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:



May 21, 2017 | Posted by in GENERAL | Comments Off on Occupational Therapy: Emphasis on Clinical Practice
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