Occupational therapy (OT) is the use of assessment and treatment to develop, recover, or maintain the daily living and work skills of people with a physical, mental, or cognitive disorder. The American Occupational Therapy Association defines an occupational therapist as someone who..."helps people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes." Occupational therapists promote skill development and independence in all daily activities. For an adult, this may mean looking at the areas of self-care, home-making, leisure, and work. The "occupations" of childhood may include playing in the park with friends, washing hands, going to the bathroom, cutting with scissors, drawing, etc. Occupational therapists work with individuals whose goals are to gain back basic functions that they have lost due to a form of disability. Stroke patients who lose function in one side of their body will need therapy to help regain fine motor skills and to learn to adjust performing basic functions like eating and brushing teeth with that lost function. An individual who has lost lost a limb or become paralyzed will need therapy to adjust to performing occupational tasks. Occupational therapists assist in the rehabilitation of these individuals through working on fine motor skills and regaining the ability perform everyday functions.
The American Occupational Therapy Association's practice framework identifies the following areas of occupation:
The Occupational Therapy Intervention and Process Model (OTIPM) by Anne Fisher is a model designed to guide occupational therapists in their clinical reasoning. Its focus is on a top-down (first looking at where activities are not being completed by the person within their context and then figuring out where and how intervention may take place). (Fisher, A.D., 2014)
Scandinavian Journal of Occupational Therapy 2013; 20: 162–173. Scandinavian Journal of Occupational Therapy, 21(sup1), 96-107.
The role of occupational therapy allows occupational therapists to work in many different settings, work with many different populations and acquire many different specialties. This broad spectrum of practice lends itself to difficulty categorizing the areas of practice that exist, especially considering the many countries and different health care systems. In this section, the categorization from the American Occupational Therapy Association is used. However, there are other ways to categorize areas of practice in OT, such as physical, mental, and community practice (AOTA, 2009). 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.
In each area of practice below, an OT can work with different populations, diagnosis, specialities, and in different settings.
In 1951, Joan Erikson became director of activities for the “severely disturbed children and young adults” at the Austen Riggs Center. At that time, “occupational therapy” was used “for keeping patients busy on useless tasks.” Erikson “brought in painters, sculptors, dancers, weavers, potters and others to create a program that provided real therapy.”
Occupational therapists work with infants, toddlers, children, and youth and their families in a variety of settings including schools, clinics, and homes. Occupational therapists assist children and their caregivers to build skills that enable them to participate in meaningful occupations. Occupational therapists also address the psychosocial needs of children and youth to enable them to participate in meaningful life events. These occupations may include: normal growth and development, feeding, play, social skills, and education.
Occupational therapy with Children and Youth may take a variety of forms:
The potential for unnecessary treatment of children by occupational therapists does exist in for-profit health care systems: occupational therapists in some affluent areas in South Africa, particularly in the Northern Suburbs of Johannesburg, have been accused by the country's largest private medical aid scheme, Discovery Health, of engaging in over-treatment of children in collusion with schools.
The practice area of Health and Wellness is emerging steadily due to the increasing need for wellness-related services in occupational therapy. A connection between wellness and physical health, as well as mental health, has been found; consequently, helping to improve the physical and mental health of clients can lead to a general increase in wellness.
As a practice area, health and wellness can include a focus on the following:
Mental health and the moral treatment movement have been recognized as the root of occupational therapy. According to the World Health Organization, mental illness is one of the fastest growing forms of disability. There is a focus on prevention and treatment of mental illness in populations including children, youth, the aging, and those with severe and persistent mental health issues. More specifically, military personnel and veterans are populations that can benefit from occupational therapy but currently, there is a lack of focus on these populations regarding mental health care. Occupational therapists provide mental health services in a variety of settings including hospitals, day programs, and long-term-care facilities.
Mental health illnesses that may require occupational therapy include schizophrenia and other psychotic disorders, depressive disorders, anxiety disorders, trauma- and stressor-related disorders (post traumatic stress disorder or acute stress disorder), obsessive-compulsive and related disorders such as hoarding, and neurodevelopmental disorders such as autism spectrum disorder, attention deficit/hyperactivity disorder and learning disorders.
Occupational therapists help individuals with mental illness acquire the skills to care for themselves or others including the following:
Within the scope of occupational therapy, there are a variety of assessments that can be used for individuals with mental health conditions.These evaluation tools generally assess occupational performance and participation in a variety of areas.
The use of psychology in occupational therapy dates back to its beginnings as a profession. Occupational therapy's rather recent start lines up with the majority of psychological studies of the 20th century. The field can date some of its core ideas to Sigmund Freud, using his theories to give an emotional perspective on how the emotions develop and how this affects behavior. Freud's personality theory about the psychic energies he titled the id, ego and superego all reflect on how a chronic unbalance between the three leads to physical and mental illness. This unbalance later affects a person's behavior, which will interfere with their occupations of daily, including simple things as socialization with others, attending a course for leisure, and even managing finances. While the field does not subscribe to the psychosexual development undertones of Freudian personality theory, it does still appreciate how when what one needs to survive (the id component) and the internally engraved mores of one's culture (the superego part) are in conflict, it can lead to a severe handicap when the conscience aspect (or ego) can no longer manage this stress, leading to mental illness .
Along with influence of Freud. Carl Jung has also contributed to some of the psychological perspectives used in occupational therapy today. Like Freud, Jung's theories are primarily about the unconscious's effect on a person's behavior. For the occupational therapist, the unconscious plays a role in how patients will choose to comply with and do certain therapeutic activities. This particularly applies to the influence of art as a form of therapy, which is often used in pediatric facilities; where compliance is often an issue. The usage of therapeutic art techniques, such as molding putty of various compliance, makes something like strengthening the muscles of the hand, look like a playtime rather than an exercise to be carried out. Jung also lent a core belief to the occupational therapist philosophy in his ideals regarding the potential to be able to touch other's souls. This directly correlates with the occupational therapist philosophy that an interpersonal relationship between the therapist and the client is key to helping the patient reach their full potential. The work of Lev Vygotsky was also influential in his theory regarding the Zone of Proximal Development. By utilizing this technique, the therapist can use scaffolding to teach the patient how to resume their prior independence without undermining their autonomy; which can be a potential issue for any therapist. Another way to try and aid a patient in this is the work of Albert Bandura and his social learning theory. By using this far-reaching theoretical perspective, the therapist can model the targeted behavior to be learned and the patient can attempt to copy it. The use of these techniques can combat the common issue of providing too much assistance for a patient so they will avoid failure, but ultimately will not be able to complete the needed tasks without the help of the therapist.
The first time a treatment model for the mentally ill emerged it was created by Johns Hopkins University and titled Habit Training. While it was not created with occupational therapy as its recipient, it still continues as a reminder to the contemporary occupational therapist that their roots began in helping those with primarily mental illness rather than physical disabilities or developmental delays. However, today the same goal as before exists: to treat the entire person, whether the primary problem relates to physical or mental health. This psychological philosophy relates back to the diversity of the field of occupational therapy.
As with the usage of Freud mentioned previously, the use of personality theory most definitely applies to the field of occupational therapy. The occupational therapist Jane Sorenson created the "Wholelife Resume" to cover the areas of expertise in the patient and learn further about how she could expand their overall potential. In her research, she related that ethnicity and stereotype beliefs play a large role in a patient's mental state. By understanding the aspects that make up a person, the occupational therapist can better understand the person's behaviors and value and, therefore, can more affectively use the patient's own belief system to support, develop and enhance their behavioral change that will restore them to former, or even better, health.
Occupational therapists work with older adults to maintain independence, participate in meaningful activities, and live fulfilling lives. Some examples of areas that occupational therapists address with older adults are driving, continuing to live at home, low vision, and dementia or Alzheimer's Disease (AD). When addressing driving, driver evaluations are administered to determine if drivers are safe behind the wheel. Cardiologists must give accurate heart history to DMV and therapists. To enable independence of older adults and injured humans at home, occupational therapists perform fall screens and evaluate all humans functioning in their homes and recommend specific home modifications. When addressing low vision, occupational therapists modify tasks and the environment. While working with individuals with AD, occupational therapists focus on maintaining quality of life, ensure safety, promote independence, and utilize retained abilities.
Occupational therapists address the needs of rehabilitation, disability, and participation. Occupational therapists provide treatment for adults with disabilities in a variety of settings including hospitals (acute rehabilitation, in-patient rehabilitation, and out-patient rehabilitation), home health, skilled nursing facilities, and day rehabilitation programs. When planning treatment, occupational therapists address the physical, cognitive, psychosocial, and environmental needs involved in adult populations across a variety of settings.
Occupational therapy with adult rehabilitation, disability, and participation may take a variety of forms:
Because of the rising need for occupational therapists, many facilities are opting for travel occupational therapists—who are willing to travel, often out of state, to work temporarily in a facility. Assignments may run as short as 8 weeks or as long as 9 months, but typically last 13–26 weeks in length.
Occupational therapists may also work with clients who have had an injury and are trying to get back to work. Testing may be completed to simulate work tasks in order to determine best matches for work, accommodations needed at work, or the level of disability. Work conditioning and hardening are approaches used to restore performance skills needed on the job that may have changed due to an illness or injury. Occupational therapists can also prevent work related injuries through ergonomics and on site work evaluations.
Source : Wikipedia
