Occupational Therapy

Introduction

Using assessment and intervention, occupational therapy (OT) is a healthcare profession that helps people acquire, regain, or continue meaningful professions for themselves, their communities, or others.

Healthcare professionals with training and education in OT are focused on enhancing both mental and physical performance.

The areas of expertise for occupational therapists include instructing, educating, and encouraging engagement in any activity that takes up a person’s time.

It is an autonomous health profession that includes occupational therapy and is occasionally referred to as an allied health profession.

Occupational therapy (OT) therapists and assistants (OTAs). OTs and OTAs work with individuals who wish to improve their physical and/or mental health, as well as any disabilities, injuries, or impairments, despite having different duties.

Using therapeutic use, occupational therapists “help people across their lifespan participate in the things they want and/or need to do,” according to the American Occupational Therapy Association. of everyday activities (occupations)”. Other professional organizations that deal with occupational therapy have similar definitions.

Typical actions consist of:

• facilitating the participation of disabled children in social and educational settings (independent mobility is typically a significant concern)
• instruction in life skills, meaningful and purposeful activities, and assistive technology.
• Rehabilitation from physical injuries
• Rehabilitation for mental dysfunction
• assistance to those undergoing cognitive and physical changes at any age
• evaluating assistive seating alternatives and ergonomics to reduce the incidence of pressure injuries and maximize independent function
• Instruction regarding illness and the process of recovery
• promoting the health of patients
• Locating employment opportunities

Occupational therapists are often professionals with a university education who need to pass a licensing exam in order to practice.

As of right now, in order to practice in the US, licensed occupational therapy assistants need an associate’s degree after two years, whereas entry-level occupational therapists need a master’s degree.

In most states, people have to apply for a state license and pass a national board certification. Physical therapists, speech-language pathologists, audiologists, nurses, dietitians, social workers, psychologists, physicians, and assistive technology specialists frequently collaborate closely with occupational therapists.

History

Early History

The first indications of the use of jobs as a therapeutic approach date back to antiquity. Greek physician Asclepiades used therapeutic baths, massage, exercise, and music to cure mentally ill patients in a humane manner around 100 BCE.

Later, the Roman physician Celsus advised his patients to engage in conversation, exercise, music, and travel. But by the Middle Ages, these therapies were hardly ever used, if at all, with patients who suffered from mental disease.

During the seventeenth century, medical professionals such as Philippe Pinel and Johann Christian Reil altered the European hospital system. In the late eighteenth century, their establishments employed strenuous work and recreational activities in place of metal chains and restrictions.

This was included in the concept of moral treatment. Throughout the 19th century, enthusiasm for the reform movement in the United States fluctuated despite its success in Europe.

Additionally influencing occupational therapy was the Arts and Crafts movement, which flourished from 1860 to 1910. The developed world manufacturing labor’s lack of autonomy and routine gave rise to the movement.

A creative outlet, a means of preventing boredom during extended hospital stays, and an approach to learning by doing were all offered via arts and crafts.

Development into a Health Profession

The early 1900s saw a rise in the prevalence of disabilities brought on by tuberculosis, mental disease, and industrial accidents, which raised public awareness of the problems at hand.

Early in the 1910s, the Progressive Era was reflected in the conception of occupational therapy as a health profession. Early professionals combined scientific and medical ideas with highly esteemed ideals, such as the value of handy crafting and having a strong work ethic.

Some people refer to American nurse Eleanor Clarke Slagle (1870–1942) as the “mother” of occupational therapy. Slagle suggested habit training as the main therapeutic approach in occupational therapy.

Habit training was based on the idea that meaningful routines influence an individual’s well-being and aimed to provide a balance and structure between work and leisure.

Though habit training was first created to help people with mental health issues, its fundamental principles may be found in contemporary treatment methods that are applied to a variety of clientele.

World War I

Slagle established the Henry B. Favill School of Occupations, the first occupational therapy training program, at Chicago’s Hull House in 1915. In January 1916, British-Canadian architect and instructor Thomas B.

The Canadian Military Hospitals Commission appointed Kinder as its vocational secretary. He was tasked with either retraining soldiers who could no longer do their prior responsibilities or preparing soldiers returning from World War I to resume their previous vocational duties.

He created an initiative that included soldiers recuperating from combat. illnesses or tuberculosis in their places of employment, even while they remained bedridden.

The troops would work in a therapeutic workshop until they recovered enough to go on to an industrial workshop, and then they would be put in a suitable work environment.

Using vocations (everyday activities) as a medium, he assisted injured people in returning to productive tasks like labor and provided manual instruction. A pivotal moment in the history of the profession in that nation was the United States’ entry into World War I in April 1917.

The profession’s main focus has been on treating mental health patients up until this point. The number of wounded and crippled soldiers increased as a result of US involvement in the conflict, posing a difficult challenge to those in authority.

In October 1917, Slagle, Kinder, and other American physicians, including William Rush Denton, created the National Society for the Promotion of Occupational Therapy (NSPOT) in the United States.

To aid in the rehabilitation of individuals injured in the conflict, the military recruited and trained over 1,200 “reconstruction aides” with NSPOT’s help.

Published in the journal Public Health in 1918, Denton’s paper “The Principles of Occupational Therapy” served as the basis for his textbook Reconstruction Therapy, which he published in 1919.

Because he believed that occupational therapy lacked the “exactness of meaning which is possessed by scientific terms,” Denton found the term “cumbersome.”

Alternative terms like “work-cure,” “ergo therapy,” and “creative occupations” were considered as alternatives, but none of them had a broad definition.

Occupational therapy practice is required to encompass the variety of treatments that have been available since the field’s founding. In 1921, occupational therapy received its official designation.

Inter-War Period

It was difficult to retain personnel in the field in the years following World War II. The emphasis switched from the selfless mindset of the war years to the financial, career, and personal fulfillment that comes with being a therapist.

Both the education and practice were standardized to increase the appeal of the profession. The American Occupational Therapy Association promoted stable employment, respectable pay, and equitable working circumstances, and entry and departure standards were set.

Occupational therapy sought and received medical credibility in the 1920s through these means. The assumptions of conventional scientific medicine were challenged by the rise of occupational therapy.

Occupational therapists contended that dysfunction is caused by a complex interplay of social, economic, and biological factors rather than only concentrating on the medical model.

To broaden the scope of the profession, concepts and methods were taken from a variety of fields, including but not limited to physical therapy, nursing, psychology, rehabilitation, self-help, orthopedics, and social work.

The 1920s and 1930s saw the establishment of educational requirements as well as the establishment of the profession’s organizational framework. In 1922, Eleanor Clarke Slagle suggested a 12-month training program; in 1923, these guidelines were approved.

William Denton released Prescribing Occupational Therapy, another textbook, in 1928. In order to bring the qualifications for professional entry on a level with those of other professions, educational standards were raised in 1930 to include.

A total training time of eighteen months. The AOTA had set up accrediting standards and principles for education by the early 1930s.

World War II

The field of occupational therapy saw tremendous expansion and change with the start of World War II and the consequent surge in demand for OTs to treat war casualties.

In addition to being adept at using constructive activities like crafts, occupational therapists increasingly needed to be proficient in using activities of daily life.

Post-World War II

In 1947, Helen S. Willard and Clare S. Spackman produced another occupational therapy textbook in the United States.

In the 1950s, the field expanded and underwent self-reflection. In honor of its namesake, AOTA established the Eleanor Clarke Slagle Lectureship Award in 1954.

The aim of this award is to recognize an individual who has “innovatively contributed to the expansion of the profession’s body of knowledge via research, teaching, or clinical practice.”.

The sector also began to explore the potential of deploying trained assistants in an attempt to address the ongoing shortage of licensed therapists; hence, in 1960, educational requirements for occupational therapy assistants were put into place.

The profession struggled to absorb new information and deal with the sudden and quick growth of the field in the preceding decades, thus the 1960s and 1970s were a time of continuous change and progress.

Novel conceptions and therapeutic modalities emerged as a result of advancements in neurobehavioral research; A. Jean Ayres’ sensory integrative approach may have been the most revolutionary.

The field has kept developing, broadening both its breadth and its practice areas. Founded in 1989 at the University of Southern California, occupational science (the study of occupation) aims to provide basic science to study.

Topics related to “occupation” and foundational research on occupation to support and advance the practice of occupation-based occupational therapy. Occupational science was created by Elizabeth Yerxa.

Occupational therapists now play a larger part in political lobbying, from grassroots initiatives to upper-level legislation.

For instance, AOTA’s political efforts helped pass the habilitation clause of PL 111-148, the Patient Protection and Affordable Care Act, in 2010.

In addition, practitioners of occupational therapy have been working toward ideas of occupational justice and other human rights concerns that affect communities locally and globally, both on a personal and professional level.

Numerous position statements on occupational therapy’s involvement in human rights concerns may be found in the Resource Center of the World Federation of Occupational Therapists. Occupational therapy was placed #19 in the U.S. The 2021 edition of “100 Best Jobs” by News & World Report.

Practice Frameworks

With a client, an occupational therapist employs a methodical set of procedures known as the “occupational therapy process.

” This process exists in multiple variations. The elements of evaluation (or assessment), intervention, and outcomes are present in all practice frameworks.

This procedure guarantees uniformity and structure across therapists while offering a framework for occupational therapists to support and promote health.

Occupational Therapy Practice Framework (OTPF, United States)

The foundational knowledge of occupational therapy in the US is the Occupational Therapy Practice Framework (OTPF). The domain and process parts comprise the two components of the OTPF.

The environment and client factors—such as the person’s motivation, health, and ability to accomplish activities related to their job—are included in this domain.

In order to assist the occupational therapist in making a diagnosis and providing treatment for the patient, the domain examines the larger context.

The steps the therapist takes to carry out a plan and strategy for treating the patient are known as the process.

Canadian Practice Process Framework

The Canadian Practice Procedure Framework (CPPF) is the primary occupational enablement procedure in Canada, and the Canadian Model of Client-Centered Enablement (CMCE) recognizes occupational enablement as the fundamental competency of occupational therapy.

Eight action points and three contextual elements make up the Canadian Practice Process Framework (CPPF), which are as follows: create the scene, assess, decide on an objective plan, execute the plan, monitor/modify, and assess the result.

The emphasis on discovering the strengths and resources of the client and the therapist before creating the outcomes and action plan is a key component of this process model.

International Statistical Classification of Health, Disability, and Functioning (ICF)

The World Health Organization uses the International Statistical Classification of Health, Disability, and Functioning (ICF) framework to quantify health and ability by showing how these factors affect an individual’s function.

The statement “the profession’s core beliefs are in the positive relationship between occupation and health and its view of people as occupational workers” applies particularly to occupational therapy. beings” Practice Framework.

The practice framework’s second edition includes the ICF. Examples of activities and involvement from the ICF overlap with the framework’s performance patterns, performance skills, and occupation areas.

Contextual elements, or personal and environmental aspects, are also included in the ICF and are related to the framework’s setting.

Furthermore, the ICF’s classification of bodily structures and functions aids in describing the client variables found in the Occupational Therapy Practice Framework.

McLaughlin Gray has out additional research on the connection between occupational therapy and the elements of the ICIDH-2 (a revision of the original International Classification of Impairments, Disabilities, and Handicaps (ICIDH), which subsequently became the ICF).

The literature points out that in order to guarantee accurate communication about certain topics, occupational therapists should utilize the ICF in conjunction with specialized language from occupational therapy.

It’s possible that some categories in the ICF don’t adequately capture the messages occupational therapists must convey to their clients and peers.

Additionally, it might not be feasible to precisely align occupational therapy terminology with the meanings of the ICF categories.

ICF vocabulary should not be used in place of professional occupational therapy terminology since the ICF is not an assessment tool. The ICF serves as a broad framework for modern therapeutic approaches.

Occupations

Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF-4) published by the American Occupational Therapy Association (AOTA) defines occupation as “everyday activities that people do as individuals, and families and communities to fill the time and give life significance and direction.

People work in professions because they are required to, voluntarily, or out of obligation. A client’s (individual, group, or population’s) occupations have special significance and value for them and are essential to their identity, competence, and general well-being.

Practice Settings

Occupational therapists are employed in a wide range of practice settings, including hospitals (28.6%), schools (18.8%), free-standing outpatient clinics (13.3%), home health (7.3%), academic institutions (6.9%), early intervention (4.4%), mental health (2.2%), community (2.4%), and other (1.6%), according to the.

American Occupational Therapy Association’s 2019 Salary and Workforce Survey. Hospitals are the most typical primary work site for occupational therapists, according to the AOTA.

Additionally, the poll indicates that 46% of occupational therapists are employed in metropolitan areas, 39% in suburban areas, and 15% in rural areas.

As of 2020, according to data from the Canadian Institute for Health Information (CIHI), almost half (46.1%) of occupational therapists were employed in hospital settings, followed by community health (43.2%), long-term care (LTC) (3.6%), and “other” (government, industry, manufacturing, and commercial settings) (7.1%).

According to the CIHI, only 3.7% of occupational therapists in Canada work in rural areas, compared to 68% who work in urban areas.

Areas of Practice in The United States

Children and Youth

In a range of environments, such as clinics, homes, schools, hospitals, and the community, occupational therapists provide care to newborns, toddlers, kids, teens, and their families.

The first step in an occupational therapy (OT) intervention is to assess a person’s capacity for engaging in everyday, meaningful activities.

This involves evaluating how well a young child does in their line of work when it comes to eating, playing, interacting with others, using daily living skills, or going to school.

A child’s underlying capabilities, which might be physical, cognitive, or emotional in origin, as well as the play setting and environmental demands, are all taken into account by occupational therapists.

Occupational therapists collaborate with other healthcare professionals to plan treatments. parents, guardians, educators, or the kids and teenagers themselves to create useful objectives in a range of professions that are important to the young client.

For a child between the ages of one and three years old, early intervention is a critical part of their everyday life.

The norm or tone for treatment in the educational context is established by this field of practice. Occupational therapists that specialize in early intervention help families better care for their kids.

With special needs and encourage their child’s involvement and function in the most natural setting possible. feasible. Individualized Family Service Plans (IFSPs), which center on the family’s objectives for the child, are mandated for every kid.

An occupational therapist (OT) may coordinate services for a family and lead the team in developing an IFSP for each eligible kid.

When working with children and adolescents, an occupational therapist may have a range of goals in mind. For example:

• In a hospital burn unit, splinting and caregiver education.
• encouraging the development of handwriting in school-aged children by offering interventions to improve fine motor and writing readiness.
• treating patients with sensory processing issues on an individual basis.
• teaching a youngster with generalized anxiety disorder coping mechanisms.
• requesting advice on adaptations, accommodations, and supports in a range of areas, such as sensory processing, motor planning, visual processing, sequencing, transitions between schools, etc. from educators, counselors, social workers, parents, and caregivers.
• educating caregivers on mealtime interventions for autistic children who struggle with feeding.

As a “related service” for kids with Individual Education Plans (IEPs), pediatric occupational therapists in the US provide their services in schools.

An IEP, a highly customized plan created for each individual student, is mandated by law for every student receiving special education and related services in the public school system (U.S. Department of Education, 2007).

described as “other supportive, developmental, and remedial services as necessary to help a child with a disability obtain special education benefits.”

Related services encompass a range of vocations, including audiology and speech-language pathology, interpreting, psychology, physical and occupational therapy, and more.

As a related service, occupational therapists assist academic performance and social involvement throughout the school day by working with children with a range of disabilities to address the skills required to attend the special education curriculum (AOTA, n.d.-b).

Occupational therapists help children prepare for the transition to higher school, employment, and community inclusion by helping them act like students (AOTA, n.d.-b).

Occupational therapists are equipped with specialized knowledge to boost students’ engagement in school activities throughout the day, such as:

• alterations to the learning environment to provide students with impairments with physical access
• Give students access to assistive technology to help them succeed.
• assisting in the preparation of educational activities to be used in the classroom
• Assist in identifying strategies for alternative forms of learning assessment in order to meet the needs of students facing substantial obstacles.
• assisting kids in acquiring the skills required to move on to independent life, work after high school, or further study (AOTA).

Occupational therapists work with children and teenagers in a variety of crucial locations, including homes, hospitals, and the community, to support their independence in fulfilling daily activities.

A popular outpatient OT intervention known as “Sensory Integration Treatment” is provided by clinics. Originally created by occupational therapist A. Jean Ayres, this therapy is administered by skilled and educated pediatric occupational therapists.

The evidence-based practice of sensory integration therapy helps kids better integrate and process sensory information from their surroundings and body, which enhances their behavior, emotional control, learning capacity, and functional engagement in important everyday activities.

Globally, there is a growing recognition of occupational therapy programs and services for children and teenagers.

The United Nations now recognizes occupational therapy as a human right that is connected to the socioeconomic determinants of health, applicable to both adults and children.

As of 2018, there were about 500,000 occupational therapists working worldwide, a large number of them working with children, and 778 universities offered occupational therapy programs.

Health and Wellness

“Achieving health, well-being, and participation in life through engagement in occupation” is how the American Occupational Therapy Association (AOTA) defines the occupational therapy domain in its Occupational Therapy Practice Framework, Third Edition.

The capacity of occupational therapy practitioners to leverage routine tasks to attain optimal health and well-being is a unique asset.

Occupational therapists are able to determine the obstacles to attaining general health, well-being, and involvement by looking at a person’s roles, routines, surroundings, and professions.

In order to improve health and wellness, occupational therapy practitioners can intervene at the primary, secondary, and tertiary levels of intervention.

In order to prevent illness and injuries and to help individuals with chronic illnesses adopt healthy lifestyle habits, it can be addressed in all practice settings.

The REAL Diabetes Program and the Lifestyle Redesign Program are two new occupational therapy initiatives that focus on health and wellness.

Each setting has different occupational therapy strategies for health and wellness:

School

Occupational therapy practitioners focus on school-wide health and wellness advocacy, such as school lunches, bullying prevention, backpack awareness, and physical education inclusion.

Additionally, they deal closely with pupils who have learning difficulties, including those who are autistic. According to Swiss research, the majority of occupational therapists work in conjunction with educational institutions.

With half of them offering direct treatment in traditional classroom settings. The findings also demonstrate that, rather than emphasizing the child’s handicap, services were mostly given to kids with medical diagnoses and an emphasis on the school setting.

Outpatient

Occupational therapy professionals provide both individual and group treatments to address the following issues: managing stress and anger, preparing healthy meals, leisure, health literacy and education, and medicines.

Acute care

When a patient is admitted to acute care, occupational therapists evaluate if they have the social support, cognitive, emotional, and physical abilities necessary for them to live freely and take care of themselves after the hospital.

Because they concentrate on both the clinical and social determinants of health, occupational therapists are in a unique position to assist patients receiving acute treatment.

Occupational therapists in acute care provide the following services:

• Provide one-on-one or group rehabilitation treatments that target the patient’s physical, emotional, and cognitive abilities in order to help them carry out self-care and other crucial tasks.
• Training for caregivers to help patients once they are discharged.
• Suggestions for assistive technology to improve safety and autonomy with everyday tasks (e.g., dressing assistance, bathing chairs, and medicine organizers for self-administration of prescriptions).
• In order to recommend changes for better safety and function following discharge, they also conduct home safety assessments.

Occupational therapists employ a client-centered discharge planning strategy by utilizing a range of models, such as the Canadian Occupational Performance Model, Person, Environment and Occupation, and the Model of Human Occupation.

It was discovered that the single most important spending category in hospitals for lowering the risk of readmission for heart failure, pneumonia, and acute myocardial infarction was occupational therapy treatments provided in acute care.

Community-Based

Occupational therapy professionals create and carry out community-wide initiatives to support the prevention of illnesses and promote healthy lifestyles. These initiatives include: teaching preventive classes; assisting with gardening; providing ergonomic assessments; and organizing enjoyable leisure and physical activity programs.

Mental Health

The field of occupational therapy holds that a person’s active participation in their work promotes their health (AOTA, 2014). A person’s capacity to engage fully in their work may be impeded when they are in need of mental health services.

For instance, a person suffering from depression or anxiety may find it difficult to take care of themselves, have trouble sleeping, be less motivated to engage in leisure activities, find it difficult to focus in class or at work and avoid social situations.

Occupational therapy practitioners can support initiatives for mental health promotion, prevention, and intervention since they have a solid educational foundation in mental health.

Occupational therapy professionals can offer services that prioritize early detection, prevention of harmful behaviors, and social and emotional well-being.by means of screenings and comprehensive treatment (Bazyk & Downing, 2017).

Occupational therapy practitioners have the ability to collaborate with families and other team members, work one-on-one with clients, and train staff members.

Occupational therapists, for example, are particularly adept at recognizing how an individual’s strengths and the demands of a task relate to one another. Equipped with this understanding, professionals can create a strategy for successful engagement in fulfilling careers.

In order to enhance involvement in activities linked to school, education, employment, play, leisure, ADLs, and instrumental ADLs, occupational therapy services might emphasize occupation (Bazyk & Downing, 2017).

The public health approach (WHO, 2001) to mental health, which prioritizes the promotion of mental health as well as the prevention and intervention of mental illness, is applied in occupational therapy.

According to Miles et al. (2010), this paradigm emphasizes the special importance of occupational therapists in mental health promotion, prevention, and intensive interventions for people of all ages. The three main service levels are shown below:

Tier 3: Intensive Interventions

Individuals with recognized mental, emotional, or behavioral illnesses that impair everyday functioning, interpersonal connections, emotional well-being, or the capacity to deal with obstacles in daily life are offered intensive therapies.

Occupational therapy professionals are dedicated to the recovery model, which emphasizes helping people with mental health issues live fulfilling lives in the community and realize their full potential through a client-centered approach (Champagne & Gray, 2011).

Functional assessment and intervention (skills training, accommodations, compensatory strategies) and the identification and implementation of healthy habits, rituals, and routines to support wellness are the main.

Goals of intensive interventions (direct–individual or group, consultation); these interventions are focused on occupation to foster recovery or “reclaiming mental health” leading to optimal levels of community participation, daily functioning, and quality of life (Brown, 2012).

Tier 2: Targeted Services

Persons who are at risk of developing mental health issues, such as those with emotional experiences (such as trauma or abuse).

Situational stressors (such as physical disability, bullying, social isolation, or obesity), or genetic factors (such as a family history of mental illness), are intended to receive targeted services in order to prevent mental health problems.

Practitioners of occupational therapy are dedicated to recognizing and treating mental health issues in a timely manner across all contexts.

Targeted services (education, consultation, small groups, and accommodations) center on participation in jobs that support mental health and reduce early symptoms; small, therapeutic groups (Olson, 2011); and environmental changes that increase participation (e.g., sensory-friendly homes, workplaces, or classrooms).

Tier 1: Universal Services

All people, including those with impairments and diseases, are eligible for universal care, regardless of their mental health or behavioral issues (Barry & Jenkins, 2007).

The goal of occupational therapy services is to promote and prevent mental health issues in all people.

This is achieved by supporting engagement in activities that promote health (such as pleasurable hobbies, a balanced diet, regular exercise, and enough sleep), as well as encouraging self-regulation and coping mechanisms (such as practicing yoga and mindfulness.

Encouraging mental health literacy, or understanding how to look after one’s mental health and what to do when suffering signs of mental illness.

Occupational therapy professionals create universal programs and incorporate techniques to support mental health and well-being in a range of contexts, including the workplace and educational institutions.

Universal programs to assist all individuals in successfully participating in careers that promote positive mental health are the main focus of universal services (individual, group, school-wide, employee/organizational level) (Bazyk, 2011); educational and coaching strategies with a

broad range of pertinent parties concentrating on the promotion and prevention of mental health issues; the creation of coping mechanisms and resilience; and environmental changes and supports to encourage involvement in jobs that promote mental health.

Productive Aging

Occupational therapists assist senior citizens in retaining their freedom, engaging in worthwhile pursuits, and leading satisfying lives.

Occupational therapists work with older persons in a variety of settings, including driving, aging in place, impaired vision, dementia, and Alzheimer’s disease (AD). Driver assessments are conducted in order to assess drivers’ safety while operating a motor vehicle.

To facilitate senior citizens’ independence at Occupational therapists evaluate clients’ functioning in their homes, identify areas of risk for falls, and provide recommendations for particular home improvements while they are there.

When treating limited vision, occupational therapists adjust the surroundings and tasks. Occupational therapists prioritize preserving quality of life, guaranteeing safety, and encouraging independence while working with persons diagnosed with AD.

Geriatrics/Productive Aging

Occupational therapists deal with every facet of aging, including treating different disease processes and promoting health.

Ensuring older persons may preserve their independence and lowering health care expenses related to hospitalization and institutionalization are the two main objectives of occupational therapy for older adults.

Occupational therapists in the community can evaluate an elderly person’s driving abilities and safety. If it is determined that a person is not a safe driver, the occupational therapist can help locate other modes of transportation.

As part of home care, occupational therapists also assist senior citizens in their homes. An occupational therapist can focus on fall prevention and improving independence in the home.

assisting with everyday tasks, guaranteeing safety, and allowing the individual to remain in the house for as long as they so choose. To maintain safety in the house, an occupational therapist may also suggest making changes to the interior.

Chronic illnesses including diabetes, rheumatoid arthritis, and heart-related disorders are common in the elderly. Occupational therapists can assist in managing these issues by providing knowledge on coping mechanisms or energy-saving techniques.

Occupational therapists work with elderly patients in hospitals, assisted living facilities, and post-acute rehabilitation in addition to their homes. Occupational therapists in nursing homes work with residents and caregivers to provide safe care education.

changing the surroundings, arranging requirements, and improving IADL abilities, to mention a few. Occupational therapists assist patients in returning home and to their pre-hospitalized state following an illness or accident through post-acute rehabilitation.

For those who have dementia, occupational therapists also have a special role to perform. As the illness worsens, the therapist could help with environment modifications to guarantee safety and caregiver education to avoid fatigue.

Occupational therapists are involved in hospice and palliative care as well. Making sure that the roles and careers that the person finds meaningful continue to be meaningful is the aim at this point in life.

When an individual can no longer carry out these tasks, The occupational therapist can provide fresh approaches to completing these duties that take into account the environment in addition to the patient’s physical and psychological needs.

Occupational therapists work with older persons not only in typical settings but also in ALFs and senior centers.

Visual Impairment

Among the top 10 disabilities among adult Americans is visual impairment. By making the most use of their residual vision, occupational therapists collaborate with other medical specialists like optometrists, ophthalmologists, and trained low-vision therapists to optimize the independence of individuals with visual impairments.

The “Living Life to Its Fullest” campaign goal of AOTA relates to people’s identities and interests, especially when it comes to encouraging participation in worthwhile activities, regardless of visual impairment.

Occupational therapy may be beneficial for the following populations: older adults, those with traumatic brain injuries, adults who may be able to resume driving, and children with visual impairments.

There are two categories of visual impairments that occupational therapists treat: neurological visual impairments and poor vision.

A cortical visual impairment (CVI) is characterized as “…abnormal or inefficient vision resulting from a problem or disorder affecting the parts of the brain that provide sight” and is an example of a neurological disability.

The function of occupational therapy in working with visually impaired individuals will be covered in the section that follows.

Task analysis, environmental assessment, and necessary task or environment change are all part of occupational therapy for older persons with limited vision.

In order to address visual deficits in acuity, visual field, and eye movement in individuals with traumatic brain injury, many occupational therapy practitioners collaborate closely with optometrists and ophthalmologists.

This collaboration includes teaching compensatory strategies for safe and effective completion of daily tasks.

Occupational therapy may be beneficial for adults with stable visual impairments in providing a driving assessment and an examination of the possibility of getting back behind the wheel.

Finally, occupational therapy professionals use compensatory measures to help visually impaired children perform self-care duties and engage in school activities.

Adult Rehabilitation

Occupational therapists treat patients who require rehabilitation after an illness or injury. Occupational therapists plan treatments that take into account the physical, cognitive, psychological, and environmental demands of adult populations in a range of contexts.

Adult rehabilitation can benefit from occupational therapy in a number of ways.

• utilizing social skills training to encourage healthy connections and community involvement with persons with autism in day rehabilitation programs
• Improving a cancer patient’s quality of life by finding them meaningful work, offering techniques for reducing stress and anxiety, and making suggestions for how to manage fatigue
• teaching those who have lost their hands how to put on and take off a myoelectric limb and preparing them for the limb’s functional use
• Prevention of pressure sores in people with impaired sensation, such as those with spinal cord injuries.
• putting new technology to use, including video games like the Nintendo Wii and speech-to-text software,
• using telehealth techniques to communicate with clients who reside in remote places as a model of service delivery
• Assisting adult stroke survivors to resume their everyday activities

Assistive Technology

Occupational therapy practitioners, often known as occupational therapists (OTs), are in a unique position to advise, encourage, and educate their clients about the use of assistive technology in order to enhance their quality of life.

OTs have good expertise in activity analysis and are able to focus on helping clients reach their goals by understanding their unique demands regarding occupational performance. Thus, occupational therapy practice models strongly advocate the use of a wide variety of assistive technologies.

Travel Occupational Therapy

Travel occupational therapy practitioners, who are willing to travel, frequently out of state, to work temporarily in a facility, are becoming more and more popular among facilities due to the growing need for occupational therapy practitioners in the United States.

Assignments normally last between 13 to 26 weeks, however, they can span anywhere from 8 weeks to 9 months. Although travel therapists serve in a variety of environments, home health and skilled nursing facilities have the greatest need for therapists.

To work as a travel occupational therapy practitioner, no further schooling is required; however, there can be state practice acts and rules for licensure that need to be adhered to.

As of July 2019, the national average compensation for a full-time travel therapist in the United States ranges from $62,500 to $100,000, according to Zip Recruiter. Travel occupational therapists typically start their careers between the ages of 21 and 30 (43%).

Occupational Justice

The “benefits, privileges, and harms associated with participation in occupations” as well as the consequences of being denied access to or opportunities to participate in occupations are the focus of the occupational justice practice area.

The relationship between employment, health, happiness, and quality of life is highlighted by this hypothesis. There are two ways to approach occupational justice: individually and collectively. Functional limitations, illness, and disability are all part of the unique route.

Public health, gender and sexual identity, social inclusion, migration, and the environment make up the collective way.

The abilities of The ability to advocate for systemic change that affects institutions, policies, people, communities, and entire populations is provided by occupational therapy practitioners.

Populations that suffer from occupational injustice include those who are refugees, inmates, homeless, have survived natural disasters, are nearing the end of their lives, have disabilities, are elderly and live in residential homes, are poor, are children, are immigrants, or are LGBTQI+.

An occupational therapist who advocates for occupational justice, for instance, might do the following:

• evaluating tasks and making necessary adjustments to settings and activities to reduce obstacles to engaging in worthwhile daily activities.
• addressing both mental and physical issues that could impair a person’s capacity for function.
• Make sure the intervention is appropriate for the client’s family and social environment.
• Encourage people with disabilities to engage in worthwhile activities on a global scale to support global health. The World Health Organization (WHO), non-governmental organizations, community groups, and policymaking are all active with occupational therapists in promoting the health and well-being of people with disabilities globally.

In addition to supporting ideas of procedural and social justice, occupational therapy practitioners have a responsibility to promote the intrinsic need for meaningful work and the ways in which it advances a just society.

People’s well-being, and a quality of life that is appropriate for their particular context. It is advised that physicians incorporate occupational justice into their daily work in order to support the goal of assisting individuals in engaging in tasks that they both need and want to complete.

Occupational Injustice

On the other hand, situations when people are deprived, excluded, or denied chances that are relevant to them are referred to as occupational injustice. Examples of occupational injustices in the field of occupational therapy include the following:

Occupational deprivation: the rejection from fulfilling careers as a result of outside circumstances beyond one’s control. For instance, transportation restrictions could make it difficult for someone who struggles with functional mobility to reintegrate into the community.

In order to lessen occupational deprivation, OTs can assist in bringing communities together and increasing awareness. OTs might suggest removing obstacles from the environment to make occupation easier while creating programs that encourage participation.

Information-based advocacy for policies that aim to reduce unintentional occupational deprivation and promote social inclusion and cohesion

Occupational apartheid:

the rejection of a person from certain professions because of personal traits including age, gender, ethnicity, nationality, or socioeconomic standing.

Children from low socioeconomic backgrounds who have developmental problems and whose families choose not to pursue therapy because of budgetary restraints provide one example.

In order to increase occupational engagement, occupational therapists (OTs) working with a segregated population must prioritize extensive contextual change and occupational exploration.

Occupational therapists (OTs) can address occupational engagement through community-based activities that explore free and local resources, as were group and individual skill-building opportunities.

Occupational marginalization:

relates to how social expectations or implicit behavioral norms prohibit someone from pursuing their chosen career.

For instance, because of the functional restrictions brought on by his physical limitations, a youngster with physical disabilities might only be provided tabletop leisure activities as an extracurricular activity rather than athletics.

Occupational therapists (OTs) are capable of creating, developing, and/or offering programs that lessen the detrimental effects of occupational marginalization and promote the best possible performance and well-being to allow for participation.

Occupational imbalance:

the restricted involvement in a fulfilling career due to a second role in a different profession. This is evident in the case of a caregiver for an individual with a handicap who also needs to manage other responsibilities, such as that of a parent raising other children, a job, or a student.

OTs can support creating supportive settings for people to engage in careers that enhance their well-being as well as supporting the development of sound public policy.

Occupational alienation:

the forced adoption of a profession that doesn’t resonate with that individual. This shows itself in the OT field when rote exercises are given that have little to do with the objectives or interests of the clients.

To help each person reach their full potential, OTs can create customized exercises based on their interests. OTs are capable of creating, developing, and promoting inclusive programs that offer a range of options for the person to choose from.

In the practice of occupational therapy, injustice can occur when laws, political conditions, standardized treatments, professional supremacy, or other factors negatively affect our clients’ ability to engage in their jobs.

The therapist will be able to evaluate his own work and come up with creative solutions for their client’s issues while advocating occupational justice if he is aware of these inequalities.

Community-Based Therapy

Community-based practice has risen from an emerging area of practice to a key component of occupational therapy practice as occupational therapy (OT) has expanded and progressed (Scaffa & Reitz, 2013).

Through community-based practice, occupational therapists can collaborate with clients and other stakeholders, including families, schools, businesses, agencies, service providers, and retail establishments.

Daycare centers and others might have an impact on the client’s level of participation success.

Additionally, it enables the therapist to observe what is actually taking place in the setting and create interventions that are pertinent to what may assist the client in taking part and identify any obstacles to doing so.

Community-based practice encompasses all areas of practice for occupational therapists (OTs), including mental health, spirituality, and physical health. All clientele types can be seen in community-based settings.

OTs can play a variety of roles, such as advocates, consultants, program designers, direct care providers, adjunctive services providers, and therapeutic leaders.

Nature-Based Therapy

Outdoor activities and nature-based therapies can be used in occupational therapy practices since they offer a variety of therapeutic advantages. Adventure therapy, animal-assisted therapy (AAT), and therapeutic gardening are a few examples.

In one research on parent perceptions of the effects of AAT with trained dogs, for example, parents observed improvements in their children’s emotional regulation and social engagement who had autism spectrum disorder (ASD).

Additionally, they saw a decline in troublesome behaviors. Similar outcomes were discovered by a source used in the study when AAT used llamas and horses.

Participating in group gardening can be an additional intervention in stroke recovery; it not only promotes socialization and mental relaxation but also aids in skill mastery and serves to evoke memories of earlier experiences.

A horticulture therapist oversees Royal Rehab’s Productive Garden Project in Australia, which gives patients and caregivers an opportunity to engage in purposeful activities apart from traditional hospital settings.

Hence, rather than depending solely on clinical interventions during rehabilitation, tending a garden helps support experiential activities, potentially achieving a better balance between clinical and real-life hobbies.

It has been discovered that nature-based therapy enhances motor skills, cognitive function, and overall quality of life in persons with acquired brain damage.

A greater sense of well-being when in contact with nature, nature’s beneficial effects on problem-solving and attentional refocusing, human nature’s natural connection to and response to the natural world, and the emotional.

Nonverbal, and cognitive aspects of human-environment interaction all contribute to a theoretical understanding of such successes in nature-based approaches.

Education

A variety of credentials are needed all over the world to work as an occupational therapist or occupational therapy assistant.

Associate degree, Bachelor’s degree, entry-level master’s degree, post-professional master’s degree, entry-level Doctorate (OTD), post-professional Doctorate (Droit or OTD), Doctor of Clinical Science in OT (CDCs).

Doctor of Philosophy in Occupational Therapy (PhD), and combined OTD/PhD degrees are among the degree options, depending on the nation and expected level of practice.

There are positions for occupational therapists and assistants worldwide. There are now two points of entrance for OT and OTA programs in the US. Entry-level Master’s or entry-level Doctorate for OT is what that means.

That is an associate’s or bachelor’s degree for OTA. The minimal standards for occupational therapy (OT) courses set by the World Federation of Occupational Therapists (WFOT) were updated in 2016.

It is imperative that all educational programs worldwide adhere to these basic requirements. Academic standards established by a nation’s national accrediting body can be added to or subsumed by these standards.

All programs must provide a curriculum that includes practice placements, or fieldwork, as part of the basic standards.

Acute care, inpatient and outpatient hospitals, skilled nursing homes, schools, group homes, early intervention, home health, and community settings are a few examples of fieldwork settings.

The field of occupational therapy has a broad theoretical and empirical foundation. The occupational therapy curriculum emphasizes the theoretical underpinnings of occupation by utilizing.

Many scientific domains such as anatomy, physiology, biomechanics, neurology, and occupational science. This scientific basis is further combined with insights from sociology, psychology, and other fields.

There are legal requirements for licensure in the US, Canada, and other nations. To become an OT or OTA, a person needs to pass a national certification exam, finish fieldwork requirements, and graduate from an accredited program.

Philosophical Underpinnings

Over the course of the profession’s history, occupational therapy’s guiding principles have changed.

The founding fathers’ ideology was heavily influenced by the principles of humanism, pragmatism, and romanticism—all of which are regarded as the main philosophies of the previous century.

Adolf Meyer, a psychiatrist who immigrated to the US from Switzerland in the late 19th century was asked to share his ideas with the newly formed Occupational.

Therapy Society in 1922, delivered one of the most frequently referenced early papers concerning the philosophy of occupational therapy.

At the time, Dr. Meyer was the head of Johns Hopkins University’s new psychiatric department and Phipps Clinic in Baltimore, Maryland, and regarded as one of the country’s top psychiatrists.

William Rush Dunton worked to advance the notions that employment is therapeutic and that it is a fundamental human need as a supporter of the National Society for the Promotion of Occupational Therapy, presently recognized as the American Association of Occupational Therapy.

Some of the fundamental tenets of occupational therapy emerged from his remarks, and they include:

• Having a job improves one’s health and happiness.
• A job arranges time and provides structure.
• A career gives life purpose on both a societal and personal level.
• A person’s occupation is unique. Different professions are valued by different people.

These presumptions, which have evolved over time, serve as the foundation for the moral principles that guide the national associations’ Codes of Ethics. The primary focus is still on the importance of occupation to health and well-being.

A more reductionist worldview came into being in the 1950s as a result of criticism from the medical community and the large number of handicapped World War II veterans.

Although this method produced advancements in technical understanding of occupational performance, physicians grew more pessimistic and reexamined their assumptions. Client-centeredness and occupation have therefore come back to dominate the field.

The fundamental tenets of occupational therapy have changed over the last century, moving from sickness diversion to treatment to enablement via purposeful work.

Three philosophical tenets of occupational therapy are frequently stated: people, their occupations (activities), and the surroundings in which those activities occur are the core elements of the field; activity is essential for health; and its ideas are grounded in holism.

There have, nevertheless, been some opposing viewpoints. Specifically, Mocellin declared the concept of occupation as a means of achieving health to be outmoded in contemporary society and urged its abandonment.

Furthermore, he questioned whether it was appropriate to promote holism when the evidence for it was so scant.

A number of the values established by the American Occupational Therapy Association have come under fire for being too therapist-focused and out of step with the realities of multicultural practice today.

Those who practice occupational therapy have recently been urged to consider the profession’s potential broader reach and to include working with groups that experience occupational injustice resulting from factors other than disability.

Therapists who work with refugees, children who are obese, and those who are homeless are a few examples of new and developing practice areas.

Theoretical Frameworks

Occupational therapists frequently support using theoretical frameworks to structure their practice, which sets their profession apart.

Many have claimed that providing patient-driven care does not need the application of theory and that doing so makes routine clinical care more difficult.

Keep in mind that academics use different language. The following is an imperfect list of theoretical underpinnings for framing a human and their occupations:

Generic Models

The general term for a collection of related ideas, research, and knowledge that constitute conceptual practice is “generic models.” “Those aspects which influence our perceptions, decisions, and practice” is a more general definition of them.

Charles Christiansen and M. Carolyn Baum first published the Person Environment Occupation Performance model (PEOP) in 1991. It describes an individual’s performance based on four elements: environment, person, performance, and occupation.

The model focuses on how these elements interact and how that interaction either prevents or encourages successful occupation.

Workplace-specific practice models, Anne Fisher and colleagues developed the Occupational Therapy Intervention Process Model (OTIPM).

Model of Human Occupation (MOHO) and Occupational Performance Process Model (OPPM) (Gary Kilhefner and others) Occupational Alienation In 1980, MOHO was first published. It describes how people choose, plan, and carry out their jobs in relation to their surroundings.

The approach has been effectively implemented globally and is backed by data gathered over a thirty-year period.

The Occupational Performance and Engagement Model for Canada (CMOP-E) Originally known as the Canadian Model of Occupational Performance (CMOP), this framework was developed in 1997 by the Canadian Association of Occupational Therapists (CAOT).

To increase involvement, Palatjko, Townsend, and Craik expanded it in 2007. The framework supports the idea that there are three interrelated components: the individual, the environment, and the occupation.

The concept of engagement was expanded to include job performance. A triangle with the person in its center is used to represent the person in a visual model.

With a spiritual core, the triangle’s three points stand for mental, emotional, and physical aspects. An inner ring represents the context of occupation, while an outer ring represents the context of environment surrounding the human triangle.

Australian version of the Occupational Performances Model (OPM-A) (Chris Chapparo & Judy Ranka) The OPM(A) was first conceived in 1986, and its present incarnation was introduced in 2006.

The OPM(A) offers a framework for occupational therapy education and serves as an illustration of the complexity of occupational performance and the range of occupational therapy practice.

• Michael Iwama’s model, Kawa (River)
• Models of biopsychosocial interactions

Engel’s biopsychosocial model considers the ways in which social, environmental, psychological, and physiological factors might influence disease and sickness.

The biopsychosocial approach is distinct in that it considers the relationship between the client and provider as well as the client’s subjective experience when determining well-being.

Considering that various nations have diverse societal norms and beliefs, this model also takes cultural variation into account.

This is a multifaceted and multifactorial model that aims to comprehend both the person-centered approach—in which the provider takes on a more introspective and active role—and the etiology of disease.

Interpersonal neurobiology (IPNB), polyvagal theory (PVT), and the dynamic-maturational model of attachment and adaption (DMM) are other models that integrate biological (body and brain), psychological (mind), and social (relational, attachment) aspects impacting human health.

Particularly the last two go into great length regarding the origin, mode, and purpose of somatic symptoms. Kasia Kozlowska explains how she applies these models to comprehend the complicated human condition.

Build stronger relationships with her clients, and incorporate occupational therapists as a member of a group to treat symptoms of functional soma.

Her findings suggest that children diagnosed with functional neurological disorders (FND) use more complex or higher DMM self-protective attachment techniques to manage their home surroundings and that these strategies have an effect on functional somatic symptoms.

Occupational therapists can enhance their methods and approach by learning more about the relationship between the attachment system and psychological and neurobiological processes, as investigated by Pamela Meredith and colleagues.

They have discovered connections between adult sensory processing, pain perception, and attachment. In a study of the literature, Meredith noted several, occasionally unique, ways in which occupational therapists can successfully utilize an attachment viewpoint.

Frames of Reference

An occupational therapist might use frames of reference as an extra knowledge base while developing treatment plans or conducting assessments of individual patients or client groups.

Even though the therapist can conceptualize the patient’s occupational roles using the conceptual models (mentioned above), it’s frequently crucial to incorporate additional references to integrate clinical reasoning.

As a result, many occupational therapists will make use of extra frames of reference while evaluating their patients or service users and creating treatment objectives.

• A framework for biomechanics
• The main focus of the biomechanical frame of reference is motion during occupation. It is utilized by those who have trouble moving about, have weak muscles, or lose their stamina when working. To reduce the possibility that movement or exercise may take center stage, occupational therapists should adapt the frame of reference to the occupational therapy viewpoint, even though they were not the ones who initially assembled it.
• Reparative (rehabilitative)
• Gordon Muir Giles and Clark-Wilson’s neurofunctional theory
• Theory of dynamic systems
• A framework of reference that is client-centered
• Carl Rogers’ work serves as the foundation for this frame of reference. It places the client at the center of all therapeutic activities, with their needs and objectives serving as the guide for how occupational therapy is delivered.
• The cognitive-behavioral framework of reference
• Modeling the ecology of human performance
• The model of recovery
• Integration of senses
• Occupational therapy practices in clinics, communities, and schools frequently use the sensory integration framework. Children with developmental difficulties, including dyspraxia, autism spectrum disorder, and sensory processing disorder, are the ones who utilize it the most frequently.

The main components of sensory integration therapy are giving the patient chances to receive and process input through a variety of sensory modalities, testing the patient’s abilities therapeutically, and including the patient’s interests in the process.

Therapy, setting up the space to encourage the client’s participation, assisting in the creation of a physically and emotionally secure environment, and adapting activities to accommodate the client’s abilities and limitations.

And providing sensory experiences within the framework of play to foster intrinsic motivation. Although sensory integration techniques are typically used in juvenile settings, there is growing proof that adult users can also benefit from these procedures.

Global Occupational Therapy

Across the globe, occupational therapists are members of the World Federation of Occupational Therapists, which serves as an international voice for the field. WFOT fosters international cooperation among nations to support occupational therapy practice.

Currently, WFOT has 900 recognized educational programs, 550,000 occupational therapy practitioners, and over 100 member country organizations.

Every year on October 27, the profession observes World Occupational Therapy Day to raise awareness of the field and to highlight its development efforts on a local, national, and worldwide level.

Since 1959, WFOT and the World Health Organization (WHO) have worked closely together on projects aimed at enhancing global health.

In line with the 17 Sustainable Development Goals of the United Nations, which center on “ending poverty, fighting inequality and injustice, tackling climate change, and promoting health,” WFOT supports the vision of healthy people.

A significant contributor to “the creation of more meaningful lives” and “chosen and necessary occupations” for people and communities is occupational therapy.

The practice of occupational therapy is widespread and adaptable to a wide range of locations and cultural contexts.

Regardless of the nation, region, or situation, the concept of occupation is universal across the profession.

Nowadays, it is claimed that employment and active involvement in it have a significant positive impact on one’s health and well-being and are recognized as human rights.

Many people are leaving their home nations to work as occupational therapists in search of better chances or employment as the field expands. In this setting, occupational therapists must learn to live in a culture that is different from their own.

The occupational therapy ethos requires an understanding of cultures and their communities. Recognizing the social views and beliefs of each client and their family is a necessary component of effective occupational therapy treatment.

The fastest route to independence is, in fact, to understand the client’s priorities and use their culture.

FAQ

Author: Arjun Sharma