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FORM 4 Activity Analysis for Therapeutic Intervention Student: Enrique Rivera and Kelly Garcia Date: October 5, 2011_______________ Activity: Miniature Piñatas __________

Section 1: Activity Description A.

Provide a Brief Description of Activity

‘Miniature Piñatas’ is an activity that basically consists of making paper mache piñatas. The piñatas are actually balloon casts that are created with newspaper strips and a paste mixture made from flour and water. After the molds of the piñatas are created, the piñatas are creatively decorated with tissue paper or construction paper, and then filled with candy. B.

Identify Major Steps 1.

Buy and gather the materials necessary for the activity, which include the following: balloons, newspaper, tissue paper, construction paper (optional), string (optional), glue, scissors, flour, water, measuring cups (for dry and liquid ingredients), candy, a large cooking utensil, a pot, and a bowl.

2.

Measure 2 cups of flour with a measuring cup, then two cups of warm water, and mix them together in a bowl until a smooth consistency.

3.

Boil eight cups of water in a pot and then carefully add the previous mixture into the boiling water.

4.

Constantly mix the contents of the pot with a cooking utensil to remove any clots and let boil for 2-3 minutes. This mixture makes 9 balloons or more.

5.

Blow up desired balloons and securely tie a knot at the end of them to keep the air in.


6.

Separate the newspaper into single sheets of paper and cut them in half. Cut enough newspaper as to completely cover the balloon more than once. Cut more sheets of newspaper if more balloons will be casted.

7.

Once the mixture in the pot has cooled down to the point where it is warm, grab some on your fingers and apply a thin layer of the mixture on one side of a newspaper sheet.

8.

Carefully apply the ‘wet’ side of the newspaper sheet on the balloon and smooth out any ripples as best as you can with your fingers.

9.

Repeat the previous step until everything, except for the top of the balloon where the candy will be inserted, is completely covered.

10.

After the balloon is completely covered, add at least four more layers of newspaper sheets to make it sturdy.

11.

Let the balloon stand overnight to dry.

12.

If the balloon is not sturdy enough the next day, meaning the balloon’s elasticity is still felt after the newspaper has completely dried, make the flour/water mixture again and add more layers.

13.

Pop the balloon once the newspaper strips around it have completely stiffened and discard any balloon remains that may be left in the stiffened mold.

14.

Cut the tissue or construction paper in to strips, shapes, or desired designs with scissors.

15.

Glue the tissue or construction papers that have been cut onto the stiffened newspaper mold.

16.

Decorate as desired until the newspaper is completely covered

17.

Let dry and insert candy through the opening at the top


** Optional: push a string through the top opening of the piñata and tie the two ends of the string together, hang, and enjoy!

Section 2: Therapeutic Qualities A.

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). Consider the client factors of the cardiovascular and respiratory systems as well as muscle endurance. The Metabolic Equivalent level (MET) of this activity can be classified as light, due to the amount of walking and standing involved. As a result, the whole process of completing the activity is 2 to 3 METs. The activity is not considered to be an MET level of ‘very light’ or ‘minimal’, because a person has to be able to stand for at least 15 minutes. Five of those minutes include the amount of time it takes to measure all of the ingredients and 10 of those minutes include the amount of time it takes to mix the flour/water mixture on the stove. This activity requires upper and lower body strength as well as resistance and endurance to stand while dissolving clogs in the mixture. Appropriate lung and hand strength is required to blow up the balloon and to tie a knot around it. Although the act of separating the newspaper sheets and cutting them may require minimal energy, the act of spreading the flour/water mixture on the newspaper sheets and applying them to the balloon, requires more energy. All of the body systems need to be functioning in order to complete the activity. However, the tasks of the activity are not excessively demanding of the body systems, which is why the MET level is not moderate or heavy.

B.

Activity Patterns—indicate the patterns of the activity expected for successful completion of the activity.


1.

Structural/Methodical/Orderly - In order to complete this activity one must have a method that will help guide them in the piñata-making process. The person should have an idea of what size he or she wants the piñata to be. That is, a very small piñata requires a small balloon and a larger piñata requires a bigger balloon. The shape of the piñata is determined by the balloon selected. Colors and themes are determined by the tissue paper and or construction paper, along with an assorted variety of materials to decorate the piñatas (beads, string, and buttons) will give the piñata a distinguishing look. The person should dedicate a full day to complete this activity, from the time he or she starts the process, until the piñata has fully hardened and is ready for decoration.

2.

Repetitive - There are several repetitive steps in the piñata-making process. First of all, mixing the flour/water mixture in the pot is a repetitive process due to the clumps that form and have to be constantly dissolved. Separating the newspaper sheets and cutting them is repetitive because you have to get enough newspaper sheets to completely cover the balloon. Steps 8-9 of the piñata process are repetitive, because this is the part where you apply the flour/water mixture to all of the newspaper sheets you are going to use, apply them one by one on the balloon (for at least five layers). If the mold does not stiffen enough then the process from the beginning will have to be repeated. The actually decorating of the newspaper mold is repetitive because you have to continually cut your desired designs from the tissue and/or construction paper and paste them onto the mold until completed.

3.

Expressive /Creative/Projective - This activity can be used to express an emotion such as a ‘happy face’ piñata, it can also be used to celebrate an event such as a birthday or anniversary. A person can be as creative as they want with their piñata; it all depends on


how much time and effort they want to dedicate to the activity. Piñatas are traditionally used for special occasions, typically amongst Hispanics. They are also used to project a festive atmosphere. Piñatas are synonymous with family functions and social events. 4.

Tactile a.

Contact with Others (e.g., hands-on, stand by assist) - Miniature piñatas are usually a one person activity because they are small compared to more traditional larger piñatas; they do not require additional assistance. However, when working with small children or clients who have severely impaired fine motor skills, they may need assistance when cutting or pasting items on the piñata.

b.

Material (pliable, sensual) - The materials needed for this activity are: newspaper, construction paper, tissue paper, balloons, flour, mixing bowl, cooking pot, cooking utensil, measuring cup, scissors, water, glue, beads, candy, and aluminum wire. The piñata molds are pliable to a certain degree; however, once they have hardened they are less pliable and easier to damage. The newspaper is rough but very thin and easy to tear. The tissue paper is used as a second layer for the piñata and is soft and easy to tear. Once on the piñata, the tissue paper acts as a color foundation. The construction paper can also act as a foundation or as an accessory item to add features to the piñata such as, facial features, color, and attire. The construction paper is rough, easy to bend, and can tear and form creases which can affect its strength and durability. The balloons are soft and stretchable when not inflated. However, once they are inflated they become slippery and easy to damage/pop. The


flour is a soft powdery consistency; it cannot be conformed unless it is mixed with another substance. The mixing bowl is a hard material usually made from plastic, which is not pliable. The cooking pot is a hard material, usually stainless steel which is not pliable and in most cases very sturdy and hard to damage. The cooking utensil used in our activity was made from hard plastic, it is pliable to a certain extent, but will usually break if bent. The measuring cup is a hard plastic or glass material that is not pliable. The scissors are a hard metal with hard plastic handles or plastic scissors with metal blades, the cutting blades are thin and sharp, the scissors are not pliable. The water is a wet liquid substance that is not pliable, only when mixed with another material, such as flour. The glue is a sticky liquid substance, once hardened it becomes a hard material that is not very pliable. The beads are a hard plastic material that is not pliable. The candy is assorted and some are of a hard substance, soft substance, but both turn into a liquid form once ingested. The aluminum wires are a thin hard metallic material that is pliable. c.

Equipment (e.g., size, manageability, shape) - The size of the equipment used in this activity did not require any special considerations, such as heavy lifting or special transportation. The construction paper used is 9 in x 12 in, the tissue paper used is 20 in x 26 in, and the size of the newspaper used 8 in x 14 in. This activity was very manageable because the sizes of the pi単atas were not very large. The shape of the pi単atas makes for easy storage and does not create any additional problems.

C.

Performance Patterns


1.

Habits (useful, impoverished, dominating) - Habits that would be useful to have when completing this activity are ensuring the cup measurements are accurate, that they have an adequate amount, and reading all the directions first before starting the activity. Another useful habit to have would be to look down at your hands when you are cutting the newspaper sheets, tissue paper, and construction paper. This allows you to make sure that are cutting in the correct direction. Impoverished habits are habits that are not established, which depend on the individual, and can include starting an activity without reading the instructions. Dominating habits during this activity might include things such as cutting and organizing all of the materials before actually starting. Also, looking at every task to make sure it meets the specific requirements.

2.

Routines: The routines in this activity follow a sequence of steps to make the miniature piñata, such as gathering the materials first and then preparing the flour/water mixture. This activity could fall into a potential client’s annual routine of celebrating a birthday or special occasion. They can make piñatas for a loved one’s birthday, graduation, or even to celebrate at a party.

3.

Roles: There are a wide range of roles for people engaging in this activity: A father or mother guiding and helping his or her child complete this activity as part of a ritual, a child in a school setting learning to work with others on a team building exercise, or a student teaching this activity as part of an analyzing tool to dissect the steps that go into doing an activity.

Section 3: therapeutic Application A.

Population—Discuss for whom and in what way increased occupational performance can be derived from use of this activity. Consider performance skills for motor and praxis, sensory-perceptual, emotional regulation, cognitive and communication and social. Identify any contraindications.


In children (at least 5-years-old), adolescents, adults, and older adults with non-impaired or impaired motor and praxis, sensory-perceptual, emotional regulation, cognitive, and communication and social skills, can improve their occupational performance by completing this activity. Working on this activity has the potential to improve a client’s occupational performance due to the performance skills and the activity demands involved. For example, a child diagnosed with autism, which has trouble with fine motor skills and following directions would benefit from completing this activity. This is because the client would have to focus at the task at hand, such as coordinating their hands and arm movements to cut the newspaper, and refining their emotional regulation skills to not get frustrated if they make a mistake. Clients who have lost some function in their hand due to surgery, stroke, or injury would benefit from this activity due to the amount of fine motor skills necessary to complete the activity. Motor & Praxis skills: The motor and praxis skills required for this activity include fine motor coordination movements to separate the newspaper sheets, cutting the newspaper sheets with scissors, cutting the tissue and construction paper into shapes or designs that will be used, tying a knot at the end of the balloon, and picking up the candy to fill the piùata. Additionally, fine motor coordination is needed to turn the glue cap and apply glue to the shapes that you will be pasting on the newspaper mold. Balance is also needed to stand and prepare the flour/water mixture. An individual needs to be able to stand up and stir a pot without falling due to poor vestibular coordination. Proper posture is needed to stand while cooking the mixture, as well as for sitting if the client is sitting while decorating the piùata. Reaching for materials across table counters or kitchen counters is also a necessary a motor and praxis skill.


Sensory-perceptual skills: Sensory-perceptual skills that are necessary include, visually seeing the materials, the measuring indications on the measuring cups, and instructions, if they are given on paper. You need to visually determine how big you want to blow up the balloon, how big the newspaper sheets need to be to cover the balloon and the correct size of the pot and bowl for the mixture. You also need to be able see the water boiling. Hearing is a necessary sensory skill if the instructions are given orally. Hearing also helps in determining when the water is boiling. Tactile skills are necessary to distinguish materials from touch, such as feeling that the construction paper is rougher than tissue paper and newspaper. Tactile skills are necessary to determine if the flour/water mixture is cool enough to be used. Gustatory and olfactory skills are not applicable to the process of making miniature pi単atas. The proprioceptive skills used, include cutting materials without having to look at your hands and fingers to know where they are in relation to your body. Additionally, being able to reach for materials across a counter or surface and applying them to the pi単ata mold without having to look at your arms, hands, and feet (if you are walking to get the materials). Vestibular skills are necessary to maintain balance while mixing, preparing the mixture, and decorating the pi単ata (e.g. siting down and holding scissors to cut paper). Emotional regulation skills: For emotional regulation skills, an individual needs to be able to control their frustration levels. A client needs to persist in the task at hand, despite frustrations that may arise from the newspaper sheets tearing, falling, or sticking to their hands. If working with others, the person needs to respond to what others are saying, depending on if it is a


question, a comment, or a joke. Displaying appropriate emotions are necessary, such as not being overly excited or sad. Cognitive skills: The cognitive skills required for this activity deal with organization because the client needs to be able to organize the materials required. The client also needs to know which tools to select for certain tasks. For instance, they need to use their cognitive skills to determine what tools they need in order to measure flour and water, deciding what to mix the flour and water in, and what tool to select in order to cut newspaper sheets, tissue paper, and/or construction paper. Sequencing is an important component of this activity because the client needs to sequence the tasks of the activities. The client needs to be able to prioritize steps, such as knowing that the flour/water mixture needs to be made first before the pi単ata can be decorated. The activity also prompts for a client to engage in multitasking, because they can separate and cut newspaper sheets while they look and wait for the 8 cups of water to boil. Depending on how they complete the activity (e.g. sitting/standing or both) a client can engage in multitasking, by standing while mixing the ingredients in the pot. Communication and social skills: Communication and social skills are utilized in this activity if it is completed in a group or social setting. In this case, the client needs to know how to keep an appropriate distance between him or herself and another person. They need to be able to do gestures (hands and facial) when appropriate. A person also needs to know how to take turns in a conversation (e.g. waiting for your mom to finish talking before speaking). If the client has a question


about the activity, they need to wait for an appropriate moment, or wait for a pause from the therapist or person teaching the activity before asking the question. B.

Gradation—Describe ways to grade this activity in terms of: 1.

Activity Sequence, Duration, and/or the Activity Procedures

Sequence: Grade up – To grade up the activity the instructor can simply give the client the required materials and let the client figure out, through trial and error, how to make the piñatas. That includes letting the client figure out what are the necessary steps, how to sequence them, and the amount of material necessary to make a functional piñata. Grade down- To grade down the activity the instructor can provide detailed instructions to the client, whether visually or orally, and give them cues to help him or her throughout the process. Duration: Grade up - The instructor can designate an allotted time period for each section of the piñata-making process. The therapists can assign time limits for each step thus making the client use time management and critical thinking skills necessary for completing this activity in a time efficient manner. Grade down - To grade down, the instructor can give the client as much time needed to complete the activity. He can give the client a deadline of a couple of days or weeks to complete this task. Taking away time constraints can give the client more creative freedom and take some of the pressure away. Activity Procedures:


Grade up - To grade up the activity the therapist can make the client complete the activity from step one; that is, letting them go through all of the procedures of creating the flour/water mixture and decorating the piñata. The practitioner can also add procedures, by creating specific steps on how to decorate the piñata. The steps can be complicated, require more fine motor skills, and test the clients ability to follow directions; thus grading the activity up. Grade down - The therapist can remove some procedures from the piñata making process to make it easier for the client, such as already having the flour/water mixture made and the balloon inflated. To grade the activity significantly down, the therapist can let the client skip procedures 1-13 and simply provide them with a stiffened newspaper mold to decorate. 2.

Working Position of the Individual:

Grade up - For the working position of the individual, the instructor can have the client do this activity while standing, lying down, on their knees, on their stomachs, standing on one leg, or using only one arm. Grade down - For the working position of the individual, the instructor may have the client seated upright in a comfortable chair, place the client in a position where arms are not obstructed so they can use them freely, and have the client in a position where he or she can rest their piñata on a stable surface so their upper extremities aren’t being overly exhausted. 3.

Tools: Scissors, mixing spoon, measuring cup: a.

Position:


Grade up (scissors) - Abducting arm to 90 degrees and flexing elbow to use subscapular and middle deltoid muscle more. If client had a rotator cuff injury, this position could be used to strengthen these muscles. Grade down (scissors) - One can place an elbow support (such as pillow, small stool, or use a table) to support the clients arm weight. Grade up (mixing spoon) - While mixing the flour, the practitioner can instruct the client to use a pad-to-pad pinch grip in order to strengthen their palmaris longus, flexor pollicis brevis, and flexor pollicis longus. This would grade the activity significantly up for a client who has some trouble doing this pinch grip, due to a stroke or injury. Grade down (mixing spoon) – To grade down, the practitioner can have the client sit on a stool that will be at the same height or near the same height as the stove. This facilitates the client’s ability to reach down far and it places less strain on the legs and back. Grade up (measuring cup) - Do not flex the elbow, rather keep arm and forearm extended at 90 degrees without bending elbow to measure water. When pouring, pronate only forearm to pour water into pot. Grading up may be useful to work on a person who needs to strengthen upper extremity muscles but has joint pain when flexing elbow. Grade down (measuring cup) – To grade down the client can flex the elbow. Flexing your elbow to 90 degrees makes the task of holding the measuring cup easier on the person. Grading down this task may be useful for people who have suffered from a stroke; they may have difficulty extending their elbow. b.

Size:

Grade up (scissors) – To grade up the activity, the client can use large industrial scissors. Using large industrial scissors for cutting becomes a challenge when you have to cut


small pieces of newspaper. A therapist might want to grade up this activity to test for fine motor movement. Wrist maneuverability is needed to manipulate the cutting angle due to the larger scissors. Grade down (scissors) – To grade down this activity, the practitioner can give the client scissors that are easy to manipulate. Having scissors that are light and easy to manipulate helps facilitate the cutting motion and does not strain interossei and wrist stabilizer muscles. Grade up (mixing spoon) - The mixing spoon should be large. The tip of the spoon should have a large diameter to make mixing resistance greater. Grading up the mixing spoon can serve to strengthen biceps, flexor forearm muscles, and grasping muscles. A person who suffered a mild stroke and needs to strengthen their upper extremity muscles might use this grading up technique for muscle strengthening. Grade down (mixing spoon) - The mixing spoon should have a small diameter tip, this way there is not so much strain on flexor muscles and resistance when mixing the flour. Grading down might be necessary for someone who has hypotonia due to muscular dystrophy. Grade up (measuring cup) - Using a measuring cup that is large with a small handle is a way to grade the activity up. Grading up this task using a small handle and large cup can pose difficulties for the person. This may useful for a person who needs to develop pinch strength. Grade down (measuring cup) - Using a measuring cup that has a large handle would grade the activity down. Using a measuring cup with a large handle would grade down this activity because it is giving the person more space to grab and maneuver the cup. A


person who has poor/low vision and grasp would benefit from having a larger handle on the cup. c.

Shape:

Grade up (scissors) - Using scissors that have square or triangular handles will make the cutting more difficult for the person. Learning to adapt to this unorthodox shape and having to compensate for lack of stability, forces the person to concentrate more on cutting and stabilization. Grade down (scissors) - Scissors that have large circular handles that fit the conformity of the thumb and fingers will make the cutting easier. Grading down can help facilitate people who may have problems with manual dexterity due to age or pathology. Grade up (mixing spoon) - A mixing spoon that has an irregular shape. Using a spoon that has an irregular shape will grade the activity up, because it will force people to hold it in an uncomfortable way. This might cause them to encounter some difficulty when dissolving the clumps of the flour/water mixture. A person who has rheumatoid arthritis and wants to work on their joint flexibility can use an irregular shaped mixing spoon to challenge themselves and improve their joint movement. Grade down (mixing spoon) - Using a mixing spoon that has a long straight neck and large cylindrical handle. Grading down for this task can benefit a person that has muscle weakness in their upper extremity, the long straight neck and large handle serve to distribute the weight much like a wrench does. Grade up (measuring cup) – A way to grade the activity up would be using a measuring cup that has an irregular shape (triangular, hourglass, tear drop). This would cause the client some trouble getting any contents into the measuring cup. A client might have to


problem-solve and use a funnel to get the flour or water into the measuring cup. Grading up the shape can help improve balance. A person who suffers from Parkinson’s disease can use this to help or measure their tremors. Grade down (measuring cup) – To grade down the client can use a cup that has a larger circumference at the base, and a smaller circumference at the top. A measuring cup that has a shape like this provides for easy transporting. A person that suffers from chronic tremors may use a measuring cup like this to prevent spilling. d.

Weight:

Grade up (scissors) – The client can use heavy metal scissors. The heaviness of the scissors will create a larger workload on the stabilizer muscles of the wrist, forearm, and arm. Grading up the weight of the scissors will create an isometric strain on the muscles of the upper extremity. Isometric strength training exercises are useful when someone has joint problems and cannot do full ROM. Grade down (scissors) – The client can use lightweight scissors. The use of scissors that are not heavy to the person will facilitate the use of this tool when cutting. Grading down is useful when a person has problems with fine motor movements and can ease the motion of lateral pinch motions. Grade up (mixing spoon) – The client can use a heavier mixing spoon. The use of the heavier mixing spoon can make the task of carrying, circumduction motion, and wrist flexion/extension harder for the person because of the excessive weight. A person who needs to work on, or strengthen these muscles would benefit from grading up. Grade down (mixing spoon) – The client can use a mixing spoon that is lightweight. A plastic spoon that does not have any extra padding would help minimize the amount of


strength a client needs to have in order to pick up or move the spoon. Minimizing the weight can help with people who are recovering from carpal tunnel surgery and want to start getting some flexibility back in their wrist. Grade up (measuring cup) - A measuring cup that is all glass would grade the activity up. Using a measuring cup that is glass is heavier and gives the person more strain on their muscles when liquids are added. Grading up is useful when a person needs to build strength in wrist and forearm stabilizer muscles. Someone who suffered a wrist injury may use a glass measuring cup to begin to build strength in their wrist. Grade down (measuring cup) – A lightweight plastic cup grades the activity down. Using a plastic cup offers the person virtually no added weight, besides the liquid. Grading down is useful when a person is really weak due to age or illness. d.

Texture:

Grade up (scissors) - Using scissors with rough pointy handles. Scissors with rough pointy handles on the placement of the fingers will create an uncomfortable sensation for the person participating in this activity. A potential reason to have handles like this is to have the person apply only a minimal amount of pressure to cut the newspaper and be able to sense discomfort. Grading up would be useful if a person is starting to regain sensation after nerve damage to the hand from surgery or injury. Grade down (scissors) - Using scissors with rubber padding to have a comfortable sensation when cutting. The use of rubber padding in the handles is good when people have recently received surgery in the thenar compartment of their hand. Grade up (mixing spoon) - The use of a mixing spoon that has a flat metal handle. Using this type of mixing spoon is more difficult because gripping the spoon becomes more


strenuous when a person has to apply grasping force to the spoon. Grading up this task is useful for someone that might have problems with grasp strength due to muscle damage by strengthening the numerical and flexor muscles of the hand. Grade down (mixing spoon) - To grade down the texture of the mixing spoon, one can have smooth rubber padding on the handle to provide comfort to the person while they grip the mixing spoon. Grading down for texture may be useful in a situation where the person had a palm injury and wants to start using their injured hand again. Grade up (measuring cup) - To grade up for texture, the measuring cup handle can be very smooth, thus making it more difficult to sustain a lateral prehension grip. A person, who needs to develop or strengthen their pinch, can use this measuring cup to build on that. Grade down (measuring cup) - To grade down for texture, the measuring cup handle can have a large rubber cover for added comfort and grip. Grading down is useful for people who have problems with making a complete fist grip due to arthritis, this handle is helpful because it gives the person the ability to not make a complete grasp. C.

Materials a.

Position:

Grade up: To grade up the activity in terms of the position of the materials, they could be placed further away from the client. This causes the client to use more of their energy by making them get up and walk to get them. Grade down: To grade down, the materials can be positioned closer to the client so that he or she can easily reach them. b.

Size:


Grade up: The size of the materials used, such as the balloons, construction/tissue paper, candy, and newspaper can be made smaller. This would cause the client to use their fine motor skills more, thus grading the difficulty of the activity more. A smaller sized balloon is also harder to inflate by mouth, than an averaged sized balloon. Also, using a smaller glue bottle, with a smaller cap, would grade the activity up because it makes the client use their fine motor skills more, particularly their pincer pinch. Grade down: The size of the materials used can be made bigger. For instance, inflating a balloon that is average sized or providing bigger sheets of decorative paper would cause the client to rely less on their fine motor skills. It would also make it easier for them to decorate the pi単ata, since they would have a lager surface area to work with. A bigger glue bottle with a bigger glue cap would grade the activity down, because it makes it easier for person to turn it and not have to rely so much on their pincer pinch. c.

Shape

Grade up: Instead of using a round or oval balloon for the activity, it can be a long, thin balloon or a balloon animal. Using a different shape for the balloon grades the activity up, because it would be harder to inflate and decorate it. For example, to create the pi単ata mold out of a long, thin balloon or balloon animal, prompts the client to use his or her cognitive skills to determine the appropriate newspaper strips necessary to completely cover the balloons in layers, and the size of the construction/tissue paper necessary to decorate it. Additionally, using newspaper sheets, construction, and tissue paper that are irregularly shaped, not rectangular or square, can be more difficult to decorate the pi単ata because a client would have to cut around them to get the desired shape. Also, using different types of candies (lollipops, chocolates, hard candy) can make it more difficult


for a client to put the candy through the opening in the mold, because some candies may be square shaped or bigger than others and have to be inserted differently. Grade down: To grade down the activity the shape of the balloon should be round or oval, because it makes it easier to inflate and decorate. Using newspaper, construction, and tissue paper sheets that are average and rectangular shaped, also makes it easier to create and decorate the piñata. Furthermore, if the client wants to decorate the piñata with a specific shape, such as stars or hearts, having paper shaped hearts or stars cut out already grades the activity down. Using small, round candy also grades the activity down because it makes it easier to insert into the piñata. d.

Weight

Grade up: Increasing the weight of the glue bottle, by using a bigger bottle, grades the activity up, because it causes the client to use their arm and hand strength to hold the glue bottle up when pasting objects. The weight of the candy can also be increased by using bigger and bulkier candy. This grades the activity up for clients who have minimal weight bearing strength in their hands. Grade down: Reducing the weight of the glue bottle by emptying half of it out, grades the activity down because it reduces the amount of strength a client needs to use when pasting things on the piñata mold. Also using smaller candy or light weight candy, such as pixie sticks, reduces the weight of the candy and makes it easier for clients who do not have strength in their hands. e.

Texture

Grade up: Using newspaper or construction paper that is rough and sturdy, grades the activity up, because it makes it more difficult to cut and glue pieces onto the piñata mold.


The texture of the glue can also grade the activity up. The glue is liquid and runny, which can make it more difficult and messier to glue the pieces. If using a string to hang the piñata, the texture of the string can be changed to grade the activity up. For example, using aluminum wire as string makes it more difficult to cut and bend, because it requires an individual to use their hand strength. Grade down: To grade the activity down, tissue instead of construction should be used to decorate the piñata. Tissue paper is thinner, softer, more manageable and easier to cut and glue to the piñata mold, than construction paper. Also, using glue sticks or gel glue, instead of white liquid glue makes it easier to paste things, because they are thicker and do not have the tendency to rundown. They also do not have the tendency to bleed through the tissue paper, like liquid glue. In order to grade the activity down when using glue sticks, the glue should be applied on the piñata mold first and then the tissue paper should be placed where the glue was applied. If using a string to hang the piñata, regular string made from yarn can be used to grade the activity down, because it is easier to cut, manage, and to tie. D.

Nature/Degree of Interpersonal Contact Grade Up: To grade the activity ‘up’ in terms of interpersonal contact, a client can complete this activity in a group or social setting. This would grade the activity up because the client will have to use their communication and social performance skills. The client will also have to share supplies and materials with others if they complete the activity in a group setting. The client will have to interact with others in an appropriate manner and learn to work while talking to others.


Grade Down: To grade this activity down in terms of interpersonal contact, the client can complete this activity alone. This would significantly lower the amount of interpersonal contact the client will have and thus grade the activity down. The client will also not have to share any supplies or materials with others. This would limit the amount of communication and social performance skills the client will need to use. E.

Extent of Tactile, Verbal, or visual Cues Used by Practitioner During

Activity Grade Up: By the practitioner using less tactile, verbal, and visual cues during the activity to guide the client, the activity becomes more difficult. The less cues given by the practitioner, the more the client has to use his or her cognitive skills to determine what to do. For example, telling the client everything they have to do but not showing them, would be limiting the extent of visual cues and cause the client to have to visualize the steps. Also, simply stating to decorate the pi単ata and not giving any verbal, visual, or tactile cues when the client asks how to decorate it, would make the activity more difficult. Grade Down: To grade down the activity, the practitioner can use tactile, verbal, or visual cues whenever the client is having problems completing a procedure of the activity. For example, showing or re-explaining how to apply the flour/water mixture on a newspaper sheet and then on the balloon, would significantly help the client. Also, giving them verbal, visual, or tactile cues on how to decorate the pi単ata would grade down the activity because it assists them with their cognitive and problem solving skills. F.

The Teaching-Learning Environment


Grade Up: To grade up the teaching-learning environment, the activity can be completed in a noisy or crowded environment. This can make it more difficult for the client to concentrate and it works on the client’s ability to focus on the task at hand. For example, having music in the background would be a way to grade the activity up, whether the client enjoys the music or not, because it can be distracting. Also, being in a cold or warmer than usual environment, would grade the activity up because it would make it more difficult for the client to follow directions and perhaps even challenge their ability to remain calm and not get frustrated (emotional performance skill). Completing the activity in a room with dim lighting further grades the activity up, because it makes it harder for the client to concentrate on the activity. Grade Down: To grade down this activity, in terms of the teaching-learning environment, the practitioner can have the client complete the activity in a peaceful setting or room with proper lighting and temperature. This type of environment removes distractions and allows the client to focus on the activity more easily. An environment with minimal background noise and hardly any people, also avoids putting a client in an over stimulating environment. G.

Therapeutic Modifications—Indicate ways in which this activity may be

changed to increase occupational performance. State your reasoning. Write N/A if not applicable. 1.

Therapeutic Adaptations a.

Orthotic Devices: If a person suffers from scoliosis and requires a back brace for proper alignment, the activity can be adapted for the client. The pasting


and decorating portion of the activity can be done sitting on a chair and with pi単ata and materials on a table. A back brace limits movement, therefore having all the materials needed for this activity in front of the client, will facilitate pasting and decorating. The use of foot orthotics (shoe insoles) that are specially designed to take some of the weight-bearing strain off the lower back, as well as providing foot support and comfort for prolonged periods of standing. During this activity, the person will only be standing while heating the flour/water mix, unless the therapist grades the activity up. b.

Prosthetic Devices: Precaution needs to be taken when heating the flour/water mixture, because of the potential for damage to the prosthetic device from the heat of the stove. This activity can be done with upper and lower extremity prosthetic devices: partial lower limb device; complete lower limb device; partial upper limb device; complete upper limb device, hooks and pinch grips can be used to stir flour/water mixture, paste, and hang pi単atas once complete. Practitioners need to take into consideration potential hazardous areas that may cause problems for the individual and either grade down or up the activity, so they are challenged enough but not to the point where they will not be able to complete the activity.

c.

Assistive Technology and Adaptive Devices: i. Architectural Modifications: Adjusting the height of the chair to make the activity easier or harder for the individual to reach things on a table or counter, would be an architectural modification. Another architectural modification would be modifying the table so it is at chest level of the


individual. This way they do not have to bend over or reach down to pick up a piece of material for the pi単ata. Conversely, the therapist can modify the table to be at a comfortable level for the individual. ii. Environmental Modifications: Adjust temperature to be at a comfortable setting for the person. Adjust lighting in accordance with client preference. If client prefers to work in a quite environment, make sure that outside or white noise is significantly reduced. Music is another modification that the client can elect to have if they feel comfortable working this way. iii. Tool and Equipment Modifications (low-tech (e.g., reacher) or hi-tech (e.g., computer control devices) : Low-tech - A pinch or hook prosthetic can be used as a low-tech device to reach for materials, paste, or decorate pi単ata. High-tech - A high tech device such as a computer-assisted prosthetic that detects shape and mass of object can be used to grab mixing spoon, pinch the newspaper molds, and decorate the pi単ata. i.

Wheelchair modifications: A therapist can place a tablet on the lap of the individual so they can work on the pi単ata. Manufacturing a cup holder into the arm rests so the client can place glue and decorating materials inside.

Prevention

2.

a. i.

Energy Conservation Energy-Saving Procedures


Procedures that would save energy include doing the activity while sitting down. This would help increase occupational performance for people who cannot stand for long periods of time or have trouble balancing while standing, because they will be able to complete the activity to a greater extent. Steps that a person could do sitting down to save energy are, measuring the cups of water and flour necessary for the flour/water mixture, cutting the newspaper into sheets, inflating the balloon, gluing the newspaper sheets onto the balloon, and decorating the pi単ata. ii.

Activity Restrictions The activity restricts a person from sitting down when cooking flour/water mixture in steps 3-4. A person needs to be standing in order to remove any clumps in the mixture as it cooks over the stove.

iii.

Work Simplification. To conserve energy, the work can be simplified by plainly decorating the pi単ata. Once the mold is stiff enough, a person can simply cover the pi単ata with colorful tissue paper, without cutting designs or decorating it in a specific or complicated way. All the materials that need to be cut can also be provided for the client to simplify the work and conserve energy.

iv.

Time Management To conserve energy in the aspect of time management, the activity can be expanded over a few days. Making the flour/water mixture can be done one day, making the actual mold can be done the next day, and then the pi単ata can be


decorated the following day. This allows the person to manage their time better, take things slow, and not use up all of their energy. Environmental Organization

v.

To conserve energy the environment needs to be organized so that it is room temperature, properly lit, and everything needs to be easily accessible. This allows for the person to comfortably focus on the activity at hand and not have to constantly move or get up to get supplies. b. i.

Joint Protection/body Mechanics Using Proper/Body Mechanics In order to prevent any injuries, the client needs to use proper body mechanics when standing, sitting, and walking. This activity does not require any heavy lifting, however, proper body mechanics still need to be utilized when bending down and reaching to get an object. For example, a person needs to keep their back as straight as possible when standing, sitting, and walking, in order to prevent any abnormal spinal curvatures. They need to make sure to use a stool if reaching for something that is on a high counter and they need to make sure to bend their knees and lift with their legs, not their back, when picking something off of the ground.

ii.

Avoiding Static/Deforming Postures To avoid deforming postures, the client performing the activity needs to be able to sit up straight and not hunch his or her shoulders while completing the activity. To avoid static postures, the client needs to be aware that it is not good to stay in


one position over a long period of time. The client needs to move around in their seat or change positions from sitting to standing every once in a while. Avoiding Excessive Weight-Bearing

iii.

To avoid excessive weight-bearing the client should not be leaning on one side of his or her body when sitting down or when standing. Standing on one leg, leaning on one leg, resting on one shoulder, or elbow are examples of things that should be avoided. Also, having a strong base of support prevents excessive weigh bearing on one side of the body or on a particular limb. c.

Positioning The client needs to be properly positioned in order to protect joints and use proper body mechanics. In the sitting position, the client is able to conserve energy, reduce stress on the back, and reduce stress on joints of the lower extremity. When the client is sitting down in a chair he or she needs to be sitting up straight with both feet on the floor. The client also needs to stand up straight when walking or standing. These positions are safe and protect both the therapy practitioner and client. Positioning can be changed to increase occupational performance depending on the client. If they cannot stand for long periods of time then the client can sit and complete certain steps, but then stand to complete other steps, in order to improve their standing endurance.

d. i.

Balance of Performance Areas to Facilitate Health and Well-Being Enhancement of Occupational Performance Areas This activity enhances occupational performance areas because it works on performance skills, such as motor, sensory, and cognitive skills, that are necessary


for other activities. The activity requires a person to follow directions, which can be useful when doing IADL’s (cooking, managing money). It also works on a client’s fine motor skills, which can help a client with their ADL’s of eating, dressing, and hygiene. If this activity is completed in a group setting, it allows the client to work on their communication skills, which can help them in a variety of social settings. This particular activity is beneficial for children who are struggling in school, because it focuses on following directions, sequencing, cognitive thinking, and motor skills. ii.

Satisfaction of Client and/or Caregiver This activity has the potential to bring satisfaction to the client and caregiver because it is an arts and crafts activity that enables them to explore their creativity. The activity allows them to create something of their own, express themselves, and it can be made as a gift for someone. At the same time, it has the potential to improve their performance skills and help them complete the activities that are meaningful to them in their everyday life.

iii.

Quality of Life Quality of life can be improved by this activity because it allows a client to work on the skills they need to live an independent life, such as motor skills of standing, walking, and fine motor skills. It works on the cognitive functions of sequencing, following directions, and organization. It also may improve quality of life by bringing them satisfaction in completing the activity and/or by making it as a gift for someone.


(Hersch, Lamport & Coffey, 2005) Kelly Garcia’s Reflection After going through the process of making the miniature piñatas and completing Form 4, I have come to learn what goes into completing an activity and how extensively an activity can be broken down. For example, I had not realized the various performance skills required to make or even decorate a paper mache piñata and the different ways that an activity can be graded up/down. Initially, I thought that making miniature piñatas would be a relatively simple task, but I was wrong. Making the piñata molds was a very time consuming task. It took approximately two days, because I did not layer them with enough newspaper sheets the first time and I had to re-layer them a second time. From this experience, I have learned the importance of taking into consideration the feasibility of an activity and the amount of preparation needed to complete it. In general I feel that completing this assignment was beneficial, though time consuming and tedious, because it allowed me to apply the concepts that I have learned in class. This has been the first I have ever had to do something like this and it has been quite an experience. I have learned so much about what goes into analyzing the different components of an activity and what it can mean to potential clients.


Miniature Pinatas