Occupational therapy

Occupational Therapy, often abbreviated as "OT", incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life. Occupational therapists work with individuals, families, groups and populations to facilitate health and well-being through engagement or re-engagement in occupation. Occupational therapists are becoming increasingly involved in addressing the impact of social and environmental factors that contribute to exclusion and occupational deprivation.¹²

The World Federation of Occupational Therapistsdefines occupational therapy as a profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment, or the activity to better support participation.³

Another way of thinking about the ideas contained in these definitions could be: occupational therapy is about understanding the importance of an activity to an individual, being able to analyze the physical, mental and social components of the activity and then adapting the activity, the environment and/or the person to enable them to resume the activity. In other words, occupational therapists would ask, "Why does this person have difficulties managing his or her daily activities (or occupations), and what can we adapt to make it possible for him or her to manage better and how will this then impact his or her health and well-being?”

Occupational therapy gives people the "skills for the job of living" necessary for "living life to its fullest."⁴

The College of Occupational Therapists (2004) describes OT as follows: Occupational Therapy enables people to achieve health, well-being and life satisfaction through participation in occupation.

Occupational Therapy draws from the field of occupational science to provide an evidence base to practice and develop academic and practice links to other related disciplines such as social science and anthropology, and also utilises a range of generic models to guide the practice of OT.

Occupation, occupational form and occupational performance

Occupation is the dynamic relationship between the occupational form and occupational performance.⁵⁶

Many people see the term occupation as a job one does. However, the meaning of occupation is seen in a much wider context by an Occupational Therapist. A human being can be engaged in a wide range of occupations: leisure, self-care or educational activities are just a few examples of occupation.⁷

Wu and Lin (1999) stated that the occupational form was the “...objective pre-existing structure or environmental context that elicits or guides subsequent human performance”. The occupational form consists of objective features. These may include materials, human context and socio-cultural dimensions.⁸

Occupational therapy process

An Occupational Therapist works systematically through a sequence of actions known as the occupational therapy process. There are several versions of this process as described by numerous writers. Creek (2003)⁹ has sought to provide a comprehensive version based on extensive research. This version has 11 stages, which for the experienced therapist may not be linear in nature. The stages are:

Areas of practice in occupational therapy

There are many areas of practice in occupational therapy which have often been divided into Physical Health and Mental Health. The division is not so clear as occupational therapists consider the physical, mental and social well-being of all clients in every setting. These divisions occur when the setting is defined by the population it serves for example acute physical or mental health settings (e.g.: hospitals), sub-acute settings (e.g.: aged care facilities), outpatient clinics and community settings.

Physical health

Mental health

Community

Community based practice involves working with people in their own environment rather than in a hospital setting. It can also involve working with atypical populations such as the homeless or at-risk populations. Examples of community-based practice settings:

Occupational therapy approaches

Activity analysis

Activity analysis has been defined as a process of dissecting an activity into its component parts and task sequence in order to identify its inherent properties and the skills required for its performance, thus allowing the therapist to evaluate its therapeutic potential¹³

Therapeutic activity

Occupational therapists use therapeutic activity or therapeutic occupation to improve an individual's occupational performance and increase function in activities of daily living (ADLs).

A core and unique feature of occupational therapy practice is the use of occupation as a therapeutic medium¹⁴. An occupational therapy core skill as defined by The College of Occupational Therapists (COT) is the use of activity as a therapeutic tool¹⁵.

Occupational therapists have utilized activities, such as crafts, since the profession was founded¹⁶. The arts and crafts movement in the very early 20th century had ascertained that goal directed activity had a curative effect on the social problems inherent in the newly industrialized societies. The founders of the occupational therapy profession extended this thinking to the treatment of individuals' with mental health problems and as a consequence between 1920 and 1940 much of occupational therapy practice concentrated around the use of crafts as purposeful activities¹⁷. The emergence of occupational therapy in physical medicine began during World War II and craft activities were utilised to rehabilitate injured soldiers¹⁸. This method of practice was later termed by Mosey¹⁹ as activity synthesis.

Activity synthesis or occupational synthesis is the core of occupational therapy practice; occupational therapists, in collaboration with clients, design occupational forms to produce a therapeutic occupation or activity, that is meaningful and purposeful to the client²⁰. The therapeutic activity or occupation may be used to assess the client’s occupational needs or to achieve a therapeutic goal. The component parts of an activity or occupation are matched with the required occupational performance outcomes. For example, the muscle movements elicited by pottery may address fine motor and gross motor skills to improve shoulder flexion and extension, range of movement and elbow extension and flexion.²¹.

Other therapeutic activities or occupations may include cookery activities, such as making a smoothie or a healthy soup. The components of this activity such as planning and following a recipe may address cognitive components of occupational performance such as problem solving, sequencing and learning. Health may be promoted through this occupation, enabling clients to consider healthy eating issues²². Occupational therapists may further use therapeutic activities or occupations to assess occupational performance. For example, an occupational therapist may ask a client to make a cup of tea or prepare a simple meal to assess performance in activities of daily living (ADLs). An occupational therapist may use a board or card game to assess cognitive components of occupational performance. This application of therapeutic activity/occupation involves use of the core skills of the occupational therapist, chiefly assessment and problem solving²³.

Theoretical Frameworks

Occupational Therapists use a number of theoretical frameworks to frame their practice. Note that terminology has differed between scholars. Theoretical bases for framing a human and their occupation being include the following:

Frames of Reference/Generic models

Frames of reference or generic models are the overarching title given to a collation of compatible knowledge, research and theories that form conceptual practice²⁴. More generally they can be defined as "those aspects which influence our perceptions, decisions and practice"²⁵.

Frames of reference have generally been a precursor to the design of theoretical models of practice. As such, through the development of such models, different terminology exists to define different frames of reference. Some broad terms as defined by Foster²⁶ include: Developmental, Biomechanical, Learning and Compensatory.

Approaches/Intervention models

These are the methods of carrying out the Frames of Reference. Again, terminology differs depending on your viewpoint and literature base. Using the above author (²⁶), approaches can include the Adaptive (based on the compensatory Frame of Reference),

Models

The Ayurvedic Model of Human Occupation: The Ayurvedic model of human occupation draws no clear distinctions between mind and body or physical and mental illness. The mind is not thought to reside in the brain, but in energy that permeates the entire body. Health is believed to depend on a constant flow of that energy through the body. The nature of the energy flow is related to occupation through two-way causal mechanisms. Lifestyle regulation is therefore believed to be a determinant of health.²⁷

Theories

Evolution of the philosophy of occupational therapy

The philosophy of occupational therapy has evolved over the history of the profession. The philosophy articulated by the founders that have owed much to the ideals of romanticism²⁸ , pragmatism²⁹ and humanism which are collectively considered the fundamental ideologies of the past century³⁰³¹³².

William Rush Dunton, the creator of the National Society for the Promotion of Occupational Therapy, now the American Occupational Therapy Association, sought to promote the ideas that occupation is a basic human need, and that occupation was therapeutic. From his statements, came some of the basic assumptions of occupational therapy, which include:

These have been elaborated over time to form the values which underpin the Codes of Ethics issued by each national association. However, the relevance of occupation to health and well-being remains the central theme. Influenced by criticism from medicine and the multitude of physical disabilities resulting from World War II , occupational therapy adopted a more reductionistic philosophy for a time. While this approach lead to developments in technical knowledge about occupational performance, clinicians became increasingly disillusioned and re-considered these beliefs³³³⁴. As a result, client centeredness and occupation are re-emerging as dominant themes in the profession, perhaps indicating growing maturity and self confidence³⁵³⁶³⁷. Over the past century, the underlying philosophy of occupational therapy has evolved from being a diversion from illness, to treatment, to enablement through meaningful occupation¹. This became evident through the development and widespread adoption of the Canadian Model of Occupational Performance.

The two most commonly mentioned values are that occupation is essential for health and the concept of holism. However, there have been some dissenting voices. Mocellin in particular advocated abandoning the notion of health through occupation as obsolete in the modern world and questioned the appropriateness of advocating holism when practice rarely supports it³⁸³⁹⁴⁰. The values formulated by the American Association of Occupational Therapists have also been critiqued as being therapist centred and not reflecting the modern reality of multicultural practice⁴¹⁴².

Central to the philosophy of occupational therapy is the concept of occupational performance. In considering occupational performance the therapist must consider the many factors which comprise overall performance. This concept is made more tangible using models such as the person-environment-occupation model proposed by Law et al. (1996)⁴³. This approach highlights the importance of satisfactions in one's occupations, broadening the aim of occupational therapy beyond the mere completion of tasks to the holistic achievement of personal wellbeing.

In recent times occupational therapists have challenged themselves to think more broadly about the potential scope of the profession, and expanded it to include working with groups experiencing occupational deprivation which stems from sources other than disability⁴⁴. Examples of new and emerging practice areas would include therapists working with refugees¹⁰, and with people experiencing homelessness⁴⁵

Challenges for Occupational Therapy

Occupation profoundly affects the aetiology and prognosis of several pathologies ranging from infection and autoimmune disorders⁴⁶ to cancer⁴⁷. While these effects are well known in specific scientific communities⁴⁸ they are not immediately obvious to stakeholders and the occupational therapy profession as a whole has largely failed to utilise the scientific knowledge available to market itself to funding bodies such as government departments or health insurance providers. Occupational therapy is therefore consistently losing out to service providers that market themselves more aggressively such as pharmaceutical companies and to a lesser extent physical therapists.

Maladaptive attempts by occupational therapy services to survive have resulted in role blurring⁴⁹, generic working and non-holistic practice that is no-longer identifiable as occupational therapy in its true sense. This has led to ambiguity and mass confusion as to what occupational therapy actually is⁵⁰. A key challenge for occupational therapy is to develop and maintain a definition of it's nature and scope. Common misconceptions are that occupational therapists just provide equipment to aid activities of daily living or are hospital discharge facilitators. Cara and MacRae⁵¹ assert that whilst this presets a challenge, it also results in a unique flexibility which allows the discipline to move with the flow of social, cultural and environmental change. This difficulty in definition may be a cause of chronic strain for practitioners⁵² and may also contribute to a lack of role definition and subsequent blurring⁵³. Loss of role definition and failure to practise holistically has resulted in other service providers filling the occupational therapy niche. Examples of this include physiotherapists practising cognitive behavioural therapy, life coaches⁵⁴ and reverse therapists.

The future viability of the profession could be enhanced by prospective longitudinal studies into the impact of holistic, preventative occupational therapy on disease incidence, and the integration of evidence from psychoneuroimmunological research into occupational therapy marketing campaigns. Recent literature has also called for Occupational Therapy to address the political nature of who we are and what we do⁵⁵.

The World Federation of Occupational Therapists

TheWorld Federation of Occupational Therapists (WFOT) is the key international representative for Occupational Therapists and Occupational Therapy around the world and the official international organisation for the promotion of Occupational Therapy. Founded in 1952, WFOT currently has 66 member associations. Click on the link below to WFOT member nations to find specific information about each country’s history, occupational therapy education system, registration requirements and relevant organizations.

Occupational Therapy Associations

Occupational Therapy Education

Licensing and Registration requirements

References

^ ^a ^b ^c Townsend, Elizabeth A. and Helene J Polatajko. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-Being & Justice Through Occupation. Ottawa: CAOT Publications ACE.
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^ http://www.wfot.org/information.asp
^ AOTA http://www.aota.org
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Hobcroft, N. (1949). "Life in the Occupational Therapy Department at Porirua." New Zealand Occupational therapy Newsletter Number Two. (May).

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Contents

Defining occupational therapy

Occupation, occupational form and occupational performance