How would the Occupational Therapist Enable Cooking
When considering how a client could be enabled to cook, the therapist would use the theories and guiding philosophies unique to their profession to choose a suitable model. The frames of reference should then be considered to guide the process of intervention by describing how knowledge in a specific area of practice can be applied. This will support the model chosen to identify the specific intervention approaches that can be used to enable the client vto reach their chosen goals (Parker 2006).
Enabling cooking through modification of the environment
Our environment will influence the way we behave and for the therapist it will enable them to identify the context with which the occupation of cooking will be performed (Rigby et al 2008). Having restricted access and limited use of the space available, will not only present a physical barrier to enablement, but will also impact the purpose and meaning that cooking may bring to that individual (Bryant and Mckay 2005). This may also further impact their motiation and enjoyment to continue (Bryant and McKay 2005). This fits well with the social model of disability as the therapist should consider that it is not always the person who needs to change, but rather their surrounding environment, as it may be this that is preventing enablement (Hughes 2008; Bryant and McKay 2005).
An Occupational Therapist would be guided by the NICE standards and the NSF to ensure that their environment was better suited to enable them to:
- · Increase their independence
- · Minimise the impact on their activities
- · Reduce the risk to the individual or carers (MS Society 2009).
The therapist would achieve this by first analysing the task to identify what the performance requirements are and the contextual considerations of the environment with which the task is to be performed. They would then look at what are the reasons for the client not being able to do the task such as it is their functional limitations or the contextual environment (Birge James 2008).
Whilst analysising the occupation of cooking, the therapist would therefore consider the following points –
- · The accessibility in and around the kitchen and can it physically be altered
- · Is there room for them to sit and rest or is there space for a wheelchair if required
- · Height of work surfaces
- · Accessibility of utensils from cupboards
- · Is the kitchen just for their personal use or is it to be shared
- · Is there already any equipment in place
- · Are there any potential hazards that could cause harm such as risk of trips and falls
- · What is the lighting like and could it be improved to compensate for any visual impairments such as using different colours to reduce glare or enhance contrast
- · How can they reduce the problems of heat sensitivity whilst working with hot objects in the kitchen (Fasoli 2008).
The therapist would need to work with the individual client to determine what environmental changes could be made to enable them to cook whilst also considering the needs of the rest of the household using the kitchen (Bryant and McKay 2005). They would also need to take into consideration the cost and how the funds may be sourced.
Being able to maintain or restore an individuals independence to enable them to live safely at home will not only improve their ability to manage activities of daily living, but will also greatly improve their self esteem and sense of efficacy (Fasoli 2008). It is this rehabilitative approach that would lead the therapist to consider using cooking as occupation as an end, as it will enable the client to restore their ability to cook and participate in their valuable role as a mother or partner (Fasoli 2008). For clients with a progressive condition such as Multiple Sclerosis, providing equipment can help to improve their current level of function and ensure it is available in anticipation of any future changes in ability (Fasoli 2008).
An Occupational Therapist would be guided by the NICE standards and the NSF to ensure that when providing equipment to enable them to cook, they would:
- · Assess the clients abilities and the support they currently have
- · Consider if new equipment would improve their occupational performance
- · Consider and plan for their potential needs in the future due to the unpredictable nature of Multiple Sclerosis
- · Assess if the client was safe and able to use any new equipment
- · Involve other health professionals if needed
- · Establish what the arrangements for funding the equipment may be
- · Ensure that provision is in place to regularly inspect and risk assess the equipment
- · Ensure that the client and or carers are properly trained on how to use the equipment either by themselves or through an external agency (MS Society 2009)
- · How they could improve any limited range of movement for the client to be able to reach and use the cooking utensils such as long handled utensils
- · Compensating for weakness and limited endurance through equipment that is specifically adapted to be more lightweight
- · If the use of utensils with ergonomically designed handles or double handled pots would enable the client to have a better grip
- · If visual or auditory aids may enable the client to remember, plan and organise what they need to do to complete the meal
- · Would seating such as a perching stool enable the client to take regular breaks to reduce fatigue and be able to complete the meal (Fasoli 2008).
Enabling cooking through adapting the task
Clients who have been diagnosed with Multiple Sclerosis will find that their ability to manage activities of daily living will fluctuate due to the unpredictable nature of the condition. By adapting the way they need to cook will enable them to continue their valuable role and meaningful occupations.
An Occupational Therapist would be guided by the NICE standards and the NSF to ensure that when adapting the way they cook, they would:
- · Consider factors such as fatigue and how it may impact their occupation performance
- · Consider if weakness is affecting their voluntary motor control and are they at risk of developing a contracture at any joints
- · Have they any sensory loss that means they have difficulty with tasks involving fine motor control
- · Is their ability to carry out the task being compromised by pain (MS Society 2009).
When analysis the occupation of cooking, the therapist would therefore look to adapt the task by:
- · Altering the way the task is completed such as simplifying the way they cook by using more packet, frozen or pre-prepared foods as this would reduce the time it will take to prepare the food and mean there will be less steps to master.This is called grading where the therapist can support the client to increase or decrease the demands of the task depending on their abilities (Hagedorn 2005).
- · Encourage the client to involve other members of the family to help with some of the task stages.
- · Encourage the client to plan and organise the sequence of the task so that they can take rest breaks during preparation.
Enabling cooking through Learning
The therapist would use the principles of the learning frame of reference with an educative approach so that they can enable the client to develop strategies to manage the unpredictability of their symptoms. As fatigue has such a debilitating effect on their physical and mental capabilities, the therapist can teach the client to consider new ways to simplify the task and planning times during a task when they can take a break and conserve energy. They would also look to address any cognitive difficulties such as memory and concentration.
Examples could include:
- · Decrease the amount of information the client needs to remember
- · Encourage them to get all the equipment they may need ready before beginning the task
- · Teach strategies such as making notes, planning and sequencing the task
- · Teach ways to use visual or auditory cues such as an alarm to help them remember and plan the steps
Enabling Cooking through Biomechanical approaches
By using the Biomechanical frame of reference, the therapist may use their knowledge of human anatomy and movement to enable the remediation of the clients functional difficulties (Hagedorn (2005). They would do this by assessing the positioning of the client whilst cooking and considering if their function could be improved by adapting or improving either the position or the movement of their body (Hagedorn (2005).
An example of this could be:
- · Can a movement be eliminated or promoted by having a better position at the kitchen work surface
- · Is movement being restricted when they bend, twist or reach and could these be improved or adapted.
- · Can they use two hands rather than one when carrying heavy objects such as saucepans