The two major categories of method of instruction are direct and indirect.¹⁰ The combination of direct and indirect instruction is known as an eclectic approach. The practitioner using a direct method teaches in a formal style. The environment is not a free-choice for instruction. The learner is expected to pay attention. The practitioner uses an autocratic leadership style.^1,7 Box 5-1 lists the characteristics of a teacher who uses the direct method of instruction.

BOX 5-1 Direct Teaching: Characteristics of the Teacher

1. Analyzes student’s behavior.

2. Responds to observable behavior.

3. Directs decisions and activities.

4. Keeps records.

5. Uses external motivations such as grades.

Using an indirect method involves an informal style of teaching. The environment allows the learner to make choices.1,7 For example, reading, writing, and math centers in a preschool setting allow children to learn on their own. This method encourages self-initiation and expression. The teacher uses a laissez faire leadership style.^1,7 Box 5-2 describes the characteristics of a teacher who uses an indirect method of instruction.

BOX 5-2 Indirect Teaching: Characteristics of the Teacher

1. Cares for and respects students.

2. Encourages student-initiated behaviors.

3. Solicits ideas for students.

4. Focuses on nonobservable behaviors such as thoughts and feelings.

5. Encourages learner’s inner potential.

OT practitioners frequently set up the environment and allow the client to problem solve through the activity with little instruction. This indirect method may help clients gain ability and feel empowered. They may develop unique ways of doing things. Their problem-solving abilities allow them to work through a variety of situations and are helpful for the future. Practitioners also use a direct method of teaching that involves instructing or demonstrating each step of an activity. Often a combination of approaches serves clients best, allowing clients some direct instruction to learn basics before allowing them to problem solve and figure out solutions on their own. See Box 5-3 for examples of each method.

BOX 5-3 Examples of Direct and Indirect Methods

Direct Method

The OT practitioner uses direct instruction when teaching a group of children the proper mechanics of letter and number formation. The children are seated at a table with writing materials available. The OT practitioner instructs the children to start their letters at the top and to stay on and between the lines on the paper.

The OT practitioner may use a direct instructional approach while teaching a client to perform a transfer. The steps of the specific transfer are taught. The client is tested for accuracy and safety prior to performing the transfer.

Indirect Method

The practitioner uses indirect instruction during a sensory processing intervention session. The environment is structured to meet the sensory needs of the members of the group. The children choose which activities to engage in with facilitation from the OT practitioner.

An informal instructional approach may be used when planning what clothes to wear during activities of daily living interventions. The session may first begin with a discussion of the weather and clothes available. The client may want to have a conversation about the colors and types of clothes to wear.

Learning Environment

Instruction occurs both in formal and informal environments.⁷ A formal instructional environment is characterized by individual work, emphasis on assessment, and use of external motivators. The result of formal instruction is typically academic achievement. For example, the OT practitioner uses formal instruction during prewriting and handwriting groups. The OT practititioner teaches the steps, strokes, and patterns sequentially. Children complete work independently and are assessed to determine how well they have achieved the needed skills.

An informal instructional environment is characterized by freedom in choosing activities and minimal emphasis on assessment or the use of external motivators. This type of environment fosters thoughtful and creative learners. Learners must decide how to do things and develop solutions. Informal environments are helpful for clients who must learn to problem solve. Therefore, this type of learning requires some basic skills and is often used after periods of direct instruction.1,10 The occupational therapy practitioner uses informal instruction during sensory processing groups. Throughout the occupational therapy process a combination of formal and informal teaching styles is applied.

Tools for Teaching

The choice and use of teaching tools depend on the content and context of the subject matter (Box 5-4). The objects and materials used in the activity may serve to teach clients. For example, providing an adult who has experienced a stroke with a shirt to put on may remind the client of the technique. The adult may be able to recall putting on a shirt and now needs to figure out how to do this with limited arm use. In this way, the object serves as a reminder to facilitate the learning. Media and methods are terms that an occupational therapy practitioner uses when planning interventions on an individual or group basis. Media is the plural form of the word medium. A medium is the materials used during the intervention process.² For example, a child engaged in making paper bag puppets uses media that include the paper bag, glue, and other materials and supplies, and the method refers to the set-up, steps of the process, and cleaning up. A method is a means of accomplishing a task.² OT practitioners use an eclectic approach combining the direct and indirect methods while providing interventions. Examples of therapeutic media are playdough, arts and crafts supplies, and scented markers.

BOX 5-4 Tools for Teaching

Objects that stimulate learning

Visual aids (e.g., colorful handouts)

Meaningful repetition

Plain language

“Just-right” challenge

Active engagement

Activity analysis

Visual aids may be useful to remind clients of key points, sequences, and directions. Visual aids used for teaching can be based in low or high technology. Visual aids provide cues to remind clients of the steps. Examples of low-technology visual aids are picture boards, handouts for sequencing the steps of an activity, and handwritten transparencies projected from an overhead (Figure 5-1).

Figure 5-1 Low technology instructional tool: overhead projector.

High-technology visual aids include things such as PowerPoint shows or DVDs for teaching. Auditory aids may also be used to facilitate learning. Recorded music incorporated into the learning environment or auditory feedback systems are examples of auditory aids. Many learners benefit from a kinesthetic approach to teaching. This means learning through moving and doing. A multisensory approach using several sensory pathways simultaneously with teaching is often the most successful (Figure 5-2). For example, while working with a preschool child who has autism spectrum disorder, the OT practitioner may incorporate music to help the child focus while engaging the child in movement experiences.

Figure 5-2 Students being directly instructed during dance class using a multisensory approach: visual, vestibular, and somatosensory pathways.

Clients learn by doing and OT practitioners help facilitate clients’ engagement in activity. This involves providing clients with plain language (sixth-grade level). Using clear and concise directions to highlight key aspects of the activity helps clients learn. Meaningful repetition provides clients with the practice needed to fully integrate the movements or sequence of steps.⁶ Learning how to divide the parts of the activity into basic actions is an essential part of practice. Practitioners teach clients by providing the “just-right” challenge, a challenge that is not so easy as to make clients bored nor a challenge that is so difficult as to make clients frustrated. Often, the key to successful intervention is understanding the activity and how to change the demands for specific clients.

Active engagement in a variety of activities helps clients learn. Using visual, auditory, and movement methods reinforces learning. OT practitioners rely heavily on learning by doing. In this way, much time is spent in OT teaching clients through “doing.” As clients become actively involved in activities, they learn.⁶

Frequently, practitioners use home programs, handouts, or visual cues to help clients remember, learn, and follow through. Colorful and attractive handouts written in plain language are most effective. Handouts should not be overwhelming or include extraneous language.

Table 5-1 provides a completed chart to help students examine the tools they are using in practice. This example shows how a meal preparation activity making pasta can be organized to address each suggested guideline when providing direct or indirect instruction.

TABLE 5-1

Using Tools for Teaching: Meal Preparation