The Occupational Therapy Practice Framework guides and defines occupational therapy practice. It describes both the domain and the process of occupational therapy and demonstrates the link between the two. The domain consists of aspects such as activity demands, performance skills, performance patterns, client factors, context and environment, and areas of occupation. The process consists of the evaluation, the intervention, and the outcomes of therapy as client and practitioner work together throughout the therapeutic process.
There are eight main areas of occupation including activities of daily living (ADLs), instrumental activities of daily living (IADLs), rest and sleep, education, work, play, leisure, and social participation. ADLs include bathing and showering, bowel and bladder management, dressing, eating, feeding, functional mobility, personal device care, personal hygiene and grooming, sexual activity, and toilet hygiene. IADLs include care of others (including selecting and supervising caregivers), care of pets, child rearing, communication management, community mobility, financial management, health management and maintenance, home establishment and management, meal preparation and cleanup, religious observance, safety and emergency maintenance, and shopping. Rest and sleep includes rest, sleep, sleep preparation, and sleep participation. Education includes formal education participation, informal personal needs or interests exploration (beyond formal education), and informal personal education participation. Work includes employment interests and pursuits, employment seeking and acquisition, job performance, retirement preparation and adjustment, volunteer exploration, and volunteer participation. Play includes both play exploration and play participation. Leisure includes both leisure exploration and leisure participation. Social participation includes community, family, and peer/friend. These areas of occupation help to categorize all areas of daily life in a systematic manner for improved intervention approaches.
Client factors influence and impact participation in all areas of life. These include values, beliefs and spirituality, functions, and structures. Each of these differs based on whether it is referring to the person, the organization, or the population level. Values, beliefs and spirituality refer respectively to the principles, standards, or qualities considered worthwhile or valuable, the cognitive content held as true, and the personal quest for understanding answers to the ultimate questions about life, meaning, and the sacred. Functions refer, at the person level, to the basic functions of the body including mental functions, sensory functions and pain, neuromusculoskeletal and movement-related functions, cardiovascular, hematological, immunological and respiratory system functions, voice and speech functions, digestive, metabolic and endocrine system functions, genitourinary and reproductive functions, and skin and related-structure functions. Structures refer, at the person level, to the basic body structures including structure of the nervous system, eyes, ear and related structures, structures involved in voice and speech, structures of the cardiovascular, immunological and respiratory systems, structures related to the digestive, metabolic, and endocrine systems, structures related to the genitourinary and reproductive systems, structures related to movement, and skin and related structures. All of these factors systematically evaluate what the client brings to the situation and helps to better identify areas of need that may be addressed during therapy.
Activity demands refer to the specific requirements for successful completion of the activity in question. Aspects of activity demands may include objects and their properties, space demands (relates to physical context), social demands (relates to social environment and cultural contexts), sequencing and timing, required actions and performance skills, required body functions, and required body functions. When one or more client or environmental characteristics does not adequately match the activity demands then successful completion of the activity is more difficult or not possible and targeted intervention is warranted.
Performance skills include motor and praxis skills, sensory-perceptual skills, emotional regulation skills, cognitive skills, and communication and social skills. They are the basic components that make up each and every activity a client completes each day. Performance patterns are the habits, routines, rituals, and roles that an individual, organization, or population carries out. They define the meaning in otherwise seemingly random sequences of activities.
Contexts and environments refer to the situations under which an activity is carried out. These include cultural, personal, temporal, virtual, physical, and social environments. The context and environment influence the meaning and reasoning behind the activities carried out by clients.
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