CRAFT Model - Functional Therapy's Expansion of the Wholistic View of Personhood

This is a snapshot of an interactive presentation we are developing to help consumers and therapists to better understand the interaction of Functions, Abilities and the Context in which we live.

 It embodies a globe which contains the Context of the person; the pillars represent four domains of Abilities; and the pillars support the platform of Functions or 'Things we do'. These are also known as Occupations.

In the interactive presentation we represent external supports by additional pillars and external burdens as weights. The new adage 'The more you do the more you can do!' plays into this system by the performance of functions feeding back into the diameter of the pillars; doing more means you develop more ability. The system works to try to maintain a balance and the old adage 'All work and no play makes Jack a dull boy' is represented by relative sizes of the Functions, with too much of one unbalancing the others.

This is an adaptation of several models with painstaking effort to add a significant reworking so as to avoid infringing anyone's copyrights. The CRAFT model is a reimagining of how we can propound a more integrated vision in Healthcare. It is published under a Creative Commons Copyright and we would ask that you reference us and http://www.functionaltherapist.org/ when you copy or adapt it.

"Don't worry about people stealing your ideas. If your ideas are any good, you'll have to ram them down people's throats."
- Howard Aiken

I hope you enjoy this preview of our interactive presentation as much as we are proud to present it to you.

Yours,

Ed Kaine, OTR, RFT

President of the American League of Functional Therapists

RegisteredFunctionalTherapist@gmail.com

Functional Therapy... the Next Generation of Occupational Therapy!

Discussion with a discouraged OT Grad Student.

This is a reprint of a facebook discussion with a Masters OT student. Reprinted with permission of SVS.

From: SVS June 6 at 8:18pm
Hello Ed,
It has been a while since I bent your ear about the OT field.

I have been having concerns while in grad school concerning the efficacy of OT treatment; the validity of it as a science, do people believe it helps them?
I am falling prey to adverse notions and thinking that PTs, CNAs, Recreational Therapists, Psychologists - can all do what OTs do, working as a team - and that OT will be phased out due to medicare cuts.
Family members who have aging parents have felt that OT was pretty much a waste of time and that PT was what helped.
Am I totally off base - or is there something to what I am feeling? Do you believe OT is here to stay? Do you believe that the field will continue to produce jobs and will help people?
If you share your insights with me ---I thank you!
-SVS

Response: Ed Kaine June 6 at 10:01pm

Thank you SVS for your question and I understand your concern.

Congratulations on getting into grad school working towards OT... and keep heart.

I really did think that OT was doomed when I graduated. I still believe the biggest barrier to the profession's popularity is its incomprehensible name, hence the drive to change it to 'Functional Therapy' which is closer to it's meaning and purpose. That said, I was wrong, OT, maybe as Functional Therapy, is here to stay. I actually thought that we'd just teach everyone our wholistic philosophy and our prefession wouldn't be needed; it made too much sense for it not to be adopted wholeheartedly by anyone who cared for people. I was wrong, it hasn't caught on like I expected, and thus we fulfill an essential role, the Health Care generalist.

Imagine, the profession is coming on its 100th anniversary in 2014 and it is still revolutionary in it's ideas. It is true that other fields are encroaching on the supposed territory of OT but they continue to have large gaps (as in each of the fields you mention could do a small part of what OT does). The truly wholistic philosophy of OT (as represented by the CRAFT model) is the gem of genius behind the applied science and craft of OT. It has been hard for the other groups you mentioned to grasp this core philosophy.

For example, Physical Therapy will often be consulted to find out if the patient is safe for discharge, they do this by answering the question "can they walk and not fall over?" Well, couldn't this question could be answered by anyone just looking at a patient? If they can get up then off they go. Functional therapy argues that it is not as simple as this... it is not whether you can walk with balance (though that is important) it is whether you will make bad judgements while walking that might cause you to fall. If you sat up and felt dizzy you would call for help... not so for someone with decreased attention and recall, for them an overwhelming need to go to the bathroom may override the safety message, and thus the patient falls.

How do you treat this? By doing more of it. The more you do the more you can do! And you don't do it only in a clinic but you carry it over into every day things.

OT and Functional Therapy qualify heartily as an applied science; in every treatment you have the potential to do an experiment. You see something, you hypothesize on its cause and postulate an approach, you try it and if it works you continue, if it doesn't you go back and start over. OTs recognize that if they don't see something improving within the session they are doing something wrong and should change the approach.

Most clinicians go through a phase of not knowing if they are effective. I started to wonder that maybe people were just getting better because they would anyways (despite my work). I then had a funny situation that lead to an unintentional longitudinal study.

JK had extensive brain cancer and was not expected to do very well, in fact his sisters had wondered why we were doing anything with him. I asked them to give us a chance and see if we could help, as he had wanted to be able to go home, and they agreed. I was going on vacation but I saw him for one or two sessions before I left and I had progressed him to some functional mobility in his room, got his arms moving and got him doing some functional tasks; I saw a lot of potential to get him home. I was away for one or 2 weeks and when I returned he was in exactly the same condition as when I had left (maybe worse). Within a few days I had him up, I got him walking in the parallel bars, getting dressed, playing cards and getting back to his life. In a matter of weeks he went home where he lived a few months until he passed away. His sisters came to me and were so happy that I had done that for him and I was happy too.

I would never have subjected a patient to that longitudinal study on purpose; I expected the PTs and covering OT/COTA to continue the work but they hadn't seen his potential and they didn't know the approach. The good thing is that it helped me to really know the value of OT and my own effectiveness.

I am dedicated to the field, I tend to think it would be good career for anyone, but I'm sure it has as much to do with aptitudes and interests. If you become an OT it is unlikely that you will ever need to be out of work... in fact more than most careers it affords you a way to branch out from strict health care. OT has remained in the top 10 jobs and is often in the top 5 for my whole career.

It is natural that your family doesn't know much about it, less than 10% of the population of the USA knows much about it. Even after an intensive course of OT with a patient the family and the patient often called me a PT (actually maybe more than they called me an OT). OT is nearly unknown, despite this it remains near the top of the careers list. Just imagine if we could popularize it beyond its humble but effective current state. I believe the field will continue to help people long after I'm gone. The idea that each of the fields you mentioned could do part of what OTs do is exactly my point, it is the fact that we can do it all and integrate it in one treatment that is the gift. The idea that everyone can easily work as a team is difficult, 'to a hammer, every problem looks like a nail', an OT is more like a whole toolbench. Health care has a lot of specialists but needs a 'jack of all trades' to bridge the gaps between them, OTs fill that role.

If you're creative, resourceful, and an excellent problem solver OT / Functional Therapy is the field for you. There are other fields that might be able to use your potential but few do it as completely as OT.

I hope you'll keep considering it, your questions suggest that you're open minded. Just imagine one field that could bring the most effective parts of the 4 disciplines you mentioned and then can integrate tools from other areas too (social work, medicine, nursing, education, etc.) It's a great field.

Yours,
Ed Kaine, OTR/L, RFT
Registered Functional Therapist RFT
President of the League of Functional Therapists, LLC.

Functional Therapy, the next generation of OT!


P.S. I may re-work this into a blog post, do you mind if I reprint your question? I would like to print your name also but if you would prefer initials I can do that too.

From: SVS June 7 at 8:48pm

What an amazing response. I thank you for it. Yes, you can publish my question, I would prefer that you use my initials.
Where did you receive your education? In Canada? It has served you well, indeed! Not to mention, of course, your accumulated work history. You'd be a great role model for any OT students who are having doubts. Do you teach?
Okay, so enough flattery!
I thank you, again and I especially like your characterization of OT as the "jack of all trades" It is such a clear description and I learned from it - that OT is unique in that it is so comprehensive - fully accounting for the whole person and how best to deliver services to that person. I wish most others had some appreciation of OT - don't we all. My sister is married to an anesthesiologist who told me to go into nursing because when money gets tight, OTs are cut. Also, my sister had no idea what OT is.
During my first fieldwork, Team meeting in the morning. The COTA seemed to be devalued by others - her opinion was rarely solicited. It is my hope that where I work the hierarchy/the system will not devalue me. I'll do what I can to make sure that doesn't happen, by speaking up.
-SVS

More about CENT - Principles of Controlled Eccentric Neuromuscular Training.

Now to the meat...

CENT stands for Controlled Eccentric Neuromuscular training. It is partly because the acronym spells something that it was chosen. It will stick in your head and make writing about it easier. (See "Introducing DAP notes" article for some of my views on acronyms.)

Guiding Principles:

Switching between agonist / antagonist muscle actions takes time, effort and is not necessary to start.

The Flexor Synergy exists for a very good reason, if you're a caveman...

Praxis is the key to purposeful movement.

"The more you do the more you can do" (a basic Functional Therapy tenent that applies here too).

Next time we'll break these out a little.


Ed Kaine, OTR/L, RFT
President of the League of Functional Therapists, LLC.

Introducing CENT - Controlled Eccentric Neuromuscular Training.

Today I am introducing CENT - Controlled Eccentric Neuromuscular Training. Over the next few days I will give you more information about this marvelous treatment option I am exploring and developing. I will tell you the foundational tenents of CENT in a moment but first a bit of history.

I desperately want to give credit where it is due... but I can't find that person. Instead I will tell you a brief story and maybe you can help.

About 5 years ago we had a Physical Therapist from India come to our facility. While transitioning and looking to finish requirements to allow her to be licensed here she volunteered on Bridgeport Hospital's Acute Rehabilitation Unit in Bridgeport, Connecticut. Her name was Priti or Preeti. If you read this or know Priti please contact me at RegisteredFunctionalTherapist@gmail.com.

Priti gave a presentation on a paper she had read that she said came out of Australia. From this she identified several things, and I have refined those into this this:

• Work on movements opposite to abnormal synergies (the flexor synergy in the arm).
• Overflow movements or movements outside of the specific action you want should be discouraged and stopped.
• Eccentric muscle actions are often first to recover.
• Work on one muscle action eccentrically and concentrically to keep the patient's focus on a single effort.
• Any muscle action could be your starting point. Just get some success.

Using this on many patients and experimenting in light of other observations I have about stroke I have come to the synthesis known as CENT. I know that the novel direction this has taken would not have occuring without Preeti. Unfortunately I can't find any papers from Australia or elsewhere about this approach. If you read this and think it is referring to something you had heard, read or done I would love to hear about it. Also, if you'd like to collaborate on this and develop your own skills please contact me.

I will give you the meat of this great technique over the next week.

Ed Kaine, OTR/L, RFT
President of the League of Functional Therapists

"Functional Therapy... the Next Generation of Occupational Therapy."

www.FunctionalTherapist.org

Online Meetings And The Next Wave Of Innovation!

The League of Functional Therapists (LOFT) is an international organization. Communicating with diverse people over vast distances is one of our key business needs. A phone is an essential tool, the internet and email have been remarkable enablers... and now online meeting has the potential to be a revolution.

As part of our business software we have a subscription to GoToMeeting. This Citrix product allows up to 16 people to be on a conference call (as a phone call or as Voice over Internet Protocol (VOIP)) and all looking at the same screen. Any attendee's screen can be viewed and or, with your permission, completely controlled. Is this functionality worth less than $50/month? It is to me.

I have met with people all over. I have used this in my work to avoid a long walk, kept all my tools and materials on hand, solved a problem in 2-5 minutes and gone on to do other things. With a software developer we designed together as he taught me what he was doing. With family we have met and planned together and shared photos.

Oh, by the way, the distance is not required... we could do this in the same room too, a few laptops in a conference room and an old fashioned meeting turns into generating work. These capabilities are incredible.

Why then does it seem so routine to people I introduce it to? I have them go to a site (JoinGoToMeeting.com) and put in a meeting number. The program downloads a little file to let it run on your system and the person is asked to put in their name and email address. Then, suddenly, we are meeting together. Instead of talking or planning and sending someone off to do it and report back later, we are able to finish the project in real time together. Just because it's easy doesn't mean it's routine. Can you imagine the possibilities?

If you're an Occupational Therapist and you want know more about our organization we want to talk with you. We can set up a meeting anywhere in the world. So far the farthest East is London, England and farthest West is Queensland, Australia. We want people to understand our mission and objectives and sometimes it takes a guided tour.

So far we have met with supporters and detractors. It is incredible to problem solve together with supporters and it is remarkably inciteful to get feedback from detractors. There is so much that we can learn together.

Set up a meeting with us, learn about the League of Functional Therapists and get to try out GoToMeeting. Contact me at EdKaine@FunctionalTherapist.org.

I'm looking forward to meeting with you.

Yours,


Ed Kaine, OTR/L, RFT
President of the League of Functional Therapists

"Functional Therapy... the Next Generation of Occupational Therapy."

Survey Results Are In - Very Encouraging! A Little Statistical Background.

Over the last few weeks we have been trialing and tailoring our survey. I'd like to thank all the people who helped us by taking the survey. In the end we had a very good tool that participants praised as interesting and enjoyable.

Someday I'll tell you about our $49 lesson but right now I'll tell you of ALOFT's wonderful success.

First, a bit of statistical background. In order to make our survey results as generalizable to the public as we could we sought to have a stratified random sample. The factors we decided on were that we could accept a 5% error rate in the responses. Also we wanted a 95% confidence level, or only a 5% possibility that the results could be due to chance. We set our expected variance to require the maximum number of responses by setting it to 50% (as in equal chance a subject would pick one or the other). Then we wanted to generalize this to the population of the U.S.A. These mean that we would have a sample that would cover 304 Million (as of summer 2008) so we added many more and found we could cover the world's population with 385 subjects.

Then again we were only sampling people in the U.S.A. so we can really only generalize to the U.S.A. We went with the higher number to allow internally guided exclusion criteria and sampling methods to allow exclusion from certain aspects of the study based on background factors.

In the end we had 500 completed surveys with 87 partially completed or eliminated due to just randomly hitting the keyboard rather than answering. So, of the 500 we confirmed many of the intuitions we had had and learned several new and supportive things that we had been unable to quantify.

So far it is saying to us at ALOFT "keep going, this can be a very helpful and positive thing." We had several criteria for the study that would have indicated that we were on the wrong track, none of those were evident. We will be sharing different results from the study as we go along.

If you are interested in this data we are interested in sharing it with you in a meeting. We can setup online meetings if you would like to delve further into any results.

Look for our results in the coming days and weeks.

Yours,

Ed Kaine, OTR, RFT
Member and President of ALOFT

RegisteredFunctionalTherapist@gmail.com

How Language May Shape Our Thoughts.

Please check out this article in the July 9, 2009 Newsweek. What’s in a Word? Language may shape our thoughts. By Sharon Begley It has some very interesting insights into language and how people think about things.


I previously discussed this topic related to the use of our title, in particular asking whether we should use the O-Word (Occupation). The answer was and is, "yes". It allows us to expand the way we think about function. However; with this is a warning that the meaning of this word for most people is not what it is for an Occupational Therapist. What about the O-word?

The challenge is open to try to expand the definition of Occupation. It does not appear that this will be possible in this year or in the next few. I discussed this with a representative of Mirriam Webster's Dictionary and it was not possible. Let's get our definition in the Dictionary!


What does this mean for us? To me it means we need to consider the words we use to promote our profession and that it does matter whether people understand the word we are using.

With only a very limited definition of Occupation available to people how can we blame them for not understanding. It is up to us to reach out to the people. We can do this by using words that have positive meaning and capture the essence of what we do.

In the word "Functional" we have the basic idea of the way we work. We structure our treatments with a focus on the function task you must do. This may involve addressing the cognitive skills, the physical skills, the motivational and social skills that go into the task. Then the functional task itself, be it work, self care or leisure, is can be the focus of our treatment. It is the emphasis on doing something functional (not just fixing the structure) that Occupational Therapy has brought to the world. By using the protected title of Registered Functional Therapist we can more clearly help people understand how we can help them.

Functional versus Occupational on the Visual Thesaurus

It's something to think about.

Yours,

Ed Kaine, OTR, RFT
President of the League of Functional Therapists

Functional Therapy... the Next Generation of Occupational Therapy!