CJOT — Vo1.57 — No.

Applicati. of the Guidelines for

Client-centred Practice to Paediatric
Occupational Therapy

Debra Stewart, Susan Harvey

KEY WORDS ABSTRACT The "Guidelines For the Client-Centred

Practice of Occupational Therapy" (De-
• Assessment process,
This paper outlines the process of incor- partment of National Health and Welfare
occupational therapy porating the "Guidelines For the and Canadian Association of Occupational
• Client-centred practice Client-Centred Practice of Occupa- Therapists (DNHW & CAOT),1983)
(occupational therapy) tional Therapy" into the practice of presents a conceptual framework for
occupational therapy in an out-patient occupational therapy, as well as general
• Pediatric occupational therapy
rehabilitation facility serving _young guidelines for practice, and specific guide-
• Screening process people with physical disabilities. lines for assessment and program plan-
Specifically, the areas of practice ning. The guidelines are process-oriented,
addressed are screening and assess- following a client through the therapeutic
ment. system from point of entry until the final
The process started in 1987 with an exit.
identification of the need to find a The purpose of this article is to outline
holistic framework that meets the the process that one occupational therapy
complex needs of clients with chronic department in a paediatric setting under-
physical disabilities. The conceptual took to incorporate the "Guidelines For the
model of occupational performance, as Client-Centred Practice of Occupational
outlined in the Guidelines, provided Therapy"(DNHW & CAOT,1983), re-
such a framework. ferred to as the Guidelines in this article,
The process of incorporating the Guide- into daily practice. The particular focus of
lines into the screening and assessment the article is on the first two stages of
practices of occupational therapists at practice described in the Guidelines: refer-
Erinoak Serving Young People With ral, which includes screening, and assess-
Physical Disabilities is described, with ment. Examples of documents developed
examples of documents developed by by the department are given, and the
the department. Suggestions are given benefits and difficulties of using the
to integrate the conceptual model of oc- Guidelines are discussed, to assist other
cupational performance into the settings interested in applying the Guide-
practice of occupational therapists lines. The need for future work to integrate
Debra Stewart, B.Se.O.T., O.T.(C)., working with children and adolescents the model of occupational performance
O.C.O.T.. is the Director of Occupational with physical disabilities. into the various stages of occupational
Therapy Services, Erinoak Serving Young therapy practice in paediatrics is dis-
People With Physical Disabilities cussed.
2277 South Mil!way, Mississauga, On-
tario, L5L 2M5. Background Information
Susan Harvey, B.Sc.O.T., O.T.(C) is Clini- Erinoak Serving Young People With
cal Supervisor, Occupational Therapy Physical Disabilities is an outpatient facil-
Services. Erinoak Serving Young People ity in Mississauga, Ontario, which pro-
With Physical Disabilities. Downloaded from cjo.sagepub.com at Purdue University on May 21, 2015
vides habilitation/rehabilitation services to

88 April/avril 1990
 CJOT — Vo1.57 — No. 2

over 800 young people with physical occupational therapy journals and books occupational performance as described in
disabilities up to the age of 22 years. readily available to us, that were recom- the Guidelines. It appeared to meet our
Clients of Erinoak have a variety of physi- mended by colleagues. needs as it was simple in format, and was
cal disabilities, the most common being Some of the literature we reviewed a Canada-wide, state-of-the-art frame-
cerebral palsy. Occupational therapy serv- supported our view that the chronic and work (DNHW & CAOT, 1983) that could
ices are provided at the Centre and out in complex nature of the disabilities of our be applied to occupational therapy practice
the community. The implementation of a clients does not fit into the medical model in paediatrics. Upon review we chose to
school health support program in Ontario of service. The scientific, reductionistic eliminate the spiritual component of per-
allowed therapists to provide services to nature of the medical model focuses on formance initially, as it was a difficult
clients in the school system. internal mechanisms to study cause and concept for staff to integrate into daily
A review of the services offered by the effect; meanwhile it ignores the relation- practice. Although some of the elements of
Occupational Therapy department at Eri- ships between mind and body, and of the the spiritual component, such as values
noak in 1987 revealed that staff were using person to the environment (Kielhofner, and motivation, were impo rtant to occupa-
a variety of approaches to provide se rv ices 1983). Children and young adults with tional therapy practice, it was felt that the
to their clients. A review of client charts chronic disabilities require a most holistic use of the term "spiritual" by occupational
revealed that a combination of approaches approach, which acknowledges the inter- therapists at Erinoak would not be ac-
was often used depending on the particu- action of the physical, mental and social cepted well by others, and currently the
lar needs of the client, although a neurode- skills of the person with elements of the Family Services department was address-
velopmental (Bobath) approach was pre- environment. (Clark & Allen, 1985; Kiel- ing the needs of our clients in this area.
dominantly used by therapists working hofner, 1983). This decision was made for the initial
with children under the age of six years. It Prior to reviewing specific models that phase of implementation of the Guide-
was evident from the department's docu- we could use, discussion took place about lines, with agreement to re-examine this
mentation and discussion that occupa- conceptual models and how they fit into component of performance at a later date.
tional therapy practice was strongly influ- clinical practice. The literature supported Following an in-depth review of the
enced by the medical model, as were other the need for occupational therapists to be model of occupational performance, a
health disciplines at Erinoak. aware of the various models that are rele- committee was struck to work on incorpo-
At a one-day departmental retreat in vant to daily practice (eg., Krefting,1985). rating the Guidelines into the first two
June 1987, concerns were raised about the Potential models that appeared to be stages of practice: screening and assess-
current practice of occupational therapy at appropriate for our setting were then ment.
Erinoak. Although therapists felt compe- chosen for review. They were:
tent in identifying and treating deficits in Kielhofner's model of human occupation Application of the Guidelines:
physical and perceptual performance (Kielhofner & Burke, 1980); the human
skills, and in the management of self-care occupations model described by Reed and The "Guidelines For the Client-Centred
skills, other important areas of function Sanderson in 1980; and the model of oc- Practice of Occupational therapy"
were not being consistently addressed, cupational performance in the Guidelines (DNHW & CAOT, 1983) describes the
such as play and life skills. It was felt that (DNHW & CAOT, 1983). delivery of occupational therapy services
the department needed a framework that The model of human occupation was as a process which can be conceptualized
was holistic and able to pull together the found to be an excellent resource, and within a systems approach. The system
various approaches being used in all stages provided detailed information on the identified in the Guidelines is the occupa-
of practice. The need to revise the screen- concept of occupation; however, therapists tional therapy process. The initial stage in
ing and assessment practices was particu- found it too complex for our current state this process is referral. Referral is defined
larly apparent, as these are the first two of practice and thought it would be diffi- as "a request to an occupational therapist
stages of the occupational therapy process cult to explain to other professionals and for advise or decision regarding client
where the client is introduced to occupa- parents. We did agree to educate ourselves services" (DNHW & COAT, 1983). Refer-
tional therapy, and documentation is read further on this model, as many of the ral includes the screening of the individual
by clients, parents and other professionals. concepts were important to the develop- for appropriateness or eligibility for occu-
Staff also acknowledged that the assess- ment of our practice. pational therapy services (DNHW &
ment stage is a primary element of our The human occupations model, de- CAOT, 1983).
practice. scribed by Reed and Sanderson, as per-
Once the problem had been identified, sonal adaptation through occupation, was 1. Referral and Screening:
some background information was gath- found to be relatively easy to understand
ered. The depth of our research was influ- and incorporated the basic concepts we Prior to implementation of the Guide-
enced by our limited resources, as Erinoak wanted. However, this was the model that lines, eligibility criteria for referral for
is not connected to any teaching hospital was adapted by the Guidelines' Task Force occupational therapy services reflected a
or educational institution, and by time to develop the current Canadian model of focus on the physical and self-care compo-
constraints on the staff. Most of our infor- occupational performance. nents of a client's performance. Referrals
mation came from recent (since 1980) It was
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from cjo.sagepub.com use
Purdue theonmodel
University of
May 21, 2015
were usually made for assessment and

April/avril 1990 89
CJOT – Vo1.57 – No. 2

treatment of fine motor and perceptual-

motor skills, and activities of daily living. FIGURE 1: OCCUPATIONAL THERAPY SCREENING REPORT
Since the implementation of the Guide- CLIENT NAME: SMITH, JOHN
lines, revised eligibility criteria for occu- DIAGNOSIS: CEREBRAL PALSY
AGE AT SCREENING: 4 YEARS, 4 MONTHS.
pational therapy services at Erinoak have
been developed using a framework within DATE: April 5, 1987 DATE: April 5, 1989
a model of occupational performance. The OBSERVATIONS
current criteria are: 1) the client is experi-
Fine Motor: Self-care:
encing dysfunction in one or more areas of • dominance - not established, parents • feeding - independent with spoon
occupational performance: self-care, think he prefers his left hand; and fork;
productivity (which includes play) and • grasp - is static tripod on pencil, • dressing - requires assistance due to
leisure; 2) there is a problem in the physi- inferior pincer grasp used on small balance difficulties;
cal or socio-cultural environment which objects bilaterally; • toiletting - makes needs known but
affects the client's ability to interact with • skills- strings small beads slowly; requires assistance, uses a wooden
the environment. stacks 10 blocks, some splaying of potty seat;
Clients are screened by occupational fingers noted on release; • bathing - lifted in and out of tub by
therapists at Erinoak to determine the • cuts jaggedly along a straight line parents
with regular scissors held in either • mobility in environment - bunny hops
appropriateness of the referral and the
hand; at home
individual's need for specific services. The
Perceptual: Productivity:
screening is conducted with other mem- • body concept - names 10 body parts; • a tt ends Miss Ellen's Nursey School -
bers of an interdisciplinary team. The • colour concept - identifies all colours integrated with an aide;
"screening team" interviews the parent/ as blue, able to sort by colour; • parents report concerns regarding his
caregiver while observing the young child • shape concept - copies only I,—,O ability to participate in fine motor
during play and specific activities. Older strokes, unable to copy geometric tasks at school, eg. cutting with
children and adolescents are often able to forms; scissors and crayoning;
participate in the interview. A.D.L.: • very social at school and adjusting
Before the Guidelines were incorpo- • feeding - independent with spoon well by report
rated into the occupational therapy proc- and fork; Play:
• dressing - requires assistance due to • prefers play with large toys, eg.,
ess, the occupational therapist would
balance difficulties; trucks, Megga blocks; is easily
participate in the screening by interview-
• toiletting - makes needs known but frustrated with smaller toys at home
ing parents briefly regarding their child's requires assistance, uses a wooden and school and therefore avoids
current level of function in self-care activi- potty chair. these
ties, and inquire about special equipment • bathing - lifted in and out of tub by Environment:
that was in the home or school environ- parents Physical: • has a wooden potty seat and
ment. She/he would structure the child's • mobility - bunny hops at home, TRAFO'S
play with a variety of carefully chosen parents are interested in getting a • parents are interested in getting a
toys, such as blocks and beads, and encour- manual wheelchair manual wheelchair
age the child to draw spontaneously with Equipment: Social: • lives at home with both parents,
crayons or pencils, imitate geometric • has TRAFO'S. who both work full time, and 2
siblings;
designs, or print/write if possible.
• at school, aide is very interested in
The occupational therapy po rtion of the
carrying over therapy programs;
screening team's repo rt, as written in 1987, • babysitter takes care of 4 other
reflected the department's focus on the preschoolers, and is unable to carry
self-care and sensory-motor performance over therapy programs.
areas. Equipment issues in the client's
physical environment would be addressed, AREAS REQUIRING ATTENTION AND RECOMMENDATIONS:
but very seldom was there mention of the • Mild fine motor inco-ordination with • Reported concerns regarding
social environment. No general statement delays in fine motor, visual motor and productive skills at nursery school,
was made about occupational perform- A.D.L. skills. frustration due to difficulty with fine
ance or the roles that the client may be • Need for equipment for bathing and motor/play activities; and difficulties
independent mobility, with dressing
having difficulty with. The left half of
• Occupational therapy assessment • Need for equipment for independent
Figure 1 gives an example of a typical
recommended with treatment as bathing and mobility;
occupational therapy portion of a screen- indicated to improve fine motor and • Occupational therapy assessment
ing report written in 1987. A.D.L. skills. recommended with intervention as
With the new framework, the occupa- required, follow-up to home and
tional therapist concentrates on interview- school as needed.
ing parents and reviewing records during Downloaded from cjo.sagepub.com at Purdue University on May 21, 2015

90 April/avril 1990
 CJOT — Vo1.57 — No. 2

the screening process to determine if the to categorize this data. a variety of ways at Erinoak. Informal
eligibility criteria are met. The client is New assessment guidelines for the observation may occur, and is often an
observed playing with toys within the Occupational Therapy Services at Erinoak important part of an occupational therapy
structured environment of the screening have been developed using the framework assessment, as it reflects the qualitative
clinic, or interacting with parents/car- of occupational performance. Specific elements of performance that are so impor-
egivers and members of the screening elements of performance that are pertinent tant to an individual's performance. Over
team, but is not asked to perform any to our clients are emphasized; for example, the years, a number of informal checklists
specific motor tasks. This is a positive side- in the area of self-care, feeding is an and rating scales have been developed to
effect of the new framework, as a child in important element of occupational therapy help structure informal occupational ther-
a new situation, such as the screening practice at Erinoak. The elements that we apy evaluations. Formal testing, using
session, often will not perform any tasks if have chosen to include in our assessment standardized tests that are available com-
asked, and is much more comfortable (and guidelines are also influenced by our mercially, gives the therapists a more
therefore often does more) when allowed current resources, and by the roles and objective measure of performance
to play spontaneously. scope of practice of other professional (DNHW & CAOT, 1983).
The occupational therapist on the groups at Erinoak. Several revisions have Prior to use of the Guidelines, the
screening team now documents observa- been necessary for the assessment guide- number of informal and formal assessment
tions and information gathered from inter- lines to be appropriate for use by all thera- tools available to the Erinoak staff at times
view and record review, about the client's pists. seemed overwhelming. The Guidelines
occupational performance and environ- A document called the Occupational have been used to organize evaluations
mental issues. If there are concerns in Therapy Record has been developed using into a framework consistent with the
either of these areas, a comprehensive Appendix A (page 37) of the Guidelines as model of occupational performance. An
occupational therapy assessment is recom- a reference. It lists the elements of the Assessment Matrix has been developed,
mended. The right side of Figure 1 gives individual that the therapist may address in which cross-references the assessment
an example of an occupational therapy a comprehensive assessment. This docu- tools with the elements of an individual's
screening repo rt using the framework of a ment has helped the staff become familiar occupational performance, performance
model of occupational performance. The with the new assessment guidelines, and components and environmental compo-
more recent report reflects a more holistic has served to keep track of data that has nents. The staff have identified which
orientation to the screening of an individ- been collected by the therapist over a components are important to address with
ual with a physical disability. period of time, as several appointments are the current client population. Figure 2'
often required to complete a comprehen- gives the outline of the areas identified and
II. Assessment: sive assessment. examples of application of the Matrix.
The most important change in occupa- Many different standardized tests had
The second stage of the occupational tional therapy assessment practice at Eri- been used by the occupational therapy staff
therapy process described in the Guide- noak is the shift in emphasis to the client's at Erinoak over the years, but it was real-
lines is assessment, which is defined as occupational performance and the interac- ized that these assessment tools did not
"the process of collecting, analyzing and tion of the client with the environment, address the client's occupational perform-
interpreting information..."(DNHW & from the performance components. The ance as a whole. Since the Guidelines were
CAOT, 1983, page xiv). three areas of self-care, productivity and incorporated into our practice, an effo rt has
leisure are now assessed first by the occu- been made to locate such standardized
Assessment Guidelines: pational therapist, to determine areas of evaluations, and to date a few have been
dysfunction and competence. If dysfunc- found that address the elements of occupa-
Prior to 1987, emphasis in the assess- tion is identified, which it is in the major- tional performance specific to children and
ment stage was on the different compo- ity of our clients, then the physical, men- adolescents with physical disabilities.
nents of function. The Evaluation Refer- tal and sociocultural performance compo- They are: 1. Children's Adaptive Behavi-
ence List, that was used by all disciplines nents are evaluated, along with a compre- our Report (Kicklighter & Richmond,
at Erinoak, had 10 categories into which hensive assessment of the physical, social 1983) and Children's Adaptive Behaviour
the therapists had to fit their data. The and cultural environment. Scale (Kicklighter & Richmond, 1982),
categories were: Neuromusculoskeletal, which focus on a child's adaptive function-
A.D.L., communication, Perception/ Assessment of Task Functioning: ing; 2. Klein-Bell Activity of Daily Living
Cognition, Education, Psychosocial, A Matrix Model Scale (Klein & Bell, 1979), which ad-
Special Equipment, Medical, Medications dresses the self-care component; 3. Play
and Placement. This reflected a "bits and "The most central element of assess- History Interview (Takata, 1974) and the
pieces" approach to assessment, that did ment in occupational therapy is to observe Preschool Play Scale (Knox, 1974). A
not adequately address our clients' needs. and test performance..." (DNHW & number of other play assessments are
It proved very difficult for an occupational CAOT, 1983,25). Assessment of task available, but at this time occupational
therapist who evaluated a client's play or functioning of children and adolescents therapists at Erinoak are limiting assess-
general school performance to decide how with physical disabilities is carried out in ment to the two listed above.
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April/avril 1990 91
CJOT — Vo1.57 — No. 2

Data Analysis and Interpretation:

FIGURE 2
One important component of the assess-
ment stage of practice is the analysis and Erinoak Assessment Matrix
interpretation of the data (DNHW &
(Partial)
CAOT, 1983). This was the area that
occupational therapists at Erinoak felt
Breaking down pædiatric
most uncomfortable with prior to implem-
entation of the Guidelines, as there was no assessments into the areas
general framework to pull together the they assess
information that they had gathered from r-
the assessment.
The conceptual framework of a model
of occupational performance has been
used to organize the assessment data to
formulate an overall picture of the client's Self Caro
functioning in the daily environment. Peeling-Oral Motor
Problems are now identified in terms of Productivity
dysfunction in occupational performance, Play
rather than delays or difficulties in per- LW-are
formance components. A sample of the Tact&
Analysis Section of two Occupational St Virion
Therapy Assessment Reports, written two Pt Audition
years apart (before and after the Guidelines Reflexes
were introduced), best illustrates the Da Developmental Skills
conceptual change that has taken place in Bottum
occupational therapy assessment practice Developmental Skills
at Erinoak.(See Figure 3). Dominance/Pref. laterality
In order to assist the staff in following Eye-Hand Co-ordination
the new framework, a Peer Evaluation Grasp
System has been used. In the first year of Gross/Pine Motor
implementation, therapists evaluated each Handwriting
other's repo rts using a feedback form. This In-hand Manipulation
form is still used to assist new staff to Motor Planning
incorporate the model of occupational Reach
performance into practice. It lists key Release
statements that should be included in the Upper Extremity Strength
contents of each section of the Occupa- Upper limb Speed do Dexterity
tional Therapy Assessment Report; for

_
example, under the Analysis section:
(i) - an initial statement indicates the
client's current function in occupational Coprnst
performance areas; (ii) - a positive state-
ment is made about the client's areas of Visual Dberimiration
competency. Pt : %MA Memory
a
Mead Spatial Relation z

Discussion ; Visual 1?erm Constancy

Vbtral Sequential Memory
The Guidelines has provided the Occu- Ground
pational Therapy Services at Erinoak with %weal Closure
the holistic framework therapists needed. i Behaviour
It has moved occupational therapy practice
away from the medical approach, where • LeetPulle
the focus tended to be on the separate -H
components of an individual, to a model of 'Copies of the full Assessment I School
occupational performance, where the Matrix are available from the an Social
client is viewed as a whole person. authors. Miscellaneous
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92 April/avril 1990
 CJOT — Vo1.57 — No. 2

The benefits of incorporating the Guide-

lines into practice have been numerous. It FIGURE 3
is now easier for occupational therapists to
SAMPLE OCCUPATIONAL THERAPY REPORTS
explain their role and to justify their in-
ANALYSIS SECTION
volvement with clients. A survey of other PRE- AND POST - GUIDELINES (1987) (1989)
interdisciplinary team members, con-
ducted by the Occupational Therapy Serv- CLIENT NAME: J.H.
ices in September 1988, indicated that DIAGNOSIS: CEREBRAL PALSY
other professionals had gained a better DATE OF BIRTH: 81/09/19
understanding of our services. Referrals
DATE: JULY 16, 1986
from other departments at Erinoak to
occupational therapy are now more appro- J.H. is a 4 year, 10 month old boy with a delightful, happy personality. He is more
priate. The screening of a new client is a affected by tone in his lower extremities than his upper extremities. As a consequence
more comfortable and efficient experience of the increased tone, he is delayed in his fine motor and A.D.L. skills. He is also
affected by tremor, difficulty in crossing his midline and by a sho rt a tt ention span.
as the occupational therapist can concen-
trate on interviewing the parent and/or Occupational therapy will provide regular intervention to encourage J.H.'s
client instead of trying to get the client to development of fine motor and A.D.L. skills.
perform fine motor/perceptual tasks. In the
assessment stage, therapists feel that their DATE: MARCH 28, 1989
analyses of data are truly interpretations J.H. is a charming and friendly 7 year 7 month old boy. He has shown significant
and summaries of the clients' task func- improvement in his productive work at school in the past year. In pa rt icular, J.H. is
tioning. now able to print words and 2-3 word phrases using the typewriter in the classroom
Relatively few disadvantages have been with minimal supervision. This is very beneficial to J.H. as he is unable to print letters
found by the occupational therapy staff at with accuracy using pencil and paper due to an unstable grasp of his pencil and a
mild tremor. He also continues to demonstrate difficulty copying two dimensional
Erinoak in incorporating the Guidelines
designs.
into practice. One problem was identified
in the initial phase in relation to documen- In terms of self-care, J.H. continues to require assistance with clothing, bathroom
tation. The new assessment guidelines transfers and some aspects of feeding. It is felt his difficulty with dressing
were developed for use with all ages of independently may be related to poor spatial concepts, possible motor planning
difficulties and tremor.
clients. Therapists had difficulty ignoring
those elements that did not apply to the Occupational therapy intervention continues to be required to encourage
particular client that was being assessed. independence in self-care and productivity within the school and home environments.
Thus, occupational therapy reports were
initially very lengthy, and ongoing super- other occupational therapy departments tion. There is, however, a great deal of
vision and use of the peer evaluation sys- seeking to incorporate the Guidelines into work to be done in these areas. When the
tem was needed to help therapists stream- practice. Administration should be made model of occupational performance is
line their documentation. O rientation time aware of the goals and benefits of chang- applied to the practice of occupational
for new staff has also increased as we have ing the model of practice, and encouraged therapy with children and young adults
found that, although occupational thera- to support the need for extra staff educa- with chronic physical disabilities, gaps in
pists may be aware of the Guidelines, they tion time. It is important for the whole service delivery are apparent. Our experi-
need assistance to incorporate it into their department to take the time initially to ence indicates that the area of play as the
daily practice in paediatrics. study the model of occupational perform- major occupation of childhood is seldom
Most of the difficulties encountered ance before applying it to practice. In the dealt with in a comprehensive manner by
related to the phenomenon of change. implementation phase, a staff working occupational therapists. Occupational
Many therapists, especially those who had committee and a peer evaluation system therapists at Erinoak have formed a group
been working for 5 years or more, knew are beneficial as the workload is shared with staff from another paediatric facility
little about occupational performance or and therapists leam from each other. Other to research play as an important area of
other conceptual frameworks. The famil- team members should be informed of the productivity. The developmental contin-
iar technical skills and treatment modali- changes, either by formal inservices or uum of play and work should be a primary
ties were being challenged by theories and written communication. National Occupa- focus of a paediatric occupational therapy
guidelines. The difficulty of introducing a tional Therapy Week is an ideal time for program, to prepare clients to be produc-
new model of practice is stated clearly by promoting the new model of practice. tive members of our society. This will
Krefting (1985) when she writes: "For require occupational therapists to start to
Future Work:
therapists with a full caseload of clients, address the development of life skills and
application of conceptual models in prac- This holistic approach has made it eas- pre-vocational skills of clients at an early
tice is an arduous task."(p. l ) ier for our practice to move into the next age.
Several suggestions can be made to stages: program planning and interven- There is a need for more standardized
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April/avril 1990 93
CJOT — VoL57 — No. 2

assessment tools that address areas of a Clark, P. & Allen, A. (1985). Occupational Reid, D. (1987). Occupational therapists'
client's occupational performance. The therapy for children. St. Louis, MO: C.V. assessment practices with handicapped
Mosby. children in Ontario. Canadian Journal of
majority of standardized tests used in
Department of National Health and Welfare & Occupational Therapy, 54, 181-188.
paediatrics focus on performance compo-
Canadian Association of Occupational Takata, N. (1974). Play as a prescription. In
nents, for example, motor or perceptual
Therapists. (1983). Guidelines for the Reilly, M. (Ed.), Play as exploratory
skills. This may be adequate for children client-centred practice of occupational learning, (pp.247-266). Beverly Hills, CA:
in acute care settings, but does not address therapy (H39-33/1983E). Ottawa, ON: Sage Publications.
the needs of clients with chronic physical Department of National Health and
disabilities. In the search for standardized Welfare.
tests that would be suitable for use at Ferland, F., Lambe rt , J., Saint-John, M., &
ACKNOWLEDGEMENTS
Erinoak, it has been found that numerous Weiss-Lambrou, R. (1987). L'ergotherapie The authors wish to acknowledge the
tests of occupational performance are et l'enfant: Description de la pratique assistance of Mary Law, who reviewed this
available in the area of adult mental quebecoise. Canadian Journal ofOccupa- article before submission. As well they
health,: the possibility of adapting some of tional Therapy, 54,125-131.
wish to thank Gae Pitman for her adminis-
Folio, R.M. & Fewell, R.R. (1983). Peabody
these tests to other client populations trative support in the development of the
developmental motor scales and activity
should be explored. Assessment Matrix.
cards. Allen, Texas: D.L.M. Teaching
Resources.
Conclusion Kicklighter, R.H. & Richmond, B.O. (1982). Résumé
It is hoped that this paper will encourage Children's adaptive behavior report. A
developmental interview guide. Chicago, Cet article décrit le processus
other occupational therapy departments,
ILL: Stoelting. d' incorporation des "Lignes directrices
especially those working with young
Kicklighter, R.H. & Richmond, B.O. (1983). relatives à la pratique de l' ergothérapie
people with chronic disabilities, to start to
Children's adaptive behavior scale (revised axée sur le client" à l'exercice de
incorporate the Guidelines into their prac- and expanded manual). Chicago, ILL: l' ergothérapie au sein d' une clinique ex-
tice. Even with limited resources, it is Stoelting. ternefréquentée par des jeunes atteints de
possible to gather enough information to Kielhofner, G. (1983). Health through
decide on a framework that is appropriate déficiences physiques. Les actes de pra-
occupation. Theory and practice in occu-
tique étudiés ici, sont le dépistage et
for a particular setting. pational therapy. Philadelphia, U.S.A.:
l' évaluation.
The Guidelines are purposefully written F.A. Davis.
Kielhofner, G. & Burke, J.P. (1980). A model Le processus fut élaboré à partir de 1987,
in general terms to allow adaptation to any
of human occupation, part 1. Conceptual par l' identification du besoin de trouver
service setting (DNHW & CAOT 1983).
framework and content. American Journal une approche holistique qui tienne compte
It is stated in the Guidelines that it is not
intended to "provide a formula for client of Occupational Therapy, 34, 572-581. des multiples besoins des clients atteints de
Kielhofner, G., Burke, J.P. & Igi, C.H. (1980). déficiences physiques chroniques. Une
care" (DNHW & CAOT 1983,p.13). This
A model of human occupation, part 4. revue des publications sur la pratique ac-
allows an occupational therapy depart-
Assessment and intervention. American tuelle de l'ergothérapie en pédiatrie
ment to be creative and flexible in adapt- Journal of Occupational Therapy, 34, 777- démontre l' absence d' un cadre théorique
ing the Guidelines to its setting, but it 787.
requires a great deal of time and thought, d'ensemble qui rallie les diverses appro-
King-Thomas, L. & Hacker, B.J. (Eds.).
and must involve all staff to make it work. ches utilisées par les ergothérapeutes.
(1987). A therapists guide to paediatric
It is a challenging and rewarding proc- Le modèle dufonctionnementoccupation-
assessment. Toronto, ON: Little, Brown &
Co. nel tel que décrit dans les Lignes direc-
ess to change a model of practice The new
framework of occupational performance, Klein, R.M. & Bell, B.M. (1979). Klein-Bell trices, est à la source de l'approche holis-
as outlined in the "Guidelines For the activity of daily living scale: manual tique nécessaire. Le procédé
Client-Centred Practice of Occupational Seattle, WA: Division of Occupational d'incorporation des Lignes directrices
Therapy, University of Washington. dans les étapes de dépistage et
Therapy" (DNHW & CAOT, 1983) guides
Knox, S.H.(1974). A Play Scale. In Reilly, M. d'évaluation en ergothérapie au "Ennoak
occupational therapists to use a holistic
(Ed.), Play as exploratory learning Serving Young People With Physical Dis-
approach and lends credibility to the pro- (pp.247-266). Beverley Hills, CA: Sage
fession of occupational therapy. abilities" est décrit ici, avec des exemples
Publications.
de documents élaborés par le service. Des
Krefting, L.H. (1985). The use of conceptual
suggestions sont apportées concernant
models in clinical practice. Canadian
Journal of Occupational Therapy, 52, 173-
l' intégration du modèle de fonctionnement
178. occupationnel à toutes les étapes de pra-
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94 April/avril 1990