Occupational TherapistsOccupational therapists provide services and create opportunities for persons to achieve independence in their home, community and workplace despite impairments, limitations or participation restrictions. Occupation, in all areas of living, is defined as a key determinant of function and well being of humans (Kielhofner, 2004). Occupational therapists are client-centered and direct their effort toward helping clients to perform those occupations that they have identified as critical to their life. Occupational therapists may use occupation to foster their clients to regaining skills after injury and to resume the tasks they feel are needed to lead a meaningful life.
Occupational therapy is most often offered as a part of health care services in hospitals (for psychiatric and physical impairments), day care hospitals, rehabilitation centers, long-term care facilities, home care programs, social services and housing, public and private schools, clinical outpatient settings and preventive community programs. Occupational therapist uniquely insure that a client can perform tasks essential to their daily life, through modified and graded performance of the tasks, adaptation of the tools needed to perform the action or through adjunctive therapies within their environment. To achieve these goals, therapists work in close conjunction with other rehabilitation and education specialists, primarily physical therapists, nurses, physicians, teachers, psychologists and social workers. The goal of intervention is to enhance functioning within the client’s chosen environment(s). There can thus be a considerable overlap between disciplines. However, the expertise of occupational therapists is based on their knowledge of occupation and the recognition of the importance of occupations within a particular environment to improve performance and the effects of disease and disability.
Occupational therapy may be indicated for any of the following health issues:
- Development, modification or restoration of activities of daily living, work, or leisure skills
- Identification and facilitation of meaningful occupations
- Improvement, development or restoration of motor, sensory, cognitive or psychosocial components interfering with occupations
- Evaluation, intervention, adaptation, provision of equipment and training, within the environment and context in which occupations will be performed
- Acute care intervention to assess the ability to return to one’s home environment safely
- Consultation with, and education of, clients, families and health care collaborators to provide a comprehensive rehabilitation approach.
Range of Current Practices
The importance of occupation as the focal point in the profession has generated an energetic debate on redefining the conceptual foundations and models of practice (Fisher, 1998). The profession, in the early 1900’s, recognized ‘‘bedside’’ activity (e.g., weaving, needlepoint and crochet) and creative arts and crafts (e.g., wood work, cooper tooling, and leather work) for ameliorating the negative effects of both cognitive and physical impairments. Early treatment thus reflected occupations which were representative of that era. An emphasis on the arts and crafts movement pervaded the effort to minimize the effects of industrialization. There was a gradual progression in the 1970’s to incorporate more body-focused techniques, modalities and motor control theories and to embrace medical science into treatment. It was assumed, in this period, that improvement in functional performance skills would be generalized, if the underlying skills were present. As the profession evolved, scholars and therapists found that a richer description of occupational therapy was required to fully understand the underpinnings of the profession. The current understanding is that techniques need to be directly connected to activities that are interesting and motivating to our clients (Schwartz, 2003). In the past decade there has been considerable discussion of occupation and the developmental study of occupation and occupational science (Clark, 1993; Clark et al., 1993). This discussion has sought to place occupation versus specific body functions at the forefront of practice and in doing so underline our unique contribution to our client’s health and to health care systems (Wood, 1998). Broadly, occupational therapists and scholars agree that a relative balance of occupational performance is an essential force influencing the human being’s state of wellbeing (Bruce & Borg, 2001; Kielhofner, 2004; Law, 2002; Law et al., 1997).
In order to assist their clients, therapists use the knowledge that engaging in occupations requires specific performance skills and that those components are both constrained by the meaning which clients assign to an occupation and the context in which the occupation is embedded. This stance invites clients to engage in a wide range of activities. It promotes the notion that engagement in occupation is essential for an individual’s restoration of function and should be directed by the meaning which an occupation has for that individual. In addition to practice frameworks to guide occupational therapy practice, occupational therapy associations publish a list of standards to which occupational therapists are accountable. For example, the American Occupational Therapy Association (AOTA) and the British Association for Occupational Therapists/College of Occupational Therapists publish standards of practice and education for Occupational Therapy. They delineate the requirement for occupational therapy practitioners in the delivery of occupational therapy services, which are client centered and interactive in nature (American Occupational Therapy Association, 1995; College of Occupational Therapists, 2003).
The American association arranges its standards under the four headings of Referral, Screening and Evaluation;Intervention Planning; Intervention/Treatment; and Discontinuation of Services. These are matched by the British association and college with Referral and Consent; Assessment and Goal Setting; Intervention and Evaluation; and Discharge, Closure and Transfer of Care. Guidelines that address practice for such a broad spectrum of clients, settings and treatment help to provide a focus for the unique role of occupational therapists (American Occupational Therapy Association, 2002). In the initial phase of treatment the therapist will be interested in evaluating which occupations are causing difficulties (e.g., work, leisure and/ or activities of daily living), the occupational history and balance of occupation, the client’s priorities and targeted outcomes and, finally, the context in which the client will be performing the desired occupation. The therapist then concentrates on an analysis of occupational performance capabilities by observing the performance of occupations and by collecting data about factors that limit completion of the occupation. These lead to an analysis of the demands of the activity and delineation of the areas for intervention, based on best practice evidence. Intervention strategies can then be implemented and are broadly classified as either establishment or restoration of function, maintenance of function, promotion of health, modification of the context of the occupation, or prevention. Therapists may use occupationally based activities (e.g., meal preparation, adaptation of a keyboard to prevent a repetitive injury), purposeful activity (e.g., practicing a golf swing), or a preparatory method (e.g., splinting and exercise).