Theory of Occupational Therapy
OT is the art (because it is very individualized) and science of enabling engagment in everyday living, through occupation; of enabling people to perform the occupations that foster healsth and well-being; and of enabling a just and inclusive society (things that are done to advocate on their behalf in world of education, funding etc. ) so that lal peopl emay participate to their potential in the dialy occupations of life.
OT is the art (because it is very individualized) and science of enabling engagment in everyday living, through occupation; of enabling people to perform the occupations that foster healsth and well-being; and of enabling a just and inclusive society (things that are done to advocate on their behalf in world of education, funding etc. ) so that lal peopl emay participate to their potential in the dialy occupations of life.
Theory of Ocupational Therapy OT is very client- centered: how the individual defines the activity is what is important Hisotry of OT Early 1900s: there was a shift toward understanding that it was important to be healthy and happy- started mostly in mental health (started in mental asylems with occupational aids) realized that when there were given jobs and were meaningfullly occupied they got better quicker
Dunton 1919: occupation is as necessary to life as food and drink; every human being should have both physical and mental occupations; all should have occupations which they engoy, or hobbies; sick minds, sick bodies and sick souls may be healthed thru occupation – thus ocupation was defined as both the domain of concern and the theapeutic medium of occupational therapy
WWI: Diversional therapy: to divert attention away from injury and illness The war lsted much longer – so many more disbled than had anticipated, found that diverting attention away from their physial problems really helped them War-aids: the early Ots, helped adapt activities for soldiers to participate in society (worked mostly with individuals who had a loss of limb) 0s- 90s: Therapeutic shift : curative potential of actibities not occupation Enablement of meaningful occupation: focus on occupational roles in society First Canadian occupational therapy guidelines on client-centred practice did not refer to occupation – but rather to the “therapeutic use of activity’ Present: focusing on enablement of meaningful occupation: focus on occupational roles in society – not just about giving people something to do
Occupation Groups of activities and tasks of everydy life, named, organized and given meaning by individuals and a culture, It iseverything people do to occupy themselves, including looking after themselves (self-care0, enjouing life (leisure), and contributing to the social and economic fabric of their communities (productivity) Shows that it is more than work – they are human activities or tasks organized to fulfil a particular function Occupation
Groups of activities and tasks of everydy life, named, organized and given meaning by individuals and a culture, It iseverything people do to occupy themselves, including looking after themselves (self-care0, enjouing life (leisure), and contributing to the social and economic fabric of their communities (productivity) Shows that it is more than work – they are human activities or tasks organized to fulfil a particular function Definitions Enabling occupation:
OT is necessary when solutions to engagement in the occupations of everyday living become a challenge, or are at risk of becoming a challenge; when solutions to performing or engaging in desired occupations become difficult Collaborating with people to choose, organize and perform occupations which people find useful or meaningful in a given environment Engage: doing or participating, draw into, involve others, involve oneself, becomes occupied
Task: set of purposeful activities in which a person engages i. e writing a report Activity: basic unit of a task, singular pursuit that contributes to the completion of a task Occupation is braoder than either of these as it encompasses more than one task, while tasks encompass more than one activity Key Features of Occupations: 1) Affects Health 2) organize time and brings structure to life 3) brings meaning to life ) are idiosyncratic – very individualized occupations can also be maladaptive- risky, unhealthy, illegal and illicit – eg. Smoking Basic Human Need Dundons credo about occupation demonstrates how occupation is a basic human need Occupations provide people with a flow experience: demands of an occuption are in harmony with the skills of the person and the environment in which the occupation is performed Determinants of Health
Health is viewed as more than the absence of disease and is infuenced by what people do in everyday life In 20th century occupation was discovered to have a motivating effect on wonded soldiers coming home from war Alma Ata Declaration of Health for All by the Year 2000 made clear that health depends on people having meaninful occupations which provide them with housing, empoyment, community and enjoyment
Source of meaning Psychological motivation and volition are dependent on people finding meaning in the occupations that comprise their everyday life The meaning of an occupation is individual and culturally determined Meaning differs from purpose in occupation – can be meaninful to person/ group without any identifiable purpose Source of Purpose
There is no universal classification of the purpose of occupation Canadian therapist defined 3 main purposes 1) self care, 2) productivity, and 3) leisure But it is relly determined by individual needs and desires within an environmental context Athough classification is arbitrary it offs a convenient and manageable way of explaing occupation to clients, professionals , also helps prompt Ots to think about the full range of occupations in a life Source of Choice and Control Control is more than choice.
People may make choices about their occupations but have little control to act on choices. There is an element of personal control when people show persistence or find creative ways of following up on their choices. Contol is dependent on opportunities provided by the environment Source of Balance and Satisfaction Balance refers to the pattern of occupation over days or years Personal views of balance are influenced by cultrual and other environmental expectations Descriptor Occupation can be used as a descriptor of hman behaviours to provide new perspectivesabout occupation Occupational: . Behaviour: aspect or class of human action that encompasses mental and physical doing 2. Competence: adequacy or sufficency in an occupational skill, meeting all requirements of an environment 3. Dvelopmetn: gradual change in occupational behaviour over time, resulting from the growth and maturation of the individual in interaction with the environment 4. Performance: the actual execution or carrying out of an occupation 5. Function: usual or required occupations of an individual Person * Believe in worth of all persons – holistic view New Canadian Model of Occupational Performance presents the person as integrated whole who incorporatses spirituality, social and cultural experiences, and observable occupational performance Spirituality (uniquely and truly human) * Has always been important in canadian OT – early badge that Ots ware depicted inegration of mind, body and spirtit * Recognizes inrinsic value and respecting their beliefs, values and goals, regardless of ability, age or other characteristics – * Consideration of S is a way of developing a clear appreciation for the uniqueness of each person in the occupational therapist-person relationship
Performance * OT has traditionally attended to the performacne components which contribute to successful engagement in occupation * 3 performance componants include: 1. affective: the domain that comprises social and emotional functions and includes both interpersonal and intrapersonal factors 2. cognitive (thinking): the domain that comprises all mental functions both cognitive and intellectual, and includes, among other things, perception, concentration memory etc 3. physical (doing: the domain that comprises all seonsory, motor and sensorimotor functions occupational performance the result of a dynamic relationship between eprsons, environment and occupation * refers to the ability to choose and satisfactorily perform meaninful occupations that are cultrually defined, and appropriate for looking after one’s self, enjoying life, and contributing to the social ad economic fabric in a community * represents the actual execution or carrying out of occupation and is the experience of a person engaged in ocupation within an environment * person-environment congruence suggests the interdependence f humans and environment – this helps ensure optimal occupational performance
Occupational Life Course: A developmental Perspective * An enlarging spiral diagram shows ones cumulative experience in occupational performance grows over time, even if the number and diversity of occupations diminishes because of aging, disability, enviro, etc. * Occupational development may result in increasing complexity in some occupations but not thers; development of self-care occupations may advance more quickly than development in productivity occupations; or leisure may be omitted when self care and productivity are overwhelming Client Centred Practice: Theme of being client centred in OT emerged in the early 1980s * CC practice refers to collaborative appraochs aimed t enabling occupation with clients who may be individuals, gorups, agencies, governments, corporations or others. Ots demonstrate respect for clients, involve clients indecision making, adocate with and for clients in meeting clients’ needs, and otherwise recognize clients’ experience and knowledge CC practice refers to collaborative appraochs aimed t enabling occupation with clients who may be individuals, gorups, agencies, governments, corporations or others.
Ots demonstrate respect for clients, involve clients indecision making, adocate with and for clients in meeting clients’ needs, and otherwise recognize clients’ experience and knowledge Started to emerge in the 1940s-mid 1960s – started in social work * Underlying theme is recognition of the autonomy of the indiviudal person even though persons are understood to be interdependent in their environment * It represents an ethical stance by occupational therapists based on democratic ideas of empowerment and justice
Client: individuals who may have occupational problems arising from medical conditions, transitional difficulties, or environmental barriesr, or clients may be organizations hat influence the occupational performance of particular groups or populations Translated into practice through proccess of enablement: clients are participents in occupational therapy Recognizes that people are active participants in occupational performance, whereas teatment and caregiving forms of helping are applied to people who are dependent on their helper
Enabling: refers to processes of facilitating, guiding, coaching, educating, prompting, listening, reflecting, encouraging, or otherwise collaborating with people so that individuals, groups and agencies or organizations have the means and opportnity to participate in shaing their own lives. Guiding Principles for Enabling Occupation in Client-centred Practice * Base practive on client values, meaning and choice as much as possible * Listen to clients visions * Facilitaite processes for clients envisioning what might be possible * Support clients to examine risks/ consequences Support them to succeed, but also to risk and fail * Respect their own syles of coping or bringing about change * Guide clients to identify needs from their own perspective * Facilitiate clients to choose outcomes that they define as meaninful even if OT doesnt agree * Encourage and actively facilitate clients to participate in decision-making partnership in tharpy, programme planning, and policy formation * Provide info that will answer clients questions in making choices * Offer services that do not overwhelm clients with beuraucracy * Foster open, clear communication Invite them to use their strengths and natural cummunity supports CMOP-E Canadian Model of Ocupational Performance and Engagemet Occupational performance is the relationship between persons, enviro and ocuupation over persons lifep It refers to the ability to choose, organize, and satisfacotily perform meaningful occupations that are culturally defined and age appropriate for looking after ones’s self, enjoying life, and contribuint to the social and economic fabric of a community The CMOP graphically illustrates an occupational thereapy perspective on the dynamic relationship between persons, environment and occupation of all ersons Occupation occurs between person and environment Everytime you see a new client you need to think about all the different parts of the * Person – (inner circle) The person in the middle converys Ots cient-cenred perspective, attends to the individuals occupational needs in his/her specific environment * spirituality (drive- essence) , * physical (strength, ROM, paralysis) * cognitive * affective (mood, mental health side) * Occupation (middle circle) * Selfcare * Productivity * Leisure * Environment (idea that occupation occurs in an environment) (outer circle) * Social Cultural (stigma based on religious view etc. – culture of university/ family) * Institutional (policies, guidelines and practices about what can/can’t do) * Physical (accessibility) Back to first example: Competence- actual or potential ability to engage in occupation * Ex. If you arent a good cook you tend to do other things (frozen/ other person cooks) tend to not continue to do things that you arent good at Deprivation: prevented from taking part in occupation * Very important Development: gradual change in occupational behaviour How do people shape and evolve into the occupational couse of their lives Identity: how you see yourself related to occupational roles * Big part of how we see ourselves Pattern: predictable way of doing occupation PRACTICE Client vs. patient * Individuals are routinely called patients because they need to be taken care of (mainly in acute care) not a lot of choice in decision making Client-centred Practice In OT because you take into consideration what is important to YOU * Collaborative relationship with clients * Clients as active participants in therapy * Client is at the centre of practice Respect for client wishes, goals, and differences Occupational Issues: Clearly distinct from symptoms – not depression, cognition etc Occupational issues BECAUSE of the health issue ‘challenges to occupational engagment… ex/ if you have left sided weakness an occupational issue may be writing, dressing Occupational Performance Issue: Someone with a head injury where there is no physical change – but could be difference in organization Prioritizing OPIs If someone has a head injury and you make a list of all the things you are wondering about – and they confirm that they are effecting them – then you have to prioritize How do you prioritize Find out what is really important to the client * What is safe * Limitations • 35 female Karen married with 2 kids aged 6 and 3 teaches JK, has SCI, uses manual wheelchair ? 10 Possible OPIs? • Child Care ? • Cooking? • Active playing with Kids? • Driving to work? • Changing baby diapers? • Intimacy with Spouse ? • Cleaning ? • Transfers? • Hygiene ? • Social Activities Limited ? o 2 Priority OPIs? • Child Care? • Hygiene ? o Treatment for OPIs Using Occupation/Activity ? • Child Care ? Policy change to increase social support? • Hygiene? Shower Seat
