Here it is, written for a Ph D course in occupation centered practice (this
was a draft version so excuse the typos here and there)--Terrianne
Occupational therapy (OT) must reconnect to occupation-based practice if we
are to uniquely contribute to health and wellbeing (Friedland, 1998/2005).
Occupations are defined in the Occupational Therapy Practice Framework (OTPF)
as Activities
of everyday life, named, organized, and given value and
meaning by individuals and a culture (American Occupational Therapy
Association, 2002. p. 619). Occupational therapy as a profession from its
inception has claimed that active engagement in occupation is the key to
enabling health and well being (Peloquin, 1991). Though the founders of the
profession were from variety of backgrounds, they shared a singular
understanding (Peloquin, p. 6) of what Reilly so eloquently articulated much
later in 1962, that man, through the use of his hands, as they are energized
by mind and will, can influence the state of his own health (p, ?). In that
same lecture, Reilly asserted that a profession must be able to identify a need
as well
as spell out its unique pattern of service to meet that need (p 81). The
founders of OT realized the occupational needs of persons debilitated by
illness or injury. To meet these needs they created a new profession whose
unique service would emphasize actual doing, actual practice (Meyer, 1920, p.
27) of the activities that made up the natural and satisfying rhythms of daily
life, as a mechanism for promoting health and recovery from illness.
To this day there is no other health profession that philosophically claims
occupation as its central focus. However, theoretical allegiance alone to our
philosophy is not enough to establish OT as a unique service. Without
practical evidence of the application of occupation as a therapeutic modality
in day-to-day practice, the profession has no distinct identity, no
recognizable unique contribution to health and well-being.
In the context of the medical model, many have long recognized that
influences of reductionism and the rehabilitation movement have made it
difficult for OT to practice in a fashion true to its roots. As a result, many
practitioners succumbed to the pressure to remediate component skills along
side other disciplines such as physical therapy (PT), often borrowing their
interventions such as exercise (Gray, 1998; Friedland, 1998; Fischer, 1998;
Yerxa 1991; Wilcock, 1998), justifying the sue of non occupation based
approaches because of the goal of function (Fischer, 1998) or occupation as an
end(Trombly, 1995).
This strategy has been ineffective at establishing a unique identity for
the profession for two reasons. First, as Friedland (1998) points out, our
qualifications are generally not as good as others who could fix broken parts
(p. 73). As a health profession versus a medical profession (Christiansen and
Baum, 1991), the emphasis on enabling participation in occupation versus fixing
component parts or systems is evident in our curriculum. Second, focusing
only on the outcome (function) is no longer unique to OT. Gutman cites several
reasons for this shift. First, when the World Health Organization in 1980
encouraged rehabilitation professionals to shift their focus from remediating
disability to promoting functional independence, other disciplines were called
to work toward function as an outcome as well. Further, the advent of pressures
from managed care organizations for efficiency and finally the recommendation
from the PEW Health Professions Commission in 1993
for cross trained rehabilitation therapists drove disciplines such as PT to
also stake their claim on function (1998).
As the profession of PT enjoys a recognition and presence nearly double
that of OT in the United States (Friedland, 1998), the impact of this shift in
focus has been significant. In competition for increasingly shrinking resources
in the medical model, the profession of PT has begun to change their practice
acts in many states such that it is within their domain of concern to assess
and treat impairments that interfere with participation in activities of daily
living (ADL) and instrumental activities of daily living (IADL), areas
traditionally associated with OT interventions (Gutman, 1998).
If it is to be a unique contributor to health and wellbeing, indeed if it
is to function as a viable profession as defined by Reilly, the best course of
action for the profession of OT is to reclaim occupation as means (Trombly,
1995) or occupation as the intervention (Kielhofner , 1997). This call for a
return to occupation as the modality of the profession is not new, though
concepts of the power of occupation are being discovered by others as new.
For example, Trombly, in her 1995 Slagle lecture to the profession, cited
research from studies in motor control theory which indicate that engagement in
goal directed and meaningful tasks elicits greater motor responses and function
as compared to engagement in contrived or simulated tasks.
Over the years many prominent figures in the field have lectured and
written extensively about the topic of occupation and its role in the
profession. Over 40 years have passed since Reilly asked is occupational
therapy a sufficiently vital and unique service for medicine to support and
society to reward? (1962, p. 77). West articulated the reaffirmed
philosophy and practice of OT for the 1980s (1984, p. 15) as one revolving
explicitly around occupation versus activities or purposeful activities.
Yerxa (1991) pointed out that it is becoming more difficult to differentiate
occupational therapy practice from physical therapy practice (p. 202) and
envisioned a foundational science in occupation that would enhance and support
our understanding of its applications. Friedland (1998) explored the
relationship between occupational therapy and rehabilitation, identifying it as
an awkward alliance (p. 69) and worried whether the profession would be up to
the
challenge of connecting to its unique focus on occupation versus function.
Nelson (1996) implored the profession to resist the temptation to redefine
ourselves with every new trend in health care (p. 550) and reminded us that we
are occupational therapists, not functional therapists or functional outcomes
therapists (p. 550). Fischer in her 1998 Slagle lecture challenged the
profession to practice legitimate occupational therapy and give back
exercises and most of our use of contrived occupation to their legitimate
owners (p. 561).
The return of occupation-based practice to occupational therapy is critical
to our identity as a profession and our desire to remain a contributor to
health and well being. We as occupational therapists are the experts on
occupation, and we need to reclaim it and use it again.. As Nelson (1996)
stated, what makes us unique is not that we document functional outcomes but
that we use occupation as the method to achieve positive outcomes (p. 550).
References
AOTA (2002).Occupational therapy practice framework: Domain and process. In R.
P.
Cottrell (Ed), Perspectives for occupation-based practice (2nd ed., pp.
601-624).
Bethesda, MD: AOTA Press.
Christiansen, C., Baum, C. (1991). Occupational Therapy: Overcoming Human
Performance Deficits. Thorofare: Slack Incorporated.
Fischer, (1998). Uniting practice and theory in an occupational framework. In
R. Padilla
Ed.), A professional legacy: the Eleanor Clark Slagle Lectures in
occupational
therapy, 1955-2004 (2nd ed., pp. 554-575). Bethesda, MD: AOTA press.
Friedland, J. (1998). Occupational therapy and rehabilitation: an awkward
alliance. In R. P. Cottrell (Ed.), Perspectives on purposeful activity:
foundation and future of occupational therapy (2nd ed., pp. 69-75).
Bethesda, MD: AOTA press.
Gutman, S. (1998). The domain of function: Whos got it? Whos competing for
it? In
R.P. Cottrell (Ed.), Perspectives for occupation based practice (2nd ed.,
pp. 555-
560). Bethesda MD: AOTA press.
Meyer, A. (1920). The philosophy of occupational therapy. In RP Cottrell (Ed.),
Perspectives for occupation based practice (2nd ed., pp. 25-28). Bethesda MD:
AOTA press.
Nelson, D. (1997). Why the profession of occupational therapy will flourish in
the 21st
century. In R. P. Cottrell (Ed.), Perspectives for occupation-based
practice (2nd ed,
pp. 113-126). Bethesda, MD: AOTA Press.
Peloquin, S. (1991). Occupational therapy service: individual and
collective understandings of the founders. American Journal of Occupational
Therapy, 45, 33-744.
Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th
century medicine. In RP Cottrell (Ed.), Perspectives for occupation based
practice (2nd ed.pp. 77-84). Bethesda MD: AOTA press.
Trombly, C. (1995). Occupation: purposefulness and meaningless as therapeutic
mechanisms. In RP Cottrell (Ed.), Perspectives for occupation based practice
(2nd ed., pp. 159-171). Bethesda MD: AOTA press.
West, W. (1984). A reaffirmed philosophy and practice of occupational therapy
for the 1980s. The American Journal of Occupational Therapy, 38, 15-23.
Wilcock, A. (1998). An occupational perspective of health. Thorofare: Slack
Incorporated.
Yerxa, E. (1991). Seeking a relevant, ethical and realistic way of knowing for
occupational therapy. The American Journal of Occupational Therapy 45, 199-204.
Terrianne Jones <[EMAIL PROTECTED]> wrote:
Hello all,
In light of the discussions re: UE/LE, exercise, acute care, etc., I'd like to
share with you something I wrote for an OT doctoral course recently. It was an
argument for the use of an occupation centered approach. The literauture to
support that arguement is mostly old, but still highly relevant today, written
by some pretty amazing, visionary OT's. Here it is, attached. -Terrianne
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