Leisure & Community Participation

Leisure & Community Participation

1. PEO FIT

   • "Nonobligatory activity that is intrinsically motivating and engaged in during discretionary time, that is, time not committed to obligatory occupations, such as work, self-care, or sleep"

2. LIFE SATISFACTION

   • Increased subjective well-being
     • Ville, Ravaud, & Tetrafigap Group (2001)
   • Decreased depressive syndrome
     • Krishnagiri & Southam (2013)
   • Maintained balance in one's life
     • Suto (1998)

3. LIFESPAN

4. POTENTIAL BARRIERS

   • Physical dysfunctions
     • Sensorimotor, reduced balance and mobility
   • Cognitive dysfunctions
     • Executive, communication issues
   • Psychosocial dysfunctions
     • Apathy, avolition, fear of falling, low self-efficacy
   • Environment
     • Lack of facilities, financial constraints, physical environment, social support

5. EVALUATION

   • Occupational history
     • Interest, hobby, occupational role, educational history
   • Living environment
   • Performance components
     • Sensorimotor, cognitive, psychosocial
   • Daily time use
   • Community resources

6. Assessment tools for leisure participation

   • Interest checklist, Activity card sort, Canadian Occupational Performance Measure (COPM), Occupational questionnaire, Role checklist
     • assess individual's perceived occupational performance in areas of self-care, productivity and leisure
       • ADL, functional mobility, life participation, occupational performance
     • assess meaningful use of time
       • life participation, occupational performance
     • self-report survey v1 to assess patient's role and satisfaction (based on MOHO)
       • life participation, motivation, occupational performance
     • tool to understand occupational histories (social, instrumental, leisure activities)
       • ADL, life participation, occupational performance
     • Assess client's strength of interest and engagement in activities in past, present and future
       • leisure participation, life participation, occupational performance

7. COMMUNITY PARTICIPATION

   • Community
     • "a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings”
       • (MacQueen et al., 2001)
   • Participation
     • involvement in a life situation
       • (WHO, 2001)
     • Essential dimensions
       • 1. Performance
         • - Execution of activities and actions in a person’s life context - Observable
       • 2. Subject experience
         • - Individual’s perception of participation - Experience is variable and contextual
       • 3. Interpersonal connection
         • - Process of connection with others and how such connections relate to activities and actions
   • Organisation of activities by groups of persons who have disabilities, in conjunction with others who do not, to increase their ability to influence social conditions, and in doing so to improve their disability situations.
   • Community-based participation
     • Action/set of actions in which one engages within naturalistic life settings outside of a treatment encounter.
   • Activity
     • “Activity is an organisational unit for performing a specific function”, "culturally defined ideas about categories of action"
       • - Community mobility/ambulation - Visiting relatives and/or friends - Grocery shopping - Taking public transport- Visiting clinics and/or hospitals- Social outing/gathering- Banking- Travel/holiday tours
   • STROKE PATIENTS
     • Limitations
       • - Older age - limited mobility - depression - fatigue - lack of social connection - lack of self-efficacy - give up high-demand leisure activities
     • Programmes
       • Mission Possible
         • Group-based (exercise, project-based) - 2x/week, 3h/session, 12 months
           • effective in reintegrating stroke survivors to community, but requires longer time to achieve meaningful gains
       • OT-led community reintegration
         • brief intervention aiming to improve outdoor mobility in community dwelling people
           • provision of information, aids, and appliances, and approaches to overcoming fear.
       • Stepping On After Stroke (Study) - multicomponent falls prevention program
         • Group session led by trained individual - 7x2h/week + 1mth post-intx (home visit) + 3mth booster sx
           • reduce fall rate and increase community participation
     • Tools to measure participation
       • Widest range: -Stroke Impact Scale, -Assessment of Living Skills/resources -Activity Card Sort
         • self-report questionnaire (evaluate disability and health-related QoL post-stroke)
           • Areas of assessment
             • ADL, cognition, communication, depression, functional mobility, gait, general health, life participation, QoL, social rs/support, UE function
               • Higher score = Less difficulty experienced, less affected by disability, improved QoL (score of 0-100)
           • stroke survivors
         • interview administered by clinicians (evaluate accomplishment of tasks > potential capabilities)
           • Areas of assessment
             • IADL
               • Higher score = Less accomplished/ More inconsistent in IADLs (0-44)
       • Smaller range: - London Handicap Scale, - Frenchay Activities Index
         • patient-reported outcome (focus on self-care and mobility)
           • Areas of assessment
             • IADL (self-care and mobility), ADL, occupational performance (housework, leisure/work, outdoor activities)
               • Higher score = Higher level of activity in IADLs
           • stroke survivors, older adults, limb loss/amputation, brain injury, non-specific patient population

8. OUTCOME MEASURES

   • - Goal Attainment Scale - Life-space assessment - Modified reintegration to normal living index
     • GAS: Individualised outcome measure involving goal selection and scaling to assess when goals are met
       • pediatric, older adults, mental health, limb loss/amputation, chronic pain, CP, non-specific patient population
       • 5-point scale: -2 to 2 with 0 as "patient achieves the expected level"
     • LS AX: questionnaire (assesses usual pattern of f/c. mobility during the month preceding the time of evaluation)
       • general population
         • Higher score = Higher participation in f/c. mobility (on a scale of 120)
     • mRNLI
       • Patient-reported outcomes (assesses individuals who have had experienced traumatic/incapacitating illness in achieving reintegration into normal social activities)
         • Areas of assessment
           • ADLs, social rs
       • stroke, SCI, BI, arthritis, cardiac dysfunction
   • Community Integration Questionnaire (TBI) Community Participation Indicators Independent Living Skills Survey Late-life Function & Disability Instrument
     • Patient-reported outcomes (assesses social role limitations and community interaction)
       • acquired brain injury, SCI, stroke
       • Areas of assessment
         • ADL, life participation
           • home integration, social integration, productive activity
           • Higher scores = Greater independence and community integration

9. COMMUNITY ENVIRONMENT

   • Hazards
     • - non lift landing - steps at main entrance - narrow common corridor - uneven ground at public car parks/common access/walkways - slippery flooring i.e wet markets - slippery drainage cover - insufficient lighting - over bridge - steps without handrails - bus stop platforms
   • Improving Accessibility
     • Public transport
       • -Station upgrading project with i) barrier-free facilities, ii) tactile guidance system, iii) ramps, iv) wheelchair-accessible toilets -Public transport stands with i) decision tactile, ii) ramps- -Wheelchair-accessible buses
     • Community ambulation
       • Main road
         • -Road kerbs (flushed w road surface that allows smooth level transition & decision tactile to guide visually impaired) -Pedestrian crossings (guide visually impaired) -Green man Plus (for seniors)
       • Pedestrian pavement
         • -Public ramps -Wider walkways on public streets (for wheelchair users) -Non-slip surface flooring -Benches in different heights
       • Lift
         • -Lift upgrading project -Installation of lifts at pedestrian overhead bridges

Images and files in the map