יישום הגישה הרב-הקשרית לקידום השתתפות בעבודה של אנשים עם מוגבלות – סקירת תיאורי מקרה

Abstract

Occupational therapists promote engagement and participation in life occupations and performance patterns for people who have various health conditions. Work participation can be influenced by health constraints that hinder adequate performance of job requirements to the point of preventing participation in the field of work overall. The purpose of this manuscript is to show how the use of assessment tools and the metacognitive treatment protocol, both based on the Multicontext Approach, aid in promoting and maintaining work participation. Using two case studies of young adults, who were diagnosed with neurodevelopmental disabilities and impaired executive functions, we will observe changes in occupational performance. Method: Data from a battery of assessments and occupational profiles were taken before and after 10 months of occupational therapy intervention provided according to Toglia's multi-contextual approach. Features from the occupational profile to determine specific occupations and contexts that needed to be addressed were identified. An analysis of occupational performance was done to identify the clients past and present challenges in work performance. The intervention process focused on increasing self-awareness of cognitive performance skills or identifying error patterns that hindered successful performance, emphasizing the enhancement of an adaptive vocational identity. By analyzing various situations from everyday life, the clients learned to identify resources and barriers in the environment, attempted learning coping strategies, and practiced self-monitoring and regulation tools. Implementing the acquired self-strategies within functional cognitive tasks allowed them to remain motivated and reduce self-stigma in terms of not being able to return to work and integrate into the mainstream workforce. Progress: Measured through setting and achieving goals in finding employment and performing job tasks. Results: A detailed description of change in occupational performance based on work integration, status awareness, and the use of compensatory strategies were noted concomitantly with improvement in performance as measured by the various assessment tools. Summary: One may favorably consider writing guidelines for using Meta-cognitive evaluation and intervention tools as an essential component of any occupational rehabilitation assessment and intervention program for working age people who are facing cognitive impairments due congenital and acquired, chronic and variable health conditions.