Occupational therapist

An occupational therapist (OT) works with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve occupational outcomes which promote health, prevent injury or disability to develop, improve, sustain or restore the highest possible level of independence."[1]

A practical definition for OT can also be illustrated with the use of models such as the Occupational Performance Model (Australia), known as the OPM(A). At the core of this approach is the ideology that occupational therapists are concerned with the occupations of people and how these contribute to health.[2] Specifically it is a person's occupational performance that influences their health and personal satisfaction of their individual needs. The OPM(A) is constructed on the following definition of Occupational Performance:

The ability to perceive, desire, recall, plan and carry out roles, routines, tasks and sub-tasks for the purpose of self-maintenance, productivity, leisure and rest in response to demands of the internal and/or external environment.[3]

It can be seen that occupational performance, the roles it creates for a client, and the areas it can encompass are so far-reaching that an occupational therapist can work with a wide range of clients of various limitations who are being cared for in an array of settings.[4] Occupational therapy is about helping people do the day-to-day tasks that "occupy" their time, sustain themselves, and enable them to contribute to the wider community. It is these opportunities to "do", which occupational therapy provides, that prove important and meaningful to the health of people.[5][6]

Preparation and qualifications

To practice as an occupational therapist, the individual trained in the United States:[7]

  • Has graduated from an occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE®) or predecessor organizations;
  • Has successfully completed a period of supervised fieldwork experience required by the recognized educational institution where the applicant met the academic requirements of an educational program for occupational therapists that is accredited by ACOTE or predecessor organizations;
  • Has passed a nationally recognized entry-level examination for occupational therapists; and
  • Fulfills state requirements for licensure, certification, or registration.

Role

Occupational therapists (OTs) help people of all ages to improve their ability to perform tasks in their daily living and working environments. They work with individuals who have conditions that are mentally, physically, developmentally, socially or emotionally disabling. They also help them to develop, recover, or maintain daily living and work skills. Occupational therapists help clients not only to improve their basic cognitive function and reasoning abilities, but also to compensate for permanent loss of occupation. Occupational therapists assist clients in performing activities of all types, ranging from using a computer to caring for daily needs such as dressing, cooking, and eating. Activity training may be used to improve Activity of daily living and dexterity, while other activities may be chosen to improve visual acuity and the ability to discern patterns. For example, a client with short-term memory loss might be encouraged to make lists to aid recall, and a person with perceptual problems might be assigned occupational activity to improve perceptual ability. Occupational therapists also use computer programs to help clients improve decision-making, abstract-reasoning, problem solving, and copying skills, as well as memory, sequencing, and coordination —- all of which are important for independent living. Occupational therapists are often skilled in psychological strategies such as cognitive behavioral therapy and Acceptance and Commitment Therapy, and may use cognitive therapy especially when introducing people to new strategies for carrying out daily activities such as activity pacing or using effective communication strategies.

Clients with permanent disabilities

Therapists instruct those with permanent disabilities, such as spinal cord injuries, cerebral palsy, or muscular dystrophy, in the use of adaptive equipment, including wheelchairs, orthotics, and aids for eating and dressing. They also design or make special equipment needed at home or at work. Therapists develop computer-aided adaptive equipment and teach clients with severe limitations how to use that equipment in order to communicate better and control various aspects of their environment.

Some occupational therapists treat individuals whose ability to function in a work environment has been impaired. These practitioners arrange employment, evaluate the work environment, plan work activities, and assess the client's progress. Therapists also may collaborate with the client and the employer to modify the work environment so that the work can be successfully completed.

With children

Occupational therapists may work with infants, children, and youth in a variety of settings. Working with children across all settings, occupational therapists collaborate with caregivers, families, and interdisciplinary teams to identify caregiver and child needs, and assure these needs are being met across all contexts.

Working in early intervention, occupational therapists collaborate with caregivers of children ages 0-3 with or at risk of developmental delay. They may use play as a way to engage a child in therapeutic activities to help them achieve developmental milestones. They may also work with infants with feeding difficulties and collaborate with caregivers to introduce new foods, utensil use, or transitioning from a bottle. Occupational therapists provide caregiver education and encourage carryover of activities between visits.

In an outpatient pediatric clinic, occupational therapists may work with children with a wide range of ages and abilities. They may work with children to develop fine and gross motor skills, social skills, and independence in self-care such as dressing and feeding. Occupational therapists may also be experts in understanding the sensory needs, providing activities to help children with tactile, auditory, vestibular, or proprioceptive sensitivities or seeking behaviors.

Occupational therapists may also work as part of a Special Education team in the school-setting. They may work with students individually, lead small groups in the classroom, consult with a teacher, or serve on a curriculum or other administrative committee. In this setting occupational therapists identify barriers to student’s participation in school programs and activities. They may work with students to develop skills such as tolerating loud school environments, improving handwriting, typing, copying from a distance, organizing their classroom materials, keeping track of assignments, developing friendships, and playing with peers at recess. They may also assist a student in learning how to use a variety of assistive technologies.

Occupational therapists can also work with children with more medical complexities in settings such as the Neonatal Intensive Care Unit (NICU). In this setting, occupational therapists may work with caregivers to provide education on the care of their infant in areas such as early feeding, integration of reflexes, or promoting hand grasp, and sleep.

With the elderly

Occupational therapy is very beneficial to the elderly population. Therapists help the elderly lead more productive, active, and independent lives through a variety of methods, including the use of adaptive equipment. Occupational therapists work with the elderly in many varied environments, such as in their homes in the community, in hospital, and in residential care facilities to name a few. In the home environment, occupational therapists may work with the client to assess for hazards and to identify environmental factors that contribute to falls. Occupational therapists are often instrumental in assessing for appropriate wheelchairs for the elderly. In addition, therapists with specialized training in driver rehabilitation assess an individual's ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommendations for adaptive equipment, training to prolong driving independence, and alternative transport options.

Mental health

Occupational therapists also work with people who have mental health problems and learning disabilities. In this work, therapists choose activities that help people learn to engage in and cope with daily life. Activities include time management skills, budgeting, shopping, homemaking, and the use of public transportation. Occupational therapists also may work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress-related disorders. The ultimate aim would be to help people to engage in a personally satisfying and socially adaptive range of occupations.

With terminally ill patients

Occupational therapy (OT) practitioners help patients with terminal illnesses and conditions by assisting them with their considerable needs related to end-of-life support. All occupational performance areas including work, play and leisure are widely affected in these patients. An occupational therapist provides various treatment modalities to help such individuals to restore or maintain their deteriorating performance components by using their residual capacities and capabilities to give them a sense of self-importance and a measure of self-confidence. The World Federation of Occupational Therapy (WFOT) recognizes the important role OT practitioners have in end-of-life care. In working with patients who have severe health conditions, disabilities and terminal illnesses, the OT clinician will help these individuals engage in meaningful, everyday occupations, as well as exercise the right to well-being and the best quality of life despite the unavoidable conclusion to their lifecycle. An OT practitioner understands the transactional relationship that exists between the individual, environment and occupation, so that life enhancing, ongoing performance in quality of life occupations is promoted. The WFOT recognizes an optimistic presence for OT in end-of-life care with an ongoing need for advocacy and support.[8]

With people experiencing chronic pain

Occupational therapists often work within interdisciplinary or multidisciplinary teams (professionals such as physical therapists, nurses and physicians) to help individuals with chronic pain develop active self-management strategies. An area of specific concern to occupational therapists is the use of time [9] but it is also common for occupational therapists to help people return to work, and to return to leisure and family activities.[10] Occupational therapists may use a variety of interventions including biofeedback, relaxation, goal setting, problem solving, planning, and carry this out within both group and individual settings.[11] Therapists may work within a clinic setting, or in the community including the workplace, school, home and health care centres. Occupational therapists may assess occupational performance before and after intervention, as a measure of effectiveness and reduction in disability.[12]

Assessment

In order for an individual or group to receive occupational therapy services they must first be referred by themselves, another health care provider, or through their support system (family, friends) to receive an occupational therapy evaluation. As part of the service delivery process, the evaluation consists of the initial occupational profile followed by an analysis of occupational performance [13]. Occupational therapy evaluations and occupational therapy assessments are important in determining an individual’s skill set or deficiency. Through the occupational profile, which is a structured interview of the client, an occupational therapist can identify the client’s self-perceived strengths and limitations in participating in daily occupations and help create an individualized treatment plan that addresses the occupations that are meaningful and necessary to the client. As part of the occupational profile, an occupational therapist also seeks to identify physical and social supports and barriers to participation [14]. Occupational therapists often gather additional information by communicating with the client's support system, which may include a child’s parents/guardians, a student’s teacher, an adult’s spouse/siblings/friends, or a senior’s caretaker. The analysis of occupational performance may be gathered through standardized assessments, clinical observations of the client performing a set of tasks and activities, and analysis of the physical or social environment and context in which the client performs the occupations. Occupational therapist utilize skilled observation simultaneously with evaluation of motor and process skills and the effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADLs). Occupational therapists are trained in the administration of standardized assessments across the lifespan from infancy to old age, although some standardized assessments require an occupational therapist to gain additional certifications to administer. Examples of the types of assessments or skill areas Occupational Therapy Practitioners assess include:

  • Sensory processing skills
  • Visual perception and visual motor skills
  • Gross motor and fine motor skills
  • Handwriting
  • Hand dexterity
  • Cognition and intelligence
  • School based evaluations
  • Developmental milestones
  • Daily living tasks include dressing and feeding
  • Pain
  • Executive Functioning

Through the initial evaluation process, occupational therapists work with the client to establish an individualized treatment plan. Data is collected and recorded throughout the treatment process to be utilized to assess progress and guide ongoing client-centered intervention. This data is also frequently utilized for reimbursement of services. At the conclusion of therapy services, an occupational therapist will complete an outcome assessment which may include a re-evaluation [15].

Assessment may also be more broad such as assessing the accessibility of public spaces for all individuals. Occupational therapists can provide recommendations for building design to allow for access for all. Occupational therapists are also skilled at completing home safety assessments and altering the environment or providing accommodations for ways to complete occupations in the home for increased safety of clients. Occupational therapists can also complete driving assessments to determine required accommodations in the car or the ability of an individual to safely drive. Furthermore, occupational therapists can work with whole organizations to assess their workspaces to ensure that the work demands and physical set up is conducive to safe working habits to prevent workplace injuries.

Hand therapy

Occupational Therapy also plays a major role in the rehabilitation and recovery of patients who have hand as well and upper and lower extremity injuries. They play a significant role in liaising with Hand Surgeon/Orthopeadic Surgeon and patients employers or case managers in providing the best client centered rehabilitation program. Occupational Therapist treats conditions ranging from soft tissue injuries such as Tennis Elbows to nerve neuropathies such as Cubital Tunnel Syndrome/ Carpal Tunnel Syndrome. An Array of Upper Limb assessment are utilised to provide a treatment care that is effective and appropriate. Treatment modalities such as orthosis/splints, soft braces and education are some of the common treatment tool that an occupational therapist will use during treatment. Hand Therapy is a specialised field of occupational therapy and it requires therapist to be highly skilled and knowledgeable in upper limb anatomy to be able to work in this area. It is definitely an area where Occupational Therapy is famous for due to the therapeutic models that the profession practices which focus on occupation as means and ends and their aim of returning patients to them performing their daily functions.

See also

Footnotes

  1. ↑ AOTA Inc., 1994, p.1073
  2. ↑ Chapparo & Ranka, 1997b
  3. ↑ Chapparo & Ranka, 1997a, p.58
  4. ↑ Punwar, 2000, p.5
  5. ↑ Crepeau, Cohn, & Schell, 2003, pp.27-30
  6. ↑ Brown, Jessica (2006). OCCP1082 assignment. University of Sydney: Australia
  7. ↑ Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy. 68 (Suppl. 1): S1–S48. March–April 2014. doi:10.5014/ajot.2014.682006.
  8. ↑ World Federation of Occupational Therapists. (2016). Position statement: Occupational therapy services in end of life care. Retrieved from WFOT.org.
  9. ↑ Liedberg, G., Hesselstrand, M., & Henriksson, C. (2004). Time Use and Activity Patterns in Women with Long-term Pain. Scandinavian Journal of Occupational Therapy, 11(1), 26-35.
  10. ↑ Persson, E., Rivano-Fischer, M., Eklund, M., Persson, E., Rivano-Fischer, M., & Eklund, M. (2004). Evaluation of changes in occupational performance among patients in a pain management program. Journal of Rehabilitation Medicine, 36(2), 85-91.
  11. ↑ Strong, Unruh, Wright and Baxter (Eds.)Pain: A textbook for therapists. 2002. Churchill Livingstone: London
  12. ↑ Carpenter, L., Baker, G. A., & Tyldesley, B. (2001). The use of the Canadian occupational performance measure as an outcome of a pain management program. Canadian Journal of Occupational Therapy - Revue Canadienne d Ergotherapie, 68(1), 16-22.
  13. ↑ American Occupational Therapy Association, 2014
  14. ↑ American Occupational Therapy Association, 2014
  15. ↑ American Occupational Therapy Association, 2014

References

  • AOTA Inc. (1994). Policy 5.3.1: Definition of occupational therapy practice for state regulation. The American Journal of Occupational Therapy, 48(11), 1072-1073.
  • Chapparo, C., & Ranka, J. (1997a). Occupational Performance Model (Australia): Definition of terms [Electronic Version], 58-60. Retrieved 5 April 2006 from http://www.occupationalperformance.com/index.php/au/home/definitions.
  • Chapparo, C., & Ranka, J. (1997b). Using the OPM(A) to guide practice and research [Electronic Version]. Retrieved 10 April 2006 from http://www.occupationalperformance.com/index.php/au/home/practice_guide.
  • Crepeau, E. B., Cohn, E. S., & Schell, B. A. B. (2003). Occupational Therapy practice today. In E. B. Crepeau, E. S. Cohn & B. A. B. Schell (Eds.), Willard & Spackman's occupational therapy (10th ed., pp. 27–30). Philadelphia: Lippincott Williams & Wilkins.
  • Crossman, A. R., & Neary, D. (2000). Neuroanatomy : an illustrated colour text (2nd ed.). Edinburgh ; New York: Churchill Livingstone.
  • Punwar, A. J. (2000). Defining Occupational Therapy. In A. J. Punwar & S. M. Peloquin (Eds.), Occupational therapy : Principles and practice (3rd ed., pp. 3–6). Philadelphia: Lippincott Williams & Wilkins.
  • Schwartz, K. B. (2003). The history of occupational therapy. In E. B. Crepeau, E. S. Cohn & B. A. B. Schell (Eds.), Willard & Spackman's occupational therapy (10th ed., pp. 5–13). Philadelphia: Lippincott Williams & Wilkins.
  • Occupational Therapists. Bureau of Labor Statistics, US Department of Labor,Occupational Outlook Handbook, 2004-05 Edition, Bulletin 2570. Superintendent of Documents, US Government Printing Office, Washington, DC, 2004.
  • Liedberg, G., Hesselstrand, M., & Henriksson, C. (2004). Time Use and Activity Patterns in Women with Long-term Pain. Scandinavian Journal of Occupational Therapy, 11(1), 26-35.
  • Persson, E., Rivano-Fischer, M., Eklund, M., Persson, E., Rivano-Fischer, M., & Eklund, M. (2004). Evaluation of changes in occupational performance among patients in a pain management program. Journal of Rehabilitation Medicine, 36(2), 85-91.
  • Strong, Unruh, Wright and Baxter (Eds.)(2002.) Pain: A textbook for therapists. Churchill Livingstone: London
  • Carpenter, L., Baker, G. A., & Tyldesley, B. (2001). The use of the Canadian occupational performance measure as an outcome of a pain management program. Canadian Journal of Occupational Therapy - Revue Canadienne d Ergotherapie, 68(1), 16-22.


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