Occupational therapy is the holistic health profession that works with individuals to attain, restore, and maintain function in daily life activities and meaningful life roles such as student, homemaker, hobbyist, and worker. The word “occupation” in the context of occupational therapy refers to activities that are valued by that individual in his or her culture. Areas of occupation include activities of daily living (grooming, dressing, eating); instrumental activities of daily living (financial, household, and health management); work (job performance, volunteering); social participation (family, friends, community); education; play; and leisure.
As a profession established in 1915, the first occupational therapists were women, a trend that continues today with 90% of women in the workforce. As of December 31, 2002, there were 104,741 registered occupational therapists (OTRs) and 43,019 certified occupational therapy assistants (COTAs). Ninety percent of OTRs and 89% of COTAs are women. Occupational therapists treat a variety of human conditions and are found in diverse practice areas such as mental health, rehabilitation, schools, home health care, nursing homes, pediatrics, outpatient, community/day treatment, hospice, teaching, management, and research. Therapists can be self-employed contracting their services and/or providing staff to facilities needing occupational therapy. Those with entrepreneurial aspirations can find new niches for occupational therapy to benefit populations either underserved or not yet identified. Work in these settings can provide flexibility in work hours beneficial to women with other responsibilities and roles.
The profession of occupational therapy has two classifications of therapists: OTRs and COTAs. OTRs must graduate from an accredited master’s or doctoral program in occupational therapy, successfully complete a minimum of 24 weeks of supervised fieldwork experience, and pass the national certification exam. COTAs work under the supervision of the occupational therapist, must graduate from an accredited associate’s degree or certificate program in occupational therapy, successfully complete 16 weeks of supervised fieldwork experience, and pass the national certification exam.
Educational programs for both the occupational therapist and occupational therapist assistant include the following: biological, behavioral, and health sciences, human development, anatomy, pathology, activity analysis, health policy, reimbursement, and ethics. Occupational therapist programs emphasize physiology, kinesiology, the neurosciences, occupational therapy theory, evaluation, and research. Assistant programs emphasize occupational therapy skills and treatment. Occupational therapists evaluate, establish, and implement treatment programs. The occupational therapy assistant focuses on the implementation of the treatment.
The fieldwork experience is designed to blend theory and practice. These integrated experiences promote clinical reasoning and the development of a repertoire of clinical skills.
Upon passing the national certification exam, occupational therapists are registered and assistants are certified. If working in the United States, they must adhere to licensure laws regulating the practice of occupational therapy, which vary from state to state.
In most instances the process of occupational therapy begins with a referral from a physician. The referred individual is first interviewed and evaluated. The evaluation gives the therapist an understanding of the individual’s experience, builds a therapeutic relationship, identifies strengths and limitations, defines what the individual feels is important regarding goals, and establishes treatment priorities. Evaluations assess areas of occupation and performance components (motor, process, and psychosocial skills needed to do daily activities). Motor skills include muscle strength, joint range of motion, sensation, balance, mobility, and coordination. Process skills include concentration, problem solving, judgment, and memory. Psychosocial skills include reality testing, orientation, coping skills, and self-esteem.
After the initial occupational therapy evaluation, goals are established collaboratively with the individual and their significant others. Treatment interventions are identified and implemented. Clients can be seen individually or in group treatment sessions. Examples of diagnoses and treatment include the following:
|Stroke||Increase coordination and balance for grooming|
|Hip replacement||Adaptive equipment training to simplify self-care|
|Hand injury||Purposeful activities to improve range of motion|
|Chemical dependency||Explore healthy leisure pursuits to structure time|
|Mental retardation||Practice and simulation of job performance activities|
|Chronic pain||Biofeedback techniques to better manage pain|
|Depression||Coping, stress management, and assertiveness training|
|Dementia||Adapt the environment to help orient the individual|
|Pediatric||Play activities that promote balance and coordination|
|Learning disabilities||Adaptive techniques to enhance the educational process|
The occupational therapy treatment plan may warrant more extensive testing. Occupational therapy assessments can help clarify diagnoses and aid in determining legal issues such as competency, guardianship, and placement. The data and recommendations of an occupational therapist can more clearly identify functional abilities and illuminate appropriate options to pursue.
Throughout treatment the occupational therapist monitors and reassesses the individual’s response to treatment and documents progress in accordance with regulatory agencies to ensure reimbursement by third-party payers. Communication with team members (physician, nurse, social worker, physical therapist), the patient, family, or caregivers is important in developing appropriate discharge plans to maintain and promote wellness.
Helping individuals achieve optimal function and satisfaction in their life roles is the unique ability of occupational therapists.