Hi all:
I am not sure if the following is helpful at all, but I selected some
excerpts from an article I had written recently. Since, we all struggle
between component-focused and occupation-based interventions, I have briefly
reflected on the rationale behind using preparatory tasks (exercises
,modalities, etc.- components) appropriately in occupational therapy (its
relation to occupation-based practice). I do believe once we, OTs,
understand the scope of the OT Practice Framework published by AOTA and use
it to its fullest intent, we should be able to practice a lot more freely
and satisfactorily.What is Occupation-based practice after all? Amongst the
many definitions that might be out there, I will quote Amy Kratz (2003) in
Pierce's book "Occupation by design: Building therapeutic power" on page
242.
" Occupation -based practice is using occupation as the framework for
intervention".
The framework may use occupation as either the means (modality) or the end
(goal/ product) of the intervention process.
My intentions by including portions of my article is to support the
"everyday stuff " that we OTs do in a normal day. Hopefully, this will help
to lessen our stressors and confusions in practice. I still believe that
most OTs are intentionally or "semi-consciously" occupation-based. In my
opinion, our "ends" must be deliberately focused on the "occupation" whether
we do hands or heads or legs or then even the spirit. To do so, we may
choose from a variety of tools/ modalities/ interventions (means) available
to us (ofcourse, within our scope of practice)!
Joe Wells, OTR/L
EXCERPTS FROM A
PAPER I HAD WRITTEN (NOT YET PUBLISHED)
Over the years, the term occupation has had different meanings to the
profession. Our founders used it in context of occupying one's time in a
purposeful manner. The occupational therapy philosophical statement of 1979
uses purposeful activities and occupation interchangeably. During the
1990s, the need to clarify its terminology was felt within the profession to
differentiate and explain the terms such as purposeful activities (Hinojosa,
Sabari, & Pedretti, 1993), function (Baum & Edwards, 1995), and occupation
(Christiansen, Clark, Kielhofner, Rogers, & Nelson, 1995). Hinojosa and
Kramer (1997) provided a statement on the relationship between these three
terms and proposed a classification in which occupation was the broadest
concept with purposeful activity as an essential factor of occupation. Reily
(1962), Kielhofner (1983, 1995, 1997), Yerxa (1967, 1998), Nelson (1988),
and Clark (1993) alerted the profession to the importance of occupation as
central to its identity. (Hinojosa, Kramer, Royeen & Luebben, 2003, p. 3).
....Occupation consists of a variety of life tasks, such as self-care,
leisure, work, and contributing to society (Christiansen, 1999; Law, 1998).
The profession currently views occupation both as a process (means) of
intervention or active doing, and as the goal (ends) or the product of the
action (Christiansen & Baum, 1997; Gray, 1998).
....We use what I call an integrative interventional approach, that is, we
use a variety of theoretical frameworks to guide our practice versus any one
in particular. We use a variety of OT intervention types namely the
therapeutic use of self, occupation-based activities, preparatory methods
and, purposeful activities (American Occupational Therapy Association
[AOTA], 2002). We also incorporate consultative and educational processes to
enhance clients' participation in occupations (AOTA, 2002).
...Preparatory methods include several techniques aimed at remediation/
restoration of performance skills in preparation for purposeful and
occupation-based activities (Pedretti and Early, 2001) especially directed
to adults with physical dysfunctions. These methods are used to address " a
very specific area of functioning judged to be the primary barrier to a more
desirable occupational pattern" (Pierce, 2003, p.245). We always use
preparatory methods in conjunction or in preparation and never in isolation
to other interventions types such as purposeful activities and/ or
occupation-based activities. The selection and use of theoretical framework
varies based upon factors such the client's age or implication/ stage of
pathology. Example: We may use components of sensory integration approach
(Ayres, 1972) with the pediatric population as purposeful activities, or
movement therapy (Brunnstorm, 1970; Pedretti, 1990) with adults with acute
or sub-acute neurological conditions as preparatory methods.
However, we predominantly use occupation- based activities as means of
interventions in the home health setting by using it in therapeutic
sub-types of adaptation, compensation, health promotion and prevention
(Nelson & Jepson- Thomas, 2003). Our OT process before beginning the
intervention phase and assessing it for outcomes, involves the evaluation
with the primary intent to generate an occupational profile via analysis of
the client's occupational performance (AOTA, 2002).
....Occupational therapy views occupation as both means and end (AOTA, 2002,
p. 610).
....We have been unable to adequately market OT as a distinct,
easily identifiable product, and the construct of occupation itself leads to
some ambiguity, thus, confusing practitioners, professionals, and the pubic
in general (Hinojosa et al., 2003). The profession is cognizant of the turf
issues facing it (Ambrosi & Schwartz, 1995). And, the profession also has a
long history of struggle with language and difficulty articulating its focus
(Schwartz, 2003)....
References
Ambrosi, E., & Schwartz, K.B. (1995). The profession's image: 1917-1925.
Occupational
therapy as presented in the media. American Journal of Occupational Therapy,
49, 715-719.
American Occupational Therapy Association (2002). Occupational therapy
practice framework: Domain and process. American Journal of Occupational
Therapy, 56, 609-639.
Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles:
Western Pyschological Services.
Baum, C., & Edwards, D. (1995). Occupational performance: Occupational
therapy's definition of function. American Journal of Occupational Therapy,
49, 1019-1020.
Brunnstorm, S. (1970). Movement therapy in hemiplegia: A neurophysiological
approach. New York: Harper and Row.
Christiansen, C.H. (1999). Defining lives: Occupation as identity: An essay
on
competence, coherence, and creation of meaning. American Journal of
Occupational Therapy, 53, 547-548.
Christiansen, C., & Baum, C. (1997). Occupational therapy: Enabling function
and well-being. Thorofare, NJ: Slack.
Christiansen, C., Clark, F., Kielhofner, G., Rogers, J., & Nelson, D.
(1995).
Position paper: Occupation. American Journal of Occupational Therapy, 49,
1015-1018.
Clark, F. (1993). Occupation embedded in a real life: Interweaving
occupational
science and occupational therapy. American Journal of Occupational Therapy,
47, 1067-1078.
Gray, J.M. (1998). Putting occupation into practice: Occupation as ends,
Occupation as means. American Journal of Occupational Therapy, 52, 354-364.
Hinojosa, J., & Kramer, P. (1997). Statement: Fundamental concepts of
occupational therapy: Occupation, purposeful activity, and function.
American Journal of Occupational Therapy, 51, 864-866.
Hinojosa, J., Kramer,P., Royeen, C.B., & Luebben, A. (2003). Core Concept of
Occupation. In P. Kramer, J. Hinojosa & C.B. Royeen (Eds.), Perspectives in
human occupation participation in life (pp. 1- 17). Baltimore, MD:
Lippincott Williams & Wilkins.
Hinojosa, J., Sabari, J., & Pedretti, L. (1993). Position paper: Purposeful
activity.
American Journal of Occupational Therapy, 46, 1081-1082.
Kielhofner, G. (1983). Health through occupation: Theory and practice in
occupational therapy. Philadelphia, PA: F.A. Davis.
Kielhofner, G. (Ed.). (1995). A model of human occupation: Theory and
application (2nd ed.). Baltimore, MD: Williams & Wilkins.
Kielhofner, G. (1997).Conceptual foundations of occupational therapy (2nd
ed.).
Philadelphia, PA: F.A. Davis.
Nelson, D.L. (1988/. Occupation: Form and performance. American Journal of
Occupational Therapy, 42, 633-641.
Nelson, D.L., & Jepson- Thomas, J. (2003). Occupational form, occupational
performance and a conceptual framework for therapeutic occupation. In P.
Kramer, J. Hinojosa & C.B. Royeen (Eds.), Perspectives in human occupation
participation in life (pp. 87- 155). Baltimore, MD: Lippincott Williams &
Wilkins.
Pedretti, L.W. (1990). Movement therapy: The Brunnstrom approach to
treatment
of hemiplegia. In L.W. Pedretti & B. Zolton (Eds.), Occupational therapy
practice skills for physical dysfunction (3rd ed., pp. 334-349). St. Louis,
MO: CV Mosby Company.
Pedretti, L.W, & Early, M.B. (2001). Occupational performance and model of
practice for physical dysfunction. In L.W. Pedretti & M.B. Early (Eds.),
Occupational practice skills for physical dysfunction (pp. 7-9). St. Louis,
MO: Mosby Company.
Pierce, D. (Ed.). (2003). Occupation by design: Building therapeutic power.
Philadelphia, PA: F.A. Davis Company.
Schwartz, K.B. (2003). History of occupation. In P. Kramer, J. Hinojosa &
C.B.
Royeen (Eds.), Perspectives in human occupation participation in life
(pp.18- 31). Baltimore, MD: Lippincott Williams & Wilkins.
Yerxa, E.J. (1967). Authentic occupational therapy. American Journal of
Occupational
Therapy, 21, 1-9.
Yerxa, E.J. (1998). Occupation: The keystone of a curriculum for a self-
defined
profession. American Journal of Occupational Therapy, 52, 365-372.
----- Original Message -----
From: "Chris Smith" <[EMAIL PROTECTED]>
To: <[email protected]>
Sent: Sunday, December 04, 2005 2:18 PM
Subject: Re: [OTlist] my own long winded non sensical rant
> Well it's really easy to tell someone to snap out of it. Sounds like
> common OT depression to me and you are far from alone. I have beeen in the
> profession for 8 years--five in school based. I left because I couldn't
> please the teachers who wanted one thing and I couldn't please the
> parents. They were either in denial (the lower incomes ones) since I was
> working with preschoolers and I was the first one to tell them their kids
> weren't perfect. The middle class parents always wanted endless therapy
> and nothing satisfied them. I had a great time with the kids who always
> enjoyedworking with me. Now I have been in long term care at a number of
> facilites and done a great deal of PRN as well and once again I found
> myself discouraged. I too have seen 99% exercise based therapy. I have
> done some activities when I was in a small facility and the only OT. But
> when I work with other OTs they don't want to do anything but exercise and
> minimum adls. I want to go to a facility that uses
> occupation to see what they do, I am sick and tired of AOTA people and
> educators saying basically just do occupation without telling us what to
> do specifically. I just started doing homehealth and find once again.
> Everyone wants a HH aide to bath them or they are very happy with sponge
> bathing. Most are elderly and unmotivated. Most days I wish I had the
> money to go back to school to become a PT. OT looks great on paper just
> like you said. Funny I just came to the same realization a few weeks ago
> and was talking about the same thing to a friend who works at a SNF with
> lots of modalities. She said if it wasn;tfor using all these treatments
> she would feel like a fraud, too.Gee, I guess I didn't provide much
> encouragement either. I think therapists need to get together and brain
> storm. What's going on with the part B caps?Chris OTR/'L
>
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