What is Occupational Therapy (OT)?

What is Occupational Therapy (OT)?
Occupational therapy is a health profession concerned with how people function in their respective roles and how they perform activities. The profession focuses on the promotion, restoration, and maintenance of productivity in people with a wide range of abilities and disabilities.

Occupational Therapy Definition –

Occupational therapy is the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain, or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, or other disorder or condition. (Uniform definition of American occupational therapy association, 1994)

The term “Occupational therapy” can often be confusing. It carries the misconception that the profession’s focus is on vocational counseling and job training. The word occupation as defined in Webster’s Dictionary is “an activity in which one engages.” Occupational therapists promote skill development and independence in all daily activities. For an adult, this may mean looking at the areas of self-care, homemaking, leisure, and work. The “occupations” of childhood may include playing in the park with friends, washing hands, going to the bathroom, cutting with scissors, drawing, etc.

For a layman, we would define occupational therapy (OT) as
“Occupational Therapy works with physically disabled, learning disabled, people with mental/psychological problems, and with older people who need help in adapting to the changes caused by aging. An occupational therapist helps them regain their maximum function so they can pick up their lives again.”

People sometimes confuse occupational therapist with other health professionals, such as physical therapist, recreational therapist, art therapist or vocational rehabilitation personnel. OT has some common interest or treatment approach with these professionals, but its main focus is different.

Read more – Occupational Therapy VS Physical Therapy

An occupational therapist may use art, music, craft, activities, and exercise during OT intervention, but the focus is always on the achievement of a therapeutic goal.

Definition of Occupational Therapy has changed over the years. Early definition emphasized the use of occupation as a remedial activity to help restore the individual to an improved state of physical and mental health and practice areas were limited. But nowadays, the demand and scope of occupational therapy have been increased and so the definition is also changed (improved).

An occupational therapist works in different settings such as outpatient clinics, mental health centers, public and private schools, home health care agencies, and private practice. Occupational therapy Assistant and occupational therapy Aide helps occupational therapist in assessment and intervention planning.

OT client base is ranging from newborn to elderly with a wide range of physical, mental, and psychosocial disorders.

Occupational Therapy History-

Occupational therapy formally began in March 1917, in Clifton Spring, New York. George Borton and Dr. William Rush Danton and Eleanor Clarke Slagle and some others started the National Society for the Promotion of Occupational Therapy. They were from a different background, but they shared a common belief and interest in the therapeutic use of Occupation.

In 1917, the United States entered world war I. Due to the war, an urgent requirement of rehab professionals increased. World War I resulted in the rapid growth of occupational therapy for physical dysfunction.

In 1923 the National Society for the Promotion of Occupational Therapy changed its name to the American Occupational Therapy Association (AOTA).

Like World War I, World War II provided great momentum for occupational therapy services. The war also played a role in defining occupational therapy, especially in physical dysfunction.

The boom of the 1970s in the health care industry (reimbursement policy) helped occupational therapy develop both within the hospital and beyond. OT services were now available in private homes, public schools, mental health centers, and the workplace.

The history illustrates occupational therapy’s struggle to advance the profession by positioning itself as a cost-effective, necessary service within the medical system while trying to maintain a broad occupational therapy definition and areas of practice.

Read More… OT month – different ways to celebrate and promote occupational therapy.

Occupational Therapy Knowledge Base –

Occupational therapy treatment approaches are based on the occupational therapy frames of reference or frameworks. These frameworks guide therapists in the evaluation and treatment of a patient. The occupational therapy planning and focus revolve around the performance area, performance components, and performance contexts.

Occupational therapists focus mainly on the performance areas, it includes –
1. Activities of daily living.
2. Work and productive activities,
3. Play or leisure activities.

Occupational therapists involve performance components in the intervention plan to improve the performance areas.
Performance components are as follows-
1. The sensorimotor component-
It includes, sensory processing, range of motion, muscle strength, endurance, postural control, etc.
2. The cognitive/ cognitive integration component-
It includes orientation, attention span, memory, sequencing, problem-solving, etc.
3. The psychosocial/ psychological components –
It includes interest, role performance, social interaction, coping skills, etc.

Performance contexts- occupational therapist consider the performance context in intervention planning. Performance context includes temporal, environmental, and social context.

Temporal includes the age and maturation requires consideration in OT treatment planning.
Plus, environmental context includes, physical environment such as furniture.
Social environment includes social groups and cultural environment includes custom, beliefs.

Occupational Therapy Practicing Areas –

Occupational therapy plays an important role in many areas such as Early Intervention, occupational therapy for children, occupational therapy in Orthopedic Rehab, neurological rehab, mental health, Elderly care, and hospice.

What Does an Occupational Therapist Do?

Occupational therapy for children-
Occupational therapy has an important role in pediatric rehabilitation. Occupational therapy deals with special children, who are having physical/neurological/social problems. An Occupational therapist generally deals with children having these disorders; Attention Deficit Hyperactive Disorder, Autism, Cerebral palsy, Down’s syndrome, learning disability, sensory processing disorder, developmental delayed and genetic disorders. Early intervention is also provided by the OTs in above-mentioned disorders.

Read More… Occupational Therapy for Children

Occupational therapy in Orthopedic Rehabilitation –
Occupational therapy also plays an important role in orthopedic rehabilitation. Occupational Therapists work with patients of post-fracture stiffness, burn injuries, arthritis, hand injuries, workplace injuries, upper or lower extremity amputation, joint replacement surgeries, and back pain. The therapist provides activities and exercises to the patient. Physical agent modalities can also be used along with a purposeful activity.

Occupational therapy in Neurological Rehabilitation –
An occupational therapist also deals with adults having neurological impairments. It includes spinal cord injury, hemiplegia, traumatic brain injury, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, etc. Various neurological approaches can be used by OTs such as Neuro-developmental therapy (NDT), Sensory Integration (SI), Constraint Induced Movement Therapy (CIMT), etc.

Occupational therapy in Mental Health –
Occupational therapy and mental health are related since the beginning of the OT profession. OTs deal with Mental health issues like anxiety disorder, depression, stress disorder, schizophrenia, bipolar disorder, mood disorder, Obsessive Compulsive Disorder, etc. OTs involve the psychiatric patient in meaningful activities and bring back the insight in psychosis patients. An OT may provide relaxation techniques, social skill training, group therapy to reintegrate the client into the mainstream.

Read More.. Occupational therapy in Mental Health

Occupational therapy for elderly and hospice care-
Occupational therapy also works in elderly care. A patient (elderly), who is dependent on others for their daily chores due to many problems like orthopedic, neurological, or mental. OT helps them in a transfer, mobility and daily living activities. Plus, OT guides them or help them to involve them in leisure activities.
OTs also work in Hospice care and palliative care, a role of OTs in these setups is to provide mental support to the patient, and provide independence (self-confidence) in daily living in the terminally ill patients.

Occupational Therapy Assessment-

An assessment is a process of gathering data, identifying problems and making decisions for treatment interventions. In occupational therapy, assessment of occupational performance areas and performance components is the basis for developing treatment strategies. An initial evaluation takes place before treatment, and reevaluation occurs periodically during the course of treatment. An occupational therapist uses formal and informal screening and evaluation methods, including the review of the medical record, interview, observation, standardized tests, and nonstandardized tests.

Occupational Therapy Treatment-

Occupational therapy treatment (intervention) is based on functional activities. An effective treatment plan is possible if the therapist has made a thorough and careful assessment. The occupational therapy treatment plan includes long and short-term treatment objectives and method based on identified problems. The occupational therapist selects one or more frame of reference or treatment approach for the guidelines and clinical reasoning of the treatment plan. Generally, the occupational therapist uses three treatment approaches;

1. Biomechanical Approach – the biomechanical approach is most appropriate for patients who have orthopedic disorders, but whose central nervous system is intact. Examples of biomechanical treatments are – therapeutic exercise, orthotics, physical agent modalities, functional activities.
# Therapeutic exercise helps in improvement of joint range of motion, muscle strength, and endurance.
# Orthotics helps to prevent the deformity or correct the position of joints.
# Physical agent modalities (as an adjunct) may be used to alleviate the pain before or after any purposeful activities. For example, application of fluidotherapy before hand activities in the case of post-fracture stiffness.
# Functional activities may be as household activities or work activities. For example, sawing wood, rolling out dough, and vacuuming carpets.

2. Sensorimotor Approaches-
Sensorimotor approaches are mostly applied in a patient with neurological disorders. These approaches are based on theories of motor recovery. OTs use these approaches to normalize muscle tone. Examples of approaches – Neuro-Developmental therapy (NDT), Proprioceptive Neuromuscular Facilitation (PNF), Roods approach, etc.

3. Rehabilitation approach –
The rehabilitation approach uses measures that enable the patient to live as independently as possible with some residual disability. Its goal is to help the patient learn to work around or compensate for physical limitations. In this approach, OT focuses on performance areas (activities of daily living, work) more than on performance components (joint range of motion, strength). The treatment methods of rehabilitation approach include-
self-care training, assistive devices, work simplification and energy conservation, wheelchair management, workplace modification, etc.

An occupational therapist uses the combination of these approaches according to the need of a patient. The general goal of the treatment program is to restore the patient to his or her maximum level of performance in life roles through remedial or compensatory treatment approaches.

Summary –

OT provides services to patients, such as evaluation/assessment, OT diagnosis, planning, intervention, and reevaluation. OTs work in different setups and with different age groups, but the main goal of OT is to make them independent.
Occupational therapy framework and approaches guide the therapist in assessment and treatment planning.
Simply, OT engages humans in purposeful activities in its intervention; it separates its knowledge base from all other professionals.
Hope, this article helps you to understand “what is occupational therapy?”

References –
1. Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction
2. Willard and Spackman’s Occupational Therapy
3. Concepts of occupational therapy, Kathlyn Reed, Sharon Sanderson, 4th Ed., Lippincott Williams and Wilkins.
4. Occupational therapy principles and practice, 3rd Ed., Alice Punwar, Suzanne Peloquin, Lippincott Williams and Wilkins.