Occupational therapy is a holistic, patient-centered, occupation-based approach to life skill development. This health profession helps people whose lives have been altered by physical or mental disease, injury, or other health problems. People of any age can benefit from occupational therapy to prevent injury and improve skills needed to perform everyday tasks or "occupations" at home, work, or school. Examples include activities of daily living such as dialing a phone, using a computer, writing a check, and driving a car.
Occupational therapists first came onto the scene during World War I, when practitioners worked with soldiers suffering from shell shock, amputations, and other injuries. Also in the early 20th century, occupational therapists treated persons with tuberculosis and polio.
Today, the role of occupational therapists is varied and broad. For the last several decades, occupational therapists have treated patients suffering from physical and developmental disabilities such as brain injury, spinal cord injury, repetitive stress injury, stroke, Alzheimer's disease, diabetes, attention deficit disorder, mental retardation, and Parkinson's disease, among others. At the turn of the new millennium, however, practitioners began to prove their worth in areas such as vision treatment, mental health, ergonomics consulting, and home modification.
Through activities of daily living (ADL) evaluations, it is determined by the practitioner how independent a patient is in performing his or her daily tasks at home, at work, and within his or her social environment. After evaluation, an occupational therapist may implement an intervention to facilitate a more independent lifestyle. The goal of occupational therapy practitioners is to facilitate the patient's physical independence. One way that they do this is by implementing exercises that aid in mobility. When a patient has impaired vision, a therapist might analyze lighting and contrast needs in the home, and equip the patient with tools to make the home and work environment more functional. Such tools might include a magnifying glass or auxiliary lighting. In ergonomics consulting, a therapist might advise businesses and industries about functional and comfortable work stations that minimize repetitive stress injuries caused by repetitive movements, such as typing or assembly line work. Interventions that help patients—such as those with developmental disabilities, or those in mental health settings—to function on a daily basis, such as stress management and communication skills, might also be facilitated by occupational therapists.
Occupational therapy practitioners may work in a variety of settings; the scope of their practice may be vast. Traditional work settings are long-term-care (LTC) and skilled nursing facilities (SNFs), outpatient clinics, and other nursing homes, in which practitioners provide direct care to patients with physical and developmental problems (e.g., arthritis, hand injuries, and dementia ). Occupational therapists and occupational therapy assistants have found their place in mental health facilities, home health agencies, and, more recently, community-based settings and private practice. No matter the setting in which a practitioner practices, the approach is patient-centered; the patient's needs and the environment in which the patient lives are considered when developing a treatment plan.
Many occupational therapy practitioners work with children in the school systems. The focus of a therapist in an educational environment may be to implement a handwriting intervention program, with the goal of improving finger dexterity in young children. According to a compensation survey of its members that the American Occupational Therapy Association (AOTA) conducted in 2000, nearly a quarter of members who responded are employed by school systems. Practitioners reported that they are also finding more opportunities in community-based settings, such as workplace ergonomics consulting and work rehabilitation programs.
Education and training
Current practitioners are credentialed as either occupational therapists, considered professionals after completing an accredited bachelor's degree program, or as occupational therapy assistants, who are considered at the technical level after completing a two-year associate program.
Prior to graduation, students must complete a supervised fieldwork program through their college or university program, and pass a national certification exam administered by the National Board of Certification in Occupational Therapy (NBCOT). The NBCOT is currently developing a recertification program.
The Accreditation Council for Occupational Therapy Education (ACOTE), following a resolution by the AOTA's Representative Assembly, moved to require a master's degree upon entry into the field of occupational therapy. By the year 2007, all educational institutions offering occupational therapy programs must do so under the standards of ACOTE's post-baccalaureate requirements. However, there are many practitioners in the field who have already earned master's and doctorate degrees. The number of practitioners with advanced degrees has steadily increased since 1990.
The profession of occupational therapy is regulated in every state; in 43 states, as well as the District of Columbia, Puerto Rico, and Guam, occupational therapists are required to be licensed. Licensure is important because it defines the scope of practice for therapists and provides guidance to facilities and health care providers on the appropriate application of occupational therapy services.
The field of occupational therapy has been playing catch-up with its allied health counterparts, such as physical therapy and speech-language pathology. More sophisticated and specialized education was necessary for occupational therapists to remain competitive and prove their worth when interacting with consumers and other medical professionals. Practitioners must be able to employ critical reasoning and develop innovative practice models.
Advanced education and training
Continuing education courses and additional training is necessary for practitioners to remain competent within the field; this must be done on a regular basis. Practitioners can utilize AOTA's continuing education courses, online courses, and annual conference and exposition workshops, as well as educational sessions that are offered by leaders in occupational therapy.
In 2000, AOTA's Council on Continued Competence in Occupational Therapy (CCCOT) implemented the Continuing Competence Plan for Professional Development, a comprehensive plan that guides practitioners in developing and maintaining competent skills. The NBCOT, through which practitioners must become certified and eventually recertify, agreed to work in coordination with the AOTA to develop a recertification program that agrees with the principles set forth in the CCCOT's plan.
As health care delivery has changed dramatically with the advent of managed care, the roles of occupational therapists and occupational therapy assistants have expanded, due mostly in the United States to Medicare provider payment cutbacks mandated by the Balanced Budget Act (BBA) of 1997. Many jobs were cut in SNFs, leaving occupational therapists out of work. This change forced practitioners to consider other markets that might values their services.
The occupational therapy profession, however, was granted a reprieve when the U.S. Congress made several changes to the Balanced Budget Act. The Balanced Budget Refinement Act of 1999 called for a suspension of a capitation on rehabilitation services. Congress agreed to suspend the capitation because of the controversy surrounding combining occupational therapy, physical therapy, and speech-language pathology.
For occupational therapy to survive, new markets had to emerge. Practitioners proved their worth in less traditional roles and work settings. While therapists still have a place in LTC facilities, they are carving a niche in school systems—the most popular work setting, according to a 2000 survey conducted by AOTA—as well as business-to-business consulting firms that specialize in ergonomics, home modification, and/or assistive devices, wellness education programs, community-based mental health programs, and a variety of specialties in private practice.
It was reported by the U.S. Department of Labor's 2001 Occupational Outlook Handbook that the occupational therapy field is expected to grow at a faster rate than any other occupation through 2008. These gains, however, are expected to be made in the years closer to 2008 due to the Congressional cuts, detailed above.
Activities of daily living (ADL)— Activities of daily living are an individual's skills and practices that determine how well he or she can function in daily life and how well he or she relates to and participates in his or her environment.
Alzheimer's disease— A progressive, neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions, such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Arthritis— Inflammation of one or more joints.
Attention deficit disorder (ADD)— A condition characterized by an attention span that is less than expected for the age of the person. There is often age-inappropriate hyperactivity and impulsive behavior, as well.
Ergonomics— The study of the relationship between people and their working environment.
Home modification— Altering the physical environment of the home so as to remove hazards and provide an environment that is more functional for the patient. Examples of home modification include the installation of grab bars and no-slip foot maps in the bathroom, to prevent falls.
Parkinson's disease— A disorder of the brain characterized by shaking and difficulty with walking, movement, and coordination. The disease is associated with damage to a part of the brain that controls muscle movement.
Stroke— A group of brain disorders involving loss of brain functions that occur when the blood supply to any part of the brain is interrupted.
The increasing demand for occupational therapists is expected, in large part, because of the emerging markets, as well as the increase in those requiring the type of services occupational therapists provide. As baby boomers (those born between 1945 and 1965) age, occupational therapy practitioners will have an even bigger market for home modification, so that the elderly, for example, can remain in their homes longer than normally expected. Advancement in medical technology continues to allow people to live longer, despite serious illness and disability, and occupational therapists can facilitate their independence in daily living and working.
Punwar, Alice J. and Suzanne M. Peloquin. Occupational Therapy, Principles and Practice, 3rd ed. Baltimore: Lippincott Williams & Wilkins, 2000.
Bonder, Bette, and Charles Christiansen. "Editorial: Coming of Age in Challenging Times." Occupational Therapy Journal of Research (Winter 2001): 3-11.
Fidle, Gail S. "Beyond the Therapy Model: Building Our Future." The American Journal of Occupational Therapy 54 (January/February 2000): 99-101.
Foto, Mary. "Professional evolution: Should Health Care Environmental Changes Force OT and PT Practice Into a New Delivery Model?" OT Week (9 April 1998): 17-19.
Gourley, Meghan. "Maintaining Career Competence." OT Practice (5 March 2001): 14-16.
Gourley, Meghan. "Postbaccalaureate Requirement Facilitates Growth." OT Practice (17 and 31 July 2000): 9-10.
Hasselkus, Betty R. "Reaching Consensus." The American Journal of Occupational Therapy 54 (March/April 2000): 127-128.
Jacobs, Karen. "Being an Occupation FANATIC." Administration & Management Special Interest Section Quarterly 16 (March 2000): 1-4.
Stancliff Walls, Bethany. "What Does Resolution J Mean to the Profession?" OT Practice (July/August 1999): 13, 15.
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Wilcock, Anne A. "An Occupational Scientist's Perspective for Future Practice." OT Week (28 May 1998): 13-14.
The American Occupational Therapy Association, Inc. 4720 Montgomery Lane, Bethesda, MD 20824-1220. (301) 652-2682. 〈http://www.aota.org〉.
The National Board for Certification of Occupational Therapy, Inc. 800 S. Frederick Ave., Ste. 200, Gaithersburg, MD 20877-4150. (301) 990-7979. 〈http://www.nbcot.org〉.
The U.S. Department of Labor, Bureau of Labor Statistics, Division of Information Services. 2 Massachusetts Ave. NE, Room 2860, Washington, DC 20212. (202) 691-5200. 〈http://www.bls.gov〉.
The primary focus of occupational therapy is enabling individuals to participate actively and meaningfully in their day to day lives. Occupation is defined as any meaningful activity a person may do throughout the course of a day, including taking care of one's self (self care), contributing to society through paid and unpaid work (productivity), and simply enjoying life (leisure). Individuals may experience many obstacles to participating in occupations as a result of the aging process, disability, environmental change, or other circumstances. Occupational therapists may work in the home, hospital, clinic, or community setting to enable clients to adapt to or overcome obstacles and optimize their involvement in daily life.
The ability to perform an occupation is impacted by interaction between the activity, the skills, and attributes of the individual and the environment. Occupational therapists strive to optimize performance by facilitating a positive interaction between the components of the person, environment, and occupation. Identified areas of concern for occupational therapy can be grouped into the three broad categories: self care, productivity, and leisure.
The area of self-care encompasses all of the tasks an individual does throughout the day to look after his or herself. It includes activities such as personal care, functional mobility, and community management. Personal care includes such tasks as feeding oneself, bathing, personal hygiene, dressing, and toileting. Activities involved in community management may include driving, taking public transportation, grocery shopping, completing community errands, and managing one's finances.
The aging process or disabilities affecting an older person may lead to difficulties in completing self-care occupations. For example, decreased balance or strength may make it difficult for older people to get about their home or community independently and safely. Disabilities such as arthritis can make seemingly simple tasks such as washing one's feet or doing up buttons or zippers extremely difficult. The onset of a dementia such as Alzheimer's may impact a person's ability to carry out effectively personal care activities or to manage their finances.
Occupational therapists play a valuable role in addressing the difficulties encountered in performing self care occupations as a person ages. The occupational therapist can assess the client's ability to complete a chosen occupation, such as bathing. During the assessment process, the therapist needs to consider a variety of factors including the client's goals, individual abilities and limitations, the environment, and the nature of the task itself. Depending on the situation, intervention may focus on the individual, adapting the environment, or modifying the task. For example, a goal identified by a client may be to regain independence with bathing. In this situation the therapist may work to help the client to develop the strength needed to get in and out of the tub, they may recommend modifying the environment to include an assistive aid such as a grab bar, or suggest the client consider adapting the task by sitting on a bath chair. Regardless of the method of intervention the focus is on enabling the clients to reach their goals, in this example independence with bathing.
Productivity refers to an individual's contributions to society through both paid and unpaid work. Older adults often take part in the productivity occupations of household management, caring for family members, volunteer work, or paid employment. The physical and/or cognitive limitations that older adults may encounter can affect an individual's ability to fulfill productivity roles and responsibilities. For example, following a stroke individuals may experience a loss of function in their dominant hand making many household tasks—carrying a pot, opening a can, or pouring a cup of tea—difficult with the use of only one hand. The occurrence of a stroke may also impact an individual's memory, concentration, or attention span, leading to potential safety concerns in the kitchen, such as leaving items on the stove unattended or forgetting to turn off the burner.
The maintenance of skills necessary to manage a household and remain in their own homes is often of primary importance to older adults. Occupational therapists work with individuals and their families to promote independence and safety in the home environment. By addressing the physical or cognitive limitations, modifying the task or adapting the environment and support structure, the occupational therapist enables individuals to meet their household management responsibilities.
In late adulthood, individuals place great importance on their leisure time, often pursuing hobbies, interests, and opportunities for socialization. Leisure activities may include quiet recreation such as reading or crafts, active recreation such as travel or community outings, and socialization such as visiting with friends and family. Many older adults have hobbies which they have participated in throughout their lives and may now have difficulty completing due to new physical or cognitive limitations. For example, knitting can become difficult as a result of pain experienced from arthritis in the hands. An occupational therapist can facilitate a hand therapy program to improve the range of motion and strength of the client's hands or adapt the knitting needles so the client is able to continue knitting. Spending time with family often plays a meaningful role in an individual's life. Occupational therapy is beneficial in providing suggestions to allow a client to interact with family or friends. For example, a therapist might suggest adapting a telephone for an individual with a vision impairment to facilitate communication with family members.
Occupational therapists are integral members of the older adult's health care team. By promoting the maintenance and development of the skills required for the job of living, occupational therapists enable clients to participate in those activities that are most important to them. Whether the goal be continuing to live independently, caring for a family member, or maintaining participation in individual pursuits, the occupational therapist can foster and enhance an older adult's quality of life.
Tobi Flewwelling Heather White
See also Home Adaptation and Equipment; Home Care and Home Services; Frailty; Functional Ability; Multidisciplinary Team; Physical Therapy; Rehabilitation.
Canadian Association of Occupational Therapy. "Position Paper on Occupational Therapy with the Elderly Population." Canadian Journal of Occupational Therapy 55, no. 2 (1988): Centerfold.
Cutler Lewis, S. Elder Care in Occupational Therapy. Thoroughfare: N.J.: Slack Inc., 1989.
Hobson, S. "International Year of Older Persons: What Occupational Therapists have to Celebrate." Canadian Journal of Occupational Therapy 66, no. 4 (1999): 155–160.
Law, M.; Baptiste, S.; Carswell, A.; McColl, M. A.; Polataajko, H.; and Pollack, N. Canadian Occupational Performance Measure, 2d ed. Ottawa: CAOT Publications ACE, 1994.
Townsend, E.; Stanton, S.; Law, M.; Polataajko, H.; Baptiste, S.; Thompson-Fransom, T.; Kramer, C.; Swedlove, F.; Brintnell, S.; and Campanile, L. Enabling Occupation: An Occupational Therapy Perspective. Ottawa: CAOT Publications ACE., 1997.
oc·cu·pa·tion·al ther·a·py • n. a form of therapy for those recuperating from physical or mental illness that encourages rehabilitation through the performance of activities required in daily life. DERIVATIVES: oc·cu·pa·tion·al ther·a·pist n.