Occupational therapy

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Template:Globalize/USA Occupational therapy (OT) is an applied science and health profession that provides skilled treatment to help individuals develop, regain or maintain the skills necessary to participate in all facets of their lives. OT gives people the "skills for the job of living" necessary for living meaningful 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

History of occupational therapy

Occupational therapy began as a profession in the United States in 1917 with the founding of the Society for the Promotion of Occupational Therapy (now, The American Occupational Therapy Association, Inc.). The creation of the society was impelled by a belief in the curative properties of human occupation (or everyday purposeful activity).It had previously been employed as part of the moral treatment movement in the large state supported institutions for mental illness that were widespread in the United States. Occupational therapy has played a prominent role in epidemics, providing treatment for patients with tuberculosis, polio, and HIV/AIDS. In 1975, following the enactment of legislation known as the Education for All Handicapped Children Act (PL 94-142), thousands of occupational therapists were employed by public schools to provide therapeutic services (known as related services) to enable children with disabilities to participate in regular school settings. Originally, therapists from approved training programs were certified, or registered by the American Occupational Therapy Association. A baccalaureate degree was required for certification beginning in the 1940s. Fifty years later, accredited programs were required to be at the Master's degree level. The 1990's saw the evolution of doctoral programs in occupational therapy. Educational programs in occupational therapy are now accredited by the Accreditation Council for Occupational Therapy Education, and national certification is granted under the auspices of the National Board for Certification in Occupational Therapy. More recently, a new discipline within occupational therapy has opened up known as occupational science. Many students in 5-year masters program now receive their undergraduate degree in this discipline and go on to receive a Masters degree in occupational therapy during their 5th year.

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 (M.S.) or Doctoral degree (OTD). A certified occupational therapy assistant (COTA) generally earns an associate degree.

To become eligible for the national examination for certification, students must complete a minimum of two (three maximum) supervised clinical internships in physical disabilities, pediatrics or mental health. Many college programs encourage students pursue a third internship in an area of OT of their choosing. Upon successful completion of atleast two internships, graduates must pass a national examination (NBCOT or National Board for Certification in Occupational Therapy). Most U.S. states also regulate occupational therapy practice (OTs must possess a license within their state).

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.

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
• rheumatoid and age-related conditions such as arthritis
• neurodegenerative movement disorders such as multiple sclerosis, amyotrophic lateral sclerosis, or Parkinson's disease
• birth injuries, learning difficulties, or developmental disabilities
• mental health difficulties Alzheimer's, schizophrenia, ADHD 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 impairments
• developmental disabilities such as autism or cerebral palsy
• domestic abuse issues

Areas of occupational therapy

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

Physical

• Orthopedics(outpatient clinics)
• Pediatrics
• Long-Term Care
• Hand therapy
• Cardiac rehabilitation
• Burn Centers
• Rehabilitation centers (TBI, Stroke (CVA), spinal cord injuries, etc.)
• Hospitals (ranging from inpatient, subacute rehab, to outpatient clinics)

Community

There is a current shift within the profession towards community based practice. Essentially this vision encourages practitioners to expand into previously uncharted territory. Thus, moving away from hospitals and rehabilitation clinics and begin working with atypical populations such as the homeless or at risk populations. This change in vision is meant to expand the capabilities and impact of the profession. As the fundamental ideologies of occupational therapy are promoting independence, the profession is beginning to realize there are many more populations that would benefit from OT services.

Examples of community-based practice settings:

• Health promotion and lifestyle change
• Intermediate care
• Day centers
• Schools
• Child development centers
• 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

Case studies

Because of the wide range of services that occupational therapists provide, the following case studies will help provide insight into the role of an OT in each specific case.

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.

Hip replacement

Mary is a 58-year-old female who enjoys an active lifestyle. Unfortunately, she has been slowed down recently due to osteoarthritis in the hips. Her doctor recommended getting a bilateral hip replacement, which she did in the next few months. One day after surgery, Mary's occupational therapist helped her get out of bed and walk towards the bathroom. The therapist provided tips on how to get out of bed and how to walk. Once in the bathroom, the therapist assisted Mary complete a toilet transfer while adhering to all hip precautions. On the second day following the surgery, the therapist once assisted Mary complete a toilet transfer. Then, the therapist showed Mary how to use a wide range of adaptive equipment that would help her complete her daily tasks, such as showering (using a long-handled sponge), putting on socks (using a sock-aid), and reaching for things on the floor (using a reacher). On the third day, Mary prepared for discharge. She was educated in how to complete car transfers and tub/shower transfers. Additionally, she was advised to get a tub seat. Finally, she was advised to temporarily put away any throw rugs to lessen the risk of tripping.

Trivia

• April is Occupational Therapy month in the US
• It is Occupational Therapy Week in the UK at the beginning of November
• In Canada, October is recognized as Occupational Therapy month
• Clifton Springs, NY is the birthplace of Occupational Therapy
• In Singapore, January 11th is Occupational Therapy Day.

References

1. Baum C., & Christiansen, C., (1997), The occupational therapy context: Philosophy - Principles - Practice. In C. Christiansen & C. Baum (Eds.), Occupational Therapy: Enabling Function and Well Being. p. 36. Thorofare, NJ: SLACK
2. Bing, R.K. (1981) Occupational therapy revisited: A paraphrastic journey. American Journal of Occupational Therapy, 35(8):499-518.
3. Low, J. (1992). The reconstruction aides. American Journal of Occupational Therapy. Jan;46(1):38-43,
4. Meyer, A. (1922). The philosophy of occupation therapy. Archives of Occupational Therapy, 1, 1-10.

External links

Occupational therapy associations

• World Federation of Occupational Therapists
• The American Occupational Therapy Association, Inc.
• Australian Association of Occupational Therapists
• Austrian Occupational Therapy Association
• Bangladesh Occupational Therapy Association
• British Association/College of Occupational Therapists
• Canadian Association of Occupational Therapists
  • Canadian Occupational Therapy Foundation
• Iranian Occupational Therapy Association
• Israeli Society of Occupational Therapy
• Italian Association of Occupational Therapists
• Korean Association of Occupational Therapists
• Uganda Association of Occupational Therapists
• New Zealand Association of Occupational Therapists
• Croatian Association of Occupational Therapists
• Singapore Association of Occupational Therapists
• [http://www.medtravelers.com/occupational-therapist.aspx

Occupational therapy associations by Australian state

• New South Wales
• ACT
• Northern Territory
• Queensland
• South Australia
• Tasmania
• Victoria
• Western Australia

Occupational therapy blogs

• Occupational Therapists' blogs on Therapy Times - Occupational Therapists' blogs on Therapy Times
• The Occupational Therapy Blog - British
• Meta OT - British

• Mental Health Missives podcast, US