Occupational therapy definition and framework

Occupational Therapy (OT) is one of the Allied Health Professions (AHP) and plays a crucial role in multidisciplinary teams of rehabilitation in the stroke field. Reed and Sanderson (1999, pp.3) state ‘Occupational Therapy is meant to convey that the

A.Kaunnil 52 person, the mind, and attention in occupation. Such occupation does by its nature take up, use up, or fills space and time’.

The definition of occupational therapy was developed and modified by the Representative Assembly of the American Occupational Therapy Association (AOTA) in 1994 for the Uniform Terminology, which is defined as follows: (AOTA 1994, pp.1051). “Occupational Therapy is the use of purposeful activity (unique

features) or interventions to promote health and achieve functional outcome (generic goals of most health care field). Achieving functional outcome means to develop, improve, or restore the highest possible level of independence (purpose/goal) of any individual who is limited by a physical injury or illness, a dysfunctional condition, a cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or learning disability, or adverse environmental conditions (population served).

Assessment means the use of skills observation or evaluation by the administration

and interpretation of standardised or non-standardised test and measurement to identify areas for occupational therapy services.

During the Second World War, OT was established through the ideas of rehabilitation to assist soldiers in recuperating and returning to military service (McDonald, 1964). From this beginning to present times, the OT profession has developed into various services such as hospitals, primary care centres, schools, factories, prisons, social care settings, charity organisations, and residential homes. Occupational therapists (OTs) are trained to provide rehabilitation services for people whose lives are disrupted by physical, psychological and social problems across genders and ages (COT, 1997).

The main purpose of OT is to serve clients in maintaining, restoring and creating the abilities for life-skills. The benefits to individuals relate to their functional performances in order to achieve goals, maintain productivity and increase satisfaction (Allen et al, 1992). OT is a partnership between the clients, family members and caregivers to deal with the problems derived from bio-psycho-social conditions leading to the cooperative work which designs and implements essential and purposeful activities (Hagedorn, 2000a). For example, if a client cannot make the decision to engage in activities, the occupational therapist will take action to collaborate with all stakeholders to address the appropriate activities.

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The vital steps to success in occupational therapy, activity analysis and synthesis are integral strategies to select the occupations from an individual’s daily life and initiate steps to regain and improve their life-skills (Allen et al, 1992). The OT process needs to be underpinned by considering the participation of client’s relatives, society, culture and economic environments in order to provide the services of assessment, planning of both short and long term goals, intervention-prevention programmes and follow-up. Moreover, OTs have to offer health knowledge, advocacy, consultation and suggestion to clients and family members in the occupational performance of self-care, home modification and management, work, ADL, play and leisure (Reed & Sanderson, 1999).

In 2002, Creek explained a role model for OTs when taking responsibility and action. OTs have to gather information and data from clients and participants in order to carry out an initial assessment, then engage in problem-formation, goal setting, action planning, action, continuing assessment and intervention, evaluation, outcome measurement and discharge. This process is based on the participants’ cooperation, personal beliefs, values, culture, language, skills, knowledge, tools, methods and experience for optimising occupational performance of the client. Importantly, OTs should not follow a stringent recipe of intervention or use an inflexible modality for a particular condition, but should pick up and draw from the nature and context of clients’ lives by considering the existence of reality and circumstances before providing OT services.

Furthermore, the boundary of OT service has covered the analysis, design, creation, training and maintenance of orthotic/prosthetic devices, assistive and rehabilitation technology including the use of ergonomic and safety application (Reed & Sanderson, 1999). Consequently, OTs should provide proper therapeutic activities for each individual in order to restore the functional skills and occupational performance of clients.

Task-specific natural activities and skills have a relationship in a hierarchical scenario. The lower level begins with a skill and develops to become a task and leads to activities which serve as occupation for life. Hence, humans achieve skills and task completion before activity and occupation (Legg et al, 2007). For instance, for an achievement in cooking meals, people have to learn and develop the skills of hand

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function, eye-hand coordination, and motor control in using kitchen equipment, they have to achieve the task of cutting and sorting ingredients, activities of driving to market, buying products and sequencing items, before they are able to cook a menu successfully.

The OT process needs to begin with an assessment of the present and expected occupations of the clients. A well-built management strategy which identifies functional limitation assists the therapist who is concerned with the skills, tasks, activities and occupation to reduce barriers and boost functional performance. The strategic partnership between services is organised through collaborating with clients in assessing functional competence, educating knowledge-skills, analysing activities, using therapeutic activities and tools, grading activities, solving problems, organising group work and adapting environments (Hagedorn, 2000a). During the period of OT service, the occupational therapist analyses the big picture of occupation/activities to arrive a smaller at image of skills synthesising from the skill level to the occupation scenario of a personal nature, context, culture and way of life. In the last few decades, there have been many theories, models and conceptual frameworks for OT in different and diverse contexts. Although there are papers and publications in the OT field, there remains a lack of research to compare and evaluate the models. Misunderstanding and confusion have occurred over the terms used in models of practice, frames of reference and intervention approaches that derive from the viewpoint of authors (Kortman, 1995). Some models were created to navigate through the intervention process and reflect the sequential methods and therapeutic treatment linked to theories and frames of reference. Some models have covered all conditions broadly but cannot be used specifically to address the needs of some patients and are seldom compatible with some contexts and circumstances. OTs must consider carefully various models and conceptual approaches when making decisions on service treatments. People living with stroke have limitations in physical and psychological functions as well as social participation. Thus, appropriate OT models and concepts were addressed to link between content- principle and core conditional problems for people in occupations. The application of selected models should rely on factors associated with the stroke patient and his/her

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family in order to improve the compatibility and effectiveness of the rehabilitative intervention.