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Application of the Person-Environment-Occupation Model: A practical Tool


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Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.
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Human activities and occupations
Models, occupational therapy
Occupational performance
volume 66 • issue 3
Application of the Person-Environment-Occupation Model:
A practical tool
Occupational therapy focuses on complex dynamic
relationships between people, occupations and envi-
ronments. Therapists must clearly communicate their
practices and how their practice influences out-
comes. This paper explores applications of the
Person-Environment-Occupation Model (Law et al.,
1996) in occupational therapy practice, and delin-
eates how this particular model helps therapists to
conceptualize, plan, communicate and evaluate
occupational performance interventions. Three case
studies illustrate how the model can be used by
occupational therapists to systematically approach
analysis of occupational performance issues while
considering the complexities of human functioning
and experience. The ways in which the model facili-
tates communication within and outside occupation-
al therapy are explained. The Person-Environment-
Occupation Model is offered as a tool for therapists
to use in client(s)-therapist alliances to enable
clients to successfully engage in meaningful occupa-
tions in chosen environments.
L’ergothérapie est axée sur les relations complexes et
dynamiques qui s’établissent entre la personne, l’occu-
pation et l’environnement. Les thérapeutes doivent
communiquer clairement leurs pratiques et la façon
dont ces dernières influent sur les résultats. Cet article
examine des façons d’appliquer le modèle personne-
environnement-occupation (Law et al., 1996) dans la
pratique de l’ergothérapie et précise comment ce mod-
èle aide les thérapeutes à conceptualiser, planifier,
communiquer et évaluer les interventions en matière de
rendement occupationnel. Trois études de cas sont
présentées afin d’illustrer comment les ergothérapeutes
peuvent se servir de ce modèle pour faire une analyse
systématique des difficultés en matière de rendement
occupationnel, tout en tenant compte des subtilités du
fonctionnement humain et de l’expérience humaine.
Les auteurs expliquent comment le modèle facilite la
communication en ergothérapie. Le modèle personne-
environnement-occupation peut être utilisé pour inciter
les clients à s’engager dans des occupations significa-
tives, dans des environnements choisis.
Susan Strong, MSc., OT(C), is
Occupational Therapist
Researcher, Rehabilitation
Services, Hamilton Psychiatric
Hospital; and Assistant Clinical
Professor and Researcher at the
Work Function Unit, School of
Rehabilitation Science, McMaster
University, Building T-16, 1280
Main Street West, Hamilton, ON
L8S 4K1
Patty Rigby, M.H.Sc., OT(C), is
Assistant Professor in the
Department of Occupational
Therapy, Faculty of Medicine,
University of Toronto, and
Professor Advisor/Team Leader for
Occupational Therapy, Bloorview
MacMillan Centre, Toronto, ON.
Debra Stewart, B.Sc., OT(C), is
Clinical Lecturer, School of
Rehabilitation Science, McMaster
University; and Associate Member
of the CanChild Centre for
Childhood Disability Research,
McMaster University, Hamilton,
Mary Law, Ph.D., OT(C), is
Associate Professor, School of
Rehabilitation Science and
Director, CanChild Centre for
Childhood Disability Research,
McMaster University, Hamilton,
Lori Letts, MA., OT(C), is Assistant
Professor, School of
Rehabilitation Science, McMaster
University, Hamilton, Ontario.
Barbara Cooper, Ph.D., OT(C), is
Associate Professor, School of
Rehabilitation Science, McMaster
University, Hamilton, Ontario.
volume 66 • issue 3
Strong et al
ccupational therapists are being asked by their clients,
other health care providers and funders to articulate
clearly the scope of their practice and how their practice
influences outcomes. Therapists are focusing their efforts on
complex processes among people, their occupations and roles,
and the environments in which they live, work and play. A
group of clinicians and researchers developed the Person-
Environment-Occupation Model (PEO) to serve as a framework
for examining person-environment processes and assessment
tools in the context of occupational therapy practice (Law et al,
1996). The PEO Model complements the Canadian Model of
Occupational Performance and other concepts in the Canadian
Association of Occupational Therapists (CAOT) document,
Enabling Occupation: An occupational therapy perspective
(1997). It provides therapists with a practical analytical tool to:
1) assist therapists to analyze problems in occupational per-
formance, 2) guide intervention planning and evaluation, and
3) clearly communicate occupational therapy practices.
Since the PEO Model was first proposed as a tool to
examine complex occupational performance issues, it has been
used in hospital, community, academic and research settings.
For example, the Model guided occupational therapy interven-
tions for youth with physical disabilities in schools, and later
proved useful in a qualitative study of the experiences of a
group of youth with disabilities making the transition to adult-
hood (Stewart, 1998). A participatory action research study
employed the Model to examine the environmental factors
affecting the participation of children with disabilities in their
communities (Law, 1993; Law, 1997). It was used to discover
the role of work in the recovery process in an ethnographic
study (Strong, 1998). Rehabilitation interventions have been
examined using the PEO Model, including a family-centred
approach to rehabilitation of children with cerebral palsy (Law,
et al, 1998), the use of assistive devices with older adults
(Cooper & Stewart, 1997), and the development of an affirma-
tive business for individuals with mental illness (Strong, 1995).
The effects of environmental sensitivity on occupational per-
formance have been analyzed with the Model (Peachy-Hill &
Law, 1996). In addition, the PEO Model has facilitated the
development of services locally and abroad (e.g., rehabilitation
services in Bosnia). It has been instrumental for international
fieldwork in India (McKye, Shin & Letts, 1998), and the devel-
opment of occupational therapy curriculum in Russia (Krupa &
Packer, 1997). The model has been incorporated into several
occupational therapy programmes in Ontario, and the CAOT
Certification Examination.
This paper will explore applications of the PEO Model in
occupational therapy practice, and will delineate how this partic-
ular model helps therapists to conceptualize, plan, communicate
and evaluate occupational performance interventions. Three case
scenarios drawn from a composite of actual clinical scenarios will
be used to describe how the Model could be used in practice.
Person-Environment-0ccupation Model
The PEO Model (Law et al., 1996) was developed using con-
cepts mainly from environment-behaviour theories (Baker &
Intagliata, 1982; Berlin, 1989; Kahana, 1982; Kaplan, 1982;
Lawton & Nahemow, 1973; Moos, 1980; Weisman, 1981), the-
ories of occupation (Csikszentmihalyi & Csikszentmihalyi,
1988) and client-centred practice (CAOT, 1991). Its theoretical
Figure 1
The Person-Environment-Occupation (PEO) Model (Law et al., 1996)
Reproduced from the
Canadian Journal of Occupational Therapy, 63,
Strong et al
volume 66 • issue 3
basis and supporting literature was described in a previous
publication (Law et al, 1996) in greater detail. The Model is
conceptualized as the person, his/her environments and occu-
pations dynamically interacting over time. These main dimen-
sions (person, environment, occupation) are represented by
three inter-related circles or spheres transacting over the life
span as shown by a cylinder (Figure 1). The extent of congru-
ence in the person-environment-occupation (PEO) relationships
is represented by the degree of overlap between the three
spheres; the closer the spheres overlap, the greater the degree
of harmony or fit. The overlap in the centre of the spheres rep-
resents occupational performance or the dynamic experience
of a person engaged in an occupation within an environment
over time.
The quality of a persons experience, with regards to their
level of satisfaction and functioning, is the outcome of the fit
between the person-environment-occupation transaction. Both
internal or local PEO changes and external or macro changes
result in reducing or increasing the PEO fit. For example, over
time there are changes in a persons age and health as the per-
son moves through life cycles, and developmental phases.
Concomitantly, a person may experience changes in self-con-
cept, disability status and environmental constraints. Political
and economic changes, such as regulatory reforms and priva-
tization, can influence daily life experiences of individuals and
organizations. These external and internal changes require
modifications and adaptations within the PEO transaction in
order to result in a satisfying and functional outcome. Using
the model, occupational therapists can work together with
their client(s) to facilitate these adjustments towards optimal
occupational performance. The focus is on enabling occupation
by improving the PEO fit.
The PEO Model and the Canadian Model of Occupational
Performance (CAOT, 1997) are complementary and share com-
mon terminology. Both models emphasize that occupational
performance is shaped by the dynamic interdependence of
persons, occupations and environments. The person can refer
to an individual client, a group of clients or an organization.
Figure 2
The Person-Environment-Occupation Model’s Application Framework
volume 66 • issue 3
Strong et al
Conceptualized broadly, the environment includes cultural,
institutional, physical and social factors affecting occupational
performance. Occupations are defined as clusters of activities
and tasks in which people engage while carrying out various
roles in multiple environments. Occupations are chosen to ful-
fill a purpose and for the value and meaning which individuals
or groups attribute to them. The Canadian Model of
Occupational Performance demonstrates the occupational ther-
apy view of the person in an integrated, holistic manner,
engaged in occupations within an environmental context. The
PEO Model demonstrates the dynamic nature of this relation-
ship and how changes in any area affect occupational perfor-
mance, the outcome of the relationship. The PEO Model facili-
tates analysis of problems in occupational performance and
evaluation of the outcomes of occupational therapy interven-
The PEO Model can be used by occupational therapists
practicing in many different roles and settings. For example, by
considering the complexities of daily human experiences, the
PEO Model enables therapists to conceptualize where there is
a less than optimal PEO fit, and what processes are potential-
ly enabling and constraining the PEO fit. Together with clients,
therapists can plan a range of potential interventions by focus-
ing interventions on the person, environments, and/or occupa-
tions in both micro and macro contexts over time. The out-
comes of interventions directed at improving the congruence of
P-E-O transactions can be evaluated by examining changes in
occupational performance. In other words, the PEO Model
offers a way to systematically analyze what occupational ther-
apists see and do. When applying the PEO Model, therapists
consider the many complex factors influencing clients daily
occupational performance. This allows therapists to analyze
complicated situations, to plan interventions, and focus on
what is important for enabling optimal occupational perfor-
mance. In addition, interventions can expand beyond the indi-
vidual client to target occupations and environments more broad-
ly and in different ways. As a result, multiple options for change
are created.
The flexibility of the Model to interface with other per-
spectives, theories and practices facilitates communication
within and outside of the profession of occupational therapy.
For example, the ability of the Model to interface with the
Canadian Occupational Performance Process Model (CAOT,
1997) and its terminology facilitates communication within the
profession. The Model appears to be easily communicated in
other languages and cultures as shown by its use in other
countries, and other cultures. Also, the Model supports occu-
pational therapists to relate to the practices of other disciplines
who examine person-environment relations, and at the same
time, demonstrates that the uniqueness of our discipline lies in
the third sphere - occupation. By focusing the analysis of diffi-
culties on all three spheres (person, environment and occupa-
tion), a shared responsibility for the situation and its resolution
is implied between the client or clients, the environment (e.g.,
Figure 3
Assessment of person, environmental and occupational factors impacting Normans occupational performance
Strong et al
volume 66 • issue 3
family, coworkers), and occupation. Hence, collaborative plan-
ning is encouraged. Each of these ideas will be expanded upon
in this paper.
Applications of The Person-Environment-
Occupation Model
Application of the PEO Model can be readily integrated into
current practice by following the PEO Application Framework
(Figure 2). Once the client(s) has identified occupational per-
formance issues, the client(s) and therapist together look at
strengths and problems in occupational performance by
assessing the environmental conditions, analyzing occupation-
al elements (activity, task, time, sequencing etc.), and aspects
of the client’s performance components which relate to perfor-
mance of the occupation in the particular environment.
Information is synthesized within a transactional framework by
focusing on the person-occupation, occupation-environment
and person-environment relationships. With the client, a plan
is developed that identifies strategies to remove barriers and
increase supports to improve occupational performance by cre-
ating a better person-environment-occupation fit’. Plans are
evaluated by examining changes in occupational performance.
Conceptually, the PEO Application Framework works well with
the Occupational Performance Process (Fearing, Law, & Clark,
1997) which provides more specific details about the process
of conducting the assessment, planning and intervention with-
in a negotiated client-therapist alliance. Application of the PEO
Model is illustrated in the following fictitious scenarios.
Scenario 1 - Norman
A. Presenting situation
Norman is an 80 year old man who fell and fractured his hip
3 weeks ago. He was recently transferred to the rehabilitation
unit of the hospital. Norman had been living on his own in an
apartment. His only son lives in the area with his own family.
They regularly have Norman join them for Sunday dinner and
have helped him with heavy household chores. The
Rehabilitation Team have started discharge planning for
Norman and want to determine whether he is safe to return to
his apartment or whether he should be placed in a long-term
care facility. Norman has been making progress in occupation-
al therapy with his self-care, however he is unable to prepare
meals on his own. Norman insists he wishes to return home
and believes he will be able to look after his meals once he is
home. During an initial interview, Norman identified occupa-
tional performance issues that were important to him. Together
they agreed to explore how to return Norman home.
Figure 4
Analysis of Person-Environment-Occupation Transactions (Norman)
volume 66 • issue 3
Strong et al
When examining the PEO transactions (Figure 4), issues
regarding the fit between Normans interests in meal prepara-
tion and his current abilities to make his own meals will be
considered in relation to the amount and type of resources
available in his home and community environments. This
requires the involvement of Normans family in the assessment
process. The transaction of person, environment and occupa-
tion components is considered from a temporal perspective
(i.e., with regard to how they relate to one another across
time) to address concerns about Norman being able to pre-
pare meals at home. This can alleviate some anxiety as
Norman and his family realize that the amount of support he
may require immediately post-discharge may reduce as his
physical abilities improve over time.
C. Intervention
The targeted outcome for Norman is to eat nutritious, satisfying
meals in his own home upon discharge. When applying the PEO
Model, the therapist, client and family can work together to
focus on ways to remove barriers and develop supports for
improving Normans occupational performance in the area of
meal preparation. Together, they can devise a plan for
obtaining meals that considers all components of person,
environment and occupation, and thus increase the quality
of the PEO fit.
Depending on assessment findings, examples of inter-
vention strategies for Norman may include:
Developing a weekly plan for meals with Norman and his
Providing family education about safety issues and com-
Norman wants to return home
B. Assessment
The PEO Model can be used to assess and formulate the pre-
senting problem in a client-therapist alliance. The PEO Model
guides the therapist to gather information about Norman (the
person), the tasks and activities which are important to him
(occupation) and his home (environment) as shown in Figure
3. Information would be obtained from Norman, the treatment
team, and his family using interviews, observations, chart
reviews and standardized assessment tools.
The therapist and Norman not only look at the problems
that Norman has preparing meals, but also consider the options
available for mealtime and the supports available to him. Thus,
the assessment places less emphasis on Normans performance
problems with preparing meals, and places more emphasis on
the options available to enable him to eat nutritious, satisfying
meals. The shift in emphasis allows Norman to feel less defen-
sive and consequently, to be able to be engaged in the process.
Using the PEO Model, the therapist can take the assess-
ment a step further by involving Norman and his family in the
analysis of the transactional relationships amongst the various
person, occupation and environment components across time
as illustrated in Figure 4 (i.e., person-occupation (PO), the
occupation-environment (OE), and the person-environment
(PE) processes). In Normans situation, it is important to assess
the fit between Normans current skills and abilities, his home
environment and the occupation of meal preparation.
Figure 5
Assessment of person, environmental and occupational factors impacting Karens occupational performance
Strong et al
volume 66 • issue 3
munity resources
Making referrals to community resources upon discharge
(e.g., Meals-on-wheels, home care occupational therapy
and homemaking
Recommending kitchen modifications and use of adaptive
aides to enable Norman to access his kitchen and con-
serve energy
By framing the challenge of meal preparation for Norman in
terms of the PEO fit, the therapist can clearly explain potential
intervention strategies. Norman and his family can be
explained how the therapist is trying to match Normans meal
preparation abilities, and preferences with the requirements for
obtaining daily nutritious meals, and the resources available to
him when living at home. They can be told how obstacles to
Norman obtaining satisfying nutritious meals can often be over
come by strategizing not only what things Norman could do,
but also what changes could be made to the meal making
process, and what supports for his family (e.g., community ser-
vices) could be enlisted to help. This also assists Norman and
his family in understanding the roles and functions of occupa-
tional therapy.
D. Evaluation/ Follow-up
At a discharge planning meeting the therapist and Norman can
report with confidence that he will be able to manage obtain-
ing nutritious meals in his own home, with environmental sup-
ports and a plan in place. After discharge, home care occupa-
tional therapy services can follow up to review Normans situ-
ation and consider any other issues related to his occupation-
al performance at home.
Scenario 2 - Karen
A. Presenting situation
Karen, a nine year old who has cerebral palsy, spastic diplegia
has been referred for school-based occupational therapy services.
Her parents and teachers are concerned as she has had difficul-
ty learning to print or write and is slow to complete her written
work legibly. The occupational therapist is asked to assess the
handwriting problems and provide intervention plans. During an
initial interview with Karen, she validated that completing written
work was an important issue for her and she agreed to work with
the occupational therapist to see what could be done.
Karen is having difficulty completing
written work at school
B. Assessment
The therapist gathers information about Karen (the person),
her school tasks and activities (occupation), and her school
and home (environments) as illustrated by Figure 5.
Figure 6
Analysis of Person-Environment-Occupation Transactions (Karen)
volume 66 • issue 3
Strong et al
Information can be obtained from Karen, her teacher, the
teaching assistant, her parents and the school records with for-
mal and informal assessment methods. However, the scope of
assessment is broadened to include the components in Figure
5 and extend to an analysis of the Person-Occupation (PE),
Environment-Occupation (EO), Person-Environment (PE) trans-
actions (Figure 6).
The assessment of personal factors influencing Karens
occupational performance notes her physical abilities and lim-
itations, including difficulties with motor planning and her lack
of initiative to seek help from others. Karen is observed to sit
and do nothing while her classmates are writing. She com-
ments ”I just can’t do it! I’m different than the others”.
Assessment of environmental and occupation factors reveal
that routinely, the class is expected to copy questions from the
blackboard and to fill in the answers independently. Karens
teacher sits at her desk and students are expected to approach
her with their problems.
During an analysis of PEO transactional relationships, the
occupational therapist recognizes a poor PO fit between
Karens competencies and the typical writing task requirements
in the class. Copying from the blackboard is very difficult for
Karen and she seems to have given up. Karens pace of writ-
ing is considerably slower than her peers, thus she always
feels behind and takes a great deal of work home. Upon analy-
sis of the OE relationship, it is evident that Karens teacher is
kept busy at her desk addressing the other students needs.
She rarely comes around to students’ desks while they are
completing writing tasks. The therapist also finds a poor fit
between P and E, specifically Karens abilities and the envi-
ronmental expectations and resources. All students are expect-
ed to complete written work in the same way, and no accom-
modations are made for Karens handwriting difficulties
C. Intervention
The targeted outcome in this scenario is to improve Karens
occupational performance in the area of written work, specifi-
cally to enable her to keep up with the written work demands
in her classroom. The focus of intervention is the fit between
her competencies, the written work expected in her class and
the environmental resources. This focus supports the need for
the occupational therapist to work together with Karen, her
family and school staff to improve the PEO fit.
Some examples of intervention strategies depending on
specific findings may include:
Educating school staff , with assistance from Karen and her
parents, about her disabilities and appropriate expectations
Discussing strategies with school staff to reduce the
amount of written work for Karen, such as using other
students notes to work with, receiving some assistance
to copy notes from a teaching assistant, and exploring
the use of computers at home and school
Introducing problem-solving strategies to Karen to help
her determine when to ask for assistance from a teaching
assistant or classmate
The therapist can use the PEO Model to develop a collaborative
plan with the different parties in a non-threatening manner.
Strategies focus on removing barriers to the PEO transactions
and developing supports, which enable Karen to keep up with
the written work in her classroom. Everyone can see how they
can contribute to Karens successful occupational performance.
D. Evaluation/ Follow-up
The therapist may revisit the school and meet with Karen, and
school staff to review the situation. The targeted outcome of
intervention can be evaluated in terms of whether Karen is able
to keep up with the written work in the classroom to the satis-
faction of Karen, her parents and school staff, with the recom-
mended supports and modifications in place. The PEO Model can
be used to evaluate the effectiveness of the intervention strate-
gies, by examining the extent to which they improved the quali-
ty of fit between person, environment and occupation.
The dynamic nature of the PEO relationships can be
addressed during follow-up visits by addressing how the opti-
mal fit can be sustained over time. This requires flexibility and
adjustments in the strategies implemented as changes occur
in the person, environment and/or occupation. For example, as
Karen develops her problem-solving skills and takes more
responsibility to ask for assistance when she needs it, the
teaching assistant and teacher need not check in with Karen
routinely, but can carry on with other work until she approach-
es them. Also, as the writing demands in the curriculum
change, new strategies may be needed to ensure Karen can
continue to keep up and feel successful at school. The PEO
Model can help the different parties to expect and anticipate
changes over time, and thus maintain optimal fit, or occupa-
tional performance.
Scenario 3 - Spencer
A. Presenting Situation
An occupational therapist working at an outpatient mental
health clinic is greeted by Spencer sliding into a nearby chair
saying “I can’t go back there”. Spencer insists he cannot work
any longer cleaning offices; a transitional work placement in
the community. Spencer has had schizophrenia for the last 15
years. About six weeks ago, he was placed with a temporary
employment agency to gain work experience. A phone call to
the agency staff reveals Spencer has become increasingly with-
drawn, ruminating about coworkers. A discussion ensues with
Spencer concerning how the work placement was intended to
help him achieve his vocational goals. Spencer agrees to
accompany the therapist to his work to investigate further by
talking with Spencer’s coworkers and supervisor, and by
observing Spencer working onsite.
Strong et al
volume 66 • issue 3
Spencer’s lack of work satisfaction
B. Assessment
Person, occupation and environment components in Figure 7
are considered with regard to how they relate to one another
across time to produce Spencer’s lack of satisfaction, and his
supervisor’s concerns about Spencer’s decline in functioning
and potentially becoming ill again (Figure 8).
An examination of the PO interaction revealed that the work
activities matched Spencer’s skills and abilities; he was generally
able to meet daily challenges with success. Although he valued
the work activities, Spencer expressed low self-efficacy regarding
his ability to do the work. Spencer was in the early stages of the
recovery process. He had not yet incorporated a sense of self as
a worker, and did not fully view himself as an active agent in his
recovery. The work was continually changing from job to job with
little routine. Spencer perceived little personal control over how
his work was performed or organized.
The OE interaction showed that although Spencer arrived
at each office with a three member team, his work was per-
formed largely in physical isolation from the rest of the team.
Team members and his supervisor expressed that Spencer’s
work was valued by the organization.
The PE interaction found the supervisor’s communication
was unclear and rules tended to be applied dogmatically to all
staff. The staff were not sure what to expect of Spencer and
appeared to treat him with ‘kid gloves’. Spencer was often not
included in social conversations. The workplaces offered
tremendous potential for work experience and training oppor-
tunities which were in keeping with Spencer’s vocational goals
and future aspirations.
Upon examining the presenting problem in this manner,
the problem was reconceptualized from what appeared initial-
ly to be Spencer becoming ill, to a complex set of transactions
constraining his satisfaction and recently his functioning on
the job. The therapist was able to rule out lack of interest, and
Spencer’s ability to function as the primary issues.
C. Intervention
Interventions focus on improving occupational performance by
removing barriers / constraints and developing supports to
improve the quality of the PEO fit. Intervention would include
targeting the relationships between Spencer, his work activi-
ties, and the work environment. The emphasis would be to
make the workplace a better place for everyone by improving
the people-work-environment fit. In this way animosity
between co-workers is avoided by Spencer not being seen as
having special concessions, the supervisor not made to feel
that he is the problem, and there is ‘buy in by all parties to
work together.
Figure 7
Assessment of person, environmental and occupational factors impacting Spencer’s occupational performance
volume 66 • issue 3
Strong et al
Examples of intervention strategies for Spencer may
Clarify job expectations, arrange clearer channels of com-
Negotiate some routine.
Negotiate to have some element of control & autonomy
over work tasks.
Educate supervisor and co-workers about mental illness.
Offer on-going facilitation of problem solving to the super-
visor re: dealing with daily issues.
Counsel Spencer re: asserting himself, dealing with oth-
ers’ reactions to mental illness.
D. Evaluation/ Follow-up
The intervention could be evaluated by discussing with
Spencer changes in his perceptions of his work environment,
perhaps facilitated by using a standardized self-report measure
such as the Work Environment Scale (Moos, 1994). If the
supervisor was also requesting feedback, the Work
Environment Scale could be completed by the supervisor,
Spencer and co-workers and a comparison made of percep-
tions. The therapist would seek reports of Spencer’s satisfac-
tion (i.e., whether it was a positive experience and meeting his
vocational goals) and his supervisor’s satisfaction (i.e.,
whether Spencer’s performance was satisfactory). On-going fol-
low-up would be provided by the therapist trouble-shooting’
routine issues as they arise. These issues would be dealt with
by Spencer, his supervisor and the therapist together problem-
solving ways to improve the quality of the fit between the per-
son, environment and occupation. Explanations and group
planning may be facilitated by drawing three over lapping cir-
cles labeled workers, the work activities, and the workplace.
Discussions can be focused on strategies to improve the fit of
the circles with group members adding words or phrases to
the drawn figure.
How the PEO Model facilitates practice
The PEO Model is being used by occupational therapists in a
variety of different settings and has been found to be a prac-
tical tool to facilitate practice. A strength of the PEO Model is
that it enables therapists to consider the complexities of
human functioning and experience in the day to day realities
of clients lives and therapists’ practices. The flexibility of the
model facilitates this by allowing the therapist to consider var-
ious combinations of P-E-O components and their transactions
across time, and in different environments. The three scenar-
ios illustrate this flexibility through the different combinations
of P-E-O. By considering the transactional effects, the therapist
is also able to obtain a clearer, more comprehensive, under-
standing of complicated occupational performance situations.
For example, with Spencer, the Model helped the therapist to
reconceptualize the central problem from an issue of Spencer
becoming ill or lacking interest, to a poor Spencer-job-work
environment fit.
Figure 8
Analysis of Person-Environment-Occupation Transactions (Spencer)
Strong et al
volume 66 • issue 3
There are many potential variations to the PEO elements
which can be examined. For example, person can refer to an
individual or to a group, organization, or community. The envi-
ronment can be examined for its cultural, socio-economic, insti-
tutional, physical and social aspects on both the micro (i.e.,
immediate clinical level) and macro levels (i.e., systems level).
For example, with Karen and Spencer, the therapist could also
intervene at the macro level by addressing the organizations
policies regarding working with persons with disabilities and
providing in-service training to the organization.
Another example of the flexibility of the Model is shown
by how it considers time through the PEO elements transact-
ing over the lifespan across changing situations as represent-
ed by a tube or cylinder (Figure 1). Therefore, therapists are
able to conceptualize and plan interventions which take into
account human development and change. With Karen, inter-
ventions will change as she develops and becomes more
assertive. For Spencer, the therapist considered his stage in the
recovery process. At an earlier time, the same client may have
considered himself a patient; his world solely focused on his
illness with different priorities and level of wellness. The ther-
apist and client might also have been operating in a different
context (e.g., an occupational therapist servicing an in-patient
and a multidisciplinary in-patient team).
In addition to flexibility, the Model offers a systematic
approach to the analysis of occupational performance issues.
As illustrated by the three scenarios, therapists examine prob-
lems in occupational performance by following the PEO
Application Framework (Figure 2). The result is an organized
and integrated approach. The structure is particularly useful
when attempting to see the forest for the treeswhen con-
fronted by perplexing situations. The time spent in analysis of
occupational performance issues can result in efficient use of
a therapist’s time by producing focused effective interventions
and relevant outcomes.
Third, the Model helps therapists to place their activities
into a framework that has a broad scope of occupational ther-
apy practice and offers multiple options for intervention. For
example, with Norman, the therapist’s scope included occupa-
tional and environmental factors and an analysis of PEO trans-
actions. Therefore the focus of the intervention expanded from
Norman making meals to multiple strategies and options for
Norman to obtain nutritious and satisfying food. A focus
beyond the individual, his/her impairments and personal com-
petencies is particularly helpful when dealing with persons
with chronic, persistent illness. With Spencer, a range of inter-
ventions were examined involving Spencer, his supervisor and
co-workers and focused on aspects of the person, the occu-
pation and different components of the environment. The
range of interventions offers the therapist the opportunity to
participate in a number of roles (e.g., provider of direct clinical
services, consultant to workplace, advocate for change or
change agent, health promotion).
The fourth benefit from using the PEO Model stems from
how the Model facilitates communication within and outside
the profession. Occupational performance problems and the
occupational therapists intentions can be explicitly described
to others using this Model. It enables therapists to explain to
themselves and others what they do uniquely. Individuals who
do not come from a medical background can understand its
rationale. Because the concepts reflect ideas in the social sci-
ences, the Model reflects the richness of occupational thera-
pys heritage. The Model is easy to understand and it does not
appear to be culturally bound. It does not require its user to
abandon his/her own perspectives; rather the Model can oper-
ate as an organizing framework for professionals to use all the
techniques or methods of intervention at their disposal for sit-
uations appropriate for a person-environment-occupation the-
oretical approach. The occupational therapist is able to use the
Occupational Performance Process (Fearing et al, 1997) togeth-
er with the PEO Model; the Occupational Performance Process
provides principles and a guiding framework for negotiating a
client-therapist alliance, while the PEO Model provides an
approach to analyzing, strategizing and communicating occu-
pational performance difficulties concerning person, environ-
ment, occupation relationships. Since the PEO Model meshes
well with other perspectives and practices, it allows team
members from different orientations or clinical training to com-
municate with a common understanding for them to work
together as a team. The Model further facilitates constructive
teamwork by reducing feelings of defensiveness by focusing
on the PEO fit issues rather than placing responsibility on any
one person or organization.
Finally, the PEO Model supports the pursuit and contin-
ued development of occupational therapy practice trends and
needs. It embodies the principles of client-centred practice and
supports the collaborative working partnership process articu-
lated in
Enabling Occupation: An Occupational Therapy
(CAOT, 1997). The profession has been returning to
its roots through discussions on occupation and occupational
performance. The model offers a way of conceptualizing how
these constructs relate to one another theoretically and sug-
gests a structure for problem-solving intervention strategies.
The Model clearly defines the outcome of occupational perfor-
mance as the product of PEO transactions which facilitates
evaluation. This means that therapists can identify what out-
comes need to be measured.
In summary, the Person-Environment-Occupation Model
(Law et al., 1996) facilitates practice by:
Considering the complexities of human functioning and
Offering a systematic approach to the analysis of occupa-
tional performance issues
Expanding the scope of practice and options for inter-
volume 66 • issue 3
Strong et al
Facilitating communication within and outside the profes-
Supporting the pursuit and continued development of
client-centred, community based practice
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occupation: An occupational therapy perspective. Ottawa, ON:
CAOT Publications ACE.
Cooper, B., & Stewart,D. (1997). The effect of a transfer device in the
homes of elderly people. Physical and Occupational Therapy in
Geriatrics, 15, 61-77.
Fearing, V,G., Law, M., & Clark, M. (1997). An occupational performance
process model: Fostering client and therapist alliances. Canadian
Journal of Occupational Therapy, 64, 7-15.
Krupa, T., & Packer, T. (1997). Canada-Russia Health and Social
Development Project. Resource Manual, Volume 1, Occupational
Theory. Kingston, ON: Queens University.
Law, M. (1993). Changing disabling environments through participato-
ry research. Canadian Journal of Rehabilitation, 7, 22-23.
Law, M. (1997). Changing disabling environments through participato-
ry action-research: A Canadian experience. In S. Smith, D. Willms,
& N. A. Johnson, Nurtured by knowledge: Learning to do partic-
ipatory action-research. New York, NY: Apex Press.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996).
The Person-Environment-Occupation Model: A transactive
approach to occupational performance. Canadian Journal of
Occupational Therapy, 63, 9-23.
Law, M., Darrah, J., Rosenbaum, P., Pollock, N., King, G., Russell, D.,
Palisano, R., Harris, S., Walter, S., Armstrong, R., & Watts, J.
(1998). Family-centred functional therapy for children with cere-
bral palsy: An emerging practice model. Physical & Occupational
Therapy in Pediatrics, 18 (1), 83-102.
McKye, A., Shin, J., & Letts, L. (1998, June). Cultural sensitivity of the
Person Environment Occupation (PEO) Model. Paper presented
at the 12th International Congress of the World Federation of
Occupational Therapists, Montreal, Quebec.
Moos (1994). The Work Environment Scale Manual. Development,
Applications, Research (3rd Ed.). Palo Alto, CA: Consulting
Psychologists Press.
Peachey-Hill, C., & Law, M. (1996, June). Impact of environmental sen-
sitivity on occupational performance: A qualitative study. Paper
presented at the Canadian Association of Occupational
Therapists Annual Conference, Ottawa, Ontario.
Stewart, D., (1998). The transition to adulthood for youth with physi-
cal disabilities: A qualitative exploration. Unpublished master’s
thesis, McMaster University, Hamilton, Ontario, Canada.
Strong, S. (1998). Meaningful work in supportive environments:
Experiences with the recovery process. American Journal of
Occupational Therapy, 52, 31-38.
Strong, S. (1995). An ethnographic study examining the experiences
of persons with persistent mental illness working at an affirma-
tive business. Unpublished master’s thesis, McMaster University,
Hamilton, Ontario, Canada.
Copyright of articles published in the Canadian Journal of Occupational
Therapy (CJOT) is held by the Canadian Association of Occupational
Therapists.Permission must be obtained in writing from CAOT to photo-
copy, reprint,reproduce (in print or electronic format) any material pub-
lished in CJOT.There is a per page,per table or figure charge for commer-
cial use.When referencing this article,please us APA style, citing both the
date retrieved from our web site and the URL.For more information,
... Ana yapılar arasındaki uyumun anlamlı katılımı arttıracağı, uyumsuzluğun ise katılımı veya okupasyonel performansını tehdit edeceği ileri sürülmektedir. Bu bağlamda çevre faktörü de kişinin günlük yaşamdaki görev performansını dinamik olarak etkilemektedir 18 . ...
... Bunun yanı sıra çoklu duyusal uyaranlarla zenginleştirilmiş bir çevre ile yaşlılar gözlemlendiğinde, okupasyonlara katılımda artış, davranış ve ruh hallerinde iyileşme görülmüştür 21,22 . Yani fiziksel, sosyal, kültürel ve sosyoekonomik gibi geniş bir yelpazede incelenen çevre faktörünün niteliği hem bireyin iyi olma haline hem yaşam kalitesinin sürdürülebilirliğine teşvik eder 18 . Kişi ve çevre etkileşiminde çevre faktörü, bireyin tercih ve yeteneklerini yansıtmasında rol oynar. ...
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Ergoterapi alanında model üzerinden inşa edilen bir sistem ile çizilen çerçevenin; terapi ve tedavi metotları planlanırken süreci bütünsel olarak değerlendirme noktasında katkı sağladığı bilinmektedir. Deneyime bağlı plastisitede rol oynayan çevresel zenginleştirme, bilişsel ve davranışsal kapsamlarda bireylerin bağımsızlık sürecine katkı sağlamaktadır. Çevre faktörünü farklı bağlamlarda esas alan ergoterapistler sıklıkla bireylerin yakın çevresine odaklanmaktadır. Çevrenin okupasyonlar üzerindeki önemli etkisi tam olarak anlaşılması önemlidir. Bu derlemede, çevrenin ergoterapideki rolü, kişi ve okupasyonlar ile ilişkisi, insanın dönüşümünde ve zihinsel süreçlerinde çevre faktörünün önemi genel kapsamları ile tartışılmıştır.
... The client-centred approach incorporates the person's wishes and needs, and actively involves the person with deficits in setting certain goals in their rehabilitation process [7,[9][10][11][12]. By using occupational models and assessments, such as the Person-Environment-Occupation model (PEO-model) [13] and Canadian Occupational Performance Measure (COPM) [14][15][16], therapists can involve the person with deficits in the process of setting unique and individual goals, which increases therapy motivation and consequently adherence. The extra advantage of the COPM is that it cannot only be used for goal setting but also for the assessment of self-perceived occupational performance [14][15][16]. ...
... Although conventional therapy also focusses on providing a client-centred approach, our results suggest that i-ACT can support a client-centred approach as about 88% of the persons' goals were implemented in i-ACT training compared to about 46% in control group during conventional therapy. This finding confirmed our third hypothesis as i-ACT is specifically developed to incorporate a client-centred approach by being able to record and set different kinds of activities (which are determined by the person with deficits), and provide individualised real-time feedback regarding the performance of the person with deficits [13]. These features distinguish i-ACT from other Kinect-based systems which mostly use commercially available (exer)games, which are not designed to meet rehabilitation goals such as feedback on compensation strategies, coordination patters, etc. [1,2,4,5,21,22]. ...
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Background A client-centred task-oriented approach has advantages towards motivation and adherence to therapy in neurorehabilitation, but it is costly to integrate in practice. An intelligent Activity-based Client-centred Training (i-ACT), a low-cost Kinect-based system, was developed which integrates a client-centred and task-oriented approach. The objectives were (1) to investigate the effect of additional i-ACT training on functioning. And (2) to assess whether training with i-ACT resulted in more goal oriented training. Methods A single-blind randomised controlled trial was performed in 4 Belgian rehabilitation centres with persons with central nervous system deficits. Participants were randomly allocated through an independent website-based code generator using blocked randomisation (n = 4) to an intervention or control group. The intervention group received conventional care and additional training with i-ACT for 3 × 45 min/week during 6 weeks. The control group received solely conventional care. Functional ability and performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) were assessed at baseline, after 3 weeks and 6 weeks of training, and 6 weeks after cessation of training. Data were analysed using non-parametric within and between group analysis. Results 47 persons were randomised and 45 analysed. Both intervention (n = 25) and control (n = 22) group improved over time on functional ability and performance as measured by the Wolf Motor Function Test, Manual Ability Measure-36, and Canadian Occupational Performance Measure, but no major differences were found between the groups on these primary outcome measures. Regarding QoL, fatigue, trunk movement, and shoulder AROM, no significant between group differences were found. High adherence for i-ACT training was found (i.e. 97.92%) and no adverse events, linked to i-ACT, were reported. In the intervention group the amount of trained personal goals (88%) was much higher than in the control group (46%). Conclusions Although additional use of i-ACT did not have a statistically significant added value regarding functional outcome over conventional therapy, additional i-ACT training provides more individualised client-centred therapy, and adherence towards i-ACT training is high. A higher intensity of i-ACT training may increase therapy effects, and should be investigated in future research. Trial registration: Identifier NCT02982811. Registered 29 November 2016.
... In brief, during the first two sessions participants were taught to reflect on occupational balance and imbalance within their own life [20,27]. The teaching in these two first sessions was primarily based on the ValMOmodel [20] and the Person-Environment-Occupation (PEO)-model [35]. ...
Background: Symptoms of stress are widespread in the working population and associated with long-term sickness absence and poor work functioning. Occupational therapy (OT)-based interventions are effective in improving return-to-work (RTW)-rates in stress-afflicted long-term sickness benefit beneficiaries (SBBs). No Danish standard on OT-RTW for stress-afflicted SSBs exists. Aims: To describe and evaluate the feasibility of a seven-week OT-RTW intervention for stress-afflicted SBBs. Materials and methods: Daily Life Coping (DLC) utilizes peer-learning and salutogenetic perspectives to address occupational imbalances experienced by long-term SBBs. Stress-afflicted SBBs (n = 54) in the municipality of Hilleroed were enrolled. Self-efficacy and well-being were measured before and after intervention using the general self-efficacy (GSE) scale and WHO-5 Well-Being Index (WHO-5). RTW-rates were measured at one-year follow-up. Participant feedback was collected using standardized evaluation forms. Results: Following the intervention, WHO-5 improved by 13.7 ± 16.5 points and GSE improved by 4.3 ± 4.8 points. Participant feedback was positive. At one-year follow-up, employment status data were available for 51 SSBs of these 58.8% achieved employment. High post-test GSE and WHO-5 scores were associated with employment at follow-up. Conclusion: DLC led to significant improvements in self-efficacy and well-being. Preliminary results indicate benefits on RTW-rates. Significance: This study provides evidence of the feasibility of DLC in a municipal setting.
... Ерготерапевтична модель «Р-Е-О» (особасередовище -заняття) надає ерготерапевту унікальні можливості використати свій досвід з метою встановлення всіх факторів, що збільшують ризик падінь, та визначення їх зв'язку з особою, середовищем та заняттям [34] . Відповідно ерготерапевти повинні володіти знаннями та навичками розроблення стратегій втручань, враховуючи конкретні фактори ризику падінь у тому чи іншому випадку . ...
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Резюме. Ерготерапевти посідають одне з найважливіших місць у проведенні оцінювання ризику падінь та розробленні програм втручань для осіб, які мають підвищений ризик падіння, вже перенесли чи мають страх падінь. Визначення факторів падіння, їх комплексне урахування в програмах втручань та своєчасне інформування пацієнтів суттєво зменшать ризики і страх падінь. Мета. Проаналізувати досвід зарубіжних та вітчизняних авторів щодо характеристики факторів падінь та їх класифікації. Методи. Аналіз та узагальнення науково-методичної літератури. Результати. У роботі висвітлено фактори ризику падінь осіб похилого та старечого віку, підкреслено необхідність їх комплексного врахування в розробленні програм втручань. Аналіз факторів, що провокують падіння, важливий з точки зору розуміння природи падінь та розроблення програм втручань. Планується розроблення комплексної програми й ерготерапії для осіб похилого та старечого віку, які мають підвищений ризик падінь. Ключові слова: ерготерапія, падіння, особи похилого та старечого віку, втручання.
... The nine intervention components 30 are organised according to the Person-Environment-Occupation model. 44 Detailed description on the intervention programme, including a brief case example, is provided elsewhere. 31 Clients in the control group receive usual occupational therapy services. ...
Full-text available
Introduction The need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council’s guidance on how to develop and evaluate complex interventions, the occupational therapy programme (A Better everyday LifE (ABLE)) was developed and feasibility tested. The aim of this protocol is to report the planned design and methods for evaluating effectiveness, process and cost-effectiveness of the programme. Methods and analysis The evaluation is designed as a randomised controlled trial with blinded assessors and investigators. Eighty participants with chronic conditions and ADL problems are randomly allocated to ABLE or usual occupational therapy. Data for effectiveness and cost-effectiveness evaluations are collected at baseline (week 0), post intervention (week 10) and follow-up (week 26). Coprimary outcomes are self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)). Secondary outcomes are perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS). Explorative outcomes are occupational balance (Occupational Balance Questionnaire); perceived change (Client-Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument). The process evaluation is based on quantitative data from registration forms and qualitative interview data, collected during and after the intervention period. A realist evaluation approach is applied. A programme theory expresses how context (C) and mechanisms (M) in the programme may lead to certain outcomes (O), in so-called CMO configurations. Outcomes in the cost-effectiveness evaluation are quality-adjusted life years (EuroQool 5-dimension) and changes in ADL ability (AMPS, ADL-I). Costs are estimated from microcosting and national registers. Ethics and dissemination Danish Data Protection Service Agency approval: Journal-nr.: P-2020-203. The Ethical Committee confirmed no approval needed: Journal-nr.: 19 045 758. Dissemination for study participants, in peer-reviewed journals and conferences. Trial registration number NCT04295837
... This correlation is consistent with basic assumptions in occupational therapy that considers the environment as one of the most important concepts in the occupational therapy evaluation and treatment process. In fact, occupational therapy researchers have long recognised the role of the environment as a treatment modality and have invented therapeutic models such as the Person-Environment-Occupation model (PEO) to show the role of each factor [43]. Caregivers are well positioned to instruct occupational therapists on specific cultural aspects and preferred ways of performing daily occupations, within their home and community environments. ...
Full-text available
Purpose: Often people with spinal cord injury (SCI) require help from their caregivers to carry out activities of daily living. Such assistance may affect caregiver quality of life (QoL). This study investigates the QoL and its associated risk factors among caregivers of people with SCI to find possible ways to increase their QoL. Material and Method. A convenience sample of 135 Iranian caregivers of people with SCI participated in a cross-sectional study from the Brain and Spinal Injury Repair Research Center of Tehran (BASIR), Iran, from June 2018 to October 2019. The World Health Organization's Quality of Life Questionnaire (WHOQoL-BREF), the Beck Depression Inventory-II (BDI-II), the Caregiver Burden Scale (CBS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was then applied to identify risk factors associated with caregiver QoL. Results: Moderate to highly significant negative correlations were observed between all domains of the WHOQoL scale and subscales of the CBS and the BDI-II. After controlling for demographic and clinical variables, depression, burden, and level of injury were found to predict caregiver QoL significantly. Furthermore, QoL was lower in caregivers of people with quadriplegia than paraplegia (p < 0.05). Conclusions: The level of injury, self-perceived caregiver burden, and depression are associated with QoL for the caregivers of people with SCI. A holistic approach incorporating caregiver training, psychological interventions, and adequate support may enable better QoL for these caregivers.
Healthcare has the past decades shifted from a narrow medical perspective to a more holistic, biopsychosocial perspective. Disability understood as a contextual condition constituted by the relation of the individual to their social and physical context. The disability model of the International Classification of Functions (ICF) contextualizes activity, participation, body functions and structure by including environmental and personal factors. However, illustrated by the consideration of the environmental factors as a neutral dimension, the dynamic interrelation of the individual parts of the system is rather unchartered. In 2017–2019, a lighting assessment was developed and tested on 60 participants in low vision rehabilitation. An action research project accompanied the pilot study from 2018. Ethnographic participatory observations of the low vision consultants in 15 consultations, semi-structured interviews, and a document analysis of the project material of the pilot project has been analyzed using the theoretical framework of science and technology studies. Mapping the physical environment showed a range of factors from spatial organization to luminaires and light bulbs. Moreover, in relation to specific activities, relevant factors were identified and assessed, and in the intervention adjusted to relevant personal and social factors. Identifying overlapping personal, environmental, and professional spheres illustrates the complexity of practicing rehabilitation in people's everyday lives. Acknowledging and coordinating different versions of lighting enabled low vision consultants to work across these spheres relationally. ICF was embedded in the practice of low vision consultants as a frame of reference, however, implementing this framework occurred through an assemblage of tools from different fields. The focus on lighting as an active element in low vision rehabilitation demonstrated a way to work across the personal and environmental to reduce the gap that caused disability. In everyday life, the physical environment was pivotal in the person–environment relationship and in enabling or disabling the individual. However, the physical environment was also key to the rehabilitation process, facilitating the individual's learning and change processes and reconfiguring their understanding and use of the environment. Consequently, the physical environment was not a neutral background to the other factors but rather enabling the rehabilitation and recovery processes.
Conference Paper
Full-text available
Objective – The aim of the study is to provide planning recommendations for special care units for patients with dementia in general hospitals. Therefore, (1) an overview of existing structural concepts and, (2) results of a systematic environmental assessment regarding the dementia-sensitivity of the built environment will be presented. Background – Due to demographic change, the number of acutely ill, geriatric patients with additional cognitive impairments in hospitals is increasing. Since this patient group often shows adverse outcomes during their hospital stay, specialised wards ("special care units") have been implemented as part of dementia-friendly hospital concepts. In Germany, the number of special care units has been rising over the last years and more than forty units are currently known. Research has shown positive effects on patients’ self-care and mobility as well as a decrease in challenging behaviour. However, an overview of spatial concepts, which can serve as basis for planning recommendations, is missing. Research question – What are architectural characteristics of special care units for the care of patients with dementia in general hospitals and how is dementia-friendly design implemented? Methods – Site visits and interviews with responsible medical and nursing staff leaders of special care units in German general hospitals (N=20) were conducted. The implementation of dementia-friendly design recommendations based on publications by Hofmann et al. 2014 and King’s Fund 2014 was systematically documented. Additionally, floor plans of the units were analysed regarding their integration into the building structure, spatial programmes and use of space. Implementation of design criteria was discussed in the light of planning recommendations for dementiafriendly hospital wards given by Büter et al. 2017 Results – The units differed greatly in terms of their building structure and their spatial programs. The floor space per unit varied from 120 to 1200 sqm depending on the number of beds in the units starting from 6 to 30 beds. Three types of structural concepts were identified which were characterised by their spatial organisation within the building and the resulting autonomy in the workflow of the units. Regarding the implementation of dementia-friendly design recommendation, it was found that especially interior design elements, such as colour contrasts or visual cues to improve visibility of patient-relevant objects, were often used. Conclusion – A high number of individual spatial concepts for special care units exists in German hospitals. These concepts were highly dependent on specific building conditions and functional requirements, especially fire protection, hygiene and floor plan structure. The implementation of some core recommendations, such as a visual relationship between areas for patients and nurses, requires early consideration in planning processes as it refers to the building structure. Otherwise, these implementations may result in extra effort in terms of construction works and financial expenses.
The Elizabeth Casson Memorial Lecture is awarded on an annual basis to a member of high standing within the occupational therapy profession. The 2020 lecture was delivered by Dr Jenny Preston MBE who contested the underlying assumptions of truth and certainty by considering how we generate, create and understand knowledge within the occupational therapy profession. Through the principles of process re-engineering, Dr Preston sought to define, analyse and identify how we interpret and apply that knowledge within our broad understanding of truth to capture the impact of occupational therapy. Finally, Dr Preston attempted to design and develop a future state in which evidence and practice are entwined to create the best possible outcomes.
Full-text available
Occupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work and play. There have, however, been few models of practice in the occupational therapy literature which discuss the theoretical and clinical applications of person-environment interaction. This paper proposes a Person-Environment-Occupation Model of occupational performance which builds on concepts from the Occupational Therapy Guidelines for Client Centered Practice and from environment-behaviour theories. The model describes interactions between person, occupation and environment, outlines major concepts and assumptions, and is applied to a practice situation.
Full-text available
In this paper we describe the development and initial evaluation of a family-centred functional approach to therapy for young children with cerebral palsy. The family-centred functional therapy approach is based on theoretical concepts from family-centred service and a systems approach to motor development. Principles of this approach include an emphasis on functional performance, and providing therapy when movement behaviors are amenable to change. Therapy focuses on identifying and changing performance constraints in the task, the child or the environment. Four initial studies were completed to develop and evaluate the feasibility of the family-centred functional therapy approach. Results indicate that children receiving this approach improve in functional performance over the course of intervention. Development of the therapy approach needs to continue to enable therapists to develop methods to identify a broader range of factors that enable or constrain task performance. Further development of specific therapeutic strategies is also required, particularly strategies that focus on changing the task or the environment around the child as a means to improve performance.
Occupational therapists, known for their ability to coach others through difficult changes, now find themselves in changing environments that include clients' desire for participation in service delivery, and the need for evidence of the outcome of occupational therapy intervention. This paper proposes a process model that is based on core concepts of occupation and client-centred practice, that incorporates theoretical approaches, and can be applied to all clients. The process model coaches the occupational therapist through a client-centred problem solving process. It represents a description or plan for occupational therapy assessment and intervention that leads to a collaborative approach to client-identified occupational performance issues. Examples of the application of the process to occupational therapy practice are included. This model helps to articulate core concepts and values, and provides guidance for occupational therapy practice within changing environments and expectations.
A novel transfer pole was installed in the homes of 30 community dwelling elderly women (mean age 76.8 years) and intermittently color-cued for 20/30 participants. Subjects' views of the device and their ability to transfer were monitored over a three-month period using survey, performance and self-report measures. Qualitative results indicated that seniors fully recognized and endorsed the functional utility and safety benefits of the pole. A repeated measures one-way ANOVA showed statistically significant changes across time for all groups on self-report measures as a consequence of the pole but none related to the cue, although positive trends were observed. The results corroborate basic assumptions of the Person-Environment-Occupation Model used to frame the study.
Thesis (M.Sc.) -- McMaster University, 1995. Includes bibliographical references (leaves 249-261).
This ethnographic study examined what makes work meaningful for persons with persistent mental illness and how this meaningfulness relates to their recovery. Twelve persons between 32 and 58 years of age who had been involved an average of 19 years with a formal mental health system participated in in-depth interviews and a focus group. Thematic analysis and case studies were understood in the context of the investigator's 15 months of participant observation of 35 persons with psychiatric disabilities working at an affirmative business. The meaning of work varied with participants perception of their illness and their self-concept. Changes in their self-efficacy and self-concept were driven by their participation in work activities to operate the affirmative business. Findings suggest that therapists could potentially facilitate these changes in clients' sense of self-efficacy and self-concept by helping them make connections with meaningful occupations and contributions to organizations in the community and to experience challenges and successes in the context of meaningful work.
Canada-Russia Health and Social Development Project
  • T Krupa
  • T Packer
Krupa, T., & Packer, T. (1997). Canada-Russia Health and Social Development Project. Resource Manual, Volume 1, Occupational Theory. Kingston, ON: Queen's University.
Changing disabling environments through participato-ry action-research: A Canadian experience Nurtured by knowledge: Learning to do partic-ipatory action-research
  • M Law
Law, M. (1997). Changing disabling environments through participato-ry action-research: A Canadian experience. In S. Smith, D. Willms, & N. A. Johnson, Nurtured by knowledge: Learning to do partic-ipatory action-research. New York, NY: Apex Press.
The transition to adulthood for youth with physical disabilities: A qualitative exploration. Unpublished master's thesis
  • D Stewart
Stewart, D., (1998). The transition to adulthood for youth with physical disabilities: A qualitative exploration. Unpublished master's thesis, McMaster University, Hamilton, Ontario, Canada.