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Variables include one's motivation, behaviors, and performance. All 3 inter-relate to form a person's identity. Kielhofner has specifically grouped these variables into 3 subsystems that he calls 1) volition, 2) habituation, and 3) performance capacity. Volition Subsystem Volition is the source of motivation for occupation. Habituation Subsystem Habituation refers to the process by which occupation is organized to patterns or routines. Performance Subsystem Performance capacity refers to the physical and mental abilities that underlie skilled occupational performance. This subsystem is also called the mind-brain-body performance. Assumptions Humans are biologically mandated to be active. Spontaneous action is the most fundamental characteristic of all living things (Boulder, 1968; von Bertalanffy, 1968). Practice Application: Persons have a fundamental and neurologically based need for action and doing. This innate need is the dominant source of motivation for participation in occupation. Thinking, feeling, and doing are influenced by a dynamic interaction between one's internal components and the environment. Situations and conditions within the environment will influence a person's motivation.
Participation in occupations help to create our occupational identity, which is formed by the person's internal structures defined by volition, habituation, and performance capacity. It is a subjective construct. Practice Application: Clients develop an identity over time. It is believed that this identity begins with self-appraisal and extends toward more challenging dynamics such as accepting responsibility for and knowing what one wants in life. Occupational competence is the degree to which one sustains a pattern of occupational participation that represents one's occupational identity. Competence is the ability to put into action what a person internally regards as meaningful. Practice Application: Clients demonstrate competency when they can organize their life to meet the basic responsibilities to themselves and the role obligation of society in satisfying and meaningful ways. Occupational Adaptation is the outcome of a positive occupational identity and achievement of occupational competence. It is dynamic and context dependent (refer to concept of heterarchy). Occupational therapy can promote change in clients. The parts within the person (throughput) that include motivation, life patterns, and performance leads to behaviors in work, play, and self care. Practice Application: The internal parts of the person are responsible for one's occupational performance and adaptation. Occupational therapy acts as a form of feedback within one's environment that can
3 Parts of a volitional subsystem Volitional Subsystem - source of motivation that guides individuals to anticipate, choose, experience and interpret what they do; thoughts and feelings about doing occupations that reflect a sense of mastery, enjoyment and value judgment. Composed of three smaller parts. - Personal Causation: refer to one's sense of competence and effectiveness; what a person feels capable of; a person's awareness of his abilities; includes feeling of self efficacy (perception of control over one's own behavior, thoughts, and emotion includes a sense of control in achieving desired outcomes). Example: "I am an intelligent person who can succeed in occupational therapy". - Values: beliefs about what is right, important, and good to do that influences one's goals; include personal convictions, principles, and a sense of obligation. Example: "I value helping others and therefore my goal is to become an occupational therapist". - Interests : what a person finds enjoyable, pleasing, an satisfying. Example: "I enjoy studying the arts and science that underlie occupational therapy as a profession." 2 Parts of the Habituation Subsystem Habituation Subsystem - made up of the behavior and roles that help person to organize their daily life. Composed of two smaller parts. Habits - automatic and repetitive behaviors that influence how person
Person + Occupational Performance Person constructs (volitional, habituation, and mind-brain-body subsystems) plus one's occupational performance contribute to the development of occupational identity, occupational competence and occupational adaption. Environment Physical and socials places in which a person performs occupation Shaped by culture Provides opportunities and resources (positive) as well as demands and constraints (negative) A significant source of feedback that can maintain or extinguish one's occupational performance. Change As a person experiments with novel behaviors and repeats them over time, these behaviors will become more automatic and habitual. Person create a sense of occupational competence when they are capable of engaging in productive and meaningful actions. Sufficient repetition and environmental feedback is required to assimilate new performance patterns.
Parts of the Performance Capacity Subsystem - Mind-Brain-Body Subsystem - composed of four constituents that represent one's capacity for occupational performance; one's underlying natural ability. Musculoskeletal - bone, muscles, joints comprising one's biomechanical structure Neurological - central and peripheral nervous systems Cardiopulmonary - cardiovascular an pulmonary systems Symbolic - abstract images that guide and give meaning
Occupational Performance or Skilled Actions (output) Goal directed action (output) that make up occupational performance. 3 categories. Motor Skills - used to move one's self or objects Process Skills - thinking and planning actions used to help one organize and adapt Communication and Interaction Skills observable operations used to verbalize
Interventions may be aimed at modifying or altering one's environment to promote opportunities for change. Interventions that are aimed at skilled performance are more efficient than those aimed at a client's underlying personal structure. Interventions that take place in one's natural environment are more likely to be assimilated by the client. Therapists should be ready to alter or modify the client's environment to increase occupational performance Interventions that relate to one's volitional subsystem provide the most meaning and impact for the client. Occupation must be relevant to the client to be effective. Research Since 1980, over 80 studies have been conducted and published Kielhofner and his constituent have offered major contributions to the field including a wide variety of assessments and extensive research concerning the impact of therapy and the positive outcomes achieved from this therapeutic approach.