Thursday, January 13, 2011

Occupational Therapy

The World Federation of Occupational Therapists provides the following definition of Occupational Therapy: 

"Occupational therapy is as a profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment to better support participation." 

Occupational therapists use careful analysis of physical, environmental, psychosocial, mental, spiritual, political and cultural factors to identify barriers to occupation.

The role of Occupational Therapy allows OT’s to work in many different settings, work with many different populations and acquire many different specialties. This broad spectrum of practice lends itself to difficulty categorizing the areas of practice that exist, especially considering the many countries and different healthcare systems. In this section, the categorization from the American Occupational Therapy Association is used. However, there are other ways to categorize areas of practice in OT, such as physical, mental, and community practice (AOTA, 2009). These divisions occur when the setting is defined by the population it serves. For example, acute physical or mental health settings (e.g.: hospitals), sub-acute settings (e.g.: aged care facilities), outpatient clinics and community settings.

Often, children need OT services for the same reasons an adult needs OT services. However, OTs approach intervention in a different way with children. OT delivers approaches treatment through occupation, and the occupations of a child are different from those of an adult, and include play, chores, self-care and schoolwork. Common conditions that are specific to or more common in the pediatric population creating a need for OT services include: developmental disorders, sensory regulation or sensory processing deficits, fine motor developmental delays or deficits, autism, emotional and behavioral disturbances (Lambert, 2005), among others. 

In addition, children are seen for every injury, illness or chronic condition that may cause a person of any age to have performance deficits in their daily life and thus benefit from OT services. Often, OT in pediatrics deals with the implications that certain medical conditions have for classroom learning and the remediation and strategies required. They need to be closely interwoven with existing teaching approaches to help the student achieve his or her educational potential.

Hand therapy is a specialty practice area of occupational therapy that is mainly concerned with treating orthopedic-based upper extremity conditions to optimize the functional use of the hand and arm. Diagnoses seen by this practice area include: fractures of the hand or arm, lacerations and amputations, burns, and surgical repairs of tendons and nerves. Additionally, hand therapists treat acquired conditions such as tendonitis, rheumatoid arthritis and osteoarthritis, and carpal tunnel syndrome. Occupational therapists who work in this field address biomechanical issues underlying upper-extremity conditions. In addition, occupational therapists use an occupation-based and client-centered approach by identifying participation needs of the client, then tailoring intervention to improve performance in desired activities.

Acute care is an inpatient hospital setting for individuals with a serious medical condition(s) usually due to a traumatic event, such as a traumatic brain injury, spinal cord injury, etc. The primary goal of acute care is to stabilize the patient’s medical status and address any threats to his or her life and loss of function. Occupational therapy plays an important role in facilitating early mobilization, restoring function, preventing further decline, and coordinating care, including transition and discharge planning. Furthermore, occupational therapy’s role focuses on addressing deficits and barriers that limit the patient’s ability to perform activities that they need or want to do related to independence in self-care, home management, work-related tasks, and participating in leisure and community pursuits.

Work hardening is a highly structured, goal oriented, individualized treatment program designed to maximize the individual’s ability to return to work. Work hardening programs, which are interdisciplinary in nature, use real or simulated work activities in conjunction with conditioning tasks that are graded to progressively improve the biomechanical, neuromuscular, cardiovascular/metabolic and psychosocial functions of the individual. Work hardening provides a transition between acute care and return to work while addressing the issues of productivity, safety, physical tolerances, and worker behaviors.

According to the American Occupational Therapy Association (AOTA), occupational therapists work with the Mental Health population throughout the life span and across many treatment settings where mental health services and psychiatric rehabilitation are provided (AOTA, 2009). Just as with other clients, the OT facilitates maximum independence in activities of daily living (dressing, grooming, etc.) and instrumental activities of daily living (medication management, grocery shopping, etc.). According to the American Occupational Therapy Association, OT improves functional capacity and quality of life for people with mental illness in the areas of employment, education, community living, and home and personal care through the use of real life activities in therapy treatments (AOTA, 2005)

Geriatric, Adult, Adolescents, and Children with any kind of mental illness or mental health issues. These conditions include but are not limited to: Schizophrenia, substance abuse, addiction, dementia, Alzheimer’s, mood disorders, personality disorders, psychoses, eating disorders, anxiety disorders (including post-traumatic stress disorder, separation anxiety disorder) (Cara & MacRae, 2005), and reactive attachment disorder (children only) (Lambert, 2005).

Community based practice involves working with people in their own environment rather than in a hospital setting. It often combines the knowledge and skills related to physical and mental health. It can also involve working with atypical populations such as the homeless or at-risk populations.

Driving is an instrumental activity of daily living and an occupational therapist may evaluate and treat skills needed to drive such as vision, executive function or memory. If a client needs more skilled assessment and training they would refer them to an OT Driver Rehabilitation Specialist which could do on the road assessment, training in adaptive equipment and make more specific recommendations. 

To be a healthy successful worker there must be a person environment fit between the task, the equipment, and the person’s skills. Occupational therapists work to achieve that fit (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007). Populations, conditions, and diagnoses: People of working age and ability who have been born with or developed a condition, injury, or illness that compromises their ability to work (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007). Settings: Return to work programs, large organizations, consultants to large organizations, work hardening programs, work conditioning programs, transitional return to work programs (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007).

Typical issues addressed: assessment of ability to work, interventions to enhancing work performance by means of work hardening, work conditioning, and improvement of ergonomics in the workplace, identification of accommodations necessary to return-to-work following illness or injury, prevention of work related injury, illness, or disability (Ellexson, 2000; Clinger, Dodson, Maltchev, & Page, 2007).

In its simplest terms, occupational therapists and occupational therapy assistants help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include 
  • an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, 
  • customized intervention to improve the person’s ability to perform daily activities and reach the goals, and
  • an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.

Occupational therapy services may include comprehensive evaluations of the client’s home and other environments (e.g., workplace, school), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.


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