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Occupation

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Activity in which one engages

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Therapy

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Treatment of an illness or disability

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Goal

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End toward which effort is directed

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Activity

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State or condition of being involved

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Independence

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State or condition of being independent (self-reliant)

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Function

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Action for which a person is specifically fitted

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Occupational Therapy

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A goal-directed activity that promotes independence in function.

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Areas of Occupation

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Various life activities including activities of daily living (ADL's), instrumental activities of daily living (IADL's), education, work, play, leisure and social participation

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Occupational Performance

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The ability to carry out activities of daily life (including activities in the area of occupation)

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Purposeful Activity

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An activity used in treatment that is goal-directed and that the client sees as meaningful or purposeful

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The Goal of Occupational Therapy

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To increase the ability of the client to participate in everyday activities, including feeding, dressing, bathing, leisure, work, education and social participation.

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Occupational Therapy Process

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Interacting with a client to assess existing performance, set theraputic goals, develop a plan and implement intervention to enable the client to function better in his/her own world.

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Preparatory Activities

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Things which help get the client ready for the purposeful activity, including range of motion, exercise or stretching.

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Contrived Activities

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Made up activities that may include some of the same skills required for the occupation. For example, tying shoes on a model before tying one's own shoes.

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Occupation-Centered Activity

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Activities performed in the natural setting (physical, social and temporal). For example, preparing lunch at home at noon using one's own kitchen supplies.

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Moral Treatment

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Grounded in the philosophy that all people, even the most challenged, are entitled to consideration and human compassion.

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Phillippe Pinel

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French physician who introduced "work treatment" for the "insane" in the late 1700's. Use of occupation diverted patients' minds away from their emotional disturbances and toward improving skills. He used physical exercise, work, music and literature in his treatment.

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William Tuke

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English Quaker who established the York Retreat, which used the Moral Treatment methods. Patients were approached with kindness and consideration.

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Benjamin Rush

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Quaker. The first US physician to institute Moral Treatment practices.

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John Ruskin and William Morris

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Founders of the Arts and Crafts movement in England. They were opposed to the production of items by machine believing this alienated people from nature and their own creativity. It was believed that using one's hands to make items connected people to their work, physically and mentally, and thus was healthier.

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Early OT Practitioners

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Backgrounds in psychiatry, medicine, architecture, nursing, arts and crafts, rehabilitation, teaching and social work.

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Early OT Practice

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Called ergotherapy, activity therapy, occupation treatment, moral treatment and work cure.

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William Rush Dunton, Jr.

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Coined the term "Occupation Therapy"

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George Edward Barton

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Suggested change from "Occupation Therapy" to "Occupational Therapy"

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Herbert Hall

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American physician from Harvard who worked with invalid patients providing medical supervision of crafts for the purpose of improving their health and financial independence.

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George Edward Barton

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Architect who personally experienced tuberculosis, foot amputation and paralysis on the left side of his body. Determined to improve the plight of convalescent individuals. Opened Consolation House in 1914 in Clifton Springs, NY where occupation was used as a method of treatment.

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William Rush Dunton, Jr.

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Psychiatrist. Considered the father of OT. Patients were expected to actively participate in their rehab by working in the workshop. Published "Occupational Therapy: A Manual for Nurses" in 1915.

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Eleanor Clarke Slagle

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Social work student. Considered the mother of OT. Developed habit training, a re-education program designed to overcome disorganized habits, to modify other habits, and to construct new ones with the goal of restoring and maintaining health. AOTA Lectureship in her honor created in 1953.

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Susan Tracy

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Nursing instructor involved in the Arts and Crafts movement and in the training of nurses in the use of occupations. Wrote "Studies in Invalid Occupations."

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Studies in Invalid Occupations

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First-known book written about occupational therapy

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Susan Cox Johnson

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Designer and Arts and crafts teacher from Berkeley, CA. Demonstrated that occupation could be morally uplifting and that it could improve the mental and physical state of patients. Taught OT in the Nursing and Health department of Teacher's College.

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Thomas Kidner

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Canadian architect. Friend and fellow teacher of George Barton. Influential in establishing a presence for OT in vocational rehab and TB treatments. Responsible for developing a system of vocational rehab for disabled Canadian vets from WW I. Recognized for constructing institutions for individuals with physical disabilities.

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March 15, 1917

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Birth of the National Society for Promotion of Occupational Therapy in Clifton Springs, NY. Meeting attendees included George Barton, William Dunton, Eleanor Clark Slagle, Susan Cox Johnson, Thomas Kidner and Isabel Newton.

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Adolf Meyer

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Swiss physician - point of view became philosophical base for OT profession: Used a psychobiological approach to mental illness and treated the individual as a complete and unified whole, not merely a series of parts or problems to be managed.

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Reconstruction aides

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The purpose of the program was to rehabilitate US soldiers who had been injured WW I so that they could either return to active military duty or be employed in a civilian job.

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Reconstruction program

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Physiotherapy aides used massage and exercise and worked primarily with orthopedic patients. OT's used arts and crafts to treat the mind and body and worked with both orthopedic and psychiatric patients.

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France

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The reconstruction program was first implemented overseas here to treat Army soldiers suffering from "shell shock."

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Soldier's Rehabilitation Act

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Established a program of vocational rehab for soldiers disabled on active duty. (1918)

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Civilian Vocational Rehabilitation Act

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Provided federal funds to states on a 50/50 matching basis to provide vocational rehab services to civilians with physical disabilities. (1920)

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1921

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National Society for the Promotion of Occupational Therapy becomes the American Occupational Therapy Association. (AOTA)

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1923

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The first "Minimum Standards for Courses of Training in Occupational Therapy" are adopted by AOTA.

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Archives of Occupational Therapy

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Publication which began in 1922, edited by Dr. Barton until 1947. Currently known as the American Journal of Occupational Therapy. (AJOT)

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Specialization

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After WW II, OT became more closely coupled with medicine and the medical model of education. This led to the beginning of specialization and of a more scientific approach.

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WW II

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Created more demand for OT's and # of practitioners increased significantly.

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1950-1960

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Continued shift away from a generalist approach to a specialization in physical rehabilitation. Discovery of neuroleptic drugs led to the "Deinstitutionalization Plan"

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Rehabilitation Movement

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Period from 1942-1960. VA hospitals increased in size and number and developed physical medicine and rehab departments.

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Hill-Barton Act

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Assisted states in determining what hospitals and health care facilities were needed and provided construction grants.

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Medicare

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Implemented in 1965, amplified the demand for OT even more. Provides assistance to those 65+ or permanently and totally disabled to receive assistance in paying for their health care.

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American Occupational Therapy Foundation

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Founded in 1965 to promote research in occupational therapy.

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Occupational Therapy Assistant

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Formal position established in late 1950's

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1970-1980

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The time included introduction of personal computers, a dramatic increase in drug/alcohol abuse and the appearance of AIDS. The "Deinstitutionalization Plan" had gained acceptance and many patients with chronic mental illness and mental retardation who formerly lived in large facilities were sent to smaller community facilities or became homeless when supporting services were no longer available.

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Rehabilitation Act of 1973

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Established priority service for persons with the most severe disabilities. Clients required to participate in the process through documentation of an Individualized Written Rehabilitation Plan (IWRP) that specified the vocational goal and key supporting objectives. Also included civil rights provisions for people with disabilities.

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Education for All Handicapped Children Act of 1975

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Established the right of all children to a free and appropriate education, regardless of handicapping condition. Includes OT as a related service.

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Handicapped Infants and Toddlers Act

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Passed as an amendment to the Education for All Handicapped Children Act in 1986 to include children from 3-5 years of age and initiated new early intervention programs for children from birth-3.

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Technology Related Assistance for Individuals With Disabilities Act of 1988

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Addresses the availability of assistive technology devices and services to individuals with disabilities.

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Prospective Payment System

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Nationwide cost schedule established for what the government would pay for a given service based on diagnosis-related groupings (DRG's). Patient length of stay in acute care shortened and use of long term care and home health care increased.

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Americans with Disabilities Act

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Guarantees equal access to and opportunity in employment, transportation, public accommodations, state and local government and telecommunications for individuals with disabilities. (ADA, 1990)

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Individuals with Disabilities Education Act

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Requires school districts to educate students with disabilities in the least restrictive environment (LRE). (IDEA, 1991)

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Balanced Budget Act of 1997

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Intended to reduce Medicare spending and create incentives for managed care programs. Under Medicare Part B, there is an annual cap of $1500 for a person receiving OT services and a separate $1500 cap per person for PT and Speech-Language Pathology COMBINED.

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Activities of Daily Living

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Refers to activities involved in taking care of one's own body and include such things as bathing, dressing, grooming, eating, feeding, personal device care, toileting, sexual activity and sleep/rest. (ADL)

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Instrumental Activities of Daily Living

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Refers to activities that may be considered optional and involve the environment. IADL's include care of others, care of pets, child rearing, communication device use, community mobility, health management, financial management, home establishment and management, meal preparation and clean up, safety and shopping. (IADL)

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Occupational Therapy Domain

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Includes Areas of Occupation, Client Factors, Performance Skills, Performance Patterns, Context and Environment and Activity Demands

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Areas of Occupation

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What the client does: ADL IADL Rest and sleep Education Work Play Leisure Social Participation

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Client Factors

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Who the client is: Values Beliefs and spirituality Body functions Body structures (integrity of)

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Performance Skills

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How the client does what they do: Sensory perceptual skills Motor and Praxis skills Emotional Recognition skills Cognitive skills Communication and social skills

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Performance Patterns

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What the client does (repeating patterns): Habits Routines Roles Rituals

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Context and Environment

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Where the client does what they do: Cultural Personal Physical Social Temporal Virtual

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Activity Demands

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What the client needs to do what they do: Objects used and their properties Space demands Social demands Sequencing and Timing Required actions Required body functions Required body structures

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Intervention Plan approaches

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Create/promote Establish/restore Maintain Modify Prevent

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Create/Promote

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Health promotion. Provides opportunities for people with and without disabilities. The OT sets up a program or activity in the hope that all those who participate will benefit by enhanced performance.

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Establish/Restore

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Remediate. Use of strategies and techniques to change client factors to establish skills that have not yet developed or to restore those that have been lost.

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Maintain

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Helping the client keep the same level of performance and not declining in functioning.

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Modify

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Compensation/adaptation. Activities are changed so that clients may continue to perform them.

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Prevent

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Keeping the client well - helping the client to engage in activities to prevent or slow down disease, trauma or poor health.

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