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I feel very strongly about this new perspective on participation because I have seen first-hand how society views disabled people. It is sad to say that disability is seen as a shortcoming or an inadequacy when society has made it so. It should not be the case that disabled people are required to minimize their disabilities in order to access the opportunities afforded to nondisabled people. Yes, though it is easier for people with less severe disabilities to live, work, and get around in the community, there are still ways that would make it even easier for those less disabled. If society would realize that they are the ones who need to adapt and that not all disabled people are home-bound (aka we exist in the world and they should not be surprised to see us up and about).

Even with my personal experience of being in a wheelchair and wanting to be able to walk again/”function” like I used to, I have had to come to realize that even if I never fully recover from my SCI my life is still worth living. For so many, it is the most depressing thing to lose all that you have known about your body. I saw this over the summer working at an ortho clinic where it could have just been a minor injury and, yet they wanted so badly to be able to use their hand “normally” again. This could definitely be a barrier for students as well. It is still hard for me to see my disability as a positive thing but just as the writer said, when people become intentional and creative about how disabled people might participate as they are, new, feasible, and exciting solutions emerge. We quickly realize that innovation delivers what rehabilitation promises and that is more fun anyway!

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Matthew Kupstas                 The article provided a helpful opportunity for me to reflect upon my own rubber meets the road assumptions that have room for improvement as to how I will approach my role as an OT. I have a few unexamined assumptions/fears as it relates to utilizing AT, environmental modification, or task modification prior to habilitating/rehabilitating my future clients inherent biological functions to their optimal capacity.  These assumptions can be summarized as "If a person learned to do such and such with AT, task modification, or environmental modification, it will likely limit the degree to which a client habilitates/rehabilitates." Thus,  adaptive equipment is a last resort only after all attempts at rehab have been exhausted. There are some black and white examples where I would see the benefits of immediately looking to utilize AT, such as utilizing equipment to help a child that struggles with mobility at an early age. I remember learning in our AT class that research indicates that early use of adaptive equipment for mobility actually improves the child's inherently biological functional outcomes related to mobility, but more importantly, it helps their sense of autonomy, confidence, and participation in their world. I also recognize that a person who has had hip surgery needs a sock aid and that will not limit their rehabilitation in the future. It is the grey areas that I could foresee being more difficult. At an intellectual level, I absolutely embrace the social model of disability. Upon reflection, I realize that I have more work to do in order to get that paradigm to really sink into my bones and generalize into my thinking and approach to OT. I am now aware of an unexamined assumption that "if a child were able to complete the button task without the use of a tool, even if it were more difficult, that would be preferable." In that assumption, I unknowingly placed more value on one way of doing a task over another. I am now left with the quandary that I simultaneously embarked in this profession as a desire to contribute positively to people's lives, while still being a product of an "ableist" culture, and have some internalized "ableist" ideas that will take some work to undue. To be clear, I have every desire to be client centered and collaborate with my future clients to the best of my ability. While I do not think that I would have made such an obviously egregious and consistent lack of clinical judgment as was highlighted in that story, if I am being honest with myself,  I likely have my own blindspots of how I could make the mistake of placing a greater value on inherent biological functioning at times over participation in occupations. 

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Matthew Kupstas                 The article provided a helpful opportunity for me to reflect upon my own rubber meets the road assumptions that have room for improvement as to how I will approach my role as an OT. I have a few unexamined assumptions/fears as it relates to utilizing AT, environmental modification, or task modification prior to habilitating/rehabilitating my future clients inherent biological functions to their optimal capacity.  These assumptions can be summarized as "If a person learned to do such and such with AT, task modification, or environmental modification, it will likely limit the degree to which a client habilitates/rehabilitates." Thus,  adaptive equipment is a last resort only after all attempts at rehab have been exhausted. There are some black and white examples where I would see the benefits of immediately looking to utilize AT, such as utilizing equipment to help a child that struggles with mobility at an early age. I remember learning in our AT class that research indicates that early use of adaptive equipment for mobility actually improves the child's inherently biological functional outcomes related to mobility, but more importantly, it helps their sense of autonomy, confidence, and participation in their world. I also recognize that a person who has had hip surgery needs a sock aid and that will not limit their rehabilitation in the future. It is the grey areas that I could foresee being more difficult. At an intellectual level, I absolutely embrace the social model of disability. Upon reflection, I realize that I have more work to do in order to get that paradigm to really sink into my bones and generalize into my thinking and approach to OT. I am now aware of an unexamined assumption that "if a child were able to complete the button task without the use of a tool, even if it were more difficult, that would be preferable." In that assumption, I unknowingly placed more value on one way of doing a task over another. I am now left with the quandary that I simultaneously embarked in this profession as a desire to contribute positively to people's lives, while still being a product of an "ableist" culture, and have some internalized "ableist" ideas that will take some work to undue. To be clear, I have every desire to be client centered and collaborate with my future clients to the best of my ability. While I do not think that I would have made such an obviously egregious and consistent lack of clinical judgment as was highlighted in that story, if I am being honest with myself,  I likely have my own blindspots of how I could make the mistake of placing a greater value on inherent biological functioning at times over participation in occupations. 

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This article demonstrates perfectly the reasoning for the shift away from bottom-up approaches. While bottom-up approaches can be beneficial in junction with top-down (client-centered approaches), it is important as OTs that we recognize that our profession is all about the holistic approach. It is so easy to get caught up in the task at hand and seeing our client's success that we forget that there are many routes to get us to that success.  While the term "function" does traditionally have more of a biomechanical view to it, it is so important to remember that it means and applies to everyone differently. To be functional at a task doesn't have to mean that there is a performance factor that needs to be remediated, but may just need adaption.

I believe the same thing about the term "meaningful". Everyone values and finds different occupations meaningful. By giving the client the opportunity to coordinate with the OT, the OT will be able to provide the most client-centered treatments. Both of these include advocating for our client's to get them the resources and interventions that will improve their quality of life.

A barrier that has been discussed in the book and most of us know too well... is just the lack of understanding of what OT is and all the different things that it can offer. OT can be such a useful tool to anyone and part of eliminating this barrier is just advocating for our profession as a whole!

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After reading Mr. Kunc’s experience, it’s easy to see how one perspective on disability provided a better quality of life for the student than the other. Traditionally I think disability was viewed as a problem. That individuals with a disability needed services to “fix” them. However, as awareness to disability has increased the mindset of “fixing” someone has shifted to acceptance and adaptation. Sometimes as therapists we get bogged down with the nitty gritty details of how someone is performing a task without realizing that regardless of how that individual is performing, the task is still being completed! With Mr. Kunc’s first OT experience, the therapist failed to realize that this student’s functional ability to manipulate buttons was not going to change. Rather than let the student unsuccessfully struggle the therapist should have made the mindset shift to modification/adaptation. I think it’s important to take a step back and make the realization that it may not be the “right” way to do something (or performing the task), but if it gets the job done, sometimes that is more important.  That is not to say that we don’t want to push our clients to be successful through repetitive practice of a skill, however having a better awareness to the specific disability and functional limitations (that will never change) is an extremely useful tool! Understanding disability is just the first step to help shift the focus from performance to participation. Finding occupations that give the student purpose, reason, and drive will give them that extra push to want to participate. Finding meaning in what we consider sometimes as mindless tasks (like handwriting) shifts that perspective from performance skill acquisition to a participation driven skill acquisition. For example, many therapists are utilizing mat-man in the school setting to improve body awareness, spatial relations, shapes, etc. Well making this mat-man student center, like a fireman because the student’s dad is a firefighter, may make the task more meaningful and give that student more of a drive to participate. Through the student’s increased participation, the skills are more likely o be gained! Now of course every school system has its barriers with financial limitations, classroom space, and time. But that’s were you are given the opportunity to be innovative. I mean if we as OT’s can figure out how to move past barriers that come with different disabilities, we can surely figure out a way to make the rigid school system setting work in our favor!

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It was hard to read about the OT that was so unaware of the consequences of the intervention (increased spasticity and client's awareness of the activity not transferring to the actual occupation). But, I too, have seen this happen. I think it is very easy for an OT to get in a rut, or see something work for a few and think it will work the same for the new. I think the best way to combat this in practice is to not only use EBP and Clinical reasoning but to treat every patient as though they are the only thing that matters in that moment. Being able to devote a respectful amount of attention to the task at hand, asking the client questions to determine if the intervention is working as you expect and not being afraid or embarrassed to make adjustments when needed is the best way to make in meaningful.

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Reading this passage really put into perspective to me just how easy it can be to get caught up in the performance of a task, that we fail to see if it is actually improving their quality of life at all.  I don’t want to be the therapist that brings out the buttons each session.  Over my fieldwork this summer, I found that some therapists would get stuck in using the same activities each session.  I forced myself to think outside of the box and I always felt like the patients got more out of the session this way.  I think it is important to not get in the same routine and to really take time to make OT client-centered.  For students especially, making OT more occupation-based could increase participation by the student (as in with the therapist who worked on playing tag).  Some barriers to treating in the natural environment might be interruptions from classmates or outside things which are out of your control.  I also feel like a barrier might be that all teachers are probably not supportive of OT’s and see it as an interruption and are less likely than others to really implement suggestions in the classroom.  Regardless, the client’s needs/goals should come first to make OT beneficial.

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"Function"
Traditionally practitioners view a person's function based on body impairments, activity limitations, and participation restrictions. In order to shift practitioners focus on performance to participation, they need to change their definition of function from "limitations/restrictions" to "ability". They should focus on a persons ability to perform a specific occupation, such as driving. For example, instead of focusing on "fixing" an individuals disability, adapt the car with devices such as a one-hand grip for steering wheels or a Menox hand control for accelerator and brake.

"Meaningful"
My thoughts about where has "meaningful" gone, reminds me of the time I shadowed in an TBI inpatient rehabilitation facility.  In morning meeting it was brought up that a patient was not making progress in OT so they were switching therapist to see if someone else could make progress. The therapist I was shadowing reviewed the patients file and saw that the patient was making no progress with the goal about making a bed. Through a family interview we found out that the patient had a housekeeper and never made her own bed. We also learned that the patient really enjoyed doing her make up/hair and dressing up everyday. Once the therapist changed her goal from making a bed to a personal hygiene and grooming goal, her progress sky rocketed. That experience taught me the valuable lesson on the importance of meaningful occupations. A few barriers the therapist faced to make OT client centered was the client was non-verbal, family members were hard to get in contact with, and waiting for family members to bring in the patients personal cosmetics and grooming tools.

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Though I believe it is important to keep function and occupations in mind, it is equally important to consider compensation, adaptation or task modification. We as OTs should prevent clients from dreading therapy and stay away from tasks that may be considered tedious and meaningless to the client. Our clients should feel as though they are not only performing an activity, but actively and successfully participating in something that is significant to them. It is a fear of mine that a future client will feel discouraged following therapy or feel as if they are incapable of participating just because they are unable to perform an activity in a conventional way. It is important that we advocate for this paradigm shift not only in the school systems but in the profession as a whole to emphasize meaningful participation rather than performance alone. In the school system specifically, I feel that it can be challenging to create an individualized treatment plan for a child that focuses on meaningful occupations and providing the necessary creativity to incorporate those occupations into treatment activities at school that will allow for successful participation.

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After reading this passage, I was immediately reminded of my CI during my fieldwork this summer. She refused to let me give therabands as the only treatment activity for a session to patients in our acute setting. She put a huge emphasis on engaging in meaningful activities with our patients. Instead we would work on many of the things our patients valued like getting dressed, washing up and bed mobility before their return home or to a rehab center. Through practicing these activities, we were often times addressing the same areas as with the theraband but in a much more functional way. This also allowed us to see where our patients could benefit from different types of adaptive equipment. For example, we worked frequently with patients with COPD. During these activities we would be working on improving activity tolerance but also recognizing how the patient could benefit from utilizing a reacher for lower body dressing rather than having to exert a more significant amount of effort through bending over. I am lucky to have had a CI that understood the balance between performance and participation. I believe both are necessary components of treating our clients as a whole and we are uniquely trained to be able to work on both where appropriate.

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I think this story showed us how easy it is to get caught up with improving function and performance and losing creativity in interventions. While the first OT in the story had good intentions, her approach did not work for this patient. I think it's very important to truly be client centered in interventions in order to recognize what works for that individual. In order for OTs to continue in this paradigm shift of focusing on participation, we need to be able to get out of our comfort zone and explore new methods to increase patient's participation. I think it is easy to get into the habit of doing the same activities with everyone, and while improvement may be made, that is not at the core of occupational therapy. We need to encourage participation in meaningful activities and find the just right challenge for all patients. We need to not give someone an activity just to do it, but rather think creatively about what we can do to improve their participation. I think if OTs can have an open mind and be willing to explore new activities and approaches the paradigm shift to participation will be successful.

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Mr. Kunc’s experiences demonstrate that performance is only as good as the desire of the individual to do the task. His telling of his buttoning experience was frustrating just reading it because he struggled so much and then had increased difficulty with school work because of the muscle strain and spasticity. Doing that task day after day and continuing to struggle day after day in an attempt to improve his buttoning performance was not worth the time. Then adding a simple button hook into the equation resulted in his ability to complete this “functional” dressing task. This portion of his experience outlines the need for a paradigm shift from performance to participation in order to bring back our friend “meaningful”. The button board was not meaningful, being able to button with the use of both hands and finger dexterity was not meaningful to Mr. Kunc. What was meaningful was his ability to use a button hook to get the task complete so he could move on to something else, and therefore increase his participation in other tasks- like his school work without fatigue or increased spasticity.

In terms of the value of function, I think we have to relate function directly with participation. Functional tasks and functional abilities are the things that we address as occupational therapists and are essential to our practice. But the way in which we address an individual’s function I think needs to be participation based with the mindset of, “how can I increase an individual’s ability to participate in this functional task that is MEANINGFUL to the individual?”.

Some barriers to intervention in a natural school environment can be things that interrupt the flow of the day including fire drills, school-based events (picture day), substitute teachers, change in library time that day, the health of the child, the other students in the classroom, the events that took place before the OT arrived (student behavior), and many other things that are not in our control. Other barriers might include the willingness of the teacher to have you in his/her classroom, the teacher’s ability to keep the entire class on track with their work while you are working with one student, or the child you are working with may feel embarrassed that you are there to work with just him/her. A final barrier in general to working with students in schools may be the parental involvement. In my experience, there were several instances in which we could not get a parent to attend a meeting or even answer the phone for a phone conference meeting. We had to follow the protocol for these instances and then after 3 (I think) documented failed attempts, we could proceed with the plan of action we developed without the parents. This was a disservice to our students but was a very real barrier that existed and drove me absolutely crazy!

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Reading this passage made me think about my fieldwork over the summer. I don't have much experience in a school system but when I did my fieldwork in a SNF this summer, I noticed some therapists doing the same activities over and over again with their patients without using these activities to relate back to something functional. The first therapist in the passage seems as though she became complacent in her treatment. She knew that the child was not improving with the button board but did not make an effort to try something different. I understand the OT's need to try to "fix" the problem, but I believe at some point, we as OTs need to realize when to adapt and change our treatment. There is a balance between remediation and adaptation of the environment that I believe OTs should try to achieve.

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Honestly, I found Mr. Kunc's story hopeful for the future of occupational therapy. Last summer, I feared that I would become the "lazy" therapist that just did the same activities with everyone and lost the creativity to that truly helps to meaningfully engage a client into an occupation that they find important. I think it is necessary that OTs continue to use that creativity and learn what is most important for the client. This is key to me. Function is extremely important to a client's life but I think it is important to note that function is subjective to the client's opinion. Yes, it would be wonderful if every client could reach full function but that is not realistic for every patient. Some patient's are okay with using adaptive equipment to compensate for the function they do not have and we should always be creative and present all options to these patients. I think some barriers that therapists have from using occupation as an intervention are: the ease to using the same old interventions they know without having to be creative and thinking; the time and the few sessions they may have with each child; and the lack of knowledge on the importance of occupation as i feel this is a newer and developing importance for the profession compared to those that graduated years ago.

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I thoroughly enjoyed reading this passage because it caused me to be reflective on some of my shadowing experience in the field of occupational therapy. Looking back it is apparent to me now that there are definitely different ways the therapist can treat a client. I guess that I always thought it was the therapists style and not their value on function and participation. I think so many times that therapists are reading the charts with the medical diagnosis and trying to find ways to help the client that addressing physical function is the most obvious approach. I do feel that balance is an important key when treating any patient. It is so important that the emotional component of participation in meaningful activities is paired with the functional aspect. I loved when the passage said “Innovation delivers what rehabilation promises.” I have witnessed this in the past year here in Hickory, NC. I volunteered with a local league called walk in roll. It is a disabled baseball league for all ages and all disabilities. A local therapy company sponsors it, and I think it is a great example of that quote from the passage. After talking with some of the parents and players, all they wanted was to hear their named called over the loud speaker and a chance to run the bases. The games were just as much therapy to them as a session in the clinic.

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There were so many thoughts that flooded into my mind upon reading the passage about Mr. Kunc's experiences with school-based OT. I first thought about my experiences in pediatric fieldworks. There were definitely times when function was emphasized over meaningful engagement in occupation, I believe, because it was a visible deficit that could be easy to "fix". But as OTs we are supposed to be creative superheros! We are supposed to see a problem, think about the child, patient, client, whomever, holistically to see how we can adapt or change things to help the individual engage. Looking back at all the history and advocacy that was done to get services into the school system, personally it seems so backwards to turn back to the "traditional occupational therapy", as Kunc puts it, frame of mind. Thinking of the school setting as a child's natural environment, the main goal that every child has is to be included. It is our jobs as OTs to help the child engage with others, break down physical or psychological barriers that may be keeping them from participating in the various aspects of the school day.

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After reading about this particular individual's experiences with 2 different OT's, I think this shows the need to find a balance between focusing too much on performance and too much on participation. If remediation of the client's deficits is possible then I think that OT should be focused more on performance because it will eventually increase participation across a variety of aspects in the client's life, but in Mr. Kunc's case remediation wasn't possible so OT so an adaptive approach that focused on increasing participation was more appropriate. If we lean completely towards one side or the other I feel we are limiting our client's potential to engage in the meaningful occupations of their choice. However, this also needs to be considered on a case-by-case basis because no 2 children will have the exact same abilities and disabilities.

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I am the jerk who is anonymous.  I got so excited reading this that I didn't even sign off.  I don't want to hide behind anonymity!! LOL.  Feel absolutely free to provide counterpoints to anything I have posed.  Wonderful, wonderful posts!!

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After reading this passage I have to agree that there are definitely two types of ways that therapists can approach their treatment interventions. As an OT you want to see your clients succeed to the best of their ability but you also need to be conscientious of their limits. Encouragement to improve is a great thing but you do not want your client to constantly fail at the same task over and over again like the child and the button board. I feel that it is our job as OTs to provide our clients with whatever they need to succeed. If that is compensated with adaptive equipment, then that is what should be provided. We need to focus on what our client can do and not what they can't do. In the school setting it is also important to not make the child feel excluded from their peers. It is important to see how the child performs in their natural environment which is in the classroom and not pulled away to the therapy room. I could see this causing issues though because it could become a distractor to the other children in the room. Overall, it is important to try and find a happy medium. The needs of your client should always come first so it is important that the client find meaning in the functional tasks that are presented to them.

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"Although improvements in functioning may assist people in their daily lives, there improvements are never seen as a prerequisite for inclusion." This quote really stuck out to me. I read this pdf, read the other pages in this module, then came to write this post, and that quote still is on my mind. Part of me thinks this quote (and article) should be brought to attention of every OT and used as a tool to advocate for their respective clients. I think I like this quote so much because it reminds me why I picked OT over other professions. OT is holistic and is more than just "fixing" the underlying limitations in body functions. It includes who the person is, what the person enjoys, what environment the person lives in, etc. I also always wondered what OT looked like before the OTPF and this article showed me exactly what it would have been like. All I have to say is thank goodness the OTPF was published and occupation, engagement, and participation was returned to occupational therapy. This article was a great reminder of what kind of therapist I want to be - the one who knows that "innovation delivers what remediation promises."

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Reading the passage exposed one of my biggest fears about being a therapist. I never what to be the therapist that solely seeks to have the client perform tasks and not feel like an active participant engaging in activities that they wouldn't normally and I often feel that I have to aim for sessions to be more focused on function than meaningful. In order for that to change, I have to  be an advocate that participates in what I believe. When it comes to the word function, I have a problem with it being applied to people as it makes it sound like a person's disability does not allow them to complete a task as expected then we must fix it by trying to fix the person instead of fixing the task. This could potentially be a barrier in the school system as some may not be flexible as the OT in the passage was about changing the rules of the game tag. Not everyone profession is as flexible as the field of OT. Perhaps a shift from performance to participation can be done not just through individual school sessions but with the OT practitioners being a part of classroom functions where all the students can be a part of participating in modified games where everyone is having a good time!

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I do believe that this recent trend within occupational therapy – the desire to focus more on client participation over performance speaks to a lot of the same shifts that have accompanied the progression of our country’s civil rights.  Unfortunately, disabled individuals have long been immediately dismissed from engaging in “normal” occupations and contexts, simply because they lacked the ability to do so, and any associated therapy took on a medical, function-based approach. I think the idea of boxing a patient into this image of “normal function” can really limit his or her success across a multitude of everyday occupations and contexts, as evident by Mr. Kunc’s experience with the button board. Gratefully, the civil rights movement has made a lot of significant advancements, and disabled individuals have reached a point of stronger understanding and advocacy. Working among disabilities is not so much a means of “What can we do to make disabled individuals normal?” as it is “How can we best support disabled individuals?” While I certainly affirm that the creativity and innovation that our field allows for is a benefit and an advantage in supporting occupational engagement, I think it’s crucial that our profession maintains a balance between the two, as a patient’s physical, mental, and social functioning is still inherently meaningful in framing a patient’s participation. Everyone possesses the ability to function at some level, and as OTs, we have the means of not only recognizing this function but designing and creating the environment that best allows this function to thrive. I don't think that this paradigm shift is meant to throw a focus on function entirely under the bus, but rather encourages practitioners to view function individually and personally, and recognize that each patient and student will inevitably operate and find success differently from another.

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In this passage, the one line that stuck out to me the most is "the ultimate goal of OT is to help people with disabilities live enjoyable and productive lives in the community." I think we spend so much time trying to define what exactly we aim to do, and I think this sums it up nicely. But this statement can also be deciphered in many ways, depending on what is enjoyable and productive to the client/family. This all leads us back to being a client centered practice and profession. I think this paradigm shift in the schools needs to come from innovation. Traditional grade schools aren't practical anymore for a child with or without a disability. I think a barrier to this is the education system as a whole, such as teacher salary, etc. But as OT's we are just a small part of the school system. I think the most important thing to keep in mind as an OT in the school is what's best for the child. Whether that is treating in class or pulling them out. I think meaningful function should be the goal. But children with disabilities don't have to function in the same way as other kids. No kid has to function the same. To make function meaningful, their should be an end goal of a meaningful activity, and that child can do whatever process or functioning they are capable of doing to get there. This is just like the example in the passage with the child and the buttonhook. The hook is the most functional way for him to reach to goal of buttoning his shirt. I think this should be the approach used for treating kids in schools.

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Reading Mr. Kunc's experiences with OT definitely makes you realize how dangerous it can be for therapists to inadvertently get into a routine that may seem to address certain areas of performance, but actually isn't client-centered at all and may even be doing more harm than good. Getting stuck in a particular approach to treatment not only disservices our clients, but also compromises the integrity of our entire profession. I think this paradigm shift begins with the way that OT practitioners are educated-- we are taught the importance of being innovative, creative, and client-centered...yet blending this with evidence based intervention is sometimes easier said than done. Focusing on performance may be appropriate in some instances, but we must be careful to not lose sight of the bigger picture. Take a second to put yourself in your client's shoes and consider their perspective-- do they understand why this intervention relates to their personal goals? Is it even meaningful to them? How will this improve their overall participation? In my opinion, simply being mindful and intentional with our approach is what will drive this paradigm shift in the right direction.

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I think that in order for this shift from performance to participation to happen OT's need to loosen their reigns on the habits, routines, and assumptions that have been gathered over the years. As humans we are creatures of habit and we are "comfortable" with what is familiar and expected. If something has been " working" for many years, the attitude can be 'why change it up?' I have seen this in a few settings that I have observed in and it drove me bananas! Not to mention as a student it does not make for a very interesting day, so I can imagine how under stimulated patients/clients could be. I can see the different levels of experience and education being a significant barrier. Regardless of both, I think the first thing that needs to happen is getting everyone (New and Experienced) on the same page with the focus on participation vs. performance.

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Before I began OT school, for some reason I thought that it would soley have a "function" approach. What this article shows, in addition to the OT profession as a whole, is that the shift towards participation should hold great value during individual treatment. From what I have learned in OT school thus far, in addition to what I took from this article, is that performance should hold an equal value to participation. While some individuals are able to improve in their functional abilities, others might have a condition that doesn't allow but for so much improvement in function. That is where participation should come in. It is the OT's job to be able to differentiate between the two and be able to make the call as to when to incorporate participation. I really enjoyed reading this article because it demonstrated how a holistic approach is so important in an individuals treatment.

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I loved when Mr. Kunc stated the goal of OT as helping people with disabilities have productive lives in the community. There are so many ways to view this statement. What does it mean to be productive? Do they need to change to fit the community or the community to fit them? What is undeniable is the OT is about participating in daily life fully. I believe for the paradigm shift of performance to participation needs to start with looking at this definition of OT. Someone can perform, but not be really participating and engaging in the activity.  Examples like Mr. Kunc’s are key to showing that he wanted to engage and participate, but the focus was on the wrong performance. The focus shouldn’t be on what he can not do, but optimizing what he does have (his functional ability) so he can participate. I believe assessing function is key, because it provides a picture of the client’s strengths, weakness, and interests, which aid in optimizing participation in daily occupations. Barriers to using occupation as the primary intervention in the schools include: a lack of resources, creativity of the therapist, or interest by the client.

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While reading this story, I automatically felt the authors frustration and joy during his varying experiences with OT. I feel that in a school setting, it is important to make the paradigm shift in order to encourage active participation in meaningful occupations. I love the use of "meaningful" in various settings; however, I feel that in a school setting where you have to focus on school related skills, they may not be as meaningful to the student (ex. handwriting). In order to have a student participate, he/she must be interested which gives an OT the opportunity to be creative in the methods that they use to perform and participate in the task, while keeping the student engaged and enjoying what they are doing.
I feel that one of the largest barriers for OT in the school is lack of resources. Some creative interventions can be pricey, OT's have to come up with a cost effective manner to incorporate different ideas for each student.
School system OT's should maintain a holistic approach in order to meet the goals that they have set for students.

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What I gathered from this story is, why spend hours practicing a function that is beyond the client's ability, out of context, or non-inclusive of the appropriate environment. In my opinion, there is no better way to lose a client's motivation to improve and engage in occupations then when there is lack of innovation and creativity from the OT and little meaning and personalization for the client embedded within the task. When the focus of intervention falls primarily on function rather than participation, how do we expect our clients to gain perspective of the importance of completing the task? By valuing participation over performance, client's are more motivated, feel more included, and are empowered to learn new ways of doing things. With more of a focus on participation rather than performance, there are barriers that may arise. The obvious one to me is that it requires more effort and judgement from the OT to create an intervention plan that is generalizable for the client to perform in his or her everyday environments. By keeping a holistic perspective, maintaining intentionality, being mindful of client goals, and focusing on adaption, the shift from valuing performance to valuing participation is within reach.

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First I think it is important to advocate for this "shift " towards participation. I feel that just because an individual with a disability does not perform a task in the same manner as someone without a disability, that does not mean they were unable to participate. This can be seen with the task modification for the tag game. While it may sometimes be appropriate to restore a person and rehabilitate them back to their prior level of function, this may not always be the case for some individuals. They may need an adaptation, such as a button hook. That is part of what is so wonderful about the holistic nature of the field. It allows us to use our creativity to make individualized plans that maximize on a person's strengths and abilities to make them able to further participate and function as a contributing member of society. The educational domain within the school setting is an important area of practice which should have much meaning to the child; however, barriers may include lack of motivation, lack of resources, or a lack of interest in the designated task. If lack of motivation or interest is an issue, I would suggest reassessing the hobbies/interests of the client and make activities more client centered.

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Upcoming and current practitioners require a change in perspective in order to promote the evolution of focus in occupational therapy.  Performance is a focus that can be discouraging to a person with a disability, whereas, participation is up to that certain individual and gives them control back to his or her life.  Performance requires a certain amount of judgment on a therapist's part, and it can take all of the control away from the client. Shifting these perspectives can be a monumental gain for occupational therapy, and it can encourage client's to engage in occupations that they may have never considered before. Creating innovative ways to complete meaningful occupations in order to let a person feel included can improve a client's mental health and confidence in their abilities. In the school system, OTs can focus on the underlying deficits a child may have and want to improve them; however, when an OT can have a functional mindset, the child's quality of life can significantly improve.  The terms meaningful and functional are both important to creating a client-centered practice that remains holistic and attainable.

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I think the first thing that needs to take place is education on the benefits of focusing on participation and how that can in hand lead to an increase in performance. Examples like Mr. Kunc’s experience provide individuals with reassurance that this “new” idea actually has substance and makes a difference in the lives of individuals. I personally think focusing on function and it’s value is imperative to optimal services. Being that we are a holistic profession, I think that we should also work to ensure we are not negatively impacting an individual’s mental health. With that being said, I think that focusing on function through meaningful activities and what a person can do ensures that the individual will have increased mental health and self-efficacy in comparison to focusing on the underlying problem and how to “fix it” like in the button board example.

One barrier to utilizing occupation within the school environment is lack of resources. I think that often OT’s repeat the same boring school-related tasks because they do not have a space to work within the school and cannot carry all of their resources with them. This limits the activity choices and can take away the client-centered aspect of the session.

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I will start by addressing performance vs participation. What is performance if the individual is not willing to participate within the task itself? So much of what goes on in school and everyday life is driven by performance. "I have to be the best." "I have to perform well so I fit in/people will like me." "I have to perform well in academics/gym class so I can fit in instead of being different." What happened to trying a hard math problem or attempting a new sport just to feel good about being an active participant? This is where I feel the shift comes into play. We as OTs must focus on celebrating the fact that a child is willing to engage in activities that are difficult for them. Isn't it an accomplishment in itself for the child to first step out on what may feel like a scary "leap of faith" when attempting a difficult task to in-turn reach the end goals of performance? Finally, I feel that both "function" and "meaning" are critical components in addressing both participation and performance. What is meaningful to the child and what allows them to function as independently as possible, I believe, drive desire to participate. If the child has the internal drive and motivation to want to engage and participate the final piece to the puzzle, or performance, should be soon to follow. In other words, function and meaning go hand in hand with willingness to engage or participate which then drives the outcome or overall performance.