Occupational Therapy: Emphasis on Clinical Practice

Fig. 4.1
The Ankh sign. A wall at the Temple of Karnak, Luxor, Egypt. (Photo: Ingrid Söderback)
Throughout this handbook, a stylized ankh is used to symbolize the OTs’ therapeutic roles (Fig. 4.1) in health care and social welfare.

The Occupational Therapy Discipline

The academic discipline of occupational therapy may be divided into basic and applied research:
  • The basic research area is termed occupational science. This area concerns studies of humans as occupational beings. Occupation refers to the goal-directed activities that characterize humans’ daily life and lifetime and how occupations affect human health and vice versa (Clark et al. 1991; Zemke and Clark 1996). Hokings, Jones, and Kirk in Chap. 9 state the base of occupational science and its connection to clinical applications (Whiteford and Hocking 2012).
  • The applied research area includes studies of (1) needs assessment (Müllersdorf and Soderback 2000; Soriano 1995, see Chap. 7), (2) clinical reasoning process (Schell and Schell 2007, see Chap. 5), (3) marketing (Soderback and Frost 1995), (4) controlled studies of evidence for the intervention’s effectiveness (see Chap. 8), and (5) cost effectiveness (Graff et al. 2008).
The applied research focuses on OTIs—the area with which the handbook is mainly concerned (Parts II–V).

The Theoretical Base of Occupational Therapy

Clinical practice is guided by the occupational therapy’s theoretical and applied knowledge consisting of the following:
  • Axioms and theories that describe the human as an occupied being.
  • Values and beliefs about people’s capacity to alter their performance of daily occupations toward health.
  • Ethical considerations.
  • Clinical reasoning about how to manage specific OTIs with clients.
  • Experience of conducting OTIs .

Axiom

An axiom is a fundamental statement that “commends itself to general acceptance” (Oxford English Dictionary 2014). Axioms include a presumption that truth is not susceptible of proof with currently available scientific methodology.
The axioms used in occupational therapy all concern hypotheses about the relationship between the occupied human being and his or her health. Meyer (1922), a psychiatrist and neurobiologist who worked with people with mental illness, is widely considered the “father of occupational therapy.” He stated this axiom:
Man learns to organize time and he does it in terms of doing things. (Meyer 1922; quoted in Christiansen and Baum 1997, p. 33)
This may be understood to mean that occupation provides the human being with “a sense of reality, achievements, and temporal organization” (Christiansen and Baum 1997, p. 33).
Another often quoted and well-known axiom was stated by Reilly (1962):
Man, through the use of his hands as they are energized by mind and will, can influence the state of his own health (p. 2).
Through creativity and doing tasks, a person can “deploy his thinking, feelings, and purposes to make himself at home” (van Deusen 1993, p. 159).
Axioms that include statements such as the above are criticized for lacking connection with the OT’s everyday role and clinical practice. Elizabeth Yerxa (1967) recognized this gap between occupational science and clinical practice. She emphasizes the role of the OT in “assisting the individual to cope with problems of everyday living and to adapt to limitations that interfere with competent role performance” (Baum and Christiansen 1997, p. 34).
A typical axiom for this handbook is that OTIs influence clients’ states of activity health, which include the experience of (1) being in a state of occupied equilibrium, (2) conveniently, and with feelings of (3) meaningfulness, (4) well-being , (5) satisfaction, and (6) optimal quality of life .
Activity health means that experience and feelings when performing occupations of daily life meet a person’s expected goals and appropriate sociocultural norms (Cynkin and Robinson 1990; Soderback 1999). This experience is a possible outcome factor of occupational therapy.

Theories and Models

Occupational theories and models describe people as occupied beings living in their social and cultural environments. Among many promising approaches, the predominate models, in my view, are as follows:
  • The Model of Human Occupation (Kielhofner 1985, 1995, 2002, 2005, 2007, 2008).
  • The Occupational Science (Johnson and Yerxa 1989; Zemke and Clark 1996).
  • The Person–Environment Occupational Performance: A Conceptual Model for Practice (Christiansen and Baum 1997).
  • Occupation: form and performance (Nelson 1988).1
These models have made invaluable contributions to the development of the discipline and to OTs’ clinical reasoning (see Chap. 5).

Values and Beliefs

The following prominent values permeate OTs’ thinking in their work with clients:
  • People have the capacity to find alternative ways of performing occupations to gain competence and master their desired and expected roles in life. This may entail changes toward a state of occupied equilibrium, meaningfulness, and well-being. This positively influences quality of life and health.
  • Participation in occupational therapy, where clients are occupied in various purposeful or meaningful ways, influences their occupational capability.
  • OTs seek to apply client-centered interventions (Sumsion 2006). Here the client is valued as his or her own expert. Therefore, it is the client’s knowledge of how to arrange his or her daily habits, and choice of meaningful and purposeful activities, that influences the OTs’ intervention plans.
  • The client is the actor, the occupied partner during all therapy sessions. The OT acts as a guide, helping the client to self-help.
  • The habilitation/rehabilitation aspect is highly valued, focusing on the client’s future ability to move from dependence to interdependence to independence.

Ethical Considerations and Priorities

Ethical considerations and priorities operate in all clinical situations in which OTs need to decide on what is right or wrong. Lindberg and Broqvist (Chap. 6) present a model for analysis of ethical dilemmas that can be used in OTs’ daily work and discuss the concept of prioritization .

The Clients

Classifying Those Who May Need Occupational Therapy

Classification systems in healthcare are used to define and describe people’s strengths and deficits. Clients2 who participate in occupational therapy are:
  • People diagnosed with medical conditions having functional limitations and restrictions in activities of daily living (ADL) , such as self-care, and in home, work, and leisure activities. Based on scientific studies, the clients who at present are representative to participate in occupational therapy are presented from two different perspectives in Chaps. 3 and 7.
  • People in general who are living in a society and are at risk for occupational deficits (see Chap. 62).
Clients participate in occupational therapy at (1) a hospital; (2) a care institution, such as a nursing home, senior citizens’ home, or health center; (3) a wide range of workplaces; and (4) in their homes. Students may participate in occupational therapy at their schools (WFOT 2008a). Clients represented in the chapters of this handbook are classified according to the International Classification of Diseases (ICD), and presented in Table 4.1.
Table 4.1
Examples of diseases/disorders represented in this handbook, thus describing the candidates who may participate in occupational therapy
ICD-RHP
  
Exemplified in the handbook
Blocks
Title
Disease
Disease/disorder specified
Chapter no.
F20–F29
Mental and behavioral disorders
Schizophrenia, schizotypical, and delusional disorders
Schizophrenia
25
F20–F29
  
Schizophrenia, schizotypical, and delusional disorders
Schizophrenia
34
F20–F29
  
Schizophrenia, schizotypical, and delusional disorders
Schizophrenia
35
F20–F29
  
Schizophrenia, schizotypical, and delusional disorders
Schizophrenia
36
F20–F29
    
Depressive disorders
51
F30–F39
Mental and behavioral disorders
Mood: state of depression
Dementia
28, 29, and 38
F70–F79
Mental and behavioral disorders
Disorders of adult personality and behavior
Mental retardation
44
G80
Mental and behavioral disorders
Disorders of personality and behavior
Rett syndrome
23
G80
Diseases of the nervous system
Cerebral palsy and other paralytic syndromes
Cerebral palsy
45
G82
Injury, poisoning, and certain other consequences of external causes
Paresis/paralysis in the lower limb
Paraplegia, tetraplegia, and muscle weakness
20
G83
Injury, poisoning, and certain other consequences of external causes
Injury, poisoning, and certain other consequences of external causes
Several various diseases, e.g., cerebral paresis
39
G00–G09
Diseases of the nervous system
Inflammatory diseases of the central nervous system
Musculoskeletal pain and fatigue
49
G82
Injury, poisoning, and certain other consequences of external causes
Paralysis of upper limb
Cumulative trauma disorders
15
G82
  
Paresis/paralysis in the lower limb
Paraplegia and tetraplegia
16
G83
Injury, poisoning, and certain other consequences of external causes
Paresis/paralysis in the lower limb
Stroke, hemiparesis
41
G83
Injury, poisoning, and certain other consequences of external causes
Paresis/paralysis in the lower limb
Mental retardation
14
H00–H59
Visual disturbances and blindness
Low vision on both eyes
Various eye diseases
22 and 32
LF30–LF39
Mental and behavioral disorders
Schizophrenia, schizotypical, and delusional disorders
Alzheimer’s disease
56
M00–M99
Diseases of the musculoskeletal system and connective tissue
Neck and back pain
Musculoskeletal pain
47
M00–M99
  
Neck and back pain
Chronic low back pain disorder
48
M00–M99
    
Neck and back pain
49
M05–M14
Inflammatory polyarthropathies
  
Rheumatoid arthritis
42
M15–M19
Inflammatory polyarthropathies
  
Arthrosis
42
S00–T98
Injuries, poisoning, and certain other consequences of external causes
Injuries to the wrist and hand, fractures, burns
Hand trauma, hand arthritis
18
S00–T98
  
Injuries to the wrist and hand, fractures, burns
Burn injury
19
S10–S19
Injuries to the neck; spinal cord injury
Injuries to the neck; spinal cord injury
Musculoskeletal pain
47
S6
Intracranial injury (brain injury; brain damage)
Acquired brain injury
Stroke
30
S6
    
Acquired brain injury, stroke
31
S6
    
Acquired brain injury, stroke: apraxia
22
S6
    
Multiple sclerosis
33
S6
    
Stroke
40
S6
    
Parkinson’s disease
43
The classification is according to the International Classification of Diseases and Related Health Problems (ICD-RHP), 10th Version, for the World Health Organization (2007).
In occupational therapy, various classification systems are in use:
  • Conducting an OTI or an occupational therapy program: Here OTs describe clients’ occupational performance deficits according to the occupational therapy model that underpins the actual OTI which is in use. E.g.,
    • Domain and Process (American Occupational Therapy Association (AOTA 2002, 2013) describes occupational therapy in general. It shows how clients have strengths and deficits in occupational spheres, performance skills/patterns in relation to context, what an activity demands, body functions and body structures, and other factors affecting the occupation. According to this framework, candidates for occupational therapy have performance limitations when conducting needed or desired occupations (e.g., Chap. 44).
    • OTI may depend on the client’s age. (For children, e.g., see Chaps. 21, 44, 45, and 52; for older adults , and frail elderly, see, e.g., Chaps. 12, 29, and 63.)
  • Clients who may need occupational therapy are described according to the following classification systems which are used alone or in combinations:
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May 21, 2017 | Posted by in GENERAL | Comments Off on Occupational Therapy: Emphasis on Clinical Practice

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