For an able-bodied person, tasks such as making a sandwich can seem ‘a piece of cake’.  

Task, such as making a ham sandwich for an ‘able bodied’ person. 

1.Clear a flat working area in the kitchen. 

2. Take butter and ham out of the fridge and the bread out of the bread bin. Take knives out of draws and a plate – carry it all to the worktop. 

3. Butter 2 slices of bread, put ham on one side and fold together. 

4. Cut in half and put on a plate. 

5. Et voila! 

But to us, living with chronic conditions can limit our ability to complete tasks that seem ‘easy’ to others. 

That’s where using activity analysis as a pacing strategy and self-management tool comes in.  

Activity analysis has been used by Occupational Therapists to establish what the barriers to the participation in activities are. It informs their clinical reasoning and identifies ways in which the occupation can adapted for optimal performance (Pentland et al., 2018). 

So, what’s stopping us from un-picking our own activities? identify, and modify any areas of difficulty, and make our lives a little bit easier. Activity analysis enables us to complete the task in full, as would any other able-bodied person, but in a slightly different way. This ensures that energy expenditure is as low as it can be and without needing a massive recovery time afterwards. This way, we can get on with the things we want to be doing. 

This allows us to understand the required processes and skills that the body goes through when completing an activity. We can discover a way in which the activity and/or environment can be adapted to compensate for reduced body processes and skill, for a successful performance of the activity. Even it is it just making a sandwich. 

Activity analysis breaks the activity down to its component parts. Almost like a recipe. So that the brain does not need to expend extra energy thinking about how to complete each activity. There’s nothing worse than coming to an activity that you’ve done 100+ times before, and not being able to remember the steps #BrainFog. Activity analysis provides you with a way to remember the steps. With an individual step by step ‘recipe’ of the activity. Complete with modifications to suit you. The recipe also ensures that if you need to take a rest break, then you can. You can come back to it and pick up from the step you left on. 

Making a Ham Sandwich

This blog post will analyse the person (client) functions and skills and performance skills needed to complete an identified activity. Making a ham sandwich. It’ll provide you with a step by step ‘recipe’ with modifications suggested, as an example of how activity analysis can be used as an energy conservation self-management technique and pacing strategy. 

A person’s functions and skills are the specific capacities or characteristics that they hold in order to complete a task (AOTA, 2020). They can influence the engagement and performance in occupations (task/activity). Considering the functions and skills we need is necessary when figuring out our own limitations. Knowing if any equipment or task adaptation might be needed to make the task just a little bit simpler. 

So, what skills and functions do we need? 

Mental functions, such as, understanding the instructions. Knowing if a knife falls on the floor we shouldn’t pick it up by the blade. Not getting distracted by other things but concentrating on the task. And having an awareness of where our body is, are important component parts of completing a task. 

We also need an understanding of our sensory and pain body functions in relation to the task. We need to be able to see the equipment in front of us or hear if a piece of equipment falls on the floor. To maintain our balance (in standing and/or sitting). Most importantly, to be able to feel pain to avoid injury e.g. when using sharp blades. 

When figuring out our own limitations to the task, we need to be aware of the motor functions needed. These can in be areas such as, the amount of muscle power needed to spread the butter. The amount of joint mobility needed for big movements like moving around the kitchen. Smaller, more dexterous movements like taking the bread out of the bag. Finally, the muscle endurance necessary to fulfil the task. 

Performance skills are observable person skills that are required for completion of the task; so the skills needed that we can see, for the task to go well, and are broken down into different categories. 

Core Skills

These categories, for example, are movement & planning skills, visual & sensory awareness skills and cognitive skills. Below is a table of skills you need to be aware of that fall into these categories. This is not an exhaustive list of all of the skills you might see, just some to get you started.

Motor & Planning	Visual & Sensory	Cognitive
– Bilateral co-ordination when stabilising bread with one hand and spreading butter/cutting bread with another.  – Muscle strength in hands when cutting bread.  – Muscle strength in legs when mobilising around kitchen to gather equipment and when standing (if standing to complete task).  – Fine (small muscles) motor skills when manipulating bread, grasping knives to butter and cut bread, when placing ham on bread, when grasping ingredients out of fridge.  – Gross (large muscles) motor skills when manoeuvring around environment to gather/replace ingredients/equipment and to place knives in washing up bowl.	– Depth perception needed judge the distance needed to place butter and ham on bread and when cutting using serrated knife.  – Proprioception – appropriately knowing where your body is in space when moving around the kitchen environment without clumsiness or un-coordinated movements.	– Initiation to begin the task  Focussing attention throughout the entire task.  – Problem solving and being able to think flexibly in event of a mistake or complication during the task.  – Sequencing to correctly perform task instructions in the correct order.  – Comprehension to follow the task instructions.  -Working memory to keep on track of the steps already taken/how to remember the steps of the task.

Like with client functions, reduced performance skills can impact the outcome of how we perform in and engage in the activity. 

Having an awareness of body structures, functions and skills required for a task enables us to document how the task can be modified to suit our needs. This allows for an enhanced performance overall, but also provides us with a self-management strategy. The step-by-step recipe reduces energy expenditure and enables us to do more of what we want to be doing. 

Using the breakdown of the body processes and structures needed, here is an example. The step by step recipe card includes modifications and could be used by an individual living with a long-term condition. To complete the task with as little energy as possible, leaving them with the energy to do other things. Things they want to be doing; things that fill their lives with a little enjoyment and fun. 

Activity analysis for a ham sandwich – breaking that task down! Make future use of this recipe to reduce energy expenditure. 

1. Clear a flat working area in the kitchen. 

2. Sit to complete the task if you feel you need to. Use a perching stool, dining chair or whatever chair is the most appropriate. 

3. Locate all of the supplies and collect them all on a tray. Alternatively, place the items on the worktop and slide to your working area in one go, so that you’re not making multiple trips. (Bread, butter, ham, butter knife bread knife, plate) 

4. Place 2 slices of bread on to the centre of the plate. Move the butter tub closer to the plate and gather the butter knife.  

5. Hold the butter knife in your dominant hand and secure the tub of butter with your free hand. 

6. Place knife into the butter, turn edge of knife away from the body, and then rotate the wrist to turn edge towards the body, scooping the butter out. Lift the knife out of the container. 

7. Use the thumb and fingers of the free hand to secure the bread to allow the spread of butter. 

8. Use the knife to spread the butter right to left. Ensure an even covering of butter from far right side to left (including the corners!). Manipulate the bread to ensure even butter coverage if needs be. Remember to butter both slices of bread. 

9. Take a piece of ham from the packet and add to one slice of bread. Place the second slice of bread on top of the other, butter side down. 

10. Use the serrated bread knife in your dominant hand to cut the sandwich in half (stabilise the bread with your free hand). Make sure to start at the outer edge (away from you). Slowly cut with a continuous sawing motion (back and forth) bringing the knife towards you as you go. 

11. Put the ingredients that you used away (bread, butter, ham), using the tray or method of pushing around the worktop. Use the tray to place the knives into the sink for washing up (do that later!). 

12. Et voila! 

13. Sit and eat your lunch! 

Using the pacing strategies (from the Pacing Masterclass), this one task can be broken down into even smaller chunks. This further reduces energy expenditure. For example: 

1. Worktop can be cleared, and a chair put in place earlier in the day. 

2. The non-fridge items can be placed on a tray and be placed near to the fridge in advance. Then collect the fridge items at lunch time. 

3. The sandwich itself can be prepared in advance and placed in the fridge. Then take out to eat at lunch time. 

4. The washing up can be done later; after you’ve eaten and enjoyed your lunch. 

Additional adaptations and pieces of equipment can be incorporated into the activity, dependent on your needs. 

• Adaptive cutlery/knives
• cutting board with edge stoppers
• finger splints to prevent hyperextension when cutting/spreading
• kitchen trolley to gather items on
• Dycem to place under plate/cutting board to prevent slipping, jar openers. 

Find out more about these and my favourite kitchen gadgets in my next post! 

Please let me know if this has been helpful by liking, sharing, or commenting on this post. Let’s get the conversation going by asking what activities you find difficult in the kitchen and what your favourite kitchen gadgets are. 

Remember, if you have any questions then please e-mail me on melanie@jboccupationaltherapy.co.uk or better still, why not book a session for a face-to-face chat. 

About the author 

I’m a third year Occupational Therapy BSc student at Coventry University. I have spent my working life and previous clinical placements in acute and community physical settings. I am determined to make the most of every learning experience given to me in this diverse placement setting. This is my final placement, so I am looking forward to implementing the OT theory and knowledge, and clinical practice experiences that I have learnt over the past 3 years.  

I live with my partner and our miniature dachshund, Jarvis (yes he was named after a Marvel character!). In my spare time myself and my partner like to take Jarvis out on nature walks… although he can’t walk too far as he has little legs! I taught myself embroidery in 2020, and I like to gift little projects to friends and family when I can.  

Having experience of a long-term condition myself, I hope to use my experiences to support and educate others in a way that best enhances their quality of life. I aim to make a difference to a people’s lives in my future career as a qualified OT.  

If anyone is happy to chat to me about their experiences of long-term conditions (clients and professionals!), then please do drop me an email webbm14@coventry.ac.uk or follow and message me on twitter. 

References 

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001  

Pentland, D., Kantartzis, S., Giatsi Clausen, M. and Witemyre, K. (2018) Occupational therapy and complexity: defining and describing practice. London: Royal College of Occupational Therapists. https://www.rcot.co.uk/practice-resources/rcot-publications/downloads/occupational-therapy-and-complexity