Article: Occupational therapy

Occupational therapy (OT) is skilled treatment that helps individuals achieve independence in all facets of their lives. OT gives people the "skills for the job of living" necessary for independent and satisfying lives. Services typically include:

• Customized treatment programs to improve one's ability to perform daily activities
• Comprehensive home and job site evaluations with adaptation recommendations
• Performance skills assessments and treatment
• Adaptive equipment recommendations and usage training
• Guidance to family members and caregivers

Information from the American Occupational Therapy Association, Inc. 5/05

Occupational therapy practitioners

Occupational therapy practitioners are skilled professionals whose education includes the study of human growth and development with specific emphasis on the physical, affective, cognitive and environmental components of illness and injury.

Most registered occupational therapists (OTR) practicing in the field today possess a Bachelor of Science degree in occupational therapy. However, in recent years, the entire profession has advanced its educational standards to post-professional levels. By 2007, all OTRs will enter the field with a Masters or Doctoral degree. A certified occupational therapy assistant (COTA) generally earns an associate degree.

Practitioners must complete supervised clinical internships in a variety of health care settings, and pass a national examination. Most U.S. states also regulate occupational therapy practice.

Philosophy of occupational therapy

Occupational therapists focus on making independence a reality. While complete independence may not occur depending on the extent of the disability, occupational therapists will work with the patient or client to come up with strategies, techniques, or adaptations so that they can be as independent as possible. Occupational therapists use occupations to enable this. In the context of occupational therapy, occupation refers to meaningful activity.

• Engagement in occupation is of value because it provides opportunities for individuals to influence their well being by gaining fulfillment in living.
• Through the experience of occupation (or doing), the individual is able to achieve mastery and competence by learning skills and strategies necessary for coping with problems and adapting to limitations.
• As competence is gained and autonomy can be expressed, independence is achieved.
• Autonomy implies choice and control over environmental circumstances, thus opportunities for exerting self-determination should be reflected in intervention strategies.
• Choice and control extend to decisions about intervention, thus identifying occupational therapy as a collaborative process between the therapist and recipient of care. In this collaboration, the patient's values are respected.
• Because of its focus on life performance, it is neither somatic, nor psychological, but concerned with the unity of body and mind in doing. (Baum & Christiansen,(p. 36, 1997))

Benefits of occupational therapy

A wide variety of people may benefit from occupational therapy, these may include people with:

• work-related injuries including lower back problems or repetitive strain injuries
• physical, cognitive or psychological limitations following a stroke, brain injury or heart attack
• arthritis, multiple sclerosis, or other serious chronic conditions
• birth injuries, learning difficulties, or developmental disabilities
• mental health difficulties Alzheimer's, schizophrenia, and post-traumatic stress
• substance abuse problems or eating disorders
• obsessive compulsions, or diagnosed obsessive compulsive disorder (OCD)
• burns, spinal cord injuries, or amputations
• fractures or other injuries from falls, sports injuries, or accidents
• visual, perceptual or cognitive impairements

Areas of occupational therapy

Occupational therapists work in a vast array of settings, these include:

Physical

• Orthopedics (fractures/falls clinics)
• Pediatrics
• Elderly rehabilitation
• Accident and emergency department (or emergency room)
• Hand therapy
• Cardiac rehabilitation
• Burns
• Road traffic accidents

Community

• Intermediate care
• Day centres
• Schools
• Child development centres
• People's own homes, carrying out therapy and providing equipment and adaptations

Neurology

• Stroke rehabilitation
• Traumatic brain injuries

Mental Health

• Child and adolescent mental health services (CAMHS)
• Forensic psychiatry
• Prisons/sections
• Mental health clinics
• Psychiatric rehabilitation programs

Occupational therapy case studies

Every day, children and adults have or develop health conditions that significantly affect their ability to manage their daily lives. With the help of occupational therapy, many of these individuals can achieve or regain a higher level of independence. When skill and strength cannot be developed or improved, occupational therapy offers creative solutions and alternatives for carrying out daily activities.

The following examples illustrate occupational therapy and how individuals might benefit from treatment.

Alzheimer's disease

Art Anderson's family was not surprised when the doctor confirmed that his growing memory problems were caused by Alzheimer's disease. The primary concern was the effect that Art's care was having on his wife, who was dealing with health problems of her own. They found help in a day care program for people with Alzheimer's disease. Here Art enjoys social interactions, meals, and leisure activities designed for people with his condition. Art's wife Martha attends weekly group meetings led by an occupational therapist. Martha learns to help her husband to participate as much as possible in the family's routine and how to manage the many tasks that make up her "job of living."

Additional occupational therapy services that may be indicated for Alzheimer's Disease patients include an assessment of the home environment. This results in detailed modifications to improve safety, item locations and labeling to enhance Art's independence, and suggestions to make Martha's increasing caregiving tasks more manageable. Occupational therapy adaptations promote efficient completion of Art and Martha's "activities of daily living" and predict and prepare for the patient's functional decline.

Bipolar disorder

Robby is a 43 year old male with Bipolar disorder. Due to his alternating episodes of mania and depression, Robby is challenged cognitively. He has difficulty doing anything that requires more than 3 steps and often forgets the order of the steps. He avoids social interaction, preferring to keep to himself. With Robby's occupational therapist, he began attending a social skills group twice a week. Additionally, the occupational therapist made a laundry checklist outlining the steps for doing laundry individually and put labels on all the buttons and dials of his washing machine. Doing the same, repetitive activities with Robby will help him develop a routine, allowing him to gain independent living skills.

Gunshot wound

Jack was going into a convenience store one night when he encountered an armed robber attempting to get away. In the ensuing altercation, Jack was shot in the arm. As a result of the shooting, Jack had multiple surgeries, but still did not have full use of his arm due to his radial nerve palsy. Jack's occupational therapist constructed a splint that would allow Jack to have more control over his arm. Additionally, Jack's arm would now be stabilized and be positioned in a more correct posture.

Stroke

Helen Richards is a publishing executive, respected for her business skills and admired for her perfect grooming. Three months ago Helen had a stroke. During her recovery she had to relearn many things, but her first goal was to face the world with her hair and make up in place. Helen's occupational therapist was empathetic and empowering. Together they found the right combination of tools and techniques so that Helen could handle her personal grooming. They also worked on the other tasks she would need to manage her home and return to work. From make-up to management, occupational therapy helped Helen recover the skills she needed.

Developmental problems

Tommy weighed just three pounds at birth. Doctors warned his parents to be on the lookout for problems that might affect his development. In the hospital nursery, an occupational therapist helped ensure that Tommy was taking in enough nourishment. As a toddler, Tommy attended a Head Start program where occupational therapists and occupational therapy assistants provided activities to aid his physical and mental development. For youngsters like Tommy, the "job of living" requires basic skills such as eating, playing, and interacting successfully with family members and friends.

Trivia

• April is Occupational Therapy month in the US
• It is Occupational Therapy Week in the UK at the beginning of October