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KASUS NEUROLOGI

Pendekatan apa yang anda


gunakan selama ini?

Holistic Approach?
OCCUPATIONAL FUNCTIONING MODEL
( OF M )
Konsep Dasar
1. PRIMARY BELIEF : ORANG YANG
KOMPETEN DI DALAM LIFE ROLES NYA
AKAN MERASAKAN:

A SENSE OF SELF-EFFICACY
SELF-ESTEEM
LIFE SATISFACTION
 Self-efficacy (besarnya keyakinan akan
kemampuannya menyelesaikan tugas dan
mencapai tujuan)
Bandura :

 Rasa keyakinan seseorang akan


kemampuannya untuk berhasil dalam
situasi tertentu
 high self-efficacy—yakin mampu
berhasil dengan baik
Pengaruh self-efficacy pada fungsional
 self-efficacy rendah  tidak mau melakukan
sesuatu

 Self-efficacy beyond actual ability  leads to


overestimation of the ability to complete
tasks.
 Self-esteem
Orang dengan self-esteem baik:
 Memiliki prinsip & values yang kuat
Mampu berfikir apa yang paling baik dilakukan,
yakin dengan keputusannya dan tidak menyesal
bila yang lain tidak suka dengan keputusannya
Tidak banyak waktu terbuang memikirkan masa
lalu dan apa yang akan terjadi nanti
Yakin akan kemampuannya untuk

memecahkan masalah, tidak mau bila


mengalami kesulitan atau gagal
 Dirinya equal in dignity dengan yang lain
 Mampu menikmati berbagai aktifitas
Life satisfaction
Kepuasan hidup. Bagaimana seseorang
merasakan hidupnya pada masa lalu,
sekarang dan bagaimana perasaannya akan
masa yang akan datang

Untuk mengukur well-being (mood,


satisfaction with relations with others and
with achieved goals, self-concepts, and self-
perceived ability to cope with daily life)
2. Kemampuan melakukan roles dan aktifitas
sehari-hari tergantung pada ‘basic abilities
& capabilities.
 Basic Abilities and Leisure Preferences
 Misal: bila memiliki fine-motor skill baik maka sangat
mungkin melakukan manipulasi benda yang kompleks

 Capabilities:
kemungkinan kemampuan
fungsionalnya untuk mencapai tujuan
3. Dikembangkan Occupational Functioning
Model (OFM).

OFM merupakan satisfactory occupational functioning


yang terjadi hanya dalam lingkungan dan konteks tertentu
pada seseorang
OFM
OCCUPATION:
OCCUPATION-AS-MEANS &
OCCUPATION-AS-END
Self-efficacy klien yakin akan kapasitas
performance-nya terhadap aktifitas tertentu
(spesific tasks) (Bandura, 1997; Resnik,
1999).
Tidak hanya skill saja tetapi juga judgments
tentang apa yang dapat dikerjakan dengan
skill tersebut
The most powerful source of efficacy
expectations is past events/actions in
similar situations.
Satisfaction with life
roles
2. Self-advancement Roles
keikutsertaan atau keterlibatan pasien pada
aktifitas produktif di masyarakat melalui
berbagai aktivitas.
Misal: latihan meningkatkan keterampilan,
kontrol, dan hal-hal yang membuat menjadi
lebih baik.

3. Self-enhancement Roles
Rasa yang berhubungan dengan perasaan
orang menikmati apa yang dilakukan.
Misal: roles yang ada hubungannya dengan
hobby, teman, club member, dll.
Korelasi OFM dengan
International Classification of
Functioning (ICF) WHO, 2001.
OFM ICF
Satisfaction with life roles Participation, societal
functioning with his/her
disability
Competence in tasks of life roles implementation of a task or
Mastery of activities and habits action by an individual at his/her
Having abilities and skills level

Developed capacities Bodily structure and


First level capacities psychological & physiological
Organic substrate function

Environment and context The complete background to the


person’s life and living, including
external environment factors
and internal personal factors
Competency in Tasks of Life Roles.

Dengan Roles yang dimiliki individu akan


memiliki banyak tasks.

Tiap individu harus menentukan roles nya


dengan mengidentifikasi tasks yang
dipercayai sangat penting agar bisa
merasa puas dengan roles tersebut

Misal: role sbg ayah. Bagaimanakah


puasnya ayah? (berhubungan dengan
mengasuh anak)?
ACTIVITIES AND HABITS

Some activities requires full


attention. Other activities does
not to have pay attention
because familiar (habits).
Physical dysfunction disrupts
habits, and OT seeks to help
the person sustain or relearn
adaptive habits.
ABILITIES AND SKILLS

A person with a great number of


highly developed abilities can
become proficient at a greater
variety of activities.

Categories: motor , sensory,


cognitive , perceptual,
sosioemotional, cardio-
respiratory
THE PROCESS OF OCCUPATIONAL
THERAPY FOR PERSONS WITH
PHYSICAL DYSFUNCTION
Process OFM
Goal of Satisfactory engage in self-
Therapy identified, important life roles
through which the person gain a
sense of self-efficacy and self-
esteem.
Evaluation Top down assessment.

to identify Identify roles, tasks, and activities the


person wants to do or needs to do.
the
Observe and analyze the person’s
problem (s)
performance within usual context;
identify inadequate performance,
identify impaired abilities or capabilities
that contribute to inadequate
performance and assess level of
impairment, identify environmental or
contextual enables or hindrances.
Plan Plan in collaboration with the person or family
Intervention to determine whether the person wants to
engage in either; Remediation of impaired
abilities or capacities to enhance overall
performance, or restoration of occupational
performance through relearning and/or
adaptation of method or environment.

Establish short term goals that directly relate to


the LTG of successful role functioning identified
by the patient.

Select intervention that have evidence for


effectiveness for the immediate goal
Implement the Utilize therapeutic mechanism Occupation:
intervention Occupation-as-end to restore
occupational functioning
Occupation-as-means to optimize
abilities or capacities.
Therapeutic rapport
Learning/relearning
Utilize adjunctive therapy to facilitate
performance.
Modify context and environment to
facilitate performance
Evaluate the Determine whether the
result targeted outcomes were
achieved.
Determine whether the person
has satisfied with his/her
achievement.
Plan for future therapy or
referral
ASSESSMENT
 OFM indicates that higher level of occupational
functioning is established on a foundation of
abilities and capabilities.
 Assessment always follows a top down approach,
that is, the therapist determines what roles and
tasks the person was responsible for in life before
the accident or disease and what the person is
expected to be and wants to be responsible for in
post-rehabilitation life, including the context in
which the person typically engaged in these valued
roles and tasks.
 When evaluating a patient’s competence to
accomplish the roles, the therapists observe the
patient;s attempting to do the tasks and
activities of those roles in the most familiar
context.
 Beconsidered is whether the environment
enables or hinders occupational functioning.
TREATMENT
Treatment may focus on changing the
environment, changing the impaired
skills and abilities of the person or
teaching compensatory ways to
accomplished activities.
Treatment may start toward the bottom of
OFM hierarchy, focusing on optimizing
abilities and capabilities,
or it may start higher, at the activity level of
the hierarchy, focusing or restoring
competence in doing the activities and tasks
of valued roles that the patient has identified
as concerns;
or it may start peripheral to the person,
focusing on modifying the context or
environment.
The starting point should acknowledge
the problem that the patient has
identified as an immediate concern,
although treatment may not actually
start here.
PROCESS OF OT: CASES
• Identitas klien/pasien
• Evaluasi untuk menentukan: sense of self-efficacy,
self-esteem dan life satisfaction
• Bagaimana occupation as mean dan occupation as
end diterapkan pada klien tsb
• Implementation Intervention
• Evaluate result

Why (Clinical Reasoning of therapist’s internal


dialogue)
TERIMA KASIH