Occupational therapy

Occupational therapy refers to the use of meaningful occupation to assist people who have difficulty in achieving healthy and balanced life; and to enable an inclusive society so that all people can participate to their potential in daily occupations of life.^[1] Occupational Therapists & Occupational Therapy Assistants work with a variety of individuals who have difficulty accessing or performing meaningful occupations.

Most commonly, Occupational Therapists & Occupational Therapy Assistants work with people with disabilities to enable them to maximize their skills and abilities. Occupational therapy gives people the "skills for the job of living" necessary for living meaningful and satisfying lives.^[2]

Services typically include:

• Customized intervention 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.^[2]

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History of Occupational Therapy in Aotearoa/New Zealand

The early use of occupation to support, treat and rehabilitate people in Aotearoa New Zealand is evident in services for returned soldiers after World War 1 ((Hobcroft 1949)). There are glimpses in mental health services during the 1930's too (Skilton 1981). However the first qualified occupational therapist Margaret Buchanan arrived in New Zealand in 1941 (Buchanan 1941). Initially employed in the then Auckland Mental Hospital she was rapidly involved not only in the development of occupational therapy services there, but also the development of the first training programmes and advice to government. Initially those trained had previous health or education backgrounds (Skilton 1981). A formal two year training programme was established by 1940 (NZNJ 1940), and state registration provided for in the Occupational Therapy Act 1949 (New Zealand Occupational Therapy Registration Board 1950) Insert a web link here to the board . From its early services in mental health and returned serviceman settings occupational therapy expanded into general rehabilitation, work with children with disabilities and services for the elderly (Wilson 2004) p88. Educational programmes moved from the health sector to the education sector in 1971 (New Zealand Occupational Therapy Registration Board 1970b 17th July)and Bachelors programmes emerged in the 1990's. An advanced diploma in occupational therapy was first made available in 1989 (Packer 1991) but not until the review of the Education Act was it possible for masters degree programmes to be made available as they are now through both schools . Insert web links here to the two schools The first New Zealand occupational therapist to complete a PhD in the country in a programme related to occupational therapy was Linda Robertson who completed her PhD in 1994 (NZJOT 1996). The development of distance education technology has enabled large numbers of therapists to participate in distance post-graduate education.

An association formed in 1948 (New Zealand Registered Occupational Therapists Association 1949) Insert a web link here to the association provides a bi-annual conference, representation at government levels, a journal and a monthly newsletter.

History of Occupational Therapy in the United States of America

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 1990s 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 Educational Requirements

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

Occupational Therapy Education in the USA

Most registered occupational therapists (OTR) practicing in the field today possess a Bachelor of Science degree in occupational therapy. However, by 2007, all OTRs will enter the field with a Masters (M.S. or MOT) 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 to pursue a third internship in an area of OT of their choosing. Upon successful completion of at least 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).

The Philosophy of Occupational Therapy

The philosophy of occupational therapy has evolved over the history of the profession. The philosophy articulated by the founders owed much to the ideals of romanticism ^[3] , pragmatism ^[4] and humanism which are collectively considered the fundamental ideologies of the past century. ^{[5] [6] [7]}

William Rush Dunton, the creator of the National Society for the Promotion of Occupational Therapy, now the American Occupational Therapy Association, sought to promote the ideas that occupation as a basic human need, and that occupation was therapeutic. From his statements, came some of the basic assumptions of occupational therapy, which include:

• Occupation has an effect on health and well being.
• Occupation creates structure and organizes time.
• Occupation brings meaning to life, culturally and personally.
• Occupations are individual. People value different occupations.^[1]

These have been elaborated over time to form the values which underpin the Codes of Ethics issued by each national association. However, the relevance of occupation to health and wellbeing remains the central theme. Influenced by criticism from medicine and the multitude of physical disabilities resulting from World War Two, occupational therapy adopted a more reductionistic philosophy for a time. While this approach lead to developments in technical knowledge about occupational performance, clinicians became increasingly disillusioned and re-considered these beliefs ^{[8] [9]}. As a result, client centeredness and occupation are re-emerging as dominant themes in the profession, perhaps indicating growing maturity and self confidence ^[10]. ^[11]. ^[12]. Over the past century, the underlying philosophy of occupational therapy has evolved from being a diversion from illness, to treatment, to enablement through meaningful occupation. ^[1]

The two most commonly mentioned values are that occupation is essential for health and the concept of holism. However, there have been some dissenting voices. Mocellin in particular ^[13]. ^[14]. ^[15]. advocated abandoning the notion of health through occupation as obsolete in the modern world and questioned the appropriateness of advocating holism when practice rarely supports it. The values formulated by the American Association of Occupational Therapists have also been critiqued as being therapist centred and not reflecting the modern reality of multicultural practice ^[16]. ^[17].

Potential Uses 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
• Fetal alcohol syndrome due to central nervous system damage from prenatal alcohol exposure
• 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
• homelessness
• refugees and asylum seekers
• sensory processing disorders

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)
• Forensic units
• Homeless Shelters
• Refugee Camps
• Community Settings
• Industrial therapy (work hardening, work conditioning, job demand analysis)

Community

Community based practice means moving away from hospitals and rehabilitation clinics and working with atypical populations such as the homeless or at risk populations.

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
• Implementing gradual return to work programmes which include workplace and work station assessments

Cognitive

• Stroke rehabilitation
• Traumatic brain injury
• Multiple sclerosis
• Parkinsons disease

Mental Health

• Child and adolescent mental health services (CAMHS)
• Forensic psychiatry
• Prisons/sections
• Mental health clinics
• Psychiatric rehabilitation programs
• CSP's
• Club houses
• Early Intervention for Psychosis services

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.

Buchanan, M. (1941). "letter " Journal of Occupational Therapy 3(2): 12.

Hobcroft, N. (1949). "Life in the Occupational Therapy Department at Porirua." New Zealand Occupational therapy Newsletter Number Two. (May).

New Zealand Occupational Therapy Registration Board (1950). "Minutes of the New Zealand Occupational Therapy Registration Board." 20th June.

New Zealand Occupational Therapy Registration Board (1970b 17th July). "Minutes of the New Zealand Occupational Therapy Registration Board."

New Zealand Registered Occupational Therapists Association (1949). "AGM Minutes."

NZJOT (1996). New Zealand Journal of Occupational Therapy 47(1): 19.

NZNJ (1940). "Editorial " New Zealand Nursing Journal 33(11): 346.

Packer, T., & Stickney, Jan (1991). "Advanced Diploma in Occupational Therapy: A comparison of therapists before and after." Journal of New Zealand Association of Occupational Therapists Inc. 42(1): 3-7.

Skilton, H. (1981). Work for your life - the story of the beginning and early years of occupational therapy in New Zealand. Hamilton, Hudlo Printers.

Wilson, L. H. (2004). Role differentiation in a professionalising occupation: the case of occupational therapy, New Zealand Department of Management Dunedin University of Otago PhD.

External Links to Occupational Therapy Associations and Institutions

National Associations

Other Organizations

• Music Therapy with old people (Alzheimer Parkinson) Italian and English language
• Advance for Occupational Therapy Practitioners
• World Federation of Occupational Therapists
• Canadian Occupational Therapy Foundation
• The European Network of Occupational Therapy in Higher Education