Understanding and negotiating: Reasoning processes used by an occupational therapist to individualize intervention decisions for people with upper limb hypertonicity

Abstract

Purpose. To describe the processes used by an experienced occupational therapist to make individualized intervention choices to support functional goal achievement for people with upper limb hypertonicity.

Method. This qualitative case study involved participant observation of assessment sessions, interviews with clients and an occupational therapist, and document review. Participants included one occupational therapist and five clients with upper limb hypertonicity. Thematic analysis was conducted to yield results.

Results. Processes used by the therapist included seeking information about the past, present and future, forming a temporary clinical picture, and developing a shared understanding about achievable goals and preferred interventions. Establishing a strong therapeutic relationship and tailoring the provision of information in response to each client's situation and experience was seen as important. These strategies aimed to optimize clients' ability to be an active participant in decision-making, to commit to the chosen intervention and to manage their hypertonicity in the long term.

Conclusions. A holistic understanding of the client's situation provided a basis for negotiating achievable goals and determining preferred interventions.

Keywords:

• Hypertonicity
• spasticity
• upper limb
• individualized approach
• clinical reasoning