Applying MOHO with Adolescents &
Adults with Cancer
Brent Braveman, PhD., OTR/L, FAOTA
Donna Kelly, OTR/L, M.ED, CLT
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Learning Objectives
At the end of this session participants will be able to:
• Explain the challenges to occupational performance experienced by adolescents and
adults with cancer.
• Explain the advantages of using the Model of Human Occupation as an underlying
conceptual practice model to guide practice in clients with cancer
• Describe the use, functionality and limitations of MOHO based assessments in inpatient
oncology rehabilitation
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The Population of Persons with Oncology
Primary forms of cancer (where cancer originates):
• Melanoma
• Carcinoma
• Sarcoma
• Leukemia
• Lymphoma, Multiple Myeloma
• Central Nervous System
12 most common symptoms
• Weakness •Swollen legs
• Dry mouth •Nausea
• Anorexia •Constipation
• Depression •Vomiting
• Pain •Confusion
• Insomnia •Dyspnea
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Cancer Treatments
• Surgical removal of cancer cells/tumors from the body.
• Radiation therapy focused on killing cancer cells and
shrinking tumors.
• Chemotherapy using drugs to kill cancer cells.
• Immunotherapy focused on strengthening and using a
person’s immune system to fight cancer.
• Hormone therapy uses hormones to slow or stop cancer
cell growth.
• Stem cell transplants which restore blood-forming cells
destroyed by high dose chemotherapy or radiation.
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Impact of Cancer on the Occupational Performance of
Adults
• Work
• Education
• Self-care
• Family roles
• Play and leisure
• Instrumental activities of daily living
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The Cancer Care Continuum
• Pretreatment
Newly diagnosed, no treatment initiated
• Active Treatment
Presently receiving treatment with a curative goal
• Maintenance
Long-term therapy to maintain remission
• Post treatment
Medical treatment is complete with no evidence of disease
• Palliative care
o Palliative treatment for incurable cancer
o Optimize comfort
o Decrease caregiver burden
o Patient-centered goals
Stubblefield, M. D., & O'Dell, M. W. (Eds.). (2010). Synopsis of Clinical Oncology. Demos Medical
Publishing
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Rehabilitation Across the Cancer Care Continuum
Stage of Care Example of Rehabilitation Interventions
Prevention Lifestyle redesign, healthy behaviors, exercise and weight loss
Early Primary and secondary prevention of functional deficits
Detection and
Screening
Early intervention to maintain function and promote positive
Diagnosis psychological health. Prepare clients for intervention.
Pre-habilitation.
Fatigue, cognition, ADL, IADL, mobility etc., symptom
Treatment
management, medication management, falls reduction.
Survivorship Lifestyle redesign, healthy behaviors, exercise and weight loss
End of Life Full range of interventions promoting function and self-
Care determination, goal attainment
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Theoretical Base
The Model of Human Occupation
Volition
Habituation
Performance Capacity
Environment
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MOHO Assessments
• Model of Human Occupation Screening Tool (MOHOST)
• Occupational Self-Assessment (OSA)
• Elements of the Occupational Performance History Interview (OPHI-II)
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Model of Human Occupation Study Group
• Initiated in 2016 by Lauro Munoz as a result of several efforts in conjunction
with Patricia Bowyer from Texas Woman’s University.
• Bi-weekly meetings to review and discuss key chapters from the MOHO Text
• Review of assessments appropriate for use with patients at MDACC
• Discussion of application of principles in treatment
• Exploration of key concepts such as narrative reasoning, client-centered
practice, narrative slope etc.
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MOHO and “Pre-Hab” for Adults with Cancer
• Multiple enhanced recovery programs (ERP) have been initiated at MDACC
• Significant success in interprofessional ERP with surgical patients
• Initiation of Enhanced Recovery for Stem Cell Patients (ER-SCT)
• Occupational therapy is included in an interprofessional pre-admission clinic
• Intervention focused on promoting occupational performance during long
inpatient stay (28 days) and 90 day follow-up in Houston
• Collaborate with other disciplines including PT, Gerontology, Nursing,
PM&R, Nutrition, PharmD to avoid duplication of services
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Roger
• 65 plus
• Scheduled to undergo an allogenic SCT
• No physical performance deficits (fatigue a 3 at rest, reports some
breathlessness climbing stairs etc.)
• Working, highly active and motivated
• Our task is to prepare Roger for inpatient stay and to maintain some sense of
normalcy by promoting occupational participation in existing roles
• Interview and initial assessment informed by MOHO
MOHO with Adolescents
and Young Adults
Donna Kelly OTR/L, Med, CLT
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Barriers to Occupational Performance in the
AYA Population
Impairments
• Motor, communication, organization and processing skills, sequencing of actions, pain,
sensation impairments, myopathies, loss of strength, impaired balance
Disease Treatment Process & Side Effects
• Nausea, diarrhea, vomiting, fever, neutropenia, pain, fatigue, mucositis, peripheral
neuropathies, hearing and vision changes, fibrosis
Environment
• Hospital room, prolonged stay, multiple lines, loss of control of daily routine
Social
• Loss of roles (student, athlete, clubs/organizations), changes in appearance (body
image), feelings of being left out or left behind, decreased access to friends, loss of
independence at an important developmental stage.
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Moho Based Occupational Assessments
MOHOST & SCOPE
• Based on information gathering, easy to administer throughout continuum of care,
assesses psychosocial and physical needs
• Similar assessments with SCOPE including assessment of family routine
The Pediatric Interest Profile
• The Adolescent Leisure Interest Profile (ages 12-21)
• 83 item assessment with focus on sports, outside activities, exercise, relaxation,
intellectual activities, creative activities, socializing, and community organizations
The Occupational Self-Assessment
• Captures occupational competence while also assessing importance of everyday
activities.
The Role Checklist
• Assesses participation in occupational roles and the value a client may place on that
role
• Based on weekly participation in each role, can be completed quickly.
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Claire
16 yo female with history of pharyngeal carcinoma. Presented to MDA for surgical
neck dissection following recurrence (1st resection at 9yo). Referred to OT services
POD 1 following R radical neck dissection with reconstructive properties due to
prior surgical interventions at OSH.
• Pt. is an only child, lives with supportive parents. Currently in 10th grade, attending H.S. Pt.
is the mascot at her school (large bulldog costume) and is very involved with the
cheerleading and football teams. Enjoys shopping, being with her friends, and being
involved at school. Reports moderate fatigue following surgery.
• Pt. displaying body image impairments, reports to therapist, “I love being the mascot, its fun
to put on a costume and pretend to be someone else.” Pt. reports concerns on how to show
her friends her surgery.
Evaluation displayed full AROM within surgical precautions, MMT WFLs with
functional tasks, pain at surgical site, significant edema at surgical site (and
throughout face/unable to open R eye)
SCOPE indicated impairments in the areas of social groups, occupational demands,
and family routine
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Thank you
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Questions?
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Contact
Brent Braveman, PhD, OTR/L, FAOTA
bhbraveman@mdanderson.org
Donna Kelly OTR/L, Med, CLT
dmkelly@mdanderson.org
bhbraveman@mdanderson.org
bhbraveman@mdanderson.org
