Occupational Therapy; Types, Uses, Grading, Technique

Occupational therapy
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Occupational Therapy (OT) is the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. It is an allied health profession performed by occupational therapists. OTs often work with people with mental health problems, disabilities, injuries, or impairments.

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, injury rehabilitation, and providing supports for older adults experiencing physical and cognitive changes.

Types of Occupational Therapy

The American Occupational Therapy Association’s practice framework identifies the following Occupations:

  • Activities of daily living (ADLs)
    • Bathing, showering, Toileting and toilet hygiene, Dressing, Feeding, Functional mobility/transfers, Personal device care, Personal hygiene and grooming
  • Instrumental activities of daily living (IADLs)
    • Care of others, Care of pets, Child rearing, Communication management, Driving and community mobility, Financial management, Health management and maintenance, Home establishment and managements, Meal preparation and cleanup, Medication management, Religious and spiritual activities and expression, Safety and emergency maintenance, Shopping
  • Rest and sleep
    • Rest, Sleep preparation, Sleep participation
  • Education
  • Work
    • Employment interests and pursuits, Employment seeking and acquisition, Job performance, Retirement preparation and adjustment, Volunteer exploration, Volunteer participation
  • Play
    • Play exploration, Play participation
  • Leisure
    • Leisure exploration, Leisure participation
  • Social participation
    • Community, Family, Peer, friend

Indications of Occupational Therapy

According to the AOTA, kids with these medical problems might benefit from OT:

  • birth injuries or birth defects
  • sensory processing disorders
  • traumatic injuries (brain or spinal cord)
  • learning problems
  • autism/pervasive developmental disorders
  • juvenile rheumatoid arthritis
  • mental health or behavioral problems
  • broken bones or other orthopedic injuries
  • developmental delays
  • post-surgical conditions
  • burns
  • spina bifida
  • traumatic amputations
  • cancer
  • severe hand injuries
  • multiple sclerosis, cerebral palsy, and other chronic illnesses

Occupational therapists might

  • help kids work on fine motor skills so they can grasp and release toys and develop good handwriting skills
  • address hand–eye coordination to improve kids’ play and school skills (hitting a target, batting a ball, copying from a blackboard, etc.)
  • help kids with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)
  • help kids with behavioral disorders maintain positive behaviors in all environments (e.g., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
  • teach kids with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting
  • evaluate a child’s need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
  • work with kids who have sensory and attentional issues to improve focus and social skills
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Practice settings of Occupational Therapy

Occupational therapists work in a wide variety of practice settings, including: hospitals, long-term care facilities, schools, outpatient clinics, and the community (e.g. home care). The Canadian Institute for Health Information (CIHI) found that between 2006-2010 nearly half (45.6%) of occupational therapists worked in hospitals, 31.8% worked in the community, and 11.4% worked in a professional practice.

Areas of Practice of Occupational Therapy

The broad spectrum of OT practice makes it difficult to categorize the areas of practice, especially considering the differing health care systems globally. In this section, the categorization from the American Occupational Therapy Association is used.

Children and youth

Tire Swing used during occupational therapy with children

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. These occupations may include: feeding, playing, socializing, and attending school.

Occupational therapy with children and youth may take a variety of forms. For example:

  • Promoting a wellness program in schools to prevent childhood obesity
  • Facilitating handwriting development in school-aged children
  • Providing individualized treatment for sensory processing difficulties
  • Teaching coping skills to a child with generalized anxiety disorder

Health and wellness

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 an increase in overall well-being.

As a practice area, health and wellness can include a focus on

  • Prevention of disease and injury
  • Prevention of secondary conditions (co-morbidity)
  • Promotion of the well-being of those with chronic illnesses e.g. sexual rehabilitation
  • Reduction of health care disparities or inequalities
  • Enhancement of factors that impact quality of life
  • Promotion of healthy living practices, social participation, and occupational justice
Occupational therapist conducting a group intervention on interpersonal relationship building

Mental health

Mental health and the moral treatment era 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. OTs focus on prevention and treatment of mental illness in all populations.In the U.S., military personnel and veterans are populations that can benefit from occupational therapy, but currently this is an under served practice area.

Mental health illnesses that may require occupational therapy include schizophrenia and other psychotic disorders, depressive disorders, anxiety disorders, eating disorders, trauma- and stressor-related disorders (e.g. 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.

Productive aging

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, aging in place, 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. To enable independence of older adults at home, occupational therapists perform falls risk assessments, assess clients 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, ensuring safety, and promoting independence.

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Adult Rehabilitation

Occupational therapists address the need for rehabilitation following an injury or impairment. When planning treatment, occupational therapists address the physical, cognitive, psychosocial, and environmental needs involved in adult populations across a variety of settings.

Occupational therapy in adult rehabilitation may take a variety of forms

  • Working with adults with autism at day rehabilitation programs to promote successful relationships and community participation through instruction on social skills
  • Increasing the quality of life for an individual with cancer by engaging them in occupations that are meaningful, providing anxiety and stress reduction methods, and suggesting fatigue management strategies
  • Coaching individuals with hand amputations how to put on and take off a myoelectrically controlled limb as well as training for functional use of the limb
  • As for paraplegics, there are such things as sitting cushion and pressure sore prevention. Presciption of these aids is the common job for paraplegics.
  • Using and implementing new technology such as speech to text software and Nintendo Wii video games
  • Communicating via telehealth methods as a service delivery model for clients who live in rural areas
  • Working with adults who have had a stroke to regain strength, endurance, and range of motion on their affected side.

Travel occupational therapy

Because of the rising need for occupational therapists in the U.S.,many facilities are opting for travel occupational therapists—who are willing to travel, often out of state, to work temporarily in a facility. Assignments can range from 8 weeks to 9 months, but typically last 13–26 weeks in length. Most commonly (43%), travel occupational therapists enter the industry between the ages of 21–30.

Work and industry

Occupational therapists work with clients who have had an injury and are returning to work. OTs perform assessments to simulate work tasks in order to determine best matches for work, accommodations needed at work, or the level of disability. Work conditioning and work hardening are interventions used to restore job skills 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.

Education

Worldwide, there is a range of qualifications required to practice occupational therapy. Many countries require a bachelor’s degree (e.g. Australia). In the United States and Canada, a master’s degree is required to practice. In Europe, a bachelor’s degree or a master’s degree is accepted.

The OT curriculum focuses on the theoretical basis of occupation and the clinical skills require to practice occupational therapy. Students must have knowledge of physiology, anatomy, medicine, psychology, and neurology to understand interventions and their client’s medical history. All OT education programs include periods of clinical education, consisting of direct work with a practicing OT.In countries such as Canada and the United States, OT students must pass a national qualifying examination in order to practice.

Theoretical frameworks

Occupational therapists use theoretical frameworks to frame their practice. Note that terminology differs between scholars. An incomplete list of theoretical bases for framing a human and their occupations include the following:

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Frames of reference and 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 practice. More generally they are defined as “those aspects which influence our perceptions, decisions and practice”.

  • Person Environment Occupation Performance Model
    • The Person Environment Occupation Performance model (PEOP) was originally published in 1991 (Charles Christiansen & M. Carolyn Baum) and describes an individual’s performance based on four elements including: environment, person, performance and occupation. The model focuses on the interplay of these components and how this interaction works to inhibit or promote successful engagement in occupation.

Occupation-Focused Practice Models

  • Occupational Therapy Intervention Process Model (OTIPM) (Anne Fisher and others)
  • Occupational Performance Process Model (OPPM)
  • Model of Human Occupation (MOHO) (Gary Kielhofner and others)
    • MOHO was first published in 1980. It explains how people select, organise and undertake occupations within their environment. The model is supported with evidence generated over thirty years and has been successfully applied throughout the world.
  • Canadian Model of Occupational Performance and Engagement (CMOP-E)
  • Occupational Performances Model – Australia (OPM-A) (Chris Chapparo & Judy Ranka)
    • The OPM(A) was conceptualized in 1986 with its current form launched in 2006. The OPM(A) illustrates the complexity of occupational performance, the scope of occupational therapy practice, and provides a framework for occupational therapy education.
  • Kawa (River) Model (Michael Iwama)
  • Biomechanical Frame of Reference
    • The Biomechanical Frame of Reference is primarily concerned with motion during occupation. It is used with individuals who experience limitations in movement, inadequate muscle strength or loss of endurance in occupations. The Frame of Reference was not originally compiled by Occupational Therapists, and therapists should translate it to the Occupational Therapy perspective, to avoid the risk of movement or exercise becoming the main focus.
  • Rehabilitative (compensatory)
  • Neurofunctional (Gordon Muir Giles and Clark-Wilson)
  • Dynamic Systems Theory
  • Client-Centered Frame of Reference
    • This Frame of Reference is developed from the work of Carl Rogers. It views the client as the center of all therapeutic activity, and the client’s needs and goals direct the delivery of the Occupational Therapy Process.
  • Cognitive-Behavioural Frame of Reference
  • Ecology of Human Performance Model
  • The Recovery Model.

References

 

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