Occupational therapy and rehabilitation: an awkward alliance

Occupational therapy's oversight: How science veiled our humanity

BACKGROUND

Occupational therapy's connection to positivist science predates the profession's formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being.

AIMS/OBJECTIVES

This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession's preoccupation with positivist science has obscured.

METHODS

This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time.

CONCLUSION

Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm.

SIGNIFICANCE

The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

Gross and applied anatomy pedagogical approaches in occupational therapy education: protocol for a scoping review

INTRODUCTION

Historically, dissection is considered the 'gold standard' for teaching foundational anatomy to student occupational therapists. However, many programmes no longer have access to gross anatomy laboratory resources, as it is considered too costly. To address this limitation, applied anatomy instructors have developed innovative novel approaches to teach gross and applied anatomy to student occupational therapists, including live/surface anatomy, medical imaging, and more recently, computer-aided instruction. The types of different anatomy pedagogical approaches used and their impact on learning outcomes in occupational therapy education are unclear. The purpose of this scoping review is to map the types of musculoskeletal gross and applied anatomy pedagogical approaches used in occupational therapy curricula.

METHODS AND ANALYSIS

Using Arksey and O'Malley's (2005) six-stage scoping review framework, approximately 304 different search combinations will be searched across five electronic library databases (ie, MEDLINE, Embase, CINAHL, AMED and ERIC) from their inception to December 2021, in addition to conducting consultation exercises with relevant stakeholders. After title/abstract and full-text screening, included articles will be charted, collated and summarised.

ETHICS AND DISSEMINATION

This study will not involve human or animal subjects. Therefore, research ethics approval is not required. The proposed scoping review will help the research, institutional and clinical rehabilitation communities to better understand the types of musculoskeletal gross and applied anatomy pedagogical approaches used to foster, build and promote musculoskeletal foundational knowledge in occupational therapy education. This could potentially inform the future physical medicine course curricula in occupational therapy programmes. The findings of this review will be disseminated to occupational therapy instructors, occupational therapists, researchers and organisations offering occupational therapy programmes (eg, Universities).

Looking Back to Move Forward: Canadian Occupational Therapy In Public Health, 1914-2019

BACKGROUND.

Decades of literature demonstrate that occupational therapy is well-suited to collaborate with public health due to overlapping views of health. However, there has been little collaboration between these professions with few examinations of why they remain distinct.

PURPOSE.

This study examines historical events that have led to the present-day separation of occupational therapy and public health.

METHOD.

This narrative review and thematic analysis of the scholarly, archival, and grey literature was conducted to examine the development of both fields.

FINDINGS.

Fifty texts were analyzed revealing four themes: the influence of structural and social forces; professional, societal, and institutional hindrances; potential for a shared vision; and next steps for integration. These themes highlight historical barriers to collaboration and provide evidence that occupational therapy could benefit public health.

IMPLICATIONS.

Collaboration between occupational therapy and public health has many potential benefits, however new approaches to bridge the divide are needed to advance collaboration.

Developing occupational therapy students' information and historical literacy competencies: an interprofessional collaborative project

OBJECTIVE

The study examined the efficacy of an interprofessional information and historical literacy project implemented by an occupational therapy educator and a librarian.

METHODS

A graduate course was revised to include information and historical literacy objectives and instruction. A course-specific questionnaire administered on the first and last day of class, assignment grades, and course evaluations provided measures of project outcomes for six years. Differences between questionnaire pre- and post-test means were determined using t-tests. Course evaluation comments were analyzed to obtain qualitative perceptions.

RESULTS

A significant difference (p<0.0001) was found between pre-test (M=3.93, SD=0.48) and post-test (M=4.67, SD=0.30) scores of total information and historical literacy competence across all years (n=242). Responses to individual items also differed significantly (p<0.0001). Student ratings (n=189) from the course evaluation historical literacy objectives were high (M=4.6 on a 5-point scale). Assignment quality and grades improved, and course evaluation comments reflected student satisfaction.

CONCLUSIONS

The findings supported the hypothesis that students' self-reported information and historical literacy competencies would increase after project participation. Acquired skills were evident in students' assignments. Research to determine if these capabilities were used post-graduation is needed. Because this was a course-specific project, findings are not generalizable; however, the instructional methods developed for this project can serve as a model for effective interprofessional collaboration. The broadening of information literacy instruction to include discipline-specific historical literacy provides a unique opportunity for health sciences librarians and educators. Developing students' historical literacy in their chosen fields can help them understand their profession's present status and be informed participants in shaping its future.

Justice and U.S. Occupational Therapy Practice: A Relationship 100 Years in the Making

At 99 years old, occupational therapy is a global health care profession with a growing orientation toward justice. Because much of the occupational justice discourse has developed outside the United States, parallels between the profession's ethos and its current focus on justice must be examined more closely in this country. Although occupational therapy practitioners in the United States are better equipped than their predecessors with language and theories that explicitly emphasize justice, the potential for bringing that focus to bear depends on practitioners' willingness to think differently about their practices. We argue that a focus on justice can be naturally integrated with curriculum standards by emphasizing the link between cultural humility, client-centeredness, and embodied habits of "seeking out unknown others." Outside formal education, practitioners can be encouraged to think of justice as something that already intersects with practice, not something that practitioners must choose whether to take up.

Thomas Bessell Kidner and the Development of Occupational Therapy in the United Kingdom: Establishing the Links

This historical research describes the life and work of Thomas Bessell Kidner (1866-1932). The purpose of the article is threefold: to describe Kidner's British heritage, to suggest how Kidner's background may have influenced his contributions to the early development of the profession, and to examine how Kidner's contributions have influenced practice. Using methods appropriate to interpretive biography, primary and secondary source materials have been gathered and analysed relating to Kidner's education and early work experiences in England; his work in Canada, teaching manual training and as Vocational Secretary during the First World War; and his time in the United States, with particular reference to his role with the American Occupational Therapy Association.

The analysis suggests that Kidner brought the ideology of educational reform, as manifested in manual training, into occupational therapy and that this work provided a foundation for his approach to the treatment of injured soldiers. Kidner's efforts to help the profession to survive and expand after the war, with the consequent alignment with medicine, are also highlighted. His contact with the profession and with key individuals, such as Elizabeth Casson, in the United Kingdom is also explored. Finally, Kidner's contributions are considered in the light of how the profession might have developed had circumstances been different.

Mapping the Evolving Ideas of Occupational Justice

The values of occupational therapy are grounded in justice, and its origins in activism and advocacy. Enabling individuals to participate in meaningful occupations to enhance health and well-being was the genesis of the profession that answered a call to justice. Occupational science brought focus to understand humans as occupational beings and made justice more visible in the discourse. A systematic mapping review was undertaken to deconstruct how notions of occupational justice (OJ) have been woven in the literature. The ideas of OJ were dominant in 40 out of the 120 articles that met the study’s inclusion criteria. OJ was represented mainly in the context of disadvantaged groups and dissonance in practice. For OJ to influence policy, the focus on the individuals’ experiences of occupational injustices must be seen as transacting with systems and policies that contribute to participation inequities in groups and populations.

Epistemological Transformation in Occupational Therapy: Educational Implications and Challenges

An epistemological analysis of occupational therapy's history opens a novel perspective on the field's evolution and on important changes facing education and practice. Kegan's theory of epistemological transformation (e.g., how ways of knowing evolve) was used as an analytic tool to reexamine mostly secondary and some primary historical sources. Although the profession's history is often portrayed in terms of large and sweeping changes, this analysis suggests that little change occurred in occupational therapy's epistemology, making it difficult for the profession to become self-defined or easily adopt occupation, participation, and health as a focus for practice, education, and research. It is also suggested that recent developments in the field are at their core epistemological developments and serve as indicators that a new way of knowing has emerged in occupational therapy that is making new demands of practitioners and educators. Further, epistemological developments can help evaluate common educational assumptions and frame new educational approaches.

Comparing and Using Occupation-Focused Models

As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.

The intermingled history of occupational therapy and anatomical education: A retrospective exploration

Few research articles have addressed the anatomical needs of entry-level occupational therapy students. Given this paucity of empirical evidence, there is a lack of knowledge regarding anatomical education in occupational therapy. This article will primarily serve as a retrospective look at the inclusion of anatomical education in the occupational therapy curriculum. Focusing on the historical inclusion is the first step to address the gap in existing knowledge. Examining the history of anatomy in occupational therapy provides an educational context for curricular developments and helps current anatomical educators understand the evolution of occupational therapy as a profession. Exploring the educational history also offers anatomy educators an identity, as significant contributors, in the training and preparedness of entry-level professionals while focusing on the ideals of occupational therapy. However, there is a critical need for empirical evidence of best teaching practices in occupational therapy and anatomical education. This manuscript provides a foundation and a starting point for further investigation into the anatomical competencies for entry-level occupational therapists.

Factors that influence the professional resilience of occupational therapists in mental health practice

BACKGROUND/AIM

Mental health practice can create challenging environments for occupational therapists. This study explores the dynamic processes involved in the development and maintenance of professional resilience of experienced mental health occupational therapy practitioners. It presents the PRIOrity model that summarises the dynamic relationship between professional resilience, professional identity and occupation-based practice.

METHODS

A narrative inquiry methodology with two phases of interviews was used to collect the data from nine experienced mental health practitioners. Narrative thematic analysis was used to interpret the data.

RESULTS

Professional resilience was linked to: (i) professional identity which tended to be negatively influenced in contexts dominated by biomedical models and psychological theories; (ii) expectations on occupational therapists to work outside their professional domains and use generic knowledge; and (iii) lack of validation of occupation-focussed practice. Professional resilience was sustained by strategies that maintained participants' professional identity. These strategies included seeking 'good' supervision, establishing support networks and finding a job that allowed a match between valued knowledge and opportunities to use it in practice.

CONCLUSION

For occupational therapists professional resilience is sustained and enhanced by a strong professional identity and valuing an occupational perspective of health. Strategies that encourage reflection on the theoretical knowledge underpinning practice can sustain resilience. These include supervision, in-service meetings and informal socialisation. Further research is required into the role discipline-specific theories play in sustaining professional values and identity. The development of strategies to enhance occupational therapists' professional resilience may assist in the retention of occupational therapists in the mental health workforce.

Beyond Dressing and Driving: Using Occupation to Facilitate Community Integration in Neurorehabilitation

During the process of community integration, individuals with acquired brain injury may experience difficulties in all areas of occupational performance including self-care, home management, community access, leisure, social activities and vocational pursuits. Community based rehabilitation services provide opportunities to minimise such difficulties by working with clients as they engage in meaningful real-life context-based occupations. The therapeutic use of occupation is at the core of occupational therapy practice. We reflect on the nature and principles of occupation and highlight particular benefits for facilitating community integration after brain injury. This is illustrated using the example of executive dysfunction. Several challenges for the occupational therapy profession arise from the shift in focus from hospital to community based rehabilitation, and the need for further research on community integration after brain injury from an occupational perspective is recognised.

Governing the Majority World? Critical reflections on the role of occupation technology in international contexts

BACKGROUND

Within occupational therapy, increasing attention has been focussed on international development work. However, many have critiqued the focus of knowledge development within occupational therapy and occupational science, arguing that it is focussed on Western values. Questions arise about how occupational therapy and occupational science, and the knowledge and therapeutic technologies that are associated with these communities, will affect the 'developing' world, which, recently, some have described as the Majority World.

AIM AND METHOD

Using Foucauldian analytical tools, this paper reflects on specific discourses that are foundational for development work. Specifically, this paper attempts to better understand how concepts like 'occupational justice' and the 'occupational being' are presented in the literature and relate to practices in international contexts. Within this analysis, attention is focussed on how practices associated with occupational development work might also be enmeshed in power dynamics.

RESULTS

  This paper outlines how occupational discourses may shape and order life in particular ways and challenges researchers and practitioners to develop a better understanding of how power can operate through occupational discourses and occupational therapy practices. This paper also adds to the literature through the interpretation and explication of various theories that may underpin work in international contexts.

CONCLUSIONS/FUTURE DIRECTIONS

Suggestions for future directions that will enable the development of more politically and culturally sensitive knowledge and practices are also explored. It is crucial that as a community we become more aware of how our theoretical frameworks may impact and shape practice.

Understanding ‘Independence’: Perspectives of occupational therapists

PURPOSE

The purpose of this study was to understand how the term independence is used in rehabilitation. In particular, we asked occupational therapists in Canada and Japan to interpret the term independence in terms of people with disabilities. In rehabilitation, independence has long been a key concept. A review of the literature shows that the term's meaning has shifted throughout the past century. However, despite its significance, the word's meaning has never been deeply analysed, and it is left to the interpretation of the individual practitioner; consequently, there is a conceptual confusion surrounding the term. Furthermore, no studies have been conducted from an inter-cultural viewpoint that included non-Western societies.

METHOD

A qualitative interpretive study was conducted, based on semi-structured interviews with 18 occupational therapists. Nine Canadian and nine Japanese therapists were interviewed in depth and their perspectives analysed for themes and categories corresponding to their working definition of independence.

RESULTS

Therapists' interpretation of the term independence consisted of three perspectives: "Independence as competence,""Independence as autonomy," and "Independence as psychological qualities". These perspectives were typically combined into two patterns of dealing with independence in practice. Differences between Canadian and Japanese perspectives were explored.

CONCLUSIONS

The study's findings confirm some ideas about independence that have been pointed out in the professional literature, but they also add several important ideas - the idea of psychological characteristics as key to independence, and the notion of a cultural overlay on the definition and application of the concept independence. This study's findings should contribute to the ongoing discussion in the professional literature about the virtues and limitations of pursuing independence as the ultimate goal in rehabilitation.

The history of occupational therapy assistants in Canada: a comparison with the United States

In the middle of the twentieth century, the role of occupational therapy assistant was introduced in North America. Although the role, utilization and training of assistant personnel have raised much controversy and debate within the profession, Canada and the United States have taken very different paths in terms of dealing with these issues. This paper focuses on the history of occupational therapy assistants in Canada, using the experience in the United States for comparison purposes. The occupational therapy literature and official documents of the professional associations are used to present a chronology of major historical events in both countries. Similarities and differences emerge in relation to historical roots; training model and standards of education; certification, regulation, and standards of practice; career laddering and career mobility; and professional affiliation. The paper concludes with a summary of issues which require further exploration, debate and resolution if the profession is to move forward in Canada.

Cultural relativism: occupation and independence reconsidered

In this article, findings from a qualitative study of a cohort of occupational therapy students in Auckland, New Zealand are presented. The study focussed on the experiences of students as they learned to work with people from different social and cultural backgrounds over a 3-year period. As well as identifying curriculum and teaching/learning processes that enhance intercultural competence development, the data that emerged from the study also highlight important issues about how occupation and independence are conceptualised across cultures. A review of the trans-disciplinary and occupational therapy literature dealing with theoretical, conceptual and educational issues relating to cross-cultural practice is followed by a presentation of narrative extracts that address the key concepts of occupation and independence. These are then discussed with reference to relevant occupational therapy literature. In conclusion, implications for future research and practice are explored focussing on a need for occupation and independence to be reconsidered as culturally relative constructions.