Activity Analysis

When I was an OT student one of my teachers made it her mission to provide us with an understanding of the role of an OT.  She wanted us to understand why we’re different from other therapists within our department.  One of the biggest differences was this assignment called an “Activity Analysis” (which took us weeks to complete).  It is the specialty of an OT.  It is what sets us apart from other therapy disciplines.  Our interventions are based on a top down approach where we assess the activity our patients are unable to successfully complete.  From this point, we break down the various components, such as areas of occupation (ADLs, IADLs), client factors, activity demands, performance skills, performance patterns, and contexts/ environments.  Once the patient’s weaknesses and strengths have been addressed and identified, it is anticipated that overall independence and quality of life will improve.


This was my partner and I’s final copy of our activity analysis.


Form 1

Activity Awareness Form

Student:                  Lauren Doss

Date:                         December 4, 2010

Activity:                   Dream Catchers                                                                                                                                                                                                                                                                                                                                                                   Course:                    OT 561. Therapeutic Media

Directions: Reflecting on the activity just performed, complete the following sentences with the first words that come to mind.


  1. During this activity I was thinking about…

the possible ways that this activity could be used in the future with our prospective clients. I considered the ritualistic importance of this activity, which brought me to the conclusion that practitioners should be cautious with this activity’s use. I thought this, because a Native American culture, which is the origin of this activity, could be offended at the production of dream catchers if there’s no meaning behind it. However, if you have a client that is interested in the Native American culture, such as a small boy who plays cowboys and Indians a lot, then this could be an excellent way to get them to open up since you’re actively relating this activity to their specific interests. I thought that this activity would be great for strengthening of various muscles over the body, which would most occur with clients that have physical disabilities or control issues regarding their movements. If you ask the client the sit or stand you could work on strengthening core muscles, leg muscles, hand muscles, and arm muscles. If you have a client that has difficulty controlling their energy by giving them a task with neat history and ritualistic meaning behind it you could help them channel their energy into a purposeful activity.


  1. While doing this activity I felt…

frustrated and purposeful. I felt frustrated, because I had never done an activity like this before. I also did this activity without guidance from instructions, which caused me to use a lot of mental processing and sequencing, more so than if I had used guidance or instructions. Doing a novel activity without instructions created a lot of stress and frustration due to the fact that I was creating a dream catcher for a grade and to eventually teach a class how to make them. I felt purposeful, because I was offering options that my classmates, as future practitioners, could use with prospective clients. I also enjoyed creating something that could be culturally significant, which is always a great thing with regards to being able to relate to specific populations.


  1. In doing this activity, the parts of my body I remember using were…

my hand muscles, my forearm muscles, my arm muscles, my epaxial muscles, my hypaxial muscles, and various parts of my brain and nervous system.


  1. To do this activity I need to (mentally, emotionally, physically)…

mentally prepare for an activity that challenged my mental processing, specifically my sequencing abilities. Also, I need to plan out before hand how much of my materials I will be using in order to ensure that I have all of the resources that I will need. I need to emotionally prepare for the frustration that accompanies the completion of a novel activity without instruction. Physically, this activity made my arms very tired by the completion of my first dream catcher, so I should be prepared for muscle and mental fatigue. I had to pre-plan the spacing that I would be using. I needed a fairly open area that was well lit and clutter free, which had to be thought out before hand, because moving around after you’ve started making a dream catcher is difficult due to the amount of resources and textures of the materials that cling onto the little things that may be sitting near by.


  1. When I do this activity again I will…

consider the group that I’m working with more so than I did this time. This activity was difficult to complete with a large number of people, because each participant needs more assistance than two people could provide. I will also follow instructions when making my own dream catchers, because it was hard to teach a group how to complete an activity that I don’t really know how to complete successfully myself.



  1. From doing this activity I became aware of…

the difficulties that come along with not only completing but also teaching a novel activity. I did something that was difficult and frustrating for me, so it helped me see, first hand, an area that I need self and emotional regulation with. I became aware of my mental processing abilities, because I had not planned to do this activity without instruction. However, for me it seemed easier, which allowed me to inadvertently experience this activity in a graded fashion. We said that if you were working with or trying to push a group that was highly functioning in regards to cognitive abilities then they could try to complete this activity without instruction. I realized that I could be put into this category of highly functioning cognitive beings after we determined that this is how we could grade up, rather than grade down, this activity.

Form 2

Action Identification Form

Student:                  Lauren Doss

Date:                         December 4, 2010

Activity:                   Dream Catchers

Course:                    OT 561. Therapeutic Media


Directions: Select an activity, and using the Do-What-How style, list the major actions (in sequence in 10 steps or less) required for you to perform this activity. Repeat the exercise after observing someone else perform the same activity.

Observation of Another

  1. Wrap the suede lacet on itself and around the metal crafting ring until there is no metal crafting left visually to see.
  2. Tie the end of the lacet in a hitch knot leaving the left over suede lacet hanging down.
  3. Start the loop the sinew around the suede lacet until you complete a circle.
  4. Start to loop the sinew around itself similar to how you complete step 3, until you arrive at the middle of the dream catcher.
  5. Go back outward with the sinew in a reverse manner as step 4.
  6. Tie off the sinew at the point that you tied the suede lacet in a knot in step 2.
  7. Tie feathers onto the hanging suede lacet.

Observation of Self

  • After getting the materials out and ready, I grabbed the ring and began to wrap the suede lace around the metal ring, using a close pin to secure the end of the suede as I wrapped it around
  • Once I had wrapped the suede around the entire ring I cut the string leaving minimal excess lace. Then I used a hot glue gun to glue down the suede lace tip to the suede underneath and pressed down for a couple of seconds
  • Then I grabbed the sinew and tied an initial knot on the ring.
  • Using the directions that I found online I began to tie little hook knots on various spaces away from each other around the knot in a swooping motion. I tied these knots by holding one end of sinew with my left hand while taking the excess sinew and going on the outside of the ring and pulling the sinew back through the center of the ring and then going underneath inside the loop they I just made and pull tight making a swoop like design.
  • I continued to do this around the circle until I got to where I was an then I just did the same pattern just instead of swooping it around the ring itself I swooped it around the previous loops.
  • Once I got to the center and couldn’t make any more loops I tied a double knot and cut the excess sinew
  • I wanted to add feathers so I decided to take some extra sinew and tie a knot with the sinew around my desired feathers then with the other end I tied a knot around the ring.
  • The last thing I did was add a hanging loop at the top. To do this I cut a short portion of suede lace and wrapped it around the top of the ring opposite to where I placed the feathers. Once I had it wrapped around the ring only once I tied a knot and then tied another knot an inch or two up making a hanging loop.


From Hersch, G. I., Lamport, N. K., & Coffey, M. S. (2005). Activity Analysis: Application to Occupation (5th ed.). Thorofare, NJ: SLACK Incorporated. © 2005 SLACK Incorporated.

Form 3

Activity Analysis for Expected Performance

Student:                  Kelsey Bicking & Lauren Doss

Date:                         December 16, 2010                                                                                                      _______

Activity:                   Dream Catcher

Course:                    OT 561


Section 1: Activity Summary

Directions: Respond to the following in list format.


  1. Name & Brief Description of Activity
  • With the supplies provided create a dream catcher in a 20-minute time span by using the directions provided.
  1. Sequence of Major Steps (in 10 steps or less; specify time required to complete each step) (2 Main Steps)
  • After getting the materials out and ready, grab the ring and began to wrap the suede lace around the metal ring, using a close pin to secure the end of the suede as you wrap it around. (3 minutes)
  • Once the entire ring is wrapped in the suede, cut the string leaving minimal excess lace. (1 minute) Then use a hot glue gun to glue down the suede lace tip to the suede underneath and pressed down for a couple of seconds. (1 minute)
  • Then grab the sinew and tie an initial knot on the ring. (1 minute)
  • Using the directions began to tie little hook knots on various spaces away from each other around the knot in a swooping motion. Continue to do this around the circle until you arrive at the initial knot then continue the same pattern just instead of swooping it around the ring itself I swooped it around the previous loops. (5-10 minutes)
    • Explanation for a hitch knot: hold one end of sinew with left hand while taking the excess sinew with your right hand and going on the outside of the ring then while wrapping it around the ring pull the sinew back through the center of the ring. Then bring the sinew inside the loop that was just made by going underneath and pull tight and repeat, making a swoop like design.
  • Once at the center tie a double knot and cut the excess sinew (1 minute)
  • Add feathers or any decorations you wish. (1-2 minutes)
  • Add a hanging loop at the top by cutting a short portion of suede lace and wrap it around the top of the ring opposite to where you placed the feathers. Once wrapped around the ring only once tie a knot and then tie another knot an inch or two up making a hanging loop (2 minutes)




  1. Precautions (review “Sequence of Major Steps”)
  • Be careful when using the suede lace that someone does not use it to hurt themselves for example by placing it around their neck. When using close pins be sure that the client is not using them to pinch themselves.
  • Hot glue can burn an individual so make sure that are careful when using this by using sometime of buffer such as a cardboard stick to block the heat from burning the clients fingers. Or you can tie the suede lace around itself so you do not have to do this step.
  • With sinew make sure the client does not try to ingest the sinew because this is something they could potentially choke on, same goes for the feathers and beads if you use these you need to be mindful that someone could ingest them.


  1. Special Considerations (age appropriateness, educational requirements, cultural relevance, gender identification, other)
  • Age/Population appropriateness: This group was designed for OTS and clients with physical disabilities. Creating a dream catching requires a high level of cognitive functions so you would not want to do this activity with younger children because it would be too complex. Therapist should evaluate their client’s joint stability, because this activity is not suggested for clients who have joint stability issues, such as arthritis. You also wouldn’t want to do this with older adults with dementia but rather maybe older adults who are still functioning on a high cognitive level and maybe younger adults.
  • Educational requirements: You must be able to read and follow directions in order to complete this activity. Also, like mentioned above you must be able to think at a higher cognitive level
  • Cultural Relevance: Dream catchers are particularly relevant to the Native American culture and hold spiritual value to their culture and ways of life, but it is not an activity that is secluded to this culture only it is a wide spread interest across the United States.
  • Gender Identification: Making dream catchers are neither a male or female activity, it would be considered a unisex activity


  1. Acceptable Criteria for Completed Activity
  • Every member has a dream catcher to take home with them
  • The suede is laced around the entire metal ring not exposing any gold metal
  • The sinew is wrapped around the ring in a web shape format
  • The dream catcher is has personal touches unique to each group member
  • It resembles the model dream catcher we gave as an example.
  • No one is injured or hurt during the activity
  • Everyone enjoys the activity
  • The group members work together to get through any obstacles or hardships they encounter





  1. Activity Demands
  2. Objects & Their Properties (tools, materials, equipment, inherent properties)
  • 3-25 yard rolls of genuine suede lace (colorful, texture is rough)
  • Approximately 50 feathers of various colors (colorful, texture is soft)
  • 3” diameter metal craft rings (shiny, smooth in touch)
  • 25 yards of sinew. (texture is filmy)
  • Leather glue/hot glue (temperature hot)
  • Beads (colorful-visual stimulus)


  1. Space Demands (size, arrangement, surface, lighting, temperature, noise, humidity, ventilation)
  • Size of group: We did this with a group of 20 students, however because of the cognitive requirements for this specific activity it would have worked better for a group of four participants rather than 20, which would allow for more one-on-one help.
  • Arrangement: We arranged the tables so that there were 5 groups of four. The tables were in an L-shape, which helped us encourage the participants to share and help one another through the activity.
  • Environmental needs: This activity requires lighting that would be adequate for reading or other ‘close work’. The temperature of the room should be around 70 degrees with low humidity to limit the amount of residue that is left on the hands from the sinew. The workspace should contain only the materials & supplies needed and external distractions, such as noise, should be kept at minimum due to the amount of concentration required.


  1. Social Demands
  • The group was structured so that three group members shared one glue gun, which helped the facilitators promote sharing and social interaction. The group members at each table also had to share the feathers and decorative beads.
  • This set up facilitated interactions amongst members. Those who finished early because they understood the activity were able to assist those individuals who were having trouble.


Section 2: Analyzing Performance Areas of Occupation

  1. Activities of Daily Living (ADL)
  2. Bathing, Showering


  1. Bowel & Bladder Management



  1. Dressing: Making dream catchers requires you to use fine motor abilities along with mental processing and sequencing. Fine motor movements of the hand are used in wrapping the suede lacet around the metal crafting ring along with braiding and weaving the sinew around itself. Cognitive processing is required along with sequencing to plan when and where the weaving and braiding of the lacet and sinew should occur. Performing this activity allows you to strengthen the muscles in the forearm and hand that are used for buttoning, zipping, and tying of clothing articles. Making dream catchers allows clients to improve their cognitive skills, specifically motor planning, mental processing, problem-solving and sequencing, which are all needed for dressing. For example, when buttoning a shirt you have to make sure that the correct button goes into the correct hole. If you put the wrong button into the wrong hole you have to problem-solve a solution, but proper sequencing prior to the buttoning process can prevent this. All of this can be improved and practiced in the making of dream catchers.


  1. Eating
  • This activity works with sequencing, eye-hand coordination, and manipulation of tools for an end product. These are all tasks that are useful with eating.
    • Processing and sequencing are practiced with dream catchers by knowing how and when to make certain loops and weaves to make a dream catcher. While eating you have to preplan the steps of eating. For instance, you have to direct your attention to the food you are eating, then figure out how to get the food to your mouth, then get it into your mouth, then chew, then swallow. This is a vague comparison, but the same processing skills are used for each activity. You have to sequence the steps in your mind prior to performing them, so this activity could help improve cognitive processing.
    • Eye-hand coordination is used with both activities. Eye-hand coordination, in making dream catchers, promotes clients to see where the looping and weaving needs to occur, which then directs your hands into the correct placement to accomplish this activity. When eating, you have to get the food from your plate or bowl into your mouth. The eyes, along with proprioception, are used to guide the hand to the mouth before chewing can commence.
    • Tools are used in both the making of dream catchers and eating. With the dream catchers the tools are the metal crafting ring, the suede lacet, and the sinew. You use these tools to create a dream catcher. When eating, spoons, knives, and forks are used to get the food into the mouth. Because you are not using your hands as the tools your brain has to process how and where the tools should be placed in order to complete the final task of either eating or making dream catchers. By making dream catchers in therapy the OT could help improve and strengthen the clients’ abilities to do this, which would later be used when the client is independently living if that’s their final goal.


  1. Feeding



  1. Functional Mobility: This activity can be used to promote functional mobility. This is true, because preparation and clean up require individuals to move around the room looking for and organizing the necessary materials, while cleaning up requires the participants to either store or discard of the materials that weren’t used. In doing this, therapists can assess how well their clients move throughout their immediate environment. This activity can be used to optimize independent living by improving the client’s ability to functionally move around their home, which could be assessed by the Kohlman Evaluation of Living Skills.


  1. Personal Device Care



  1. Personal Hygiene & Grooming



  1. Sexual Activity



  1. Toilet Hygiene



  1. Instrumental Activities of Daily Living (IADL)
  1. Care of Others



  1. Care of Pets



  1. Child Rearing



  1. Communication Management



  1. Community Mobility



  1. Financial Management



  1. Health Management & Maintenance



  1. Home Establishment and Management



  1. Meal Preparation & Cleanup

This activity is not messy, but there is a bit of clean up required. By promoting clean-up and preparation of this activity OTs can facilitate the mental processing, attention, and sequencing along with the functional mobility required for meal preparation and cleanup in their independent lives at home. Prior to this activity, the suede lacet and sinew should be measured and cut. The metal crafting ring should be set out, and the decorations used afterwards should be set out. All of this should be done in an organized and clutter-free way. After the completion of this activity all of the excess materials should either be put away or thrown away. When preparing a meal the materials needed for cooking and baking should be set out in an organized, safe, and clutter-free way. When the meal preparation is complete the excess food and materials should either be discarded or put away. By activating the neuronal pathways that make the functional mobility, needed to move around a room for clean up or preparation, possible the client has the potential to improve upon their processing skills, such as their sequencing, sustained attention, and pre-planning skills that affect their day to day living.


  1. Religious Observance



  1. Safety Procedures & Emergency Maintenance

Safety precautions should be recognized and promoted with both of these activities. While preparing the dream catcher materials, it is likely that scissors will be used, sitting around, and transported for preparation and clean-up. Effective transportation and storage of scissors is imperative for preventing accidents. It is important that OT clients recognize these situations, because they can be directly related to meal preparation where knives or other sharp utensils are used. Making dream catchers allows OT clients to practice their safety precaution awareness and implementation through sequencing and precautionary measures, which are useful in the home. Scenarios could be give before, during, or after the dream catcher activity to ensure that the OT client knows what to do in case of an accident. For example, the OT could ask while the client is cutting their sinew what they would do if they cut themselves badly. The client should give a response of calling 911 or requesting help from their caregivers. Afterwards any bodily fluids that were left on the floor should be cleaned to prevent slipping later. This is a concept that is with the KELS assessment tool, so this could be practice for actual assessments that determine whether or not the client is ready for independent living.


  1. Shopping
  • The facilitators could ask the clients to shop for the materials used rather than simply providing them for the participants. Shopping is an instrumental activity of daily living, so through this activity we could practice, improve, and facilitate independence in our client’s daily lives by requiring the client to purchase the materials prior to the acitivity.


  1. Rest & Sleep
  2. Rest



  1. Sleep



  1. Sleep preparation
  • Dream catchers are intended to catch bad dreams for their owners. If clients are having night terrors or bad dreams in general the dream catchers could be incorporated into the client’s nightly sleep preparatory routine to reduce anxiety around going to sleep. A specific population this could be used with are small children around the age of five or six. You could have the client touch the dream catcher before bed or say a sleep poem while holding the dream catcher to facilitate this process.


  1. Sleep participation



  1. Education
  2. Formal Educational Participation
  • This activity was used in a formal education setting. The purpose of our activity was to allow the participants to experience a novel activity and the frustrations that accompany that. This promotes the participants’ ability to empathize with someone who is experiencing difficulty with a novel activity. We also wanted to demonstrate different facilitation techniques, like structuring of the room and instruction guidelines, that could be used with facilitations that they might perform in the future with their careers or community service experiences.
  1. Informal Personal Educational Needs or Interests Exploration
  • This applies to the dream catcher activity, because if someone is interested in pursuing specific cultural learning activities then making dream catchers would be a great way to explore the Native American culture. However, this could also be a self-learning activity if an individual wants to learn about themselves and how they emotionally regulate with the stressors of learning a novel activity.
  1. Informal Personal Education Preparation Participation


  1. Work
  2. Employment Interest & Pursuits
  • This activity would be a great way to explore one’s ability to facilitate groups, social activities, and novel activities within a therapeutic or learning environment. For example, if someone is interested in seeing whether or not they wanted to be a teacher they could perform this group facilitation activity to see what they need to improve upon personally in order to successfully facilitate an activity. Another example of someone who would benefit from this acitivity facilitation would be someone whose interested in crafting activities. They could perform this novel activity to see if they have the emotional regulation and skill set required to pursuing crafting as a career.
  1. Employment Seeking & Acquisition
  • Again, if someone wants to pursue a career in crafting or teaching this activity could be used to build experience that could be used within their unique setting. This activity could be seen as a “resume builder”, which refers to improving and accumulating skills that would benefit their career or job choice.
  1. Job Performance
  • This activity could be used to improve job performance, because of the skills that are focused on within the creation of dream catchers. If a seamstress or tailor are your client within the therapeutic setting then you could use this activity to creatively work on hand strengthening or sequencing skills to prepare them for reentering the work field.
  1. Retirement Preparation & Adjustment
  • This activity could be used as a coping strategy for life changes, such as retirement. Older individuals who are retiring may experience a lack of purpose within society and their lives. By learning a new activity that will occupy their time they can increase their level of productivity in their daily lives. This activity could provide that for them. This activity could provide a way to remain active physically and cognitively, which is important for successful aging.
  1. Volunteer Participation
  • This activity could be used within the mentoring or volunteer setting, which fits into an individual’s ability to participate in volunteer work. Focus, in this case, should be emphasized on facilitation abilities, fine motor skill acquisition, emotional regulation, and social interaction to promotes one’s ability to perform this activity within the volunteerism setting.
  1. Play
  2. Play Exploration


  1. Play Participation



  1. Leisure
  2. Leisure Exploration
  • This activity could provide insight into one’s leisure interest. If someone is interested in finding out whether or not they would enjoy or be good at crafting activities they could perform this activity.
  1. Leisure Participation
  • This activity could be used as a leisure activity in the retirement population. As previously stated, this activity could help bring meaning to someone or help facilitate coping strategies for stress and emotional regulation through a leisure activity.


  1. Social Participation
  2. Community
  • This activity could be used within the communal setting in order to promote social interaction and communal relationship formation. The focus would be on the social growth of a community rather than acquiring skills with crafts in this case. By performing this leisure activity or by learning a novel activity together a group can emphasize communal growth with regards to relationship improvement.
  1. Family
  • This activity could be used within families to promote quality time together. Parents and their kids could use the time to work on communication skills while facilitating emotional regulation through modeling. This would give purpose to family time spent together, which would promote feelings of support and parental involvement for the children.


  1. Peer, Friend
  • This activity could be used in support groups or friendly gatherings as purposeful interactions. Groups might not be motivated to continue meeting if socialization is the only purpose, but if you add in an activity with these gatherings then participants might be more motivated to attend the meetings. It also provides focus and goals to the meetings, which promotes personal growth along with social interaction.

Section 3: Analyzing Performance Skills & Client Factors

Part I. Performance Skills


  1. Motor & Praxis Skills
  • Wrapping the suede lace around the metal ring
    • The individual must remain stabilized in their chair, with postural control in both their trunk and lower limb muscles
    • Coordinate upper body movements. Both shoulders abducted approximately 25 degrees and internally rotated approximately 20 degrees, scapula protracted, arm flexed approximately 100 degrees wrist flexed 15 degrees when reaching for the ring with your non-dominant hand and the suede with dominant hand
    • Grasp the ring with a cylindrical grasp through manipulation in your non-dominant hand. In order to do so the metacarpalphalangeal joint of all digits must flex allowing you to grasp the ring. After picking up the ring you can alternate the cylindrical grasp by applying more pressure and stabilization with opposition of digit 1 and digit 2.
    • Grasp the suede lace and place one loose end under your tight grasp of ring and begin to wrap the suede around by keeping the hand in a pronated position as you wrap it around once and pull then pull tight using pincer grasp.
    • Anticipate next movement and adjust posture when necessary.
  • Tying little hook knots on various spaces away from each other around the knot in a swooping motion.
    • Again, stabilize and coordinate movements from both sides of the body
    • When tying the initial knot you must manipulate the sinew in with mainly digits 1 and 2 in opposition in a pincer grasp in both hands with coordination between both of them.
    • When tying the next knot you can rest the ring in the palm of your hand and hold the knot in opposition with the non-dominant hand and pronate and supinate arm to wrap around the ring.
    • Then with the non dominant hand pull the loop and hold in opposition between digit 1 and 2 while pulling the end of the sinew through the center of the ring and up into the loop between where you are holding the sinew and the ring then pull tight and repeat through pronation followed by supination of the forearm This requires hand strength and finger manipulation.


  1. Sensory-Perceptual
  • Wrapping the suede lace around the metal ring
    • Using proprioception and vision locate all of the materials from the center of the table
    • Through tactile sensitivity respond to the texture of the suede and the combination when wrapped around the metal ring
    • Visually concentrate on wrapping the suede around the ring through eye-hand coordination.
    • Position the body to where you can see what your hands are doing and where your upper body has room to move freely
  • Tying little hook knots on various spaces away from each other around the knot in a swooping motion.
    • Through vision and proprioception locate where you would like to place your initial knot
    • Through tactile sensitivity respond to the texture of the sinew and the combination of holding the suede wrapped ring
    • Usnig vision and proprioception provide the adequate amount of space between each hook knot
    • Again, visually concentrate on tying the knots using eye- hand coordination
    • Using proprioception, vision, and the vestibular system know where your upper extremities are and the movements they are performing


  1. Emotional Regulation
  • Tying little hook knots on various spaces away from each other around the knot in a swooping motion.

This is the step that challenged everyone and appeared to be frustrating for the members. The members found the directions to be difficult to follow. Many of the participants could not figure out how to complete a “hitch knot”. Because of this we hope to facilitate coping strategies for the stress the participants experience with future use of this activity. The frustration of this activity could affect one’s self-efficacy or participation in this activity. Participants that know they don’t like to perform crafting activities may have mentally shut down before the activity even started, which could have been a cause for the tension within the groups. Many of the participants were verbal and obvious, through lack of persistence in the activity, about their frustration, which points to impulse-control issues. We saw a few group members express their frustration of not understanding how to complete this step and others who continued to persist in the activity. We also saw a couple members quit and give up because they were too frustrated to continue to try. Some of the participants problem-solved and came up with new ideas of how to create a web like design without following the specific directions and example provided. This affected the group dynamics in a negative way, so for future facilitations the facilitators could promote behavioral and emotional regulation. This will be important for future facilitations, because inability to cope with these problems obviously affected the group members’ abilities to cognitively process this activity.

  1. Cognitive
  • Wrapping the suede lace around the metal ring
    • Each member selected the color of suede they wished to make their dream catcher out of, tan, red, or green. And using various reasons whether it be for their favorite color, or it was the only one available, or the color they planned to use
    • Each member had to sequence the process of wrapping the suede around the ring
    • Pick a specific spot in which to start to wrap the suede.
    • Choose whether to glue the suede lace down or wrap it around itself
    • Concentration and attentiveness to the activity rather than other distractions
  • Tying little hook knots on various spaces away from each other around the knot in a swooping motion.
    • Read directions on the sheet and process the information while also remaining attentive to the task and to the verbal directions
    • Visually plan the end result
    • Sequence the steps involved of how to create a hitch knot
    • Or some members choose to freehand different knots throughout the ring creating their own personal design rather than following the specific pattern and template provided
    • Judge the distance between each knot in choosing where to place them.
    • Organize and complete this novel activity within allotted time frame
    • Concentration and attentiveness to the activity rather than other distractions.
    • This activity helps promote cognitive flexibility. We saw this in one participant specifically. This participant was wrapping the sinew around the outside of the metal crafting ring rather than working internally of the ring.       This participant had to change her perspective of the activity in order to successfully complete it.
    • Concept formation – knot Concept formation was evident in the learning of the hitch knot. That’s a task that not many of the participants had much experience with, so they had to sequence, plan, and learn new tasks and skills in order to successfully complete this activity.
    • Spatial & temporal relationships Spatial and temporal relationships were a major component of this activity. This is true because the participants had a time limit to work with along with spatial restrictions due to the group format of this activity. The participants had to finish the activity within 15 minutes, which added an extra element of stress along with working within a confined space due to the fact that three other participants were sharing the table with them.
    • Recognition Pattern recognition was used with this activity, because you had to establish a rhythm or pattern in order to create the design with the sinew. The participants had to plan and sequence their hand movements in order to produce an intricate design with the sinew, which required recognition skills.


  1. Communication & Social Skills
  • All Steps
    • Looking at what everyone else is doing and how they are doing it and how it differs from the way you are doing it
    • Taking turns on using the hot glue to secure the suede around the ring
    • Acknowledging other individuals at the table that are struggling and assisting them when capable
    • Work through directions and frustrations together
    • Initiating questions to facilitator or classmates when in need of assistance
    • Maintaining adequate personal space from other group members, making sure you are not in their way
    • Talking to each other and sharing with the class about their attitudes and thoughts toward the project and the cultural relevance behind the activity
    • Ability to work well in group setting sharing materials


Part II. Client Factors

  1. Values, Beliefs, & Spirituality
  2. Values
  3. Person
    1. This activity would be great for a person who values cultural learning, because of the insight it provides into the Native American culture.
    2. People who like to promote and facilitate creative activities that challenge their ability to sequence and plan fine motor movements, such as those required for the weaving, would also be individuals suited for this activity.
  4. Organization-
    1. JMU promoted this activity facilitation within the Occupational Therapy program for educational purposes for the students.
  5. Population
    1. Promoting openness to different cultural activities and ceremonies aids in a community’s cultural education along with promoting diversity beliefs, values, and spiritual experiences.
    2. Beliefs
    3. Person
  6. If someone feels that this is a violation of their own personal beliefs then therapists should hesitate to use this activity with that person, but if this is the group activity that was planned for that day then the client could help with preparation and cleaning afterwards.
  7. Organization
  8. If an organization doesn’t want spiritual beliefs promoted in their name then therapists or facilitators should use caution with this activity. By performing a cultural activity some individual’s may view this as a stand for cultural diversity acceptance, which may not be in certain organization’s best interest.
  9. Population
  10. A population that would promote or benefit from this activity would be the Native American culture because of their beliefs behind it, which refer to the catching of nightmares.
  11. Spirituality
  12. Person
    1. There is spiritual meaning behind making a dream catcher. Dream catchers are used to protect people from nightmares by catching them in their weaving.
  13. Organization & Population
    1. This activity could be used for spiritual exploration in the school or communal setting. For example, if a group is interested in the Native American spirituality they could perform this activity to gain insight into this culture and the possible meanings behind their way of living.


  1. Body Functions
  1. Mental Functions
    1. Higher level cognitive functioning
      1. Concept formation-
        1. Using all the materials provided to develop an idea of what you want your dream catcher to look like in the end
        2. This was used with learning the steps to tie the hitch knot. For most of the participants, this was a novel task, so they had to mentally sequence along with using pattern recognition what the most effective way was to complete the hitch knot. This is true if they didn’t follow or couldn’t decipher what the written instructions were for making the hitch knot.
      2. Concept flexibility-
        1. Allowing yourself to think outside the box and adding your own personal touch to the dream catcher.
        2. This characteristic can be defined as the ability to think about solving problem from different perspectives, which as stated previously was exhibited by one of the participants.
        3. When issues arise about specific knot to be used such as hitch knots your ability to continue to try to master the knot or perhaps develop new ideas of different knots that would work and try those.
        4. Instead of using the hot glue to secure the suede onto the ring, creating a new way to tie it over itself
  • Judgment-
    1. Ability to judge how much suede you will need to wrap around the ring.
    2. Ability to judge where to tie the hitch knots and how much space to allow between each one.
    3. Whether or not to add beads anywhere on the dream catcher
    4. Where to end the center of the dream catcher
  1. Attention-
    1. Sustained attention: concentrating on the steps to making the dream catcher for 15 minutes
    2. Selective attention: to listen to facilitators and concentrate on the process of creating a dream catcher and not getting distracted by side conversations in the room or objects in the room, or thoughts about the test that we have in the next few days
    3. Divided attention: finishing creating the dream catchers and making the knots while also participating in discussion about the activity and giving valuable feedback to facilitators
  2. Awareness- members need to be aware and of where they are and what they are doing in order to focus and complete the dream catcher.


  1. Memory
    1. Immediate Memory/working memory
      1. Listening to directions and demonstrations presented by the facilitators and recalling how to make a hitch knot and how to start the initial knot process
    2. Short Term Memory
    3. Ability to take directions and replicate them from visual pictures on

the handout instructions

  • Long Term Memory
    1. If any of the participants have crafting experience this could be applied to making dream catchers. For example, if the participants have braided or woven string before there are similar hand movments, which could be recalled from long term memory to assist in the completion of a dream catcher.


  1. Perception- multi-sensory processing
    1. Tactile: ability to process the different perceptual feelings of the metal ring, the suede lace, the sinew, the beads the feathers, and recognize the differences of texture of each of these items
    2. Visual: ability to process all the different colors incorporated within the project, the multiple colors of suede string available, beads and feathers and ability to recognize the different colors.
  • Vestibular- knowing where you body is in space and being able to balance yourself in your chair while making the dream catchers with the upper extremity muscles
  1. Proprioception– this applies to the force that has to be appliedon the sinew in order to pull the weaving tight along with the position of objects in relation to yourself or other objects, which refers to the participants crafting project in relation to those around them and the supplies or materials around them
  2. Spatial relations- ability to perceive and understand the spatial differences between each of the hitch knots of sinew in the dream catcher, ability to plan accordingly with the initial size ring that was provided.


  1. Thought
    1. Recognition
      1. When wrapping suede around the ring
        1. Ability to recognize how much suede you are going to need and recognize if you do not have enough.
        2. Ability to sequence and begin to wrap it around by recognizing that this task requires both hands
      2. Tying little hook knots on various spaces away from each other around the knot in a swooping motion.
        1. Recognizing the sequence of how to complete a hitch knot
        2. Following the directions provided of how to proceed to make a dream catcher
      3. Categorizing- the different feathers and beads that you intend to use and where you intend to use them
  • Logical/coherent thought-ability to problem solve when you can not find a way to make the web with the sinew or tie a knot.


  1. Mental Functions of sequencing complex movements
    1. Planning and executing the sequential movements of wrapping the suede around the ring and tying various knots around to create a web like design in the center of your ring.


  1. Emotional (Discussed in part one performance skills)


  1. Experience of Self & Time
    1. Self-esteem-several members felt embarrassed that they could not wrap their head around the design of tying knots in the center of the ring. Self-esteem issues may have contributed to the lack of persistence with this activity for some of the participants.
    2. Self-conscious-it was noted that some members felt self-conscious about their dream catcher when they were done because it did not look like the example or it was different than other members, leaving members with a sense of disappointment or discouragement and frustration


  1. Global Mental Functions
    1. Consciousness– members must be alert and aroused and functioning so that they can process and comprehend the directions and think through the process of making a dream catcher and problem solve when necessary.


  1. Orientation– members must be oriented to the person, place, time, self and others so that they can socialize with other group members and comprehend the idea of how to wrap the suede around the ring or tie the knots to make a web like design. If they are not aware of where they are or who they are most likely they will be unable to process and sequence the steps to complete a dream catcher.


  1. Temperament & Personality– (Discussed above) Members must be emotionally stable and able to regulate their emotions so they do not hurt themselves or others during the group. Also, it is important that all members have an optimistic, open minded view on the activity and not allow unconstructive thoughts or attitudes to bring themselves or others moods down.


  1. Energy & Drive– Group members must be motivated to complete the dream catcher to the best of their abilities. They also must manage their impulse control which goes along with temperament & personality. Members must control urges in order for the group to run smoothly


  1. Sleep-Members need to be awake and functioning and in order to do so they need to have slept the night before or else it will impact their performance because they will be tired and unmotivated and grouchy.


  1. Sensory Function & Pain


  1. Seeing & relating functions
    1. Visually scan and register the materials and read the directions and see the examples and demonstrations
    2. Coordinate eye and hand coordination by watching what you are doing when wrapping the sinew around and processing this visual information in your brain and responding through different actions.
  • If a member were unable to see this activity would be rather difficult and near impossible due to the reliance on eye-hand coordination and complexity of the fine motor skills need with your hands.


  1. Vestibular functions: ability to remain seated and balanced in chair with upper extremities moving against gravity throughout all the steps


  1. Proprioceptive functions:
    1. Awareness of body placement and what your hands and arms are doing when wrapping the suede around the ring and tying the sinew around the ring. It is essential that you understand how your muscles are working together to make the dream catcher. Therapists have to be aware of the force that needs to be put on the materials, because this could affect what clients they work with.
    2. Understand how some other individuals have trouble with this and how that would affect their ability to make a dream catcher. If an individual could not understand where their arms are in space they would be unable to coordinate movements. For example, an individual with a stroke that affects the left side of their body in which they actually neglect their left side. You would not want to do this activity with this individual early on in treatment because they will not have the proprioceptive abilities to understand where their left arm is and how to use it in coordination with the right arm. However, later on in treatment you can do with this with them so they practice using both arms in conjunction with one another and practice not neglecting the left side.


  1. Pain/Temperature/Pressure:
    1. Muscle ache from fatigue in hand muscles: several members experienced fatigue in their hands from the extensive strength and pressure that is put on your fingers when holding the loose end of the suede when wrapping around the ring.
    2. Burnt hands: several members experienced pain with the hot glue guns because they got some of the hot glue on their hands
  2. Neuromusculosketal & movement-related functions
    1. Joint Mobility (ROM) (specifics are found in the section above)
    2. Joint Stability
      1. Joint stability must be considered for this activity due to the forces that are put on the materials from the fingers. For example, if someone has recently had flexor tendon surgery you might not want to use this activity with them, because the extra applied force on the joints may cause more damage then benefits.
    3. Muscle Power
  3. When wrapping the suede around the ring you must apply approximately five to ten pounds of pressure with your non-dominant hand that is holding the end of the suede down which requires moderate hand strength.
  4. When tying knots with sinew it is also important that you have moderate muscle strength in your arms and fingers (specifically: the ability to apply five to 10 pounds of pressure to the materials) so that you can do the fine motor skills required and also pull the knots tightly although this is not as strenuous as when wrapping the suede around.
    1. Muscle Tone
  5. In order to complete the multiple muscle hand movements required to wrap the suede around the ring it essential that an individual has muscle tone. People need tone to allow for free, voluntary control of muscles approximating ‘typical’ AROM particularly within UE. For example, if your client is suffering from spasticity it would be difficult for them to perform fine motor skills without excessively tensing the muscles to the point of injury or pain. An individual with low muscle tone for example, an individual with flaccidity would be unable to hold movements such as holding the ring while you wrap it around & apply adequate force.
  6. Muscle tone is even more important for the smaller more precise movements required when tying a knot. With too much tone you would be stiff and unable to perform the bilateral integration between fingers that is required when you tie a knot. With low tone you would be unable to grasp the sinew and pull it tightly


  1. Muscle Endurance
  1. The repetitive fine motor movements preformed by your hands when making a dream catcher require that you have the ability to tolerate approximately five to ten pounds of force in your hands against gravity with multiple repetitions for 15 minutes.
  2. The tying step requires similar demands.


  1. Motor Reflexes: There are no real reflexes thrown into this activ
  2. Involuntary Movement Reactions
  1. As you are sitting in your chair you are unconsciously making postural adjustments to allow you to remain sitting up straight and remain seated. These come from your righting and equilibrium reactions to help keep your body in balance from your lower extremities, trunk, upper extremities, head and neck.


  1. Control of Voluntary Movement
  1. Eye-Hand coordination is necessary in order to make a dream catcher. An individual has to coordinate visual cues with what they are physically doing with their hands. This is needed in both wrapping the suede around the ring and tying the sinew around as well. You need to see what you are doing.
  2. Bilateral integration is needed between both of your arms. Your arms and hands must work together to wrap the suede around the ring. Having your dominant hand actually doing the wrapping and leaving your non-dominant hand to grasp and hold the ring. Your arms and hands must also work together when tying knots along the circle with the sinew because you use you non-dominant hand again for stabilization of the ring but when tying the actual knot your non-dominant hand will move to hold the loop formed and while your dominant hand wraps the sinew around the outside of the ring, pulls it through the center and then through the loop between the sinew and the rings to create a hitch knot.
  3. Depending on where the materials are placed there may be some crossing the midline going on, but it varies on how each individual chooses to do it. One individual may do it completely different than another by switching their dominant and non-dominant hands while doing this activity when one gets tired
  4. Fine motor control in your hands is essential for this activity to allow you to tie the knots and also wrap the suede around. You must have enough control to steady hold the ring without dropping it by holding it in different grasps. In order to grasp these objects with a pincer grasp you must have the fine motor skills to coordinate and hold these positions.
  5. Oculomotor control is important in scanning the room and table for supplies and also when reading the directions on the sheet provided. Usually when reading our eyes used saccades to read left from right. Also our eyes will accommodate for distance changes if we happen to move our hands further away from us. You must also have oculomotor control to allow you to follow what you are doing as you wrap the suede lace around the ring to follow how far you have gone around the ring. Also, oculomotor skills are used when trying the knots allowing you to accommodate from the larger suede to the smaller harder to see sinew.


  1. Gait Patterns: Because there is no walking required for this activity, this could not be assessed during this activity


  1. Cardiovascular, hematological, immunological, & respiratory function
    1. Cardiovascular functioning
      1. Specifc MET levels will be discussed later on within this paper, but overall this activity does not require high levels of endurance. However, when group members were getting frustrated with the directions and not understanding or comprehending how to do the activity this caused increased stress and nervousness which appeared to affect some individuals’ blood pressures and heart rates.
      2. So, you would probably not want to do this activity with a high stress group because this may set them over the edge and cause serious health conditions or a severe panic attack.
    2. Hematologial and immunological functioning
      1. This activity did not incorporate any hematological or immunological functioning. However, if a group member happened to be allergic to one of the materials used this could impair their immune system by causing them to have an allergic reaction.
    3. Respiratory functioning & additional functions
      1. Respiratory function is affected by this activity. However, it was noticeable that some of the participants were breathing harder and sighing when they became frustrated with this activity. The acquired stress and frustration from this activity caused an increase in labored breathing, which allows us to realize the importance of emotional regulation and stress coping strategies for this activity.


  1. Voice & speech functions
    1. The social aspects incorporated into this activity like sharing and assisting others involves voice and speech functions. Group members must be able to communicate with other group members in the process of sharing the materials and also must be able to communicate any questions that they have. If a group member was deaf and unable to speak we could give visual directions and communicate through non-verbal, sign language, and written words.
  2. Digestive, metabolic, endocrine system function
    1. Members need to have adequate nutrition and metabolic functioning to participate within this task. It is important that group members have eaten and hydrated because if not this could affect their performance. When an individual is really hungry they are unable to focus and it affects the mood and overall ability to complete the activity to the best of their abilities. Some endocrine imbalances may affect mood as well which could relate to emotional regulation & cognitive performance.


  1. Genitourinary & reproductive functions
    1. If an individual has difficulty controlling their bowels or bladder functioning they will have not only be distracted and unable to fully concentrate and focus on the activity but also their performance in making a dream catcher will be affected. They will be interrupted for bathroom breaks unless they are wearing some kind of depends diaper in which they would not have leave to go to the bathroom while participating in the activity so group members need to be mindful of their expressions and attitudes and make sure they are making the individual feel welcome and comfortable.
    2. Making dream catchers does not directly relate to reproductive functions, however if an individual were pregnant and participating in this activity their mood and may be affected. When a woman is pregnant their body is undergoing both physical and hormonal changes which affect the individual’s mood and attitude so as OT facilitator you need to be aware of this and accommodate for them. A pregnant woman will get fatigued faster and have to urinate more often affecting the quality of their dream catcher. Doing activities such as making a dream catcher could have a calming effect on the mother and the unborn child.
  2. Skin & related-structures & function
    1. Elderly individual’s skin is much thinner and more easily damaged so they may be injured more easily during the making of a dream catcher.
      1. When wrapping the suede around the metal ring or during the process of tying the sinew an elderly individual’s skin could potentially crack because of the strength and pressure applied to the finger tips. You could try having the elderly individual wear gloves or try a different material to protect the skin on their hands from damage
    2. If a group member already has an injury or cut to their skin it is important that you are aware of this because if they got glue or other materials into their wound it could cause an infection, so if someone does have a cut make sure they are wearing a band aid so their wound is protected.
    3. When using a hot glue gun there is always the chance that a group member my burn themselves damaging their skin tissues. That is why it is important to take necessary precautions by using a barrier to put between them and the hot glue.
    4. Body Structures
  3. Structure of the nervous system
    1. Primary Somatosensory Cortex located in postcentral gyrus of cerebral cortex of the brain would be involved with the tactile information that is received from the different textures of the metal ring, suede, sinew and feathers. Also, the pressure that is being applied by your fingers when you wrap the suede around would be processed in this center through peripheral receptors located under the skin such as Merkel’s disk, Meissner’s corpuscle, and Ruffini’s ending which are specific receptors for pressure, buzzing or flutter, and joint movement. These would all be processed and sent back to the brain through the dorsal-column medial lemisical pathway. The stimulus experienced from feeling the warmth or pain from the hot glue gun will activate the anterolateral system.
    2. Because of the various sensory systems that are stimulated when making a dream catcher it is necessary that your visual cortex, auditory system, and vestibular system are all working together to process sensory information. Your visual cortex will process the visual stimulus that you see in the various colors used within this activity, the auditory cortex will process the directions you hear from group leaders and group members as well as other noises in the classroom. Your vestibular system will work to keep you balanced and help with eye hand coordination.
    3. After your brain generates a plan to do a specific movement from the motor cortex in the precentral gyrus of the cerebral cortex it sends a message through the spinal cord to the peripheral nerves in your fingers and arms such as median nerve, radial nerve, and ulnar nerve that innervate the muscles allowing you to move your hands and arms allowing you to do the actions required for making a dream catcher.
    4. In order for you muscles to contract and perform the movements required for this activity actin and myosin must be working and sliding over one another correctly in the sarcomere.
    5. When tying the sinew around the ring and following the directions it is essential that your prefrontal and posterior parietal cortices are working to allow you to think abstractly, and make decisions about where to tie knots to what color suede to use to wrap around the metal ring, and anticipate what the dream catcher will look like if you were to tie a knot in a specific area.
    6. When completing your dream catcher and you feel as sense of satisfaction and achievement this is coming from a neurotransmitter known as dopamine that is being released in your basal ganglia.


  1. Eyes, ears, & related structures
    1. Eyes
      1. Retina receives and absorbs light, while pupil transmits the light through to the retina. The visual image is inverted on the retina.
      2. Optic disc conveys sensory information from the visual stimulus through to the optic nerve through optic chiasm, to optic tract to visual cortex
  • If an individual was unable to see peripheral visual field they would have a problem with the nasal portion of the retina and in this case if you were making a dream catcher with an individual with this deficit you would want to place all materials within their central visual field
  1. Extraocular muscles involved in allowing you to visually scan the room and locate and fixate on materials. Also allow you visually scan what you are doing by moving your eyes as you move your hands when wrapping the suede around the metal ring and then tying the sinew around the ring:
    1. Levator palpebrae will allow you to elevate your eyelid and see your visual field (Oculomotor nerve CN III)
    2. Superior oblique will allow you to abduct, depress, and rotate eye medially (Trochlear nerve CN IV)
    3. Inferior oblique will allow you to abduct, elevate, and rotate eye laterally (Oculomotor nerve CN III)
    4. Superior rectus will allow you to elevate, adduct, and medially rotate eyeball (Oculomotor nerve CN III)
    5. Inferior rectus will allow you to depress, adduct and rotate eye ball laterally (Oculomotor nerve CN III)
    6. Medial Rectus will allow you to adduct eyeball (Oculomotor nerve CN III)
    7. Lateral rectus will allow you to abduct eyeball (Abducent nerve CN VI)
  2. Ears
    1. Ability to listen to directions and interpret the directions to mimic the dream catcher on display.
      1. External ear (auricles) captures the sounds where it creates sound wave energy as it travels down the auditory canal and hits the tympanic membrane
      2. Once the sound energy hits the tympanic membrane it is in the middle ear where it is transformed into mechanical energy through stapes, incus, and malleous. Frequency is preserved in the middle ear.
      3. Then it hits the oval window where it enters the inner ear where it converts to fluid wave energy as it goes through the cochlea where the spiral ganglia encodes the information and sends it to the auditory cortex where the auditory information is processed.
    2. Ability to stay balanced in the chair while making a dream catcher
      1. Otolith organs work to detect gravity and tilts of the head and keep your body in line through masular mechanism


  1. Structures involved in voice & speech
    1. The group members were able to express their questions and concerns through comprehension and expression of speech
      1. The left hemisphere of the brain is responsible for language and speech perception, and if an individual has a lesion to this area they will develop aphasia which is a disturbance of language comprehension
      2. Broca’s area is a part of the brain that works with patterning motor output for smooth speech. Individuals know what they want to say, they plan it but have problems delivering what they want to say.
  • Wenickes area is a part of the brain associated with the specialized speech production. An individual is able to speak but words are incomprehensible
  1. Cricothyroid muscle allows you to tense vocal folds and speak by vibrating vocal folds air passes through them
  2. Thyroarthnoid muscle allows you to relax muscle folds allowing you to pause


  1. Structures of the cardiovascular, immunological, & respiration system
    1. If someone were to get stressed out and increase blood pressure or heart rate this would occur through activation of the sympathetic nervous system, your fight or flight response.
    2. This activity could also a calming effect on the participant activating their parasympathetic nervous system, your rest and digest response.


  1. Structures related to the digestive, metabolic, & endocrine system
    1. If an individual is hungry or thirsty this response is coming from the hypothalamus and this sense of hunger or thirst will affect their participation and attention on the activity of making dream catcher. Possibly making them unable to follow directions


  1. Structures related to the genitourinary & reproductive system
    1. Your kidneys with help of your pituitary gland control your urinary functioning and when the bladder should release
      1. So if you have to go to the bathroom a lot or are incontinent it is due to this system over working or due to the fact that you are consuming too much fluids and your body feels a need to remove them
      2. If an individual is pregnant the uterus is expanded and pushing down on the bladder causing this response
    2. Structures related to movement
      1. Lower limb/trunk stability (maintained throughout activity)
        1. Rectus femoris, iliacus and psoas major flex thigh at hip to allow for 90 degree seated position
        2. Biceps femoris, semitendinosus, semimembranous muscles are relaxed at stabilized not allowing extension of the thigh
  • Foot in neutral position, flat on the floor making a 90 degree angle between feet and leg
  1. External abdominal oblique, internal abdominal oblique, transverse abdominis, and rectus abdominis are stabilized with slight flexion at approximately a 160 degree angle when reaching for supplies off table
  1. Wrapping the suede lace around the metal ring
    1. Levator scapulae and serratus anterior allow individual to protract and elevate scapula
    2. Deltoid muscle abducts and flexes arm at the shoulder joint to allow for 80 degrees of reaching for suede lace with one arm and ring with the other
  • Biceps brachii, anconeous extend forearm to reach for suede lace and/or ring
  1. Flexor digitorum superficialis/profundus and lumbricals used to flex wrist 45 degrees and flex the fingers allowing you to grasp the materials
  2. Opponeous pollicus with the help from adductior pollicus and flexor pollocis brevis allowing you to grasp the ring with your non-dominant hand between thumb and digits 2, 3, 4, and 5 with a lateral pincer grasp and then manipulated in your had to establish a cylindrical grasp using interoussi muscles (lumbricals, dorsal intersossei, and palmar interoussi muscles)
  3. Opponeous pollicus of dominant hand used to oppose thumb with digit 2 forming pincer grasp to grasp the suede lace, again manipulating it in your hand to develop a variation of the cylindrical grasp using interoussi muscles (lumbricals, dorsal intersossei, and palmar interoussi muscles)
  • Once you have materials in hand, stabilize the non dominant hand with a tight grip on the ring and beginning of suede lace.
  • Through horizontal adduction, flexion at the wrist, and various flexion, extension, and thumb opposition movements begin wrap the suede lace around the ring.
  1. Brachioradialis supinates your dominant arm allowing you to wrap the suede around with the help of pronator quadratus bringing it back to a pronated position
  2. As you get further along on wrapping the suede around brachioradialis in the dominant hand that is gripping the ring will begin to help that arm supinate.
  3. Tying hook knots evenly spaced away from each other around the knot in a swooping motion.
  4. Your trunk and lower limbs remain stabilized as noted above
  • The same muscles in the hand, forearm, arm, and shoulder are used with tying the hook knots and lacing the suede.


  1. Skin & related structures
    1. Epidermis is the outer most layer of this skin and is the most easily damaged or worn in an activity like this. Your skin is thicker on your finger tips than on your arms
    2. Dermis contains blood vessels, glands and nerve endings


Part III. Activity Demands

  1. Activity Demands Aspect
    Objectives & their properties (Reference Above in Section 1, Part F)
  2. Space Demands (Reference above in Section 1: Part F)
  3. Social demands (Reference above in Section 1: Part F)
  4. Sequence & timing
    • Steps (Reference Section 1: Part B)
    • Sequence
      • Cut a sufficient amount of suede and sinew for the activity
      • You must wrap the metal ring in suede before starting to web the sinew
      • You must have the sinew all done before adding any decorations\
    • Timing: there is no specific time limit to each of these steps however the activity as a whole should last approximately 30 minutes for typical population
  1. Required actions & performance skills (Reference Section 3, Part 1)
  2. Required body functions (Reference Section 3, Part 2, Section B)
  3. Required body structures (Reference Section 3, Part 2, Section C)
  4. Performance Skills (Reference Above in Section 3, Part 1)
  5. Motor & praxis skills
    2.          Sensory-perceptual skills
    3.          Emotional regulation skills
    4.          Cognitive skills
    5.          Communication & social skills

Section 4: Analyzing Performance Patterns & Contexts

Part I. Performance Patterns

  1. Person
  2. Habits-clean up useful

A useful habit for this activity would be cleaning up afterwards and washing your hands. A dominating habit would be washing the hands repeatedly after touching the sinew. An impoverished habit would be not washing the hands at all, which could promote the spread of illness.


  1. Routines

This activity could be incorporated into sleep preparation every night for children that are having trouble with night terrors.


  1. Rituals-

If a parent used a dream catcher as a child for their night terrors then it would be a ritual if they implemented the use of their dream catcher in their children’s nightly routine.

  1. Roles

Examples of personal roles would be if a mother was helping her child cope with night terrors, if a therapist was rehabilitating their client through this activity, or if a person wanted to teach about the Native American culture through this activity.

  1. Organization
  2. Routines

If an anger management course meets twice weekly to facilitate activities such as this to promote better emotional regulation through creative but challenging crafting activities.


  1. Rituals

An organizational ritual for this activity would be culture day in the local school systems. Teachers within the school environment could promote the importance of diversity and cultural education by performing an activity such as this. They could accompany a history lesson about the Native American belief system with the making of dream catchers.


  1. Roles

James Madison University or the Occupational Therapy program could implement a cultural education day within the community by performing this activity at local churches or mentoring facilities.


  1. Population
    1. Routines

If the government were to implement cultural education programs within local communities by providing funding to increase awareness about the importance of diversity and open-mindedness for those of a minority, such as Native Americans.



  1. Rituals

The Native American population could hold cultural celebrations where this activity could be used for celebrating the belief systems and importance of their culture throughout history.




  1. Roles

The Native Americans could take a stand to promote awareness about their cultural beliefs and ways of life by teaching activities such as making dream catchers. They could go into the school systems, churches, or community facilities to increase diversity awareness.


Part II. Contexts & Environments

  1. Cultural

This is activity that is culturally specific to the Native American way of life. They believe that if you place a dream catcher above your bed at night that it will catch or prevent bad dreams. It can be used within the American culture due to the relatively high interest rate American’s hold on this culture.

  1. Personal

An example of a personal context for this activity would be a male who played cowboys and Indians as a child. He may have an interest in this cultural activity because of his childhood play experiences, which could be manipulated into motivation for this activity that promotes cognitive sequencing and fine motor neuromuscular functioning.

  1. Temporal

This activity can be completed in 15 to 20 minutes, so it could work for any time of year. This activity could also be used for any age group or population as long as it doesn’t conflict with their belief system.

  1. Virtual

Guidelines and instructions can be obtained or posted online in order to promote the successful completion of this activity.

  1. Physical

This activity could be done in any physical context or environment as long as the therapist and client can maintain control over the materials used. This activity should not be done outside on a windy day, because the decorations and materials might be blown off the working surface. The optimal location for this activity would be inside where tables or a working surface can be obtained.



  1. Social

This activity can be completed either with social interactions or without. Low cognitively functioning clients might need more social interaction than those who are highly cognitively functioning, which can be observed in our grading section later one within this paper.

Form 4

Activity Analysis for Therapeutic Intervention

Student:                  Kelsey Bicking & Lauren Doss

Date:                         December 16, 2010                                                                                                      _______

Activity:                   Dream Catcher

Course:                    OT 561


Section 1: Activity Description

  1. Provide a Brief Description of Activity
  • With the supplies provided create a dream catcher in a 20-minute time span by using the directions provided.


  1. Identify Major Steps (3 Main Steps)
  • After getting the materials out and ready, grab the ring and began to wrap the suede lace around the metal ring, using a close pin to secure the end of the suede as you wrap it around. (3 minutes)
  • Once the entire ring is wrapped in the suede, cut the string leaving minimal excess lace. (1 minute) Then use a hot glue gun to glue down the suede lace tip to the suede underneath and pressed down for a couple of seconds. (1 minute)
  • Then grab the sinew and tie an initial knot on the ring. (1 minute)
  • Using the directions began to tie little hook knots on various spaces away from each other around the knot in a swooping motion. Continue to do this around the circle until you arrive at the initial knot then continue the same pattern just instead of swooping it around the ring itself I swooped it around the previous loops. (5-10 minutes)
    • Explanation for a hitch knot: hold one end of sinew with left hand while taking the excess sinew with your right hand and going on the outside of the ring then while wrapping it around the ring pull the sinew back through the center of the ring. Then bring the sinew inside the loop that was just made by going underneath and pull tight and repeat, making a swoop like design.
  • Once at the center tie a double knot and cut the excess sinew (1 minute)
  • Add feathers or any decorations you wish. (1-2 minutes)
  • Add a hanging loop at the top by cutting a short portion of suede lace and wrap it around the top of the ring opposite to where you placed the feathers. Once wrapped around the ring only once tie a knot and then tie another knot an inch or two up making a hanging loop (2 minutes)

Section 2: Therapeutic Qualities

  1. Energy Patterns—Describe the required energy level in terms of light, moderate, or heavy work patterns and provide an explanation for the level specified (refer to description of MET levels in Unit 6). Consider the client factors of the cardiovascular and respiratory systems as well as muscle endurance.
    1. Creating a dream catcher has similar functional requirements as hand sewing but is a little more strenuous on muscles making it more similar to dressing or undressing, therefore, we think it would be considered at a 2-3 metabolic equivalent level. The muscle movements required are much similar to those fine motor skills required to button a shirt. We believe dream catchers would fall under this level because it is not an exhausting activity where individuals are required to stand for an extended period of time or doing extreme physical activity. The activity required to make dream catchers relies mainly on upper body strength rather than collaboration between both upper and lower extremities also, creating a dream catcher does not directly compromise respiratory endurance therefore, not a lot of oxygen is needed making it a lower MET level.


  1. Activity Patterns—Indicate the patterns of the activity expected for successful completion of the activity.
  2. Structural/Methodical/Orderly
  • Because this was a novel activity for the group we decided to structure the activity to make it easier for participants. If we were doing this with a group who had experience making dream catchers we would have given more complex or more variations of designs and offered more free form and individuality for the activity. We found directions of a basic dream catcher design online and used that as a template. We handed these directions out to group members along with visual pictures to go along with each step.
  • Order of the steps:
    • Activity preparation
    • Wrapping the suede around the crafting ring
    • Tying the sinew around the outer ring until you reach the center of the dream catcher
    • Decoration
    • Activity clean up
  • Methods
    • Wrapping the suede around ring
      • We only offered one size ring
      • This step was not very structured in that group members were able to choose the color of suede they would like to make their dream catcher out of however they were limited to the selection between only three different colors.
      • Also, they were offered two options of how to tie off the suede lace at the end, you could of choose to wrap it around itself, or use the hot glue gun to glue the end piece down
    • Tying the sinew around the ring in a web like pattern
      • Because we only offered a specific set of directions with specific knot types this step was very structured, however some group members choose to do their own thing, which was perfectly fine too.
    • Decorating the dream catcher
      • This step was structured in that we only offered specific beads and neutral color feathers to choose from.


  1. Repetitive:
    • This activity involves repetitive steps, specifically the physical motions required for wrapping the suede around the metal crafting ring.
  • The process of tying the sinew around was also repetitive in that it required the individual to tie the same type of knot over and over again with the same motion not allowing much variation.
  • The swooping pattern in which the sinew was tied was also repetitive


  1. Expressive/Creative/Projective
  • When choosing a color of suede to use to wrap around the ring the group was able to have somewhat of a personal decision between the two colors. This decision could be proven to be expressive of the individual if it were their favorite color or it could of just been the last color available which would make it a decision not based on personal choice
  • Since we set up the activity to a specific template for the dream catcher sinew web design we offered little creativity in this step. However, some individuals choose to not follow the listed directions and do it free form which added an element of creativity to their dream catcher. Even those that followed the given directions all the dream catchers ended up looking unique to one another and this is because of the variation in individual’s personality. Some group members are perfectionist, others rush through activities, making the dream catchers made in the group vary in looks.
  • The step in which group members were encouraged to decorate their dream catcher offered the most self expression because they were able to pick different colors or objects to use to decorate it based on what ever they wished


  1. Tactile
  2. Contact With Others (e.g., hands-on, stand by assist)
  • This activity was a hands on experience, as each member made their own .
  • Each group had to share some supplies such as the hot glue gun if that was they way they choose to secure the suede on the ring
  • During the step of wrapping the sinew around the ring based on the directions available it was noticed that some group members were struggling and the spatial set up of the room allowed for members at table to help on another when we as facilitators were unable to help an individual. This worked well and made for some noticed roles within each group


  1. Materials (pliable, sensual)
  • Supplies stimulated multiple sensory systems, including visual, tactile, proprioceptive functioning
  • Metal ring: not pliable, offers resistance, and it’s cold & hard to the touch
  • Suede: pliable
  • Sinew: pliable
  • The texture of both the suede lace and the sinew were very unique and different in the way they felt against your skin. This tactile stimulation implied different responses within the group. Some individual were not bothered by the texture, however other group members found the texture and feeling to be uncomfortable
  • Feathers
  • Beads -The visual stimulation of the various colors of suede lace, beads, and feathers offered visual stimulus for group members


  1. Equipment (e.g., size, manageability, shape)
  • Hot glue guns- small –weigh 8-12 oz loaded, easy to manage, having more would have expedited this step so that members would have more time for remaining steps.
  • We only offered the rings in one size which was 3 inch rings, however we did have one 5 inch ring that could be used as a way of grading the activity for an individual
  • We precut all the suede lace and sinew to save time in class but both of these materials were cut to a specific size determined by a dream catcher we had made
  • The shapes of the beads and feathers varied. We had bigger sparkly beads and bog or small feathers


  1. Performance Patterns
  2. Habits (useful, impoverished, dominating)           
  • Useful Habit:
    • Washing hands
    • Safely transporting the scissors throughout the room
    • Keeping the small objects away from the floor where small children could get them
    • Keeping materials and objects used in the activity off the floor to prevent falls or tripping
  • Impoverished Habit:
    • Not participating in clean up at the end of the activity
    • Not moisturizing or taking care of the skin on the hands could cause skin damage or injury during this activity
  • Domination Habit:
    • An example of this would be a person who has Obsessive Compulsive Disorder. They might have problems coping with the sinew residue on their hands, so they may try to wash their hands repeatedly throughout the activity to remove this reside.


  1. Routines
  • Satisfying
    • Incorporating the completed dream catcher into the sleep preparation process would be an example of a satisfying routine revolving around this activity. By helping a child whose dealing with night terrors decrease their anxiety around sleep while forming positive responses to a negative experience would help them later in life when dealing with anxious situations.
  • Promoting
    • The previously stated situation applies to promoting routines too. By promoting the use of a dream catcher as a coping strategy the child is learning ways to deal with negative situations, which will promote success in dealing with similar situations as they age.
  • Damaging
    • An example of a damaging routine would be if the child forms a dependent relationship on the dream catcher. For example, if the child began to develop insomnia if the dream catcher was missing or not brought with them when they travel somewhere.


  1. Roles
  • This activity could be used or empathized by a therapist rehabilitating their client, a mother helping her child deal with night terrors, or a client that’s looking to improve their cognitive sequencing skills or neuromuscular functioning.

Section 3: Therapeutic Application

  1. Population—Discuss for whom and in what way increased occupational performance can be derived from the use of this activity. Consider performance skills for motor, process, and communication/interaction. Identify any contraindications.


This activity was intended to be used for Occupational Therapy Students, but it could be used with the Native American population and with clients who have physical disabilities.


Making dream catchers challenges intrinsic muscle strength & endurance, eye hand coordination, sequencing skills, the ability to follow instructions, tool manipulation skills and self regulation skills. Our clients can improve upon these skills in the therapeutic setting to eventually re-apply them to their everyday living tasks.


This activity would need to be modified significantly for clients who have severe cognitive disabilities, such as severe traumatic brain injuries, dementia, or clients with joint stability issues in hands  Clients performing this activity must be able to attend to detail & sustain attention over time attention, be aware of the activity, and to sequence movements or tasks in order to successfully complete this activity, which remains true unless there are adaptations or gradations to assist them in the completion of this activity. Emotional regulation- client who is currently psychotic


  1. Gradation—Describe ways to grade this activity in terms of:
  2. Activity Sequence, Duration, and/or the Activity Procedures


The sequencing of this activity is as follows: Preparation:

    1. Cut, prepare, and organize the suede lacet and sinew along with setting aside the metal crafting ring.
  1. Activity Commencement:
    1. Wrap the suede lace around the metal crafting ring.
    2. Tie off or glue the end of the suede lacet.
  1. Leave the remaining suede lacet hanging down.
  2. Example: gluing on feathers or tying beads onto what’s left of the hanging suede lacet.
    1. Begin to loop the sinew around the outer ring made out of suede lacet.
    2. Continue looping and weaving the sinew through the previously made sinew loops until you reach the center of the dream catcher.
    3. Tie off the sinew in the middle.
  1. Decorate:
    1. Decorate your dream catcher the way you like.


Duration: An hour would be sufficient time to organize the supplies and complete this activity in most people’s case, which could be broken up into several different sessions. However, this activity should be completed in two to three sessions maximally, because once you start weaving or lacing you must finish. It would be more difficult to stop and restart the activity than to finish the weaving and lacing patterns due to the tension that must remain on the lace and sinew.


Some options for grading of the activity procedure are to have the woven sinew already completed so that the client can simply glue or tie it into place. This would be beneficial for clients that might not be able to complete the entire activity, while still promoting self-efficacy. An example of a situation where this would be plausible would be for clients with cognitive deficits or children between six and ten that may not have complex planning and sequencing skills yet.


  1. Working Position of the Individual


There are several options for working position of the individual making a dream catcher. For example, the individual could remain standing throughout this activity- project on vertical surface, remain seated, or prone. However, any therapeutic position could be utilized for strengthening or improvement of the individual’s balance as long as the arms and hands are free to move.


  1. Tools
  2. Position


When using the glue gun, therapists could put it on a surface around waist level to decreases the range of motion required to successfully and safely use this tool.


  1. Size


The facilitators of this activity used a smaller glue gun that doesn’t put as much torque or force on the joints of the fingers, which would be a gradation for clients with joint stability problems.


    1. Shape


The shape of the glue is graded already, because of the handle placement and shape. This tool allows for power grips of the right or left hand rather than prehension grips that would put approximately ten pounds of strain on the finger joints.


  1. Weight


A larger or heavier glue gun could be used with clients who have trouble with tactile and proprioception sensations. A heavier tool allows for more stimulation of sensory pathways, which would allow for more control in clients with these issues.





  1. Texture


A grip could be placed on the handle of the glue gun to prevent slipping within the hands since the handle is currently slick and very smooth.


  1. Materials


  1. Position


This activity works best if the tools are kept at the midline so that both hands can equally move within the visual hemifield of the individual making the dream catcher. However, this is not a concrete guideline for making a dream catcher. If an OT wants to work on core stability and strengthening on one side of the individual’s body then they could ask the client to make the dream catcher to either side of their body. This technique would also be useful for clients who have unilateral neglect of one side of their body. The tools should be held inferiorly to the chest and outward away from the body to ensure maximal vision and space to move. This too is not concrete though. If an OT would like to work on strengthen the shoulder muscles or really test their clients ability to sequence their movements then they could ask their client to create the dream catcher above their head while sitting. This would require the client to see the activity in a different way while fighting against gravity, so it would be a great way to grade up the activity.


    1. Size


The metal crafting rings are the templates for size. Larger metal crafting rings should be used for cognitively lower functioning clients while smaller metal crafting rings are used with cognitively functioning clients & fine motor dexterity. The ideal or baseline size uses three inch in diameter metal crafting rings. Changes to the crafting rings would be an adaptation rather than grading.


    1. Shape


The shape of this therapeutic tool is circular. No matter what the size, weight, texture, or position the shape of the dream catcher should be round. The looping of the sinew and suede lacet works best with circular shapes, but if you have a client whose functioning higher than average cognitively then you could experiment with different shapes, but for this activity circular rings are the optimal option.


A grading option for this specific shape would be crafting rings that hinge together on one side, which allows the circle to open up. This would be useful if clients are having a hard time working with the circle, because the circle requires that you pull the remaining suede and sinew through after every weave, which can be tiring and frustrating. This could be helpful if your client is not ready to work with the unhingeable metal crafting ring.


    1. Weight


This is a very lightweight activity. The suede lacet, sinew, and metal crafting rings all held together would weigh well under half a pound. This is great for focusing purely on sequencing and fine motor dexterity in the fingers. However, if an OT wants to strengthen while working with this activity or if an OT is working with a client with tactile issues they could implement weighted crafting rings. Muscular endurance rather than muscle strengthening is the target of this activity, but muscle strengthening could be easily added into this therapeutic activity.


    1. Texture


There are various different textures used with this activity, which would be great for use with clients whom are tactilely defensive. The metal crafting rings are smooth, sleek, and hard. The leather lacet is soft, but not smooth. The sinew has a greasy feel to it, and it leaves a sticky residue on your hands after touching it. This wide variety of textures is certain to stimulate different tactile receptors within the hands and fingers.


  1. Nature/Degree of Interpersonal Contact


  • There can be an extensive amount of interpersonal contact with this activity or none at all, depending on the grading of this activity.       We completed this activity in a large group, so there was a lot of socialization utilized, especially when certain group members understood the concept behind making the dream catchers better than others in their group. Group members helped each other and asked each other questions, so this activity was a great opportunity for interpersonal contact.


  • Small groups of four to five people could be used to facilitate social interactions with groups of shy clients or participants.


  • If an OT is working with a client that is distracted easily or if the client is having trouble mastering the activity then the OT could work one on one with this person to ensure that the level of guidance needed is met.       However, if you’re working with a client that is a highly cognitive functioning individual then little to no assistance may be necessary. This may also be true if you’re working with a client that has made dream catchers before. If this is the case, then you may chose to promote positive memories and have them share these with you if they are comfortable doing so, which would also be a great interpersonal contact experience.


  1. Extent of Tactile, Verbal, or Visual Cues Used by Practitioner During Activity


This again varies from client to client. This activity may need more cuing by the practitioner than the other activities performed due to the high demand of sequencing and visual planning. This activity will be very difficult for an individual with low cognitive functioning. If this is the case, the threads and instructions could be color coded, which would allow visual cuing. Using multi-colored sinew might make it easier to see where to thread the sinew. An OT working with this type of client would have to give a lot of manual and verbal cuing, but OTs must remember to optimize independent task completion as much as possible without negatively affecting their client’s self-efficacy. Tactile cuing might be the most effective cuing possible with low cognitive functioning clients due to the extreme variation in the different textures. If an OT allows this client to feel the textures prior to beginning this method of cuing could greatly be utilized with giving instructions and guidance. For example, the OT could say pick up the material that feels like this and do this with it. This could be focuses upon if the client is tactilely defensive, because you’re completing a task with the different textures rather than aggravatingly rubbing them with defensive textures like with the Sensory Reeducation Dowels.

However, if an OT is working with a client that has high cognitive functioning bead patterns or different, more complex knots could be used. The OT could take a step back and observe how their client completes this activity as far as sequencing and cognitive planning of the activity. You could then ask them to reflect upon their experience and methods of making the dream catcher to further challenge them. Verbal cuing could also be used or not used during their reflection.


  1. The Teaching-Learning Environment


The environment for this activity should be well-lit, quiet, and clutter-free , this eliminates distractions while promoting sustained attention on this task.   By having the room well-lit the client will be able to see exactly what they’re doing and what needs to be done. The OT should be very calm, supportive, and helpful while facilitating this activity. Making dream catchers is a stressful activity and it would be easy for your client to decrease their perceived self-efficacy through this frustration. The OT can aid in preventing this by talking in a calm and soothing voice while remaining patient during the mess-ups. This activity would be fantastic for clients who have minor to moderate problems regulating their emotions. OT’s could provoke this in their clients then make suggests about how to handle their frustrations. However, OTs should not provoke this quality in their clients unless this is a characteristic they aim to improve upon with it, because if an OT is working with a client on muscle endurance and motor coordination they could easily discourage their client with therapy.


  1. Therapeutic Modifications—Indicate ways in which this activity may be changed to increase occupational performance. State your reasoning. Write n/a if not applicable. Definitions for the following terms can be found in Appendix B, Uniform Terminology for Reporting Occupational Therapy Service, First Edition, “Therapeutic Adaptations” and The Guide to Occupational Therapy Practice (AOTA, 1999).


  1. Therapeutic Adaptations
  2. Orthotic Devices


  1. Prosthetic Devices


  1. Assistive Technology and Adaptive Devices

(1)           Architectural Modification


  • Environmental Modification


Visual and auditory distractions should be eliminated within the environment to promote cognitive attention on the completion of this activity.


(3)           Tool and Equipment Modification (low-tech [e.g., reacher] or hi-tech [e.g., computer control devices])


An equipment modification that is suggested for this activity would be to use thicker suede lacet and sinew along with bigger or smaller crafting rings. The thinner the lacet or sinew and the smaller the crafting ring the more difficult the activity will be. The thicker the lacet or sinew and the larger the rafting ring the easier the activity will be. Thicker materials allow for better grip and larger crafting rings allow for more mobility of the hands and fingers while completing the dream catcher.


A clamp would be a tool that could be used for clients with mobility problems of the muscles or joints of the hands. This would eliminate the amount of force that the individual hands need to exhibit. By using a clamp or individualized hand splint you could exhibit the force required on the tool rather than the muscles and joints.


Another equipment modification that is suggested would be to find metal crafting rings that open from a hinge rather than closed, fixed crafting rings. By opening the crafting ring clients won’t have to pull the sinew and lacet threw the ring but rather wrap it around an open circle.


(4)           Wheelchair Modification-n/a


  1. Prevention
  2. Energy Conservation

(1)           Energy-Saving Procedures


This activity requires relatively low amounts of energy at the baseline recommended procedures, but one suggestion for saving energy of our clients would be to have them take breaks for stress relief and suggestions for coping mechanisms.


This activity can be relatively challenging with respect to cognitive functioning, so breaks would allow our clients a release from their frustration or fatigue. OTs could have their clients work on meditation or relaxation techniques during these breaks to further facilitate a relaxed state between working sessions.


We previously stated that several different postural positions could be utilized during this activity. In order to save energy, OT clients could remain seated so that their hand, forearm, and arm muscles were exerting the most force. Of course, trunk muscles, both epaxial and hypaxial, are used to stabilize while sitting, but by sitting the leg muscles won’t be exerting as much force, therefore conserving overall energy.


(2)           Activity Restriction- not for use with joint instability hands-


This activity should not be used for clients with joint stability issues or for clients with severe traumatic brain injuries. This is because of the forces exhibited on the joints, which cannot be sustained if the joints aren’t stable. Clients with traumatic brain injuries may not have the ability to sequence or plan the activity.


(3)           Work Simplification- organizing.


The work area could be organized to simplify this activity. The materials could be numbered or color-coded in clearly labeled portions of the table to give more structure to the performance and order of the activity. This would allow the client assistance with processing and planning the steps required to complete this activity.


(4)           Time Management-


Time management is a portion of this activity that should be focused on intensely. From our facilitation, we realized that the time limit created excessive stress and tension on the group. Time management should be emphasized from the start of the activity if there is a time limit. However, as facilitators the therapists should not add stress about the time limit. The time limit should be given and steps dealing with the time limit should be given throughout the activity after that. So in other words, positive feedback and suggestions for dealing with the stress of a time limit should be given rather than repeating the constraints of the time limit. As with the rest of this activity, a calm and patient tone of voice should be used as to promote a positive atmosphere for working.


  • Environmental Organization-

The tables within the room should be grouped together in an L-shape or U-shape so that there’s separation between the tables. There should be four to five people at each table. By creating small groups within the larger group the activity leaders can facilitate social interactions within the smaller groups. The materials should be organized in a central location for each group within the larger group. The room should be well-lit, specifically well enough for “close working” activities such as reading. Visual and auditory distractions should be eliminated from the room, such as toys, brightly-colored large objects, or loud music.






  1. Joint Protection/Body Mechanics

(1)           Using Proper Body Mechanics



The feet should be approximately shoulder with apart (wider if there are balance issues). The trunk of the client’s body should be erect and upright. The hands should be held at the midline and out in front of the client’s abdomen. The head and neck should be erect while the gaze is directed downward. The muscles that should be used for this activity are found in the hands and forearms, so the OT should ensure that postural contortions are not used in order to accomplish the fine motor movements. The wrists and fingers will be moving in the sagittal plane for the majority of the activity, but range of motion should be assessed prior to the activity to check for flexibility problems. Things that should be corrected by the OT are poor or slouching posture, a narrow base of support, and joint locking at the fingers or wrist.




Both feet should sit flat on the floor. There should be approximately a 90-degree angle between the client’s body trunk and hips and legs. The chair they’re sitting on should support the back. The forearms should rest on the table or arm rests. The neck should be as erect as possible while the gaze is directed downward. The wrists and hands should be free to move, which will require some movement of the forearms and arms away from their resting position.


Also with this activity, standing or sitting, the necessary movements could be completed by using the larger muscle groups, such as muscles of the arm or forearm, instead of the smaller muscles, which put pressure on the joints in the fingers.


(2)           Avoiding Static/Deforming Postures


Therapists should promote muscle control in forming correcting body alignment with their posture. This is especially true for clients who have had back injuries or back surgeries. This activity may be difficult for clients with back issues, because it requires you to sit or stand, which exerts muscle tension on areas of the affected back regions.


(3)           Avoiding Excessive Weight-Bearing

This is not applicable to this activity, because you should promote proper posture while sitting or standing, which would prevent excessive weight-bearing on the limbs. Also all of the materials way far less than a pound, so excessive weight won’t result from these resources.


  1. Positioning

Reference Section 2b(1) about prevention, which is located above.


  1. Balance of Performance Areas to Facilitate Health and Well-Being

(1)           Enhancement of Occupational Performance Areas


This activity can help with activities of daily living, such as dressing, and instrumental activities of daily living, such as meal preparation and clean up. Through muscle strengthening and the promotion of proper body alignment in this activity clients can relate their success with this activity to the tasks found on form 3 section 2.


(2)           Satisfaction of Client and/or Caregiver


Satisfaction of the client or caregiver could be assessed by a questionnaire, survey, or interview. The therapist should explain the purposes and goals of this activity and responses from the client or caregiver could be given based on that. An example of an area worth assessing for satisfaction would be coping skills for emotional regulation. The client could put this into practice within their daily lives and report back to the therapist about its efficacy. Client or caregiver satisfaction is imperative, because it can help the therapist make corrections and changes to improve upon for future implementation of this activity.


  • Quality of Life


The areas of occupation found on form 3 section 2 are all important for a good quality of life. This means that these tasks listed above are necessary to actively engage in life while promoting healthy lifestyle behaviors. Making dream catchers can help improve with the activities listed in the previously listed section, which directly affects and improve one’s quality of life.

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