The growth of the profession of occupational therapy

Occupational therapy is a frequently unknown and misunderstood profession. However, occupational therapy practitioners have a rich history in the US Army, from the inception of the profession to current challenges. The article is a chronicle of historical highlights of occupational therapy which discusses how this history is harmonious with that of occupational therapy in the US Army. In researching this topic, several concepts emerged: (1) occupational therapy grew from a belief that people need occupation, or activity, to remain healthy; (2) people learn the best through purposeful activity; (3) the number of occupational therapists in the US Army decreases during peacetime, but in time of war the benefit of this profession is recognized and its numbers increase; (4) although models of health care change, the primary focus of occupational therapy remains constant; and (5) there is a direct correlation between the philosophy of occupational therapy and the philosophy of treating Soldiers with combat stress reactions, a "go-to-war" mission of Army occupational therapy practitioners. As such, the management of these Soldiers is enhanced by the unique skills offered by this profession.

The use of craft activities as an occupational therapy treatment modality in Norway during 1952–1960

The purpose of the present study was to explore the use of craft activities as occupational therapy treatment modalities in Norway during the period 1952-1960. Data were obtained through in-depth interviews with six retired occupational therapists on their experiences in using crafts. Data were analysed through textual analysis and this resulted in four themes: craft activities identified as a therapeutic tool; ambivalence in how to frame the intervention; practice relative to power relationships; and occupational therapists and patients as equals. A limitation of the present study was that participants drew on their screened memories in the context of contemporary practice, which may omit or distort the historical truth. Further research is needed to document the effect of contemporary therapeutic use of craft activities, and to bring forward how occupational therapists and clients value the craft activities of today in the context of their lives.

Changing practice patterns of school-based occupational therapists in Israel

Following the enactment of the Special Education Law in Israel in 1988, school-based occupational therapists (OTs) were expected to modify their practice patterns by, providing services within the classroom or other educational settings, increasing collaboration with other team members, and implementing indirect intervention models such as monitoring and consultation. The purpose of this study was to examine the intervention patterns of school-based OTs in Israel. The study sample included 77 school-based OTs. The survey was carried out through a questionnaire which included: (1) background information, (2) implementation and perceptions towards intervention models, and (3) team-work practices of the OTs. The findings indicated that most of the time (76.9%) OTs still implement the 'direct therapy' model, working outside the classroom and focusing on improving performance components. These findings imply that school-based OTs in Israel are still in the process of changing their practice patterns, and are mostly applying the medical model. However, due to the relatively small sample, it is important to repeat this survey using a larger sample of OTs who work in different settings and with various age groups.

Time, Space, and the Kaleidoscopes of Occupation

Our daily round of occupations occurs within time and space. Our understanding of occupation has traditionally viewed time and space as part of the external environment. Patterns of the “when?” and “where?” of occupations can be described. But relating time and space to the internal experience of occupation reflects more of the meaning to individuals and more complex patterns arise. Like the varied bits of glass in the object case of an art kaleidoscope, the multiple elements of occupation interact. Reflected in mirrors of our choice, we find always-changing, complex patterns of daily occupation. The elements of occupation most important for maintaining or regaining health and the mirrors and lens through which we view occupation historically have formed shifting patterns in occupational therapy, patterns of how we view ourselves, our practice, and those to whom we provide our services. We must combine the science and the art of occupational therapy as the metaphor of the kaleidoscope combines both, producing awe and wonder at the result.

Challenges and Strategic Solutions for a Research Emergent Profession

This paper explores some of the truisms associated with evidence-based practice. The intention is to remind the reader that evidence-based practice is a decision-making tool and not a rule; and to propose a strategic approach to overcoming the challenges we face as a research emergent profession.

Recent advances in physical and occupational therapy for children with cerebral palsy

Recent research and conceptual frameworks that emphasize family centered care and participation in family, school, and community life have contributed to advances in provision of health care by physical therapists and occupational therapists to children with cerebral palsy (CP) and their families. This article provides a contemporary perspective on physical and occupational therapy for children with CP. Topics include conceptual frameworks, early identification, prognosis for gross motor function, implications of impairment in motor control and muscle performance, and physical fitness and secondary prevention. Case scenarios and examples illustrate how current knowledge and research is applied to decision making within the context of the individual child and family.

Occupation reconsidered

The current article delineates the need for the profession of occupational therapy to maintain relevance and be responsive to current trends. As part of such responsivity, this article proposes a reconsideration of the concept of occupation as an 'adaptive response' to the current societal need for clarification regarding occupational therapy. Reconsideration of what is meant by occupation for general use is discussed and illustrated by the ambiguous use of the term occupation as both a means and an end. Although occupational therapists are comfortable with such ambiguous use because of their apparent ease with complexity, use of the term in an ambiguous manner makes it harder for society to understand what is meant by occupation. Related to this, an annotation of literature on the definitions of occupation is presented in summary form. Furthermore, the political need to reconsider the term occupation is argued in light of the revision of International Classification of Functioning, Disability and Health (ICF), which includes the use of the word activity. Finally, this article proposes that occupation should be considered as the process of doing with meaning, and that activity should be the outcome. Such reconsideration renders us consistent with ICF and paves the way to reduce ambiguity in the use of the term occupation with the general public.

Weighted Wrist Cuffs for Tremor Reduction During Eating in Adults With Static Brain Lesions

OBJECTIVE. This study examined whether weighting the forearm during feeding decreased tremors and increased functional feeding in adults with intention tremor caused by static brain lesions.

METHOD. Five individuals with various diagnoses, ages 30–81, were videotaped during 8 or 16 meal sessions, alternating treatment and control conditions within each meal. In this single-case design, treatment consisted of application of a weighted fabric wrist cuff and the baseline (control) condition employed an identical cuff with the weights removed. Dependent variables studied were time to acquire and deliver a bite, grams of food eaten, number of times food was spilled, number of times a compensatory technique was used, participant self-rating, and investigator rating of the severity of the tremor.

RESULTS. All five participants demonstrated improvement during treatment in one or more of the dependent variables. t Tests of the means of baseline and treatment half-sessions incorporating conservative control of Type I error revealed the following statistically significant improvements under the weighted condition: Participants 3, 4, and 5 took less time to acquire a bite; Participants 4 and 5 made fewer spills; Participants 3 and 5 showed a diminished tremor. There were no statistically significant decreases in function on any variable for any participants during the weighted condition.

CONCLUSION. The application of weight to the wrist of a person with upper-extremity tremor is accompanied by some functional improvement in self-feeding for some individuals. The size of benefit seems to be sensitive to the amount of weight used.

Changing times: trials and tribulations of the move to Master's entry-level education in Canada

BACKGROUND

Most health care professions are reviewing issues related to the changing nature of professional education and practice. Social work, physical therapy, speech-language pathology, audiology, and recently occupational therapy, have raised the entry-level training requirements to the graduate level to enhance formal education programs.

PURPOSE AND SCOPE

In the past few years, this trend has generated considerable debate and discussion within the occupational therapy profession both in Canada and internationally. In November, 2001 the Canadian Association of Occupational Therapists (CAOT) announced that Canadian universities must convert to entry-level Master's programs by 2008 to receive re-accreditation (CAOT, 2002a). This paper describes the historical evolution of Canadian occupational therapy education, outlines several issues within occupational therapy that are impacting the move, and discusses benefits and challenges to Master's level training.

PRACTICE IMPLICATIONS

Recommendations are presented for the development of Master's entry-level occupational therapy training programs in Canada.

Professional tensions in client-centered practice: using institutional ethnography to generate understanding and transformation

For almost 20 years, occupational therapists have advocated client-centered practice. Yet client-centered practice is fraught with tensions that arise outside the practice of individual occupational therapists. This paper is guided by two questions: What produces professional tensions in client-centered practice? and What understanding and change might be generated using institutional ethnography? The sociological theory and method of institutional ethnography are described using data from an ongoing investigation of mental health services as a social institution. Illustrated are the research aim, research questions, and institutional analysis that distinguish institutional ethnography from conventional ethnography. Two professional tensions are associated with attempts to fulfill client-centered practice in mental health. One is that of working at cross-purposes with the prevailing hierarchical structure; the other tension is that of being celebrated yet subordinated in the medical and management hierarchies of health services. Although client-centered practice is difficult to do, the authors recommend institutional ethnography as a research approach to generate understanding and transformation of the context and practice of occupational therapy.

Professional accountability in restructured contexts of occupational therapy practice

Professional standards for accountability establish essential competencies for clinical practices and provide strategies for professional advancement. This study examines the perspectives of a sample of occupational therapists on their capacity to engage in continuing education, to provide evidence-based practices and to have confidence in the effectiveness of available quality assurance mechanisms within restructured contexts of occupational therapy practice. The analysis of in-depth interviews with participants from program management, managed competition and private practice suggested three urgent needs: the development of strategies to assist therapists' translation of research evidence into clinical practices, research to determine the effectiveness of models of professional leadership within the workplace that promote professional accountability and alliances to advance policies that eliminate workplace barriers to professional accountability.