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:
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:
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 | ||
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).
Clients who may need occupational therapy are described according to the following classification systems which are used alone or in combinations:
International Classification of Functioning, Disability, and Health (ICF) is “used to understand and measure health conditions.” This is a system for classifying health and health-related domains that describes body functions and structures, activities, and participation . The ICF also includes a list of environmental factors. The term functioning is the catchall term for “body functions, activities, and participation,” and disability is the catchall term for “impairments, activity limitations, or participation restrictions” (World Health Organization 2007a).
According to the ICF, people may be helped by OTIs if they meet the following criteria:
Have impairments due to changed body functions or structures concerning (1) mental functions, (2) sensory functions, (3) neuromusculoskeletal and movement-related functions , or (4) functions of the skin and related structures. They seldom have impairments due to (1) voice and speech functions or (2) functions of the cardiovascular, hematologic, immunologic, and respiratory systems. They very seldom have impairments due to functions of the digestive, metabolic, and endocrine system, and they almost never have impairments due to genitourinary and reproductive functions.
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