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April, 1997, Monograph 1

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Towards a model ofoccupationalperformance:

Model development

Christine Chapparo, Judy Ranka

Christine Chapparo, MA, DipOT, OTR, FAOTA, is aSenior Lecturer in the School of Occupational

Therapy, The University of Sydney, Australia

Judy Ranka, BSc, MA, OTR , is a Lecturer in theSchool of Occupational Therapy, The University ofSydney, Australia

The primary purpose of the undergraduateoccupational therapy curriculum at TheUniversity of Sydney is to prepare students for

the academic, practical and ethical demands ofoccupational therapy practice (School ofOccupational Therapy, 1986). As part of a formerCollege of Advanced Education, CumberlandCollege of Health Sciences (CCHS), the Schoolof Occupational Therapy was required by theHigher Education Board to undergo majorcurriculum reviews every ,five years. The goal ofthese reviews was to enhance quality teachingand learning, promote academic standardsexpected of baccalaureate degrees and tomaintain curriculum relevance. In response tothese curriculum reviews, the undergraduate

curriculum has undergone considerable changeand refinement (School of Occupational Therapy,1975; School of Occupational Therapy, 1986).

One major area of change has been thedevelopment of a theoretical framework for thecurriculum which has two integrated conceptualthrusts. One is educational with curriculumdevelopment and implementation movingtowards problem-based, adult learning modes ofeducation thereby directing the process of

teaching and learning within the curriculum. Theother is the development of a curriculum contentstructure that is based on conceptual notions ofoccupational performance and functions toorganise content within the curriculum. Evolutionof the present undergraduate curriculum structure

is a product of the School's response over atwenty year period to 1) the demands forpreparation by a profession that is characterised by diverse and increasingly more community-oriented practice, 2) demands from highereducational bodies for a coherent approach toteaching and learning that is appropriate totertiary level education, and 3) the need for aunifying model of the practice of occupationaltherapy around which to organise curriculumcontent. This article focuses on the process oftheorising around concepts of occupationalperformance. The process of model building was

initially stimulated by curriculum restructuringand subsequently continued by the authors todevelop a model of occupational performancethat was relevant to occupational therapy practicein Australia.

BACKGROUND INFORMATION

Undergraduate occupational therapy curriculumdocuments within the School of OccupationalTherapy, The University of Sydney dating from

1975 to 1995 confirm the link between thestructure of curriculum content and contemporaryoccupational therapy practice. Prior to 1975, theprimary mode of practice in occupational therapyin NSW was hospital-based therapy within theDepartment of Health (Alexander, Keogh &Cheesman, 1980). Curriculum documentsdescribe occupational therapy content that waslargely categorised according to perceiveddomains of practice within the health system forgroups of clients as classified by medicine; forexample, orthopaedics, neurology, paediatrics, psychiatry, rehabilitation and general medicine.

Occupational therapy subjects, heavilyinfluenced by concepts of rehabilitation, focussedon occupational therapy in neurology,occupational therapy in psychiatry andoccupational therapy in orthopaedics and generalmedicine (School of Occupational Therapy,1975). Definitions of occupations related todisability and definitions of occupational therapyfocussed on provision of services to "individualsor groups whose abilities to cope with activitiesof daily living were threatened or impaired by


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Occupational Performance Model (Australia)

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...disability" (School of Occupational Therapy,1975, p.2).

In 1975, attempts were made by curriculumdevelopers to move away from using medicalmodels to classify occupational therapy

curriculum content in response to increasingspecialisation in occupational therapy and prevailing notions of community practice.Subject areas within the curriculum reflected themajor specialty practice domains. Subjects suchas Sensory Motor Processes, PsychosocialProcesses and Occupational Therapy becamefoundation subjects within the curriculum. Thisreflected the beginnings of a conceptual approachto curriculum design whereby occupationaltherapy practice was described as beingcomposed of core knowledge and skills(Occupational Therapy), specialist knowledge

and skills (Sensory Motor and PsychosocialProcesses), and foundation knowledge(Biological Sciences and Behavioural Sciences)

Figure 1: Interrelation of major subjects within thecurriculum framework (Occupational Therapy Stage 3Submission, 1975, p.12).

The aim of this curriculum structure was to allowstudents to focus on the sensory motor and psychosocial processes that were viewed asunderpinning occupational therapy practice, andto study the effects of disability on functional performance (School of Occupational Therapy,1986). However, this way of dividing knowledgeand skills within the curriculum, over time,reinforced divisions in the cognitive structure ofstudent learning between the psychological,

physical and functional aspects of human performance. Ultimately, there existed adichotomy between what was perceived bystudents as sensory motor occupational therapy, psychosocial occupational therapy, and'legitimate' occupational therapy (School of

Occupational Therapy, 1986). Although this typeof 'physical' versus 'mental health' curriculumstructure is still the most common world wide,questions have been raised about the role thatsuch dichotomous curriculum structures play inthe 'component' versus 'real' practice dilemmasreported in occupational therapy practice today(Yerxa & Sharrott, 1986).

A curriculum review of this course structure in1980 resulted in two changes reflecting a concernabout the lack of integration and conceptualapplication between the subjects. New subjects

(Selected Studies and Interdisciplinary Studies)were added to the curriculum to assist students torealise, "the potential for conceptual areas taughtin one segment of the course to be a foundationfor, complementary to, or common withconceptual areas in other segments of the course"(School of Occupational Therapy, 1986, p.5).However, later feedback from students, graduatesand staff, indicated that these subjects were notfully effective, and that a different curriculumstructure was required that would give moreemphasis to, "integration of subjects to reinforce

theory through application" (School ofOccupational Therapy, 1986, p. 29).

A 1985 curriculum review, involvingconsultation with the profession through surveyquestions, workshops and focus groups, indicatedthat a concern of many occupational therapistswas how to better educate students about the,"identity of occupational therapy" (School ofOccupational Therapy, 1986, p.30). Reviews ofoccupational therapy literature, together withinput from practitioners suggested that,"reference to human involvement in occupations"

was a consistent central theme for bothcontemporary theory and practice (School ofOccupational Therapy, 1986, p.31). Furtherinterpretation of the information about practicegathered from these surveys and groupdiscussions indicated that although thereappeared to be an occupational therapy identitywhich was evident in practice, it had, "not beencarefully defined to allow for a central unifyingand organising focus to be established" either foroccupational therapy practice or within the


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curriculum (School of Occupational Therapy,1986, p.30).

Appraisal of the conceptual basis of the course atthe time indicated that it did not fully encompasspresent or future visions of occupational therapy

practice, or address the nature of humanoccupations. Specifically, curriculum evaluationdocumentation indicated that the availableconceptual definition of occupational therapylacked, "an organising concept which clearlyestablished the uniqueness of occupationaltherapy" (School of Occupational Therapy, 1986, p.44). A further area of concern lay in the perceived inconsistency between the integrated,holistic view of human beings held byoccupational therapy practitioners, andcurriculum notions of what constituted 'wellness'and 'sickness' (School of Occupational Therapy,

1986, p.45). In particular, this review indicated aneed for a central unifying concept ofoccupational therapy to provide a basis foroccupational therapy content within theundergraduate course. Specifically, thefollowing statement from the Stage IV Reviewillustrates conceptual dimensions that wereidentified as missing from the curriculumstructure.

"A goal for occupational therapyundergraduate education should be for

graduates to develop a sense of professional identity which will allowthem to feel secure in their professionalrole, irrespective of the area of practicethey may select. The utilisation of acentral unifying concept of occupationaltherapy to provide a conceptual basis foran educational program would contributeto the student's development of this senseof a professional identity. This centralunifying concept would provide a filterthrough which students could examine,analyse, and select information from

broader knowledge bases utilised inoccupational therapy, as well as providing a focal point for examininggeneric and practice models ofoccupational therapy to arrive at apersonal frame of reference for practice"(School of Occupational Therapy, 1986,

p.31).

As a beginning point in restructuring thecurriculum around a central unifying concept of

occupational therapy, a conceptual model foroccupational therapy practice was sought thatwould 1) illustrate unifying concepts inoccupational therapy but allow for the pattern ofdiverse practice which was predicted for the year2000, 2) more fully explain occupational therapy

practice as well as the nature of humanoccupations, and 3) integrate the existingdichotomies between physical, psychosocial andfunctional dimensions of human ability anddisability.

In 1986, a curriculum framework was developed based on contemporary notions of occupational performance. Occupational performance waschosen as a conceptual and definitive basis ofcurriculum structure development because:

1) it had the potential to explain diverse

practice areas,

2) there was some support in occupationaltherapy literature for its use as a unifyingframework for occupational therapypractice,

3) it did not require theoretical 'loyalty' inthat it allowed therapists to use manytheoretical models within itsmetastructure to explain function anddysfunction such as the Model of Human

Occupation (Keilhofner, 1985) andSensory Integration (Fisher, Murray &Bundy, 1991).

The 1986 model of occupational performancethat was employed by the curriculum engineers atthe time was adapted from a generic model ofoccupational performance described by Reed andSanderson (1983, p.17)

The Human Occupations model (Reed, &Sanderson, 1983, p.5) was modified to include acomponent area titled, 'creativity' which

illustrated the contemporary notions of creativityas a unitary function separate from othercomponent areas of performance. Anothermodification linked the interpersonal andintrapersonal component function to form onedimension, psychosocial. For the first time,cognitive aspects of performance featured in thecurriculum structure alongside the traditional psychosocial and physical aspects (School ofOccupational Therapy, 1986, p.88). This modelrepresented an attempt to explain both the nature


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and components of human occupations as well asthe components of occupational therapy practice,and is the first recorded conceptual model for practice that was adopted by the curriculum atCumberland College of Health Sciences (nowThe University of Sydney) (Fig. 2). The central

position of the individual indicated a client-centred approach to therapy as well as the whole person. Physical, psychological and cognitiveattributes of human ability figure next asunderpinning occupational activities of self-maintenance, work and leisure. The environmentwas conceptualised as housing both the whole person and the person's occupational activitythereby influencing everything within thestructure. Human occupations were figured thus(Fig. 2):

Figure 2: The curriculum conceptual model (School ofOccupational Therapy, 1986, p. 59; Adapted from Reed& Sanderson, 1983, p.5)

Subject structure and nomenclature was changedover time to reflect this conceptual basis and theintegration of physical, cognitive andpsychosocial dimensions of human performance.

The impact of this conceptual model on thestructuring of curriculum content can be seen bycomparing the differences in subject name andfocus between the original 1975 curriculum andthe present curriculum Table 1).

From that point, the authors uncoupled the model building process from formal curriculumdevelopment and continued the process of modelbuilding which resulted in the gradual

1980: BAppSc(OT) SubjectsOccupational TherapyPsychosocial ProcessesSensory Motor ProcessesInterdisciplinary StudiesClinical Education

Special InvestigationSelected StudiesBehavioural Sciences subjectsBiological Sciences subjects

1995: BAppSc(OT) SubjectsOccupational Therapy Theory and ProcessOccupational Role DevelopmentHuman OccupationsComponents of Occupational PerformanceOccupational Therapy FieldworkEvaluation of Occupational Therapy

ProgramsBehavioural SciencesBiological Sciences

Table 1: Categorisation of past and present curriculumcontent in the BAppSc(OT) course 1980 and 1995.(Note: Subjects cross years of the course and are eachcomprised of several units).

evolution of a model of occupational performance as it is structured today.Restructuring of this 1986 model occurred inresponse to:

1) perceptions of academics using themodel that it was too simplistic, and thatthere were further dimensions tooccupations and occupational therapypractice that required concept formation,and

2) a need to evaluate whether thetheoretical concepts within the modelwere consistent with those used inoccupational therapy practice.

DEVELOPMENT OF THE CURRENT

OCCUPATIONAL PERFORMANCE

MODEL

The process of model development from 1986 proceeded through four stages. The methodsemployed to develop the model, and the productof each of the four stages of development areoutlined in Table 2.


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Figure 3: Stages of Development ofConstructs of Occupational performance.


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METHODS USED TO DEVELOP MODEL

CONSTRUCTS

Multiple methods were employed to developand test the constructs housed within the presentmodel. Literature review was used during Stage

One of the process, and additional literaturereviews were conducted to find support forconstructs that emerged during later stages ofmodel development. As new constructs weredeveloped, a process of field testing occurred todetermine their relevanceand importance within various areas of practice.To develop and field test constructs,descriptions of occupational therapy fromindividual therapists were gathered throughmultiple half-day, two-day and four-daycontinuing professional education courses andworkshops. These sessions were structured to

explore the constructs fundamental to variousforms of occupational therapy intervention. Briefdescriptions of how these methods were used ateach stage of the model building process as wellas the outcome are outlined below.

STAGE ONE (1989-1990):

The purpose of Stage One was to identifyliterature support for using occupational performance to explain occupational therapy

practice.Methods:

A review of occupational therapy literaturecovering a twenty year period from 1970 to 1990was conducted using electronic and CD-ROMdata bases, published indexes and online searchtechniques. During subsequent stages ofdevelopment this review expanded to 1995.

Findings:

The term, occupational performance, wasclassified according to how it was used in theliterature. Four classifications emerged: use ofoccupational performance as a generic frame ofreference for national practice includingdefinitions of the term, use of occupationalperformance as a generic frame of reference forundergraduate occupational therapy curricula,use of occupational performance terminology byoccupational therapy theorists to explain practice,and use of occupational performance to develop

assessment tools.

1. Use of occupational performance as a

generic frame of reference for national

practice.

Descriptions of occupational performance haveappeared in occupational therapy literature in theUnited States and Canada since 1973. The pivotal conceptualisation of occupationalperformance seems to have been generated by aseries of American Occupational TherapyAssociation, Inc. (AOTA, Inc.) task forces andcommittees charged with developing policystatements about generic domains of concern forthe profession (AOTA, Inc., 1974, 1973).Concurrently, the Canadian Association ofOccupational Therapists (CAOT) developed asimilarly conceptualised notion of occupational

performance to address growing concerns insideand outside the profession for assuring quality ofservices (Townsend, Brintnell, & Staisey, 1990).The following description of the evolution ofoccupational performance is based on thesequence and the way that discussions onoccupational performance appeared in theliterature from 1970 to 1991.

In 1973, the AOTA, Inc. presented the professionwith a unifying concept of occupational therapy.This publication described occupational

performance as a unifying, generic frame ofreference and defined it as the individual's abilityto accomplish the tasks required by his or her roleand related to his or her developmental stage.Occupational performance included self care,work and play/leisure time performance (AOTA,Inc., 1973). Subsequent AOTA, Inc. publicationshave reaffirmed that, "the generic foundation orframe of reference (of occupational therapy) is to be found in the concept of occupationalperformance" (AOTA, Inc., 1974, p.8).

Performance areas consisted of self-care, work

and play/leisure activities and reflected the coreconcept of occupational therapy: purposefulactivity. Skills carried out in these performanceareas were purported to be influenced by whatwas the called the life space of a person. Thisreferred to a cultural, social and physicalenvironment. Performance components weredescribed as behavioural patterns based onlearning, and developmental stages and were seento be the foundation attributes for occupationalperformance. These included sensory integrative


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functioning, motor functioning, socialfunctioning, psychological functioning andcognitive functioning.

In 1979 and 1989, the AOTA, Inc. publisheddocuments which sought to create a consistent

occupational therapy terminology based on thisoccupational performance framework.Terminology created by the occupationalperformance frame of reference has been adoptedby AOTA, Inc. for use in the United States for purposes of documentation, charge systems,education, program development, marketing andresearch (AOTA, Inc. 1989, p.808). Thus theconcept of occupational performance in theUnited States was developed from a series ofcommittees from the AOTA, Inc. who used professional conceptualisations of practice tocreate a generic frame of reference for practice

(Pedretti, & Pasquinelli, 1990, p.3).

Beginning in 1979, a task force of the CanadianAssociation of Occupational Therapy (CAOT)outlined a generic conceptual framework offunction as an overriding guideline within whichtherapists could use specific frames of referenceappropriate to their clients, work settings andmodes of practice. The resulting generic model ofoccupational performance, "depicts a performance view of health" (Townsend, et al.,1990, p.70). It is an adaptation from the work of

Reed and Sanderson (1980) and similar to the1986 curriculum model described earlier (SeeFig. 2).

Central to the Canadian notion of occupationalperformance was affirmation about the worth of a person as an active participant in his/her owntherapeutic relationship. Using occupational performance, the traditional holistic view of people conceptualised by Meyer in 1922/1977was reinforced. There was acknowledgment thatoccupation takes place within a developmentalperspective and emphasis on the central belief in

the therapeutic use of purposeful activity(Townsend, et al., 1990, p.70).

Similar to the American model, three areas ofoccupational performance were described: selfcare, productivity and leisure. However in theCanadian model, play was grouped with productivity rather than leisure. This modelrecognised only four performance components:mental, physical, sociocultural and spiritual.Townsend, et al. (1990, p.71) highlighted the

recognition that integration and execution of alloccupational performance components and areasis defined and shaped by a person's social, physical and cultural environment. As theystated, "in achieving occupational performance,each individual both influences and is influenced

by his or her environment" (Townsend, etal.,1990, p.71).

Using this model, the CAOT developed a newoutcome measure for occupational therapy, TheCanadian Occupational Performance OutcomeMeasure (Law, Baptiste, McColl, Opzoomer,Polatajko, & Pollock, 1990). This is described asan individualised measure designed for use inevaluating occupational performance in clientsreceiving occupational therapy intervention. Thedevelopment, validation and use of this measureis purported to contribute to providing a standard

comprehensive method of individualisedassessment for occupational therapy acrossCanada (Law, et al., 1990).

2. Use of occupational performance as a

generic frame of reference for

undergraduate occupational therapy

education.

In 1974, the AOTA, Inc. suggested that theirnotions of occupational performance be used byoccupational therapy educators as a curriculum

guide. The frame of reference was describedschematically in terms of a two level modelcomprised of performance areas and performancecomponents (AOTA, Inc., 1974, p.12) Howeverno subsequent reference to its use as a curriculummodel was found in the literature.

3. Use of occupational performance

terminology by individual

occupational therapy theorists to

explain occupational therapy practice.

During the 1980's, individual theorists employed

the occupational performance frame of referenceto describe the content and process ofoccupational therapy in different areas of practice. Each of these individuals have furtherrefined and explained different aspects ofoccupational performance, or alternatively, haveused occupational performance nomenclature todescribe related models. Reed and Sanderson(1983, p.17), for example, used an interactivemodel similar to the one proposed by AOTA, Inc.to describe the relationships between a person's


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occupations. Although they do not identify thisinteractive model as occupational performance, itis composed of the same configuration ofconstructs. Reed's (1984, p.496) subsequent workin developing a model of Adaptation ThroughOccupation uses the same categorisations but

different terminology.Mosey (1981) referred to occupational performance as the domain of concern foroccupational therapy. She described areas ofhuman existence which were of most concern tooccupational therapy as consisting of,"performance components within the context ofage, occupational performance and theindividual's environment". In applying the frameof reference to practice in mental health, Mosey(1980) suggested that a person's overall quality ofoccupational performance depends in part on the

balance established among the component performance, the environment and occupationalperformance.

Mosey's view is echoed in the work of Nelson(1984, p.130) who developed a circularinteractive model of occupational performance inwhich the three performance areas are connected,reflecting their interdependence. Housed withinconceptual boundaries made by self care activity,work activity and play, he placed six componentabilities in a complex interconnected

configuration. This was adapted and used as aworking model to demonstrate interactionbetween constructs within the model (Fig. 3).

He further described some of the mutual causeand effect relationships between the sixcomponent abilities as follows:

"motor output generates sensoryfeedback and sensation is a guide tomotor response. Perception builds onsensation and cognition builds onperception. Interpersonal abilities depend

on one's thought processes. Emotioncolours and motivates one's sensations, perceptions, thoughts and interpersonalrelations" (Nelson, 1984, pp.45-46).

Figure 4: Occupational Performanc Framework, 1988(Adapted from Nelson, 1984, p.130).

The outer boundaries of the model are purported by Nelson to form the outer boundaries of the

whole person since participation in occupational performance areas, "serves as a bridge betweenthe inner reality of the individual and the externalenvironment" (Nelson, 1984, p.38). Thisassertion reflects earlier work by Fidler, andFidler (1978, p.305).

In more recent work, Nelson (1988, p.633) hasconstructed a schema wherein occupation isdefined as the relationship between anoccupational form and occupational performance.Contextual elements of occupation are termed,

"the form" ofoccupation, whereas occupational performanceconsists of, "the doing" of occupation. Inapplying this schema, Nelson suggested thatoccupations have meaning only to the extent thattheir forms are interpreted by people who areperforming them. Therefore an occupational formcan have a social or cultural meaning, anidiosyncratic meaning or little meaning at all.Putting this into a temporal context, Nelson(1988, p.637) suggested that, "the meaning" ofoccupation is largely retrospective while, "the

purpose" of occupation is largely prospective.

Pedretti, and Pasquinelli (1990) interpreted thepractice context of physical disabilities within theoccupational performance frame of reference.They demonstrated how occupational therapistscan employ an occupation focused model as analternative to a medical model within the contextof rehabilitation and acute care service deliverymodels. They described the occupationaltherapist's domain of concern as focussing on the


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client becoming as independent as possible in performance skills, and to resuming previouslyheld occupational roles or to assuming new andsatisfying occupational roles. Their interpretationof occupational performance extended beyondthis structural model to include a

conceptualisation of occupational therapyintervention as a loose step-by-step progressionwhich takes the client through a logical progression from dependence in performanceskills to resumption of life roles (Pedretti &Pasquinelli, 1990).

Llorens (1982) identified the need for a clientcare record that had a strong scientific base andcould be used to monitor quality care andaccountability of occupational therapy services.Through research, she produced The SequentialClient Care Record (SCCR) which documents

the occupational therapy process using theoccupational performance constructs 'areas ofoccupational performance' and 'occupational performance components'. Based on structuresdeveloped by AOTA, Inc. (1974), Dunn (1988)and others (Dunn & McGourty, 1989) employeda matrix which allowed therapists tosystematically identify deficit and strength areasof performance, and to select appropriateactivities to address these areas in occupationaltherapy intervention. By employing this grid,occupational therapists are able to determine how

abilities and limitations in performancecomponents can affect functional outcomes in theperformance areas.

4. Using occupational performance to

develop assessment tools.

Using occupational performance as a guidingframe of reference, Arnadottir (1990) developedan assessment tool, The Arnadottir OT-ADLNeurobehavioral Evaluation, which was designedto detect dysfunction in self care performanceareas (The Functional Independence Scale) and

in specifically defined performance components(Neurobehavioral Scale). The assessment revealsinformation about self care performance skillsand neurobehavioural component dysfunctionthereby proposing possible links betweenneurobehavioural function and occupationalperformance.

Although many other occupational therapyassessments examined performance, this was theonly one that specifically identified the use of an

occupational performance theoretical structure toguide the development of constructs. Subsequentto 1990, other assessment formats have beendeveloped using occupational performanceconstructs, for example, the Assessment of Motorand Process Skills (AMPS) (Fisher, 1990) and

The Perceive, Recall, Plan and Perform Systems(The PRPP System) (Chapparo & Ranka, 1991a).

In summary, the major constructs associated withoccupational performance that were derived fromthe literature during this stage of model buildingincluded occupational performance, occupational performance areas, components of occupational performance and an emerging notion ofoccupational and life roles.

Outcome:

Using information derived from the literaturereview, the circular occupational performancemodel described earlier (Fig. 2) was revised andresulted in a two-level model that was similar tothe AOTA, Inc. curriculum guide. This structurewas based on three primary constructs:occupational performance, occupational performance areas (self-maintenance, leisure, productivity) and components of occupational performance (biomechanical, sensory motor,cognitive, psychosocial and creative).

STAGE TWO (1990-1991):

Purpose:

The purpose of Stage Two was 1) to determinewhether the constructs as outlined in the twolevel model were relevant to occupationaltherapy practice in Australia, and 2) to discoverwhether there were other dimensions tooccupational therapy practice that were notexplained by the model.

Methods:

A major area of practice, occupational therapyintervention for adults and children withneurological impairment, was chosen forexamination of the existing constructs because 1)it is a practice area involving the use of manymodels of intervention thereby presenting anopportunity to test for the inclusiveness ofoccupational performance, and, 2) it is an area of practice that encompasses acute and chronic,


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hospital and community aspects of occupationaltherapy intervention.

Five two-day continuing professional educationcourses were conducted over a twelve month period during 1990-1991 in the Sydney area,

titled, "Occupational performance: Acquisition ofadaptive skills in adults and children with braindamage" (Chapparo & Ranka, 1990,1991b,c,d,e). Each of the six workshopsexamined a specific aspect of occupationaltherapy intervention for adults and children withneurological impairment; such as, the use of taskanalysis to identify problems,neurodevelopmental therapy in occupationaltherapy, proprioceptive neuromuscularfacilitation in occupational therapy, upper limborthotics, and cognitive disorders andoccupational therapy intervention.

In each of the courses the three major constructsin the model (occupational performance, areas ofoccupational performance, components ofoccupational performance) were outlined anddefined. Intervention as determined by theparticular workshop topic was taught and finally, by means of case-based problem solving,therapists were asked to integrate concepts ofoccupational performance with the course topics.Detailed notation was made of therapists'descriptions of the observed and perceived

problems of client performance of functionaltasks from videotaped examples; therapists'descriptions of their own hospital andcommunity-based intervention scenarios; goals;therapists' rationales for intervention and program evaluation. Finally, therapists wereencouraged to talk about the applicability ofoccupational performance constructs relative totheir own work settings.

Findings

1. Therapists readily identified with the

existing constructs and terminology ofthe model: occupational performance,occupational performance areas andcomponents of occupationalperformance.

2. Three major occupational performanceareas addressed were self-maintenanceoccupations, work/school occupationsand leisure/play occupations. Therapistswho treated children linked play with

leisure and school with work. Therapiststalked about the nature of occupations interms of activities (constellations oftasks) or tasks (specific).

3. The components of occupational

performance that therapists routinelyconsidered important in practice werebiomechanical, sensory-motor, cognitiveand psychosocial. There was strongrejection of the notion of 'creativity' as aseparate component. Creativity wasperceived as a multifaceted phenomenoninvolving all component functions.

4. Most therapists employed many differenttheoretical and practical approaches toguide intervention that had beendeveloped for use outside the profession

(for example, Motor RelearningProgramme, Neuro-developmentalTherapy, Biomechanical Approach).Descriptions of their interventions werecharacterised by switching from oneapproach to another depending on the perceived client problem and their own personal comfort with the intervention.In these instances they used occupationalperformance constructs to focus multipleinterventions within the domain ofoccupational therapy and to achieve a

cohesive approach to complex problemsusually seen in one client.

5. Over the course of 12 months therapistsconsistently used theoretical links between the occupational performanceconstructs within their work contexts toset occupation-centred treatment goals(for example, they related sensory-motorgoals or cognitive goals to functionaloutcomes).

6. Others reported instances where use of

the model brought cohesion within largedepartments where occupational therapyservices were provided in a variety ofareas of practice.

7. Using case scenarios, it became apparentthrough therapists' story telling of their practice that two additional factorsfeatured prominently in their reasoning.One was an environmental factor thathad physical, cultural and social


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dimensions. The second factor wasconcerned with the totality, satisfactionand value of the occupational existencefor their clients that went further thanoccupational areas or components, andseemed similar to theoretical notions of

occupational roles.Outcome:

The constructs, occupational performance areas(self-maintenance, work/school and leisure/play),and components of occupational performance(biomechanical, sensory motor, cognitive, psychosocial) were confirmed to be majorconstructs used in occupational therapy practicein both hospital and community settings. Twoadditional constructs, environment andoccupational performance roles, were identified

to be important to dimensions of practice whichfocus on human occupations, and wereincorporated into a third revision of the model ofOccupational Performance.

Literature support for adding the environmentalconstruct to the revised model was found in thework of multiple authors (see for example,Barris, 1982; Clark, Parham, Carlson, Frank,Jackson, Pierce, Wolfe, & Zemke, 1991; Colvin& Korn, 1984; Howe & Briggs, 1982; Keilhofner& Burke, 1980; King, 1978; Law, 1991; Llorens,

1970, 1984; West, 1986). Support for theconstruct, occupational performance role, inactual practice was more tenuous. While therehas been increasing emphasis in the literature thatthe goals of the profession focus on valuedoccupational roles of clients, discussion of howthis construct is used in practice is almost whollytheoretical (Christiansen, 1991; Jackoway,Rogers & Snow, 1987; Keilhofner, Harlan,Bauer, Maurer, 1986; Matsutsuyu, 1971;Moorhead, 1969; Oakely, Keilhofner, Barris, &Reichler, 1986; Vause-Earland, 1991; Versluys,1980). Christiansen (1991, p.28), for example,

conceptualises a widely accepted theoreticalconcept of an occupational performancehierarchy which ranges from activities to roles.Roles, he specifically defines as sets of activitieswhich have some recognisable purpose and,which are distinctive positions in society thatcarry specific expectations for behaviour.

STAGE THREE (1991-1992):

Purpose:

The purpose of the third stage of modeldevelopment was 1) to further explore use ofoccupational performance terms in acute careenvironments where short-term stay made

traditional forms of occupational therapyintervention impossible, 2) to determine whetheroccupational performance could be used in anarea of practice that was characterised by strongadherence to a particular theoretical and practicemodel (e.g. sensory integration) and, 3) todetermine what philosophical base therapistsusing occupational performance held in theireveryday practice.

Methods:

Information collected during Stage Three of the

model building process came from three sources.First, further continuing professional educationcourses were held during 1992 in the practicearea of neurology in Victoria (Chapparo &Ranka, 1992a) and Tasmania (Chapparo &Ranka, 1992b). These courses mirrored thecontent of the courses conducted in Stage Two.The constructs occupational performance,occupational performance roles, occupational performance areas, components of occupational performance and environment were described.Intervention scenarios using videotapes of clients

acted as the stimuli to facilitate therapists to usethe constructs for treatment planning, and indescribing their own intervention styles and worksettings. Responses of therapists working in acutecare environments were particularly noted.

Second, two continuing professional educationcourses in the practice area of sensory integrationwere held in NSW (Chapparo & Hummell,1992a) and South Australia (Chapparo &Hummell, 1992b) where the occupational performance constructs were incorporated intothe constructs inherent in sensory integration

theory and practice. Case studies were used asthe stimulus for getting therapists to describetheir treatment planning and the rationales fortheir actions during these courses. Descriptionsgenerated by therapists included what theyperceived as problems that required occupationaltherapy intervention in children with sensoryintegrative disorders, perceptions of the nature oforder and disorder in childhood occupations, and perceptions of what constituted occupationaltherapy for children.


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Third, through a continuing professionaleducation course that specifically sought toexplore the process of developing a personalframe of reference for practice (Chapparo &Ranka, 1991f), therapists were encouraged to

describe important elements of their ownpersonal beliefs, values and principles underlyingtheir practice relative to occupation andoccupational performance. Descriptionsgenerated by therapists incorporated what they believed about human potential, health,occupations, and occupational therapy.

Findings:

1. Therapists working in acute carefacilities were required to considerhuman occupations at a level that was

fundamental to the previously identifiedcomponent level. This was particularlyevident in intensive care units, acuteneurosurgical units and trauma unitswhere more fundamental aspects of physical, mental and spiritual elementswere perceived as core elements ofhuman function to be considered alongwith other occupational performanceconstructs (Nicholls, 1993, Ryan &Nicholls, 1993).

2. These findings were also reflected inoccupational therapy practice withclients who were terminally ill. Spiritualaspects of existence were emphasisedand occupational role behaviour wasfocused on affirmation of life roles andpreparation for death.

3. Therapists in acute care settingsdescribed intervention as primarilyassessment, placement and dischargeplanning. Social and physical aspects ofthe environment construct featured

heavily in consideration of clientoccupational performance.

4. Direct intervention at the level ofoccupational performance areas andoccupational performance roles did notfeature prominently in descriptions ofacute care practice. However, alltherapists described a process ofreasoning in acute care that requiredthem to develop predictive visions about

client performance at these levels. These predictive visions of client role performance were used to determinedischarge plans and actions relative tospecific discharge environments.

5. Therapists working with children andusing a sensory integrative approach totreatment placed sensory integrationwithin the broader constructs ofoccupational performance.

6. Therapists reported that placing sensoryintegrative constructs within the broaderframework of occupational performancealtered intervention in two ways. First,consideration of occupational performance constructs broadened thescope of their intervention from the

child's performance at school to otherdimensions of daily living such as play,and to other component areas such asinterpersonal and intrapersonaldimensions of the child's occupational being. Second, therapists employed theoccupational performance structure as avehicle for linking sensory integrativemodes of intervention with others thatwere applicable to the same groups ofchildren, such as skills training and morepsychodynamic forms of intervention.

7. Beliefs and assumptions that therapistsviewed as influencing the way they usedoccupational performance constructs fellinto four dimensions. First, theyarticulated a series of beliefs that relatedto human potential for occupationalperformance. Included in this dimensionwas the prevalent belief that people havean occupational being that is individuallyand actively created, and is influenced by both internal and external factors. Thisoccupational being is expressed through

occupational performance and ultimatelydefined in one's occupational roles.Fundamental to this was the belief thatpeople have the right to determine theirown occupational being.

The second dimension concerned beliefsabout the nature of occupations. Humanoccupations were viewed by therapists inthese workshops as highly idiosyncratic behaviours that fell into three patterns.


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First, patterns of doing that weredescribed as tasks, sub-tasks, activity patterns or roles. Second, patterns ofthinking that involved planning,reminiscing and imagining and couldeither be incorporated into patterns of

doing or exist by themselves. Third,patterns ofbeingthat were characterisedby notions of self-actualisation and innervisions of becoming.

Occupations were categorised by peoplerelative to the meaning they ascribe tothem. The configuration of occupationschanges withchronological/developmental age, lifestage and life circumstances.Development, performance andmaintenance of occupations is influenced

by internal and external factors. There isa balance of occupations that is highlyindividual and is related to well-being inbody, mind and spirit.

The third area related to what therapistsviewed as health. Relative tooccupational performance, health wasviewed as satisfaction with the ability todevelop and perform occupations andmaintain occupational roles. Engagementin occupations was believed to support

health and well-being. Non-health wasviewed as dissatisfaction with performance of occupations and couldresult from internal or external factors.

The fourth dimension related totherapists beliefs and assumptions aboutoccupational therapy. Performance ofoccupations was viewed as involving anadaptation process. Adaptation wasbelieved to be an active process of doingand/or thinking and/or being thatdepended on goal-direction. The role of

the occupational therapist was tofacilitate the adaptation process byengaging the person in the development,performance and maintenance of chosenoccupations. Occupational therapy wasviewed as a collaborative process between the therapist, client andsignificant others. The primary tools ofthe occupational therapist wereengagement in purposeful occupations.Use of intervention methods out of the

context of the individual's occupational performance were not considered to beoccupational therapy.

Outcome:

The existing occupational performance modelwas further revised to include a construct named'core elements'. This included notions of anintegrated body/mind/spirit element of humanexistence that is expressed in all other constructsas the `doing-knowing-being' dimensions ofoccupational performance. The environmentalconstruct was further refined to specificallyinclude physical/social/cultural dimensions.

STAGE FOUR (1992-1994):

Purpose:

The purpose of Stage Four was 1) to continuefield testing the established constructs in practicespecific settings, such as paediatrics, psychiatry,spinal cord injury, community services andcommunity-based practice, and 2) to explore theapplication of the model to the administration ofvarious occupational therapy practiceenvironments,

Methods:

To fulfil the first purpose of Stage Four a seriesof seminars, group discussions and workshopswere conducted at four major multi-servicemedical facilities in Sydney. Each of thesefacilities provided a variety of services rangingfrom acute care to community outreach andplacement. The scope of specialty practice areasincluded school-based therapy, acute medicine,trauma, orthopaedics, psychiatry, transitionalliving units, nursing home and domiciliary carefacilities and community-based therapy. Eachseries began with an initial presentation of the

Stage Three model and definitions of theconstructs. Participants were asked to discuss therelevance of the model to intervention in theirspecific area. Subsequent sessions explored thisfurther through case-based scenarios which weregenerated by the participants. Through thediscussions about these scenarios, participantsdescribed how the constructs applied to theprocess of occupational therapy. Field notes fromthese discussions were generated by both participants, observers and facilitators and


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subsequently examined to determine whetherthere were aspects of occupational therapypractice which the model failed to address.

Methods used to achieve the second purpose ofStage Four involved individual and group

sessions with occupational therapists inmanagement positions in these multipurposefacilities. Sessions were initiated by managersthemselves who sought to determine howoccupational performance related to theadministration of occupational therapy services.The focus of discussions that occurred withinthese sessions was determined by the managersand varied between facilities.

Findings:

1. There was confirmation from all areas of

practice of the centrality and relevance ofthe previously established constructs ofoccupational performance, includingoccupational roles, occupational areas,occupational performance components,core elements and environment.

2. There was confirmation about the presence of some hierarchy of theseconstructs.

3. There was strong support for the addition

of two new constructs, Space and Time, particularly from community andinstitutional based practice. Notions ofspace and time were highly idiosyncraticand appeared to be linked to otherconstructs within the Model. Forexample, when talking about casescenarios many therapists talked about performance relative to the time it tookpeople to carry our their roles, activitiesand tasks. At the component level, manytherapists were concerned not only aboutthe form of the response that was

observed but also the timing of physical,cognitive and psychosocial responses.Therapists who worked with the elderlyremarked on the importance of timewhen describing the place ofreminiscence and life storytelling andintervention. Time, as interpreted inclient histories, was a major feature ofintervention described by all therapists.Time, as described by notions ofdevelopment, was emphasised by

therapists working with children.

4. There was support for modifying thestructure of 'occupational performanceareas' by the addition of another area,Rest. Therapists working in both mental

health and long term facilities identifiedaspects of their intervention thatfocussed on the purposeful pursuit of restand sleep that did not 'fit' with their perceptions of self-maintenance orleisure.

5. Descriptions of client problems andinterventions from therapists in thepractice area of psychiatry supported thenotion of separating the single psychosocial component area into twodistinct components, Interpersonal

component and Intrapersonalcomponent.

6. Therapists managing a number of diverse practice areas were able to successfullyconstruct an overall description ofoccupational therapy services in theirfacility using occupational performance(Colyer, 1994). In some cases this wasused to develop mission statements,delineate occupational therapy fromother services and to structure the

content of material used to promoteoccupational therapy both in the facilityand in the wider community.

7. Therapists used occupational performance constructs to establishhierarchies of performance indicatorswhich were expressed as predictableoutcomes of therapy (Barnett, &Hummell, 1993).

8. Therapists constructed formats fordocumentation and billing of

occupational therapy services based onconstructs of the model (Adams, &Shepherd, 1994, Hanrahan, Jackson,Neuss & Walking, 1993).

Outcome:

As a result of this Stage, the model ofOccupational Performance was revised toincorporate the constructs of Space and Time.The three occupational performance areas were


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expanded to include Rest. The psychosocialcomponent was separated into two components:Intrapersonal and Interpersonal componentfunction.

This Model at this Stage of model development

incorporates eight constructs: occupational performance; occupational roles; occupational performance areas (self-maintenance, productivity/school, leisure/play, rest);components of occupational performance; coreelements of occupational performance;environment; space, and time, and represents thecurrent structure of the Model (Figure 4). Thefinal structure has undergone several revisionsfrom 1992-1994. Selected examples of theseversions are in Appendix 1.

At this point in its development, this model is

viewed as an explanatory model. It explainsdimensions of human occupations that areinherent in occupational therapy practice. As yet,the conceptual links between the constructs areonly hypotheses. However, academics,researchers and clinicians are currently workingto validate these hypotheses and to further extendnotions of how this model can be used inoccupational therapy in Australia.

STAGE FIVE (1994-1996):

Purpose:

The purpose of Stage Five 1) to continue fieldtesting the established constructs in practicespecific settings, 2) to consolidate theoreticalsupport for the constructs, and 3) to encourageothers to write about the application of the modelto various aspects of practice.

Methods:

To fulfil the purpose of Stage 5, ongoing

informal dissemination of the model occurredthrough presentations to staff of occupationaltherapy departments (Ranka, 1995), and specialinterest groups (Chapparo, & Ranka, 1995;Ranka, & Chapparo, 1995), and presentations atinternational conferences (Chapparo, 1996;Ranka, 1995). Feedback obtained from theseactivites were considered relative to variousaspects of the model. Occupational therapistswere invited to submit manuscripts whichexplained how they were applying the model in

various practice domains.

Outcome:

1. There was confirmation that the existingstructure could explain occupational

therapy practice in diverse cultures andpractice domains.

2. A monograph was prepared for formaldissemination and scrutiny by membersof the profession.

NOTE: FIGURE 4 - NEXT PAGE


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Figure 5: Current model of Occupational Performance


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SUMMARY:

This article has outlined the process of model building that has resulted in a model ofOccupational Performance. The stimulus formodel development came from the perceived

need for a conceptual model of occupationaltherapy practice and human occupations that wasable to organise occupational therapy contentwithin the undergraduate curriculum at TheUniversity of Sydney. The current modelincorporates eight major constructs that include:occupational performance, occupational role,occupational areas, occupational performancecomponents, core elements of occupationalperformance, environment, space and time. Theseconstructs emerged through a circular process oftheorising that included literature review, fieldtesting, reflection and model construction. This

circular process is ongoing and the current formof the model is viewed as one stage in theevolution of future conceptual notions ofoccupational performance.

REFERENCES

Adams, M., & Shepherd, B. (1994). Use of theoretical models in atransitional living unit. Paper presented at The NewSouth Wales Association of Occupational Therapists 7thState Conference, Newcastle, NSW, Australia.

Alexander, P., Keogh, M. & Cheesman, G. (1980). Occupationaltherapy workforce study. (Available from The NewSouth Wales Association of Occupational Therapists, POBox 142, Ryde, NSW, Australia, 2112.

American Occupational Therapy Association, Inc. (1973). Theroles and functions of occupational therapy personnel.Rockville, MD: Author.

American Occupational Therapy Association, Inc. (1974). ACurriculum guide for occupational therapy educators.Rockville, MD: Author

American Occupational Therapy Association, Inc. (1979). Uniformterminology system for reporting occupational therapy

services. Rockville, MD: Author.American Occupational Therapy Association, Inc. (1989). Uniform

terminology for occupational therapy: Second edition. American Journal of Occupational Therapy, 43, (12)808-815.

rnadttir, G. (1990). The brain and behaviour: Assessing corticaldysfunction through activities of daily living. St. Louis:C.V.Mosby.

Barnett, D., & Hummell, J. (1993, October). Performanceindicators for occupational therapists: Working with

children and their families. Paper presented at The NewSouth Wales Association of Occupational Therapists 6thState Conference, Mudgee, NSW, Australia.

Barris, R. (1982). Environmental interactions: an extension of themodel of occupation. American Journal ofOccupational Therapy, 36, 637-644.

Chapparo, C.J. (1996, September). A model of occupational performance: expanding the concept of performance.Invited key note paper presented at the sterreichischerErgotherapiekongress, Vienna, Austria

Chapparo, C.J., & Hummell, J. (1992a). Sensory integrationtherapy: Application of theory to treatment of children

with learning and developmental disorders. Course presented for New South Wales Association ofOccupational Therapists.

Chapparo, C.J., & Hummell, J. (1992b). Sensory integrationtherapy: Application of theory to treatment of children

with learning and developmental disorders. Course presented for The Paediatric and Adolescent ActionGroup of the South Australia Association ofOccupational Therapists, Adelaide.

Chapparo, C.J. & Ranka, J.L. (1990, November). Occupational performance and the acquisition of adaptive skills in

brain damaged adults: 1 - Using task analysis to

identify problems and structure treatment for adults

with brain impairment. Course presented for The NewSouth Wales Association of Occupational Therapists,Sydney.

Chapparo, C.J., & Ranka, J.L. (1991a). Identification ofinformation processing deficits in adults with brain

injury. Unpublished research report. (Available fromFaculty of Health Science, The University of Sydney,P.O.Box 170, Lidcombe, NSW, Australia 2141).

Chapparo, C.J. & Ranka, J.L. (1991b, February). Occupational performance and the acquisition of adaptive skills in

brain damaged adults: 2 - Neurodevelopmental

Therapy. Course presented for The New South Wales

Association of Occupational Therapists, Sydney.Chapparo, C.J. & Ranka, J.L. (1991c, April). Occupational

performance and the acquisition of adaptive skills in

brain damaged adults: 3 - Proprioceptive

Neuromuscular Facilitation. Course presented for The New South Wales Association of OccupationalTherapists, Sydney.

Chapparo, C.J. & Ranka, J.L. (1991d, May). Occupational performance and the acquisition of adaptive skills in

brain damaged adults: 4 - Upper limb orthotic systems.Course presented for The New South Wales Associationof Occupational Therapists, Sydney.

Chapparo, C.J. & Ranka, J.L. (1991e, June). Occupational performance and the acquisition of adaptive skills in

brain damaged adults: 5 - Motor planning, motor

learning and occupational performance. Course

presented for The New South Wales Association ofOccupational Therapists, Sydney.

Chapparo, C.J. & Ranka, J.L. (1991f, August). Occupational performance: A model for practice. Course presentedfor The New South Wales Association of OccupationalTherapists, Sydney.

Chapparo, C.J. & Ranka, J.L. (1992a, September). Motor planning,motor learning and occupational performance. Course

presented for The Victorian Association of OccupationalTherapists, Melbourne.

Chapparo, C.J. & Ranka, J.L. (1992b, September). Motor planning,motor learning and occupational performance. Course

presented for The Tasmanian Association ofOccupational Therapists, Launceston.

Chapparo, C. J., & Ranka, J.L. (1995, September). Occupationalperformance. Invited presentation to the Neuro Special

Interest Group of OT Australia AAOT-NSW, Sydney.Christiansen, C. (1991). Occupational therapy: intervention for life performance. In C. Christiansen, & C. Baum (Eds),Occupational therapy: overcoming human performance

deficits (pp 3-44). Thorofare, NJ: Slack, Inc.Clark, F.A., Parham, D., Carlson, M.E., Frank, G., Jackson, J.,

Pierce, D., Wolfe, R.J. & Zemke, R. (1991).Occupational science: Academic innovation in theservice of occupational therapy's future. American

Journal of Occupational Therapy, 45(4), 577-585.Colvin, M.E., & Korn, t.L. (1984). Eliminating barriers to the

disabled. American Journal of Occupational Therapy,38, 159-173.

Colyer, S. (1994, September). The use of a model of O.T. practicein a rehabilitation setting. Paper presented at The New


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25

South Wales Association of Occupational Therapists 7thState Conference, Newcastle, NSW Australia.

Dunn, W.W. (1988). Uniform terminology grid: A framework forapplying uniform terminology to occupational therapy

practice. Unpublished grid. (Available from authorDunn, W.W., & McGourty, (1989). Application of Uniform

Terminology to practice. American Journal ofOccupational Therapy, 42(12), 817-831.

Fidler, G.S., & Fidler, J.W. (1978) Doing and becoming: Purposefulaction and self-actualization. American Journal ofOccupational Therapy, 32, 305-310.

Fisher, A. G. (1990). Assessment of motor and process skills(research ed. 5R). Unpublished test manual, (Availablefrom Department of Occupational Therapy, TheUniversity of Illinois at Chicago, Chicago, Illinois).

Fisher, A. Murray, E., & Bundy, A. (1991) Sensory integrationtheory and practice. Philadelphia: F.A. Davis Co.

Hanrahan, M., Jackson, J., Neuss, M., & Walkling, K. (1993,October). Development of a new quantitative andqualitative information system ("Stats System"): An

action research approach at The Prince of Wales

Hospital. Paper presented at The New South WalesAssociation of Occupational Therapists 6th StateConference, Mudgee, NSW, Australia.

Heard, C. (1977) Occupational role acquisition: A perspective on

the chronically disabled. American Journal ofOccupational Therapy, 31, 243-247

Howe, M.C., & Briggs, A.K. (1982). Ecological systems model foroccupational therapy. American Journal ofOccupational Therapy, 36, 322-327.

Jackoway, I. S., Rogers, J. C., & Snow, T. (1987) The Role ChangeAssessment: An interview tool for evaluating olderadults. Occupational Therapy in Mental Health, 1, 17-37

Keilhofner, G. (1985). A model of human occupation: Theory andapplication. Baltimore, MD: Williams & Wilkins.

Keilhofner, G., & Burke, J. P. (1985). Components anddeterminants of human occupation. In G. Keilhofner(Ed.), A model of human occupation: Theory andapplication (pp.17-20). Baltimore: Williams & Wilkins.

Keilhofner, G. Harlan, B., Bauer, D., & Maurer, P. (1986). The

reliability of a historical interview with physicallydisabled respondents. American Journal ofOccupational Therapy, 40(8), 551-556.

King, L. J. (1978) Toward a science of adaptive responses, 1978Eleanor Clarke Slagle Lecture. American Journal ofOccupational Therapy, 32(7), 429-437.

Law, M. (1991). The Muriel Driver Lecture: The environment: afocus for occupational therapy. Canadian Journal ofOccupational Therapy, 58, 171-179.

Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., &Pollock, A. (1990) The Canadian OccupationalPerformance Measure: An outcome measure foroccupational therapy. Canadian Journal ofOccupational Therapy, 57(2), 82-87.

Llorens, L. (1970). Facilitating growth and development: The promise of occupational therapy, 1969 Eleanor Clarke

Slagle lecture. American Journal of OccupationalTherapy, 24, 93-101.Llorens, L. A. (1982). Occupational therapy client sequential care

record. Laurel, MD: Ramsco Pub.Co.Llorens, L.A. (1984). Changing balance: Environment and

individual. American Journal of Occupational Therapy,38(1), 28-34.

Matsutsuyu, J. (1971). Occupational behaviour - a perspective onwork and play. American Journal of OccupationalTherapy, 25, 291-294.

Meyer, A. (1922/1977) The philosophy of occupational therapy. American Journal of Occupational Therapy, 31 (11),639-642 (Reprinted from original)

Moorhead, L. (1969) The occupational history. American Journalof Occupational Therapy, 23, 329-334.

Mosey, A. (1980) A model for occupational therapy. OccupationalTherapy in Mental Health, 1, 11-32Mosey, A.C. (1981). Occupational therapy:Configuration of a profession. New York: Raven Press

Nelson, D. L. (1984). Children with autism and other pervasivedisorders of development and behaviour: Therapy

through activities. Thorofare, NJ: Slack Inc. Nelson, D. L. (1988). Occupation: Form and performance.

American Journal of Occupational Therapy, 42(10),633-641

Nicholls, J. (1993, October). Management of agitated behaviour inadults with traumatic brain injury: A case study. Paper

presented at The New South Wales Association ofOccupational Therapists 6th State Conference, Mudgee,

NSW, Australia.Oakley, F., Keilhofner, G., Barris, R., & Reichler, R. K. (1986). The

Role Checklist: Developing empirical assessment ofreliability. Occupational Therapy Journal of Research,6, 157-170

Pedretti, L.W., & Pasquinelli, S. (1990). A frame of reference foroccupational therapy in physical dysfunction. In L.W.Pedretti and B. Zoltan, (Eds.), Occupational therapy :

Practice skills for physical dysfunction (3rd ed.) (pp. 1-17). St. Louis: C.V. Mosby.

Ranka, J. (1995, September). Occupational performance: A modelfor practice in occupational therapy. Paper presented atThe 1st Asia-Pacific Occupational Therapy Congress.Kuala Lumpur

Ranka, J. (1995, June). Occupational performance: Application topractice. Invited presentation to occupational therapistsat St. George Hospital. Kogarah, NSW

Ranka, J., & Chapparo, C.. (1996, September). Occupationalperforamnce: Implications for occupational therapy in

psychiatric settings. Invited presentation to the MentalHealth Interest Group of OT Australia AAOT-NSW,

Reed, K.L. (1984). Models of practice in occupational therapy.Baltimore: Williams & Wilkins.

Reed, K. L., & Sanderson, S.R. (1980) Concepts of occupationaltherapy. Baltimore: Williams & Wilkins.

Reed, K.L., & Sanderson, S. R. (1983). Concepts of occupationaltherapy (2nd Ed.). Baltimore: Williams & Wilkins.

Ryan, L., & Nicholls, J. (1993, October). Dysautonomia: It's effectduring upper limb splinting of comatose patients with

traumatic brain injury. Paper presented at The NewSouth Wales Association of Occupational Therapists 6thState Conference, Mudgee, NSW, Australia.

School of Occupational Therapy (1975). Stage III submission: Proposal for a degree course in occupational therapy.(Available from Faculty of Health Sciences, TheUniversity of Sydney, PO Box 170, Lidcombe, NSW,Australia 2141)

School of Occupational Therapy (1986). Stage IV review: Bachelorof applied science (occupational therapy). (Availablefrom Faculty of Health Sciences, The University ofSydney, PO Box 170, Lidcombe, NSW, Australia 2141)

Townsend, E., Brintnell, S., & Staisey, N. (1990). Developingguidelines for client-centered occupational therapy

practice. Canadian Journal of Occupational Therapy,57, 69-76.Vause-Earland, T. (1990). Perceptions of role assessment tools in

the physical disability setting. American Journal ofOccupational Therapy, 45(1), 26-31

Versluys, H. P. (1980). The remediation of role disorders throughfocused group work. American Journal of OccupationalTherapy, 34(9), 609-614.

West, W.L. (1984). A reaffirmed philosophy and practice ofoccupational therapy for the 1980's. American Jouranlof Occupational Therapy, 38(1), 15-23.

Yerxa, E.J., & Sharrott, G. (1986). Liberal arts: The foundation foroccupational therapy education, American Journal ofOccupational Therapy, 40(3), 153-159.


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APPENDIX 1:

Figure 1: Schematic Diagram of Occupational Performance (1992a)


22/23Occupational Performance Model (Australia)

Figure 2: Schematic Diagram of Occupational Performance (1992b)


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Figure 3: Schematic Diagram of Occupational Performance (1992c)

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