness levels, improve her gross motor skills, for example, walking or running and the benefits of using swimming in the long term.
At the beginning of the intervention for swimming, it is one to one basis to start with to provide a person-centred approach and focusing on improving Jessica’s gross motor skills and her confidence. Long term goal for Jessica is that she will be able to incorporate swimming into her routine, including swimming at school with other children. This would increase socialisation, makes swimming fun and whilst maintain fitness levels. Swimming as a physical activity for children with CP shows the benefits in improving chronic pain and preserves locomotor skills from deterioration in the long term (Declerck, Verheul, Daly, & Sanders, 2016). It is agreed by Kelly, & Darrah, (2005; p.69) “that children with CP to improve fitness and function because of the properties of water, reduce excessive joint loading and promote strengthening while at the same time providing assistance to help support children with decreased postural control and muscle weakness”. However, taking into consideration that all individuals are unique and have their own needs, it is argued that attention should be focused on the child’s health and well-being, especially accessibility of activity, pain, fatigue and support network (Lauruschkus, Nordmark, & Hallström, 2014; Whiteford & Townsend, 2011). The World Health Organization [WHO], (1948) defined heath as the “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Wellbeing is central to one’s physical and mental health which includes quality of life and satisfaction (Bass, Baum, & Christiansen, 2015). Long term goal for Jessica is that she will be able to return to school full time and increase improvement with Jessica’s walking, with support from her teachers and parents (Duncan, 2011). Jessica will gradually increase the duration of attendance from half a day to one full day on a weekly basis, eventually, attendance will full time. Jessica’s walking progress will be monitored by the occupational therapist, family, and teachers.
Leisure activities can be a creative therapeutic tool, or a targeted component of a holistic occupational performance plan (Polatajko, Davis, & McEwen, 2015). It is essential that children with CP should be encouraged at an early age to participate in physical activity (Zwier, van Schie, Becher, Smits, Gorter, & Dallmeijer, 2010) as it is known that children with CP have even lower physical activity levels than their typically developing peers (Maltais,Â Wiart, Fowler, Verschuren, & Damiano, 2014). Lack of physical activity has negative effects on health and wellbeing of children with CP especially an increased risk of health related conditions, such as obesity, diabetes, depression and heart disease (Bania, Dodd, & Taylor, 2010; National Institute for Health and Care Excellence [NICE], 2016). It may lead to potential barriers to enable participating in physical activity due to poor physical health and lack of support (Creek & Lougher, 2011). There is evidence of therapeutic use is that positive leisure engagement can improve subjective well-being, including short-term mood enhancement and longer lasting thoughts about life satisfaction in general. (Poulsen & Ziviani, 2010). Furthermore, it is argued by Poulson & Ziviani (2010) that choice and mastery are vital provision for a child to be satisfied with general life; consequently allowing a child to choose a physical activity that they enjoy enables a long term satisfaction (Preston, 2009). According to Harris, Yuill, & Luckin, (2007) when an individual engages in activities that are meaningful, it may deliver a suitable level of challenge and interest which encourages mastery-oriented approach. When an individual has a long-term neurological condition, it may have an impact on the choice, control and potential abilities of the individual to engage in occupations which are meaningful (Stadnyk et al., 2010). Therapeutic knowledge is required in making decisions about leisure interest that match the child’s abilities and interests and meet the family’s needs and resources (Rodger, 2010).
In conclusion, a holistic approach to working with individuals is paramount and knowledge about socio-cultural issues is required to understand many possible barriers. It is important that occupational therapists focus on the meaning than the purpose when individuals engage within an occupation. It is essential to allow individuals to have the control that allows them to be confident and capable to continue to engage in occupations independently, therefore helps them not to be reliant on others (Duncan, 2011; Crist, 2010). Wilcock, & Hocking, (2015) argued that meaning, purpose, control and choice is fundamental for a quality of life, health, and well-being.
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