Introduction to Occupational Therapy, 4th Edition, Study Guide
Introductory Terminology and Basic Concepts
Occupation: Activity in which one engages.
Therapy: Treatment of an illness or disability.
Goal: End toward which effort is directed.
Activity: State or condition of being involved.
Independence: State or condition of being self-reliant (independent).
Function: Action for which a person is specifically fitted.
Occupational Therapy (Definition): A practice that uses goal-directed activity to promote independence in function.
Areas of Occupation: Various life activities, including activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure, and social participation.
Occupational Performance: The ability to carry out activities of daily life.
Purposeful Activity: An activity used during intervention that is goal-directed and may or may not be viewed as meaningful to the client. These typically involve an end product.
Therapeutic Relationship: A relationship of mutual trust (rapport) established between the practitioner and client to guide active participation in intervention.
Occupational Therapy Personnel and Education
Occupational Therapy Practitioner: Refers to two levels of clinicians:
Occupational Therapist (OT): Performs at the "professional" level. Requires a Master's degree (as of 2007). Baccalaureate programs will be phased out by 2017.
Occupational Therapy Assistant (OTA): Performs at the "technical" level under the supervision of an OT. Requires a two-year associate's degree.
Occupational Therapy Aide: Receives only on-the-job training; not a "practitioner."
Fieldwork Requirements:
Level I: Concurrent with academic coursework; introduces the student to the profession.
Level II: Supervised, hands-on clinical training. OT students complete a minimum of 24 weeks full-time; OTA students complete 16 weeks full-time.
Regulation: Educational programs are accredited by the Accreditation Council for Occupational Therapy Education (ACOTE).
Certification: Initial certification is managed by the National Board for Certification in Occupational Therapy (NBCOT).
Historical Foundations of the Profession
18th and 19th Centuries: Moral Treatment: The philosophy that all people are entitled to consideration and human compassion. Key figures:
Philippe Pinel (France): Introduced "work treatment" for the "insane" using exercise, music, literature, and farming.
William Tuke (England): Founded the York Retreat; approached patients with kindness and family-like environments.
Benjamin Rush (US): First US physician to institute Moral Treatment.
Early 20th Century: Arts and Crafts Movement: Opposed machine production; believed using hands for craftsmanship was physically and mentally healthier.
Founders (Founding Meeting March 15, 1917):
Herbert Hall: Developed the "work cure" for neurasthenia; established a facility in Marblehead, MA.
George Edward Barton: Architect who opened Consolation House in Clifton Springs, NY.
Dr. William Rush Dunton, Jr.: The "Father of Occupational Therapy"; published Occupational Therapy: A Manual for Nurses (1915).
Eleanor Clarke Slagle: The "Mother of Occupational Therapy"; developed "habit training" (a 24-hour re-education program).
Susan Tracy: Nursing instructor; wrote Studies in Invalid Occupations, the first known OT book.
Susan Cox Johnson: Designer; advocated for high educational standards.
Thomas Kidner: Architect; established OT in vocational rehabilitation and tuberculosis treatment.
Adolf Meyer: Swiss physician who developed the psychobiological approach and holistic perspective. He identified the "big four": work, play, rest, and sleep.
World War I: Creation of "reconstruction aides" (civilian women) who used arts and crafts to treat "shell shock."
1921: National Society for the Promotion of Occupational Therapy changed its name to the American Occupational Therapy Association (AOTA).
Philosophical Principles and Core Values
Metaphysical Questions (What is humankind?): OT views humans holistically (biological, psychological, sociocultural, and spiritual elements) and as active beings. Engagement in occupation is essential to identity.
Epistemology (How do we know?): Humans learn through experience—thinking, feeling, and doing. Occupation is seen as both a "means" (the method used to change performance) and an "end" (the desired outcome).
Axiology (What is desirable/right conduct?): Focuses on client-centered care, quality of life, and humanism.
Core Values (Adopted by AOTA 1993):
Altruism: Unselfish concern for the welfare of others.
Equality: Treating all individuals with fairness and impartiality.
Freedom: The right to exercise choice and self-direction.
Justice: Abiding by laws and respecting client rights.
Dignity: Empathy and respect for the uniqueness of every individual.
Truthfulness: Behavior that is honest, accurate, and accountable.
Prudence: Ability to demonstrate sound judgment and discretion.
Current Issues and Emerging Practice Areas
AOTA Centennial Vision (2017): "Occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs."
Emerging Areas (Baum, 2011):
Aging in place (Home modification, safety assessment).
Driver assessments and training programs (Driver rehabilitation specialists).
Community health and wellness.
Needs of children and youth (Including childhood obesity issues).
Ergonomics consulting.
Technology and assistive-device developing/consulting.
Evidence-Based Practice: Basing practice on the best available research evidence.
Educational Trends: Move to Master's level entry; growth of Clinical Doctorate (OTD) programs; use of distance education.
Professional Organizations
AOTA (American Occupational Therapy Association): Mission to advance quality, availability, and support of OT. Includes the Representative Assembly (RA) as the legislative/policy body.
AOTF (American Occupational Therapy Foundation): National organization designed to advance the science of OT. Publishes OTJR: Occupation, Participation and Health.
WFOT (World Federation of Occupational Therapists): Established 1952; promotes international information exchange and minimum education standards.
AOTPAC (American Occupational Therapy Political Action Committee): Legally sanctioned vehicle for political action and influencing legislation.
Roles, Responsibilities, and Supervision
Levels of Performance:
Entry-Level: Development of skills; socialization into the profession.
Intermediate-Level: Increased independence; mastery of basic role functions; specialization.
Advanced-Level: Considered an expert or resource person.
Supervision Definitions:
Direct or Continuous: Supervising therapist is in the immediate area at all times (required for students and aides).
Close: Daily, direct contact at the site of work.
Routine: Face-to-face contact at least every 2 weeks.
General: Face-to-face contact at least once a month.
Service Competency: The determination that two people performing the same procedure will obtain the same results (interrater reliability).
Health Care Teams:
Multidisciplinary: Variety of disciplines; non-interactive relationship.
Interdisciplinary: Maintain professional roles but use a cooperative, interactive approach.
Transdisciplinary: Members cross professional boundaries and share roles.
Certification Renewal: NBCOT requires 36 Professional Development Units (PDUs) every 3 years.
The Occupational Therapy Code of Ethics (7 Principles)
Beneficence: Practitioner will contribute to the good health and welfare of the client.
Nonmaleficence: Practitioner should not inflict harm on the client (avoid exploitation).
Autonomy and Confidentiality: Protect the client's right to self-determination and privacy (Informed Consent).
Social Justice: Provide services in a fair and equitable manner to all.
Procedural Justice: Comply with laws and regulations guiding the profession.
Veracity: Duty to tell the truth; represent qualifications accurately.
Fidelity: Faithfulness in professional relationships; treating colleagues with respect.
Occupational Therapy Process: OTPF Domain and Process
OTPF (Occupational Therapy Practice Framework): Replaced Uniform Terminology.
Domain Analysis:
Areas of Occupation (ADL, IADL, etc.).
Client Factors (Values, beliefs, spirituality; Body functions/structures).
Performance Skills (Motor, process, communication/social skills).
Performance Patterns (Habits, routines, rituals, roles).
Contexts (Cultural, physical, social, personal, temporal, virtual).
Activity Demands (Objects, space, social demands, sequencing).
Process Stages:
Evaluation: Occupational Profile (interview) and Analysis of Occupational Performance.
Intervention: Intervention Plan, Implementation, and Review.
Outcomes: Measurement of engagement in occupation, health, and wellness.
Intervention Approaches:
Create/Promote (Health promotion).
Establish/Restore (Remediate).
Maintain.
Modify (Compensation/Adaptation).
Prevent.
Intervention Modalities and Activity Analysis
Modality: Medium (equipment/supplies) + Method (steps/sequences).
Preparatory Methods: Sensory input, therapeutic exercise, physical agent modalities (PAMs), and orthotics/splinting.
Purposeful Activity: Inherent goal (end product) + therapeutic goal.
Simulated (Contrived) Activity: Used when purposeful activity is not possible (e.g., clothing fastener boards).
Occupation-Based Activity: Engaging in the actual occupation in its natural context.
Activity Analysis: Detailed examination of steps and components to determine demands on the client.
Activity Synthesis: Deciding which activities to introduce, timing, and how to grade or adapt them.
Grading: Changing the process/environment to increase or decrease performance demands.
Adapting: Changing an aspect of the activity/environment to enable success (e.g., universal cuff).
Therapeutic Use of Self and Clinical Reasoning
Therapeutic Relationship Stages of Loss (Kübler-Ross): Denial, Anger, Bargaining, Depression, Acceptance.
Intentional Relationship Model (Taylor): Advocating, Collaborating, Empathizing, Encouraging, Instructing, Problem-solving.
Active Listening: Restatement, Reflection, Clarification.
Clinical Reasoning Elements:
Scientific: "What can be done?" (Evaluation data).
Ethical: "What should be done?" (Client's perspective).
Artistic: Integrating interests and interpersonal climate.
Clinical Reasoning Strategies:
Procedural: Focus on disease/disability.
Interactive: Face-to-face interaction to understand the person.
Conditional: Consideration of the whole condition and future goals.
Narrative: Storytelling/creation.
Pragmatic: Considering reimbursement, space, and skills.
Novice to Expert Stages: Novice, Advanced Beginner, Competent, Proficient, Expert.
Service Management and Documentation
Hand Washing: Most effective method for preventing disease transfer; should last at least 30 seconds.
Universal Precautions: CDC guidelines involving protective barriers (gloves, gowns, masks).
SOAP Note Format:
S (Subjective): Client's report.
O (Objective): Measurable/observable data.
A (Assessment): Practitioner's professional judgment.
P (Plan): Plan of action.
Reimbursement Sources:
Public: Medicare (65+/disabled), Medicaid (low income), VA.
Private: Health insurance, Worker's Comp (state regulated).
Coding Systems: ICD-9-CM (Diagnosis), DSM-IV-TR (Mental Health), CPT (Procedure codes).
Accreditation Bodies: TJC (The Joint Commission) and CARF (Commission on Accreditation of Rehabilitation Facilities).
Functional Independence Measure (FIM): Tool for scoring 18 items across self-care, motor, and cognitive domains.