What is this Occupational Therapy??

The World Federation of Occupational Therapists provides the following definition of Occupational Therapy: “Occupational therapy is 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 to better support participation.” Occupational therapists use careful analysis of physical, environmental, psychosocial, mental, spiritual, political and cultural factors to identify barriers to occupation. Occupational therapy draws from the fields of medicine, psychology, sociology, anthropology, and many other disciplines in developing its knowledge base. A new discipline of occupational science has been developed to enhance the evidence base of the profession.

Occupational Therapists’ help people with disabilities to fulfill their roles and responsibilities as spouse, parent, worker, and/or student. OT does this through the use of therapeutic methods, applied and assistive technology, orthotics (splints) and environmental modifications. OT helps people help themselves. Occupational Therapists’ treats a person as a whole. Life circumstances are taken into account during the treatment process. The person is what is important to the therapist. The person’s wants, needs and desires for recovery are what the therapist will address and the goals they together, along with family and friends, as a team will reach for.

OT services are beneficial to many individuals with:

Mental Illness
such as Drug Addiction, Mood disorders, Schizophrenia where occupational therapy aims at improving social, emotional and psychological behavior and occupational performance through group therapy,Conductive education,Cognitive behavioral therapy, family counseling and community integration.

Developmental Disorders
such as Cerebral Palsy, Mental Retardation, Autism, Attention Deficit Hyperactivity Disorder where occupational therapy helps the child with treatment techniques such as NDT and Sensory integration. Therapy assists in the development of neck control,trunk control, sitting, standing, and walking through the use of adaptive equipments or  assistive devices and Preschool training to prepare the child for education.

Neurological Conditions
such as Stroke, Head injury, Parkinson’s disease, etc. where therapy is aimed at retraining Cognitive-Perceptual abilities to promote independent functioning, mobility training and adaptations at home through purposeful activity training for normalising abnormal movement patterns and re-educating functional independence.

Geriatric Conditions
such as Alzheimer’s Dementia etc where therapy aims at teaching strategies for memory problems through pictorial integration activities, environmental modifications, physical exercises to maintain general body mobility.

Cardiac Disorders
such as Myocardial infarction, lung diseases-Bronchial asthma etc where therapy aims at fitness exercises, work analysis & assessment for work fitness, lifestyle modification ,work setup as well as home modifications & teaching prophylactic measures such as weight reduction.

Physical Dysfunctions
due to trauma, burns, amputations, nerve injuries, musculoskeletal disorders such as osteoarthritis, rheumatoid arthritis, Spinal cord injuries or tumors where therapy aims at restoring the functions of the affected limbs through the use of splints, assistive devices, prosthetic training and teaching joint protection and energy conservation techniques.

Cumulative Trauma Disorders
such as Carpal tunnel syndrome, work related disorders-Low back pain etc where therapy aims at education regarding prevention of work related injuries, modification of the work set up and home environment to suit disabled individuals, prevocational testing & training and Disability evaluation as well as their respective management.

Occupational therapy process

An Occupational Therapist works systematically through a sequence of actions known as the occupational therapy process. The stages are:

• Referral


• Information gathering


• Initial assessment


• Needs identification/problem formation


• Goal setting


• Action planning


• Action


• Ongoing assessment and revision of action


• Outcome and outcome measurement


• End of intervention or discharge


• Review

Another process framework for occupational therapists to use is the Canadian Practice Process Framework (CPPF), which portrays eight action points and three contextual elements for the process of occupation-based, client-centred enablement. The contextual elements are:

• societal context


• practice context


• frame(s) of reference

The eight action points include:

• enter/initiate


• set the stage


• assess/evaluate


• agree on objectives and plan


• implement plan


• monitor/modify


• evaluate outcome


• conclude/exit

Fearing, Law and Clark suggested a 7 stage process which includes:

• identifying of occupational performance issues


• choosing a theoretical frame of reference


• assessing factors contributing the identified occupational performance issue(s)


• considering the strengths and resources of both client and therapist


• negotiating targeted outcomes and developing an action plan


• implementing the plan through occupation


• evaluating outcomes

Existing Areas of practice for a occupational therapist

Physical health

Pediatrics - Schools, Community, inpatient hospital based child OT: Often, children need OT services for the same reasons an adult needs OT services. However, OTs approach intervention in a different way with children. OT delivers approaches treatment through occupation, and the occupations of a child are different from those of an adult, and include play, chores, self-care and schoolwork. Common conditions that are specific to or more common in the pediatric population creating a need for OT services include: developmental disorders, sensory regulation or sensory processing deficits, fine motor developmental delays or deficits, autism, emotional and behavioral disturbances (Lambert, 2005), among others. In addition, children are seen for every injury, illness or chronic condition that may cause a person of any age to have performance deficits in their daily life and thus benefit from OT services. Often, OT in pediatrics deals with the implications that certain medical conditions have for classroom learning and the remediation and strategies required. They need to be closely interwoven with existing teaching approaches to help the student achieve his or her educational potential

• Acute care hospitals: Acute care is an inpatient hospital setting for individuals with a serious medical condition(s) usually due to a traumatic event, such as a traumatic brain injury, spinal cord injury, etc. The primary goal of acute care is to stabilize the patient’s medical status and address any threats to his or her life and loss of function. Occupational therapy plays an important role in facilitating early mobilization, restoring function, preventing further decline, and coordinating care, including transition and discharge planning. Furthermore, occupational therapy’s role focuses on addressing deficits and barriers that limit the patient’s ability to perform activities that they need or want to do related to independence in self-care, home management, work-related tasks, and participating in leisure and community pursuits.


• Inpatient rehabilitation (e.g., Spinal Cord Injuries):People with disabilities have the right and the privilege to live meaningful purposeful lives. When a disability occurs it is sometimes possible to recover – when it is not it is important to learn the skills to adapt capacity and environmental supports to be able to participate. OTs use their knowledge to help both with recovery and adaptation.


• Rehabilitation centers (e.g., Traumatic Brain Injury (TBI), Stroke (CVA), Spinal Cord Injuries, Head Injuries)


• Skilled nursing facilities: An occupational therapists role in a skilled nursing facility is centered on each client’s individual needs. Many of the skills an OT works on are known as activities of daily living or self-care such as feeding or dressing. OTs can provide equipment to assist with activities or offer expertise in modifying the environment to maximize independence and facilitate independence. Other OT roles include education in adaptive equipment (shower bench), energy conservation, or task simplification (Hofmann, 2008).


• Home Health: Occupational therapists who work in this area of practice generally work with client’s in the geriatric population who have one or more of the following diagnoses: Alzheimer’s disease, arthritis, depression, CVA, generalized weakness, COPD, or Parkinson’s disease. Occupational therapists working with these client’s evaluate their level of independence, cognition, and safety. Moreover, occupational therapists provide intervention to maximize independence and function through remedial and compensatory strategies, with the ultimate goal of the client’s regaining the ability to live independently at home (Swanson Anderson & Malaski, 1999).


• Outpatient clinics (e.g., Hand Therapy, orthopaedics) Hand therapy is a specialty practice area of occupational therapy that is mainly concerned with treating orthopedic-based upper extremity conditions to optimize the functional use of the hand and arm. Diagnoses seen by this practice area include: fractures of the hand or arm, lacerations and amputations, burns, and surgical repairs of tendons and nerves. Additionally, hand therapists treat acquired conditions such as tendonitis, rheumatoid arthritis and osteoarthritis, and carpal tunnel syndrome. Occupational therapists who work in this field address biomechanical issues underlying upper-extremity conditions. In addition, occupational therapists use an occupation-based and client-centered approach by identifying participation needs of the client, then tailoring intervention to improve performance in desired activities.


• Specialist assessment centres (e.g., Electronic assistive technology, Posture and Mobility services)


• Hospices: An occupational therapists common role in hospice care is modifying and preventing. Modifying the demands of the activity to fit with the abilities of the client. The intervention may be directly with the client or with the client and the client’s caregivers. OT can offer the caregivers support an education. Progress is defined as improved quality of life in hospice care. (Hasselkaus, 1998)


• Assisted Living Facilities: In an assisted living facility OT services are provided by a home health agency, rehab agency, or a private practice. Medicare and some private insurance plans cover OT services in ALFs. Areas of treatment intervention often include: bathing, dressing, grooming, toileting, mobility, money management, laundry, and community participation. Can treat persons with occupational performance decline or at risk for a decline. Increase quality of life so less residents need the services of a long-term SNF. Special areas include mobility device assessment (scooter), continence training, psychosocial needs and low vision programs (Fagan, 2001).


• Productive Aging: An OT practicing in this area would provide skills and services to older adults to maximize independence, participation, and quality of life. Typical issues addressed: Any impairment or condition that would limit their ability to carry out meaningful occupations and tasks that are necessary for daily life. Skills taught include: energy conservation, education in adaptive equipment (such as a shower bench), task simplification, adapting and modifying activities to progress with a client’s changing abilities (Opp Hoffman, 2008), caregiver education and support (AOTA, 2004), safety, social interactions and communication, memory skills training, mobility device assessment and training (i.e. scooters, wheelchairs, walkers), low vision interventions, continence training, and facilitating performance in basic ADL and IADL (Fagan, 2001).


• Work hardening is essentially a specialized program designed to enable people with physical, psychological, and psychosocial issues inhibiting a person’s ability, to successfully return to work. The National Advisory Committee on Work Hardening best describes work hardening:

“Work hardening is a highly structured, goal oriented, individualized treatment program designed to maximize the individual’s ability to return to work. Work hardening programs, which are interdisciplinary in nature, use real or simulated work activities in conjunction with conditioning tasks that are graded to progressively improve the biomechanical, neuromuscular, cardiovascular/metabolic and psychosocial functions of the individual. Work hardening provides a transition between acute care and return to work while addressing the issues of productivity, safety, physical tolerances, and worker behaviors” (Ogden-Niemeyer & Jacobs, 1989, p. 1).

• Work conditioning is similar to work hardening, except work conditioning purely involves improving physical capacities, whereas work hardening improves physical, psychological, and psychosocial factors.^]
  

Mental health

According to Medicare (2005) guidance, “Only a qualified occupational therapist has the knowledge, training, and experience required to evaluate and, as necessary, re-evaluate a patient’s level of function, determine whether an occupational therapy program could reasonably be expected to improve, restore, or compensate for lost function, and where appropriate, recommend to the physician a plan of treatment.”

According to the American Occupational Therapy Association (AOTA), occupational therapists work with the Mental Health population throughout the life span and across many treatment settings where mental health services and psychiatric rehabilitation are provided (AOTA, 2009). Just as with other clients, the OT facilitates maximum independence in activities of daily living (dressing, grooming, etc.) and instrumental activities of daily living (medication management, grocery shopping, etc.). According to the American Occupational Therapy Association, OT improves functional capacity and quality of life for people with mental illness in the areas of employment, education, community living, and home and personal care through the use of real life activities in therapy treatments (AOTA, 2005).

Geriatric, Adult, Adolescents, and Children with any kind of mental illness or mental health issues. These conditions include but are not limited to: Schizophrenia, substance abuse, addiction, dementia, Alzheimer’s, mood disorders, personality disorders, psychoses, eating disorders, anxiety disorders (including post-traumatic stress disorder, separation anxiety disorder) (Cara & MacRae, 2005), and reactive attachment disorder (children only) (Lambert, 2005).

Typical issues that are addressed are as follows: Helping people acquire the skills to care for themselves or others including; keeping a schedule, medication management, employment, education, increasing community participation, community access (grocery store, library, bank, etc.), money management skills, engaging in productive activities to fill the day, coping skills, routine building, building social skills, and childcare (Cara & MacRae, 2005).

In the UK, the College of Occupational Therapists (COT) have published Recovering Ordinary Lives , which details the strategy for OTs in mental health up to 2017, and makes explicit the goals that have been set for the profession, in line with government directives (COT 2006).

Areas that Mental Health OT’s could work in are as follows:

• Mental health inpatient units
  
  
  
  • Adolescent, adult and older people’s acute mental health wards
  
  
  • Adult and older people’s rehabilitation wards
  
  
  • Prisons/secure units (Forensic psychiatry)
  
  
  • Psychiatric intensive care unit
  
  
  • Specialist units for Eating Disorders, Learning disabilities
  
  
  
  


• Community based mental health teams
  
  
  
  • Child and adolescent mental health teams
  
  
  • Adult and older people’s community mental health teams
  
  
  • Rehabilitation and recovery and Assertive Outreach community teams
  
  
  • Primary care services in GP practices
  
  
  • Home treatment teams
  
  
  • 
    early intervention in psychosis teams
  
  
  • Specialist learning disability, eating disorder community services
  
  
  • Day services
  
  
  • Vocational Services
  
  
  • Dementia & Alzheimer Care: OTs focus on adapting activities as the client progresses through the illness (Hofmann, 2008) OT also works with caregivers to teach them how to grade activities to the client’s ability. Interventions are based on using the client’s strengths to increase their quality of life and their relationships with caregivers. Use of social interactions, communication, memory, safety and self maintenance.
  
  
  
  

Community

Community based practice involves working with people in their own environment rather than in a hospital setting. It often combines the knowledge and skills related to physical and mental health. It can also involve working with atypical populations such as the homeless or at-risk populations. Examples of community-based practice settings:

• Health promotion and lifestyle change: Remaining healthy is the goal of all people in a society, including people with chronic disabling or health conditions. Achieving health requires skills to self-manage conditions that might limit their ability to function in daily life. The occupational therapist helps people acquire these skills (Wilcock, 2005).


• Private Practice


• Aging in place: Occupational therapists implement environmental modifications in senior housing, assisted living, long-term-care facilities, and homes (Yamkovenko, 2008) Environmental modifications can include rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats, and other safety equipment to use performance capabilities to their fullest (Moyers & Christiansen, 2004).


• Low Vision: Occupational therapists help clients use their remaining vision to complete their daily routines with compensation, remediation, disability prevention and health promotion. Compensations or that modifications to the environment may include proper lighting, color contrast, reducing clutter and education on adaptive equipment (Golembiewski, 2004).


• Intermediate care services


• Driving Centers: Driving is an instrumental activity of daily living and an occupational therapist may evaluate and treat skills needed to drive such as vision, executive function or memory. If a client needs more skilled assessment and training they would refer them to an OT Driver Rehabilitation Specialist which could do on the road assessment, training in adaptive equipment and make more specific recommendations.


• Day centres


• Schools


• Child development centres


• People’s own homes, carrying out therapy and providing equipment and adaptations


• Work and Industry: To be a healthy successful worker there must be a person environment fit between the task, the equipment, and the person’s skills. Occupational therapists work to achieve that fit (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007). Populations, conditions, and diagnoses: People of working age and ability who have been born with or developed a condition, injury, or illness that compromises their ability to work (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007). Settings: Return to work programs, large organizations, consultants to large organizations, work hardening programs, work conditioning programs, transitional return to work programs (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007). Typical issues addressed: assessment of ability to work, interventions to enhancing work performance by means of work hardening, work conditioning, and improvement of ergonomics in the workplace, identification of accommodations necessary to return-to-work following illness or injury, prevention of work related injury, illness, or disability (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007).


• Homeless Shelters


• Educational Settings


• 
  Refugee Camps

New Emerging  Areas 

• Children & Youth:^[36]
  
  
  • Psychosocial Needs of Children & Youth
  
  
  • Self-management for Physical & Occupational Therapy Students 
  
  
  • Life Skills Trainings for children & Youth with Special Needs (Khemthong, 2006)
  
  
  
  


• Health & Wellness:
  
  
  
  • Health & Wellness Consulting
  
  
  • Design & Accessibility Consulting & Home Modification
  
  
  • Ergonomic Consulting
  
  
  • Private Practice Community Health Services
  
  
  
  


• Productive Aging:
  
  
  
  • Driver Rehabilitation & Training
  
  
  • Low Vision Services
  
  
  • Fatigue & Leisure Management (Khemthong, 2006)
  
  
  • Musical trainings for elderly (Khemthong, 2006)
  
  
  
  


• Rehabilitation, Disability, & Participation:
  
  
  
  • Technology & Assistive Device Development & Consulting
  
  
  • Meditation trainings for Diabetes Mellitus (Khemthong, 2006)
  
  
  • Leisure management for Chronic Obstructive Pulmonary Disease (Khemthong, 2006)
  
  
  • Health Systematization of Occupational Therapy for Stroke 
  
  
  • Mental Practice & Recovery Programs (Khemthong, 2006)
  
  
  • Leisure Management for Mental Health (Khemthong, 2006)
  
  
  • Fatigue & Psychospirituality of Multi-Sensory Leisure for Cancer, Depression, Rheumatoid Arthritis(Khemthong, 2006)
  
  
  
  


• Work & Industry:
  
  
  
  • Ticket to Work Services
  
  
  • Welfare to Work Services
  
  
  • Leadership Maturity Fitness to Work Services (Khemthong, 2006)
  
  
  • Fatigue & Leisure Management to Work Services (Khemthong, 2006)