Socrates & Plato

Body and Mind connection

- Modern Roots of OT

-OT orginiated in the 1700s.

-OT originated during Europes "Age of Enlightment"

-Mentally ill patients were excluded from work activites.

-mentally ill people were treated like criminals and locked in prisons.

Pinel uses OT in Paris.

Willian Tuke- England

-French Physican

-treated mentally ill patients and their emotions.

-Began Moral treatment

-First used OT in Paris

-went from 1786 through 1860

-moral treatment ended when industrial revoulation began.

-consisted of:

       -utilization of occupation.

       -man's goals directed use of time, intrests, energy and attention.

      - in combination with purposeful daily activity for treatment.

-A Quaker

-Appalled at the inhumane treatment

-kindness and consideration

-concept of religion

-occupations and purposeful activities.

1789

-Samuel Tuke used Moral treatment in the US

-"humanitarism"

-Stressed Moral Behavior during this time

Arts and Crafts movement begins

John Ruskin (philospher)

-Arts and Crafts movement begins.

-the civil war was during this time and there were many injured soilders as a result and increase in the influence of Rehab.  

-Still in the arts and crafts movement era

-Hull House was founded. AKA healing houses places of refuge, not run by medical professionals.

-Place of refuge for people with disabilites, not run by medical professionals.

-it was a place where people went to do crafts and get a sense of life outside of the industrial revolution.

NSPOT founded.

this was the first name of OT.

National Society for the promotion of OT.

OTs grew with expanding hospitals.

Alot of practice comes from Mental Health

Archives of OT.

Began Publishing literature about OT.

moral treatment Era

Problem:

-A response to the way that mental health patients were being treated.

-The people that were being treated was wrong and this treatment developed in a way to change the way that people were previously being treated.

-the treatment was more morally and humanistic.

Mechanistic.

Machines were taking over peoples jobs.

late 1700s-early 1800s

Response to the industrial revolution.

to bring back hand made work and move away from the factories and machines.

First OT

orignially a nurse, but worked with TB patients.

Began to do arts and crafts with the patients

Wrote some of the first OT books.

Realized that activites needed to have a purpose: "A need to adapt the occupation to the conditon." & "Selection of an occupation that suited the patients needs."

-Go to france for OTs.

Called reconstruction Aides because the army did not have a classification for them.

Much stronger role for Rehab Services.

there was much more of a demand for all types of services.

-Highest award that you can be awarded in the profession.

-Established Habit training classes.

-She was concerned about the idlenss of patients in hospitals.

-Developed Habitat Training: Work, selfcare. designed by her and Dr. Adolph Meyer.

-Founder and Leader in OT.

-Only person to hold all offices in the American Occupational Therapy Association.

-Interested in the use of occupations as treatment b/c of his own handicap.

-TB amputee, paralysis of L side.

-1914 Consolation House

-first president of the OT association

-believed in the holistic part of practice: mind, body and soul.

-wrote and lectured about the use of occupations for invalids.

-noticed that patients did better with something to do.

-knew that the activity needed to have a purpose/ no earning but a purpose in doing the activity.

-Started to name Advanced nurses as therapists.

-School, workshop, and vocational center for convalescents.

-Dr.'s began to refer patients here.

-Developed by George Barton

-Arts and Crafts teacher at ah H.S

-influential in establishing minimal standards for educational programs in OT.

-taught and directed OT in nursing progams.

-combined teaching and nursing aspects.

-created a set of standards/statments stating what students must know when they are done with the OT program.

-used arts and crafts to help people develop things to do with their hands. Can be considered, "first hand therapist."

-in 1917 he came to the US to Federal Board for Vocational Education to provide Vocational education and training to returining soilders from war.

1920: Industrial Rehabilitation Act

Thomas Bessell Kidner

-theory is a body of knowledge that is related to OT.

-theories started developing that was specific to OT was in the late 60s.

-recognizable characteristic.

-consistent view and meaning of their work.

-present ourselves as a particular type of professional.

-inside identity is competence.

-things that specificially identify a person.

-the skills and knowledge that we have as a OT.

-competence is made up of knowledge.

-ability

-being able to identify and understand certain problems.

-enables us to offer similiar services in a variety of circumstances.

1. paradigm

2.conceptual practice models

3. related knowledge

-knowledge that is borrowed from other fields. applying the knowledge that we borrow is how we turn it into OT.

-final layer of knowledge, surrounds the conceptual practice models.

-collection of concepts, facts, and techniques from other fields that practitioners use to supplement unique OT knowledge.

-the core, the center.

-the field's innermost core of knowledge in that it directly addresses the identity of OT.

-this third type of knowledge surrounds the paradigm.

-provides the unique concepts, evidence, and resources that OT use in their practice.

-takes diverse ideas and brings them into a more specific type of theory.

-provides a rational and helps guide our practice.

conceptual foundations

-collective knowledge and know-how

-the professional culture of the field.

-beliefs, assumptions, values, concepts, and techniques.

-sometimes there is a disconnect between the theory and the practice.

-as you go through practice you rely on experience, common sense, and your base of skills.

-theory is not always current with practice.

-theory may not address all situations, problems encountered in practice.

-practitioners do not keep current with changes in theory.

-theory is changing alot and more research is being created to back up the information.

-theory is thinking and framing the situations.

-problematic that research is not used enough, which is why evidence-based practice is being pushed so much.

-theorists/researcher and practitioners together generate knowledge about what can/should be done in practice.

-ideally practitioners and theorist work together.

-practitioners distinguish the areas where new theories and research is needed.

1.core constructs

2. focal viewpoint

3. values.

*these three parts individually and collectively make sense of OTs profession and its practice.*

-core constructs define the nature of the field's service.

-provides a understanding of why the service is needed,the kinds of problems that the service addresses, and how it solves those problems.

-improves peoples functions

-deals with overall well-being and health.

-increases peoples independence.

-problems that people may have about being indpendent.

-if the OT is not able to help with a problem, it is important to identify other resources and refer patients out.

-help patients progess and keep them active and moving.

-help patients adapt to their environment with adaptations and assistive technologies.

-deals with specific ways of insurance reimbursement and explains how OT is different than PT.

-must be able to distinguish the two to insurance companies. what is the nature of the service that we are providing.

core constructs is made up of

1. the human need served

2. the kinds of problems that are solved.

3. the nature of the service.

focal viewpoint is made up of

1. way of thinking about the world.

2. frames the knowledge of the field.

-how we view the world as an OT

-helps us frame the knowledge that we have in our field.

-emphasize what we think is important.

-what we think is important is considering the quality of life that people have to engage in their everyday activities. if everyday activities are disrupted; their QOL gets impacted.

-injury disrupts ways to engage in occupation.

-what we define as what an Ot does.

-changes over time.

-what the OT professionals use to define their own practice.

- government or business driven.

-driven by the professional definitions; which are defnitions that people use for reimbursement purposes or to decide if whether or not you are practicing within your scope of practice.

-skillsed treament that helps individuals achieve independece in all facets of their lives.

-assists people in developing the skills that are necessary for living as independent and satisfying lives as possible. this is an example of a consumer definition.

"the practice of OT means the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of participation in roles and situations in home, school, workpace, community, and other settings.

-first state to ever have OT licensure was FL.

-definitions for AOTA guide practice but are not legal documents.

-OT services are provided for the purpose of promotiong health and wellness and to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction.

-OT addresses the physical, cognitive, psychosocial, sensory, and other aspects of performance in a variety of contexts to support engagment in everyday life activities that affect health, well-being and QOL.

a. methods or strategies selected to direct the process of interventions.

b. evaluation of factors affecting activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, lesisure, and social participation.

c. interventions and procedures to promote or enhance safety and performance of ADLs, IADLs, education, work, play, leisure, ane social participation

Methods or strategies selected to direct the process of interventions

1. establishment, remediation, or restoration of a skill or ability that has not yet developed or is impaired. (ability that is not yet developed applies to children)

2. Compenstation, modificiation, or adapation or activity or environment to enhance performance.

3. maintance ane enhancement of capabilities without which performance in everyday life activities would decline. (this would apply to the elderly or long-term care facilities that focus on long-term wellness.)

4. health promotion and wellness to enable or enhance performance in everyday life activities.

5. prevention of barriers to performance, including disability prevention.

-factors that affect ADLs, IADLs, education, work, play, leisure and social particpation.

1.client factors, including body functions (such as neuromusclar, sensory, visual, perceptual, cognitive) and body structures (such as cardiovascular, digestive, itegumentary, genitourinary systems)

2. habits, routines, roles and behavior patterns. (teens get disrupted when something happens out of routine.)

3. cultural, physical, environmental, social, and spiritual contexts and activity demands that affect performance. (look at performance components that are affected.)

4. performance skills, including motor, process, and communication/interaction skills.  (upper extremity injuries are considered performance skills. )

Florida OT Practice Act

"Occupational Therapy"

- OT means the use of purposeful activity or intervfentions to achieve functional outcomes. (this definition defines what we can do in the state of Florida)

-(when language gets moved in the Florida practice act it becomes legislative law, if you want to change some of the words you must open your practice act but it leaves room for other professions to come in and say what they object too.)  

Florida OT Practice Act

"Achieving Functional outcomes"

Florida OT practice Act

"Assessment"

Florida OT Practice Act

OT Services include, but are not limited to:

1. the assesement, treatment and education of or consulation with the indvidual, family, or other persons.

2. interventions directed toward developing daily living skills, work readiness or work performance, play skills or leisure capacities, or enhancing educational performance skills.

3. providing for the development of sensory-motor, perceptual, or neuromuscular functioning, range of motion, or emotional, motivational, cognitive, or psychosocial components of performance.

- OT is the use of purposeful activity or interventions to achieve functional outcomes by maximizing the independence and maintaince of health of any individual.

-services include evaluation and treatment to prevent or correct physical and emotional deficits.

- children and youth

-health and wellness

-mental health

-productive aging

-rehabilitation, disability, and participation

-work and industry

(the above areas are current practice areas of OT)

2003- board approves plan

2004-scenarios developed

2005- extensive national dialouge

2006- strategic visioning retreat

powerful

(centennial vision statement)

- leadership role in health care delivery system

-education as basis for power

-active in policymaking

-use of technology to provide services

-influence cahnge to benefit society

-proliferation of private-pay practices

Widely recognized

(centennial vision statement)

-clear, compelling public image

-consumer friendly language

-widespread understanding of OT

-OT identity and scope protected by law

-value of occupation to health and wellnss recognized by society

-increased OT consumer demand.

-always drivers of change in the environment; either external or internal.

-the drivers of change were pinpointed during the strategic planning.

- technology

-demographics

-health care

-unpredictable events

-catastrophic illness/disbility

- brand the profession with a unifying and widely appealing image to promote a understanding of OT

-increase understanding of OT and use of OT

-promote events: OT month=OT as a career

-expand public policy agendy to include:

1. mental health 2. research promotion 3. private payers 4. veterns, defense.

-protect, expand state licensure laws and regulations

-protect, expand use of OT

-enable members to advocate. (medicare coverage advocacy packet & private practice establishment packet)

Linkages between reserach, education, and practice

PROGRESS: Key findings

1. promoting practice scholarships with all members of the profession is key to addressing the charge.

2. indentified that scholarship and lifelong learning are not the exclusive domain of academics and researchers.

3. for the profession to continue to thrive and meet the centennial vision, we must recognize schoarship as key role of the practice, education, and research communities.

- collaborate with AOTF and global partners

-examine priorities of key federal funding agencies.

-leadership development initiative (cultivate academci leaders in research)

-Key initative: to raise the bar of excellence among our educational programs

-establish consistency in OT education and training

-Adequately prepare OT practitioners for the 21st century

-Infuse curriculum with new content related to the vision.

-can be considered the first theorist, focused mostly on mental health.

-beleived that purposeful planned activity is the very core of the OT therapeutic process. looking at how we interact witht he environment and how the environment effects us.

non-human environment and object relations

(Gail Fidler)

communication process

(Gail Fidler)

-activity serves as a way to express thoughts and feelings nonverbally.

-actions may express unconscious thoughts.

-disruptions of routines may upset people; try and understand what is important to the person so that it can help them better in therapy.

-mediate the persons inner feelings and the outer world.

-actions express our feelings

Activity analysis

(Gail Fidler)

Competence and Mastery

(Gail Fidler)

-facilitated by "doing"

-we have a sense of competency and mastery in our environment.

-humans strive for competency and mastery.

Doing

(Gail Fidler)

- connotes performing, producing, or causing purposful action in order to:

1. test a skill.

2. clarify a relationship

3. create and end product

integrative process

(Gail Fidler)

-specific actions of an activity or task elicit distinguishable and measurable sensory integrative, motor, cognitive, psychological, and social behaviors.

1. activities are an integral part of human development

2. activites represent real life situations

3. valuable and realistic way to acquire or re-develop skills that are necessayr to perform life roles and provide satisfaction.

intervention

(gail Fidler)

- therapeutic relationship of self: Use of actions that will help the patient

2. group work: important social roles and behaviors are learned in a group.

3. rehabiltative process

Rehabilitative process

(3rd step in the intervention process. Gail Fidler)

a. activities are used to explore and express the unconscious, provide gratificiation of needs, teach adaptive ego defenses and functional skills, provide a base for reality testing, and explore interpersonal relationships.

b. sustain or protext intact functions and abilities, prevent further disability

c. enhance, promote work skills and habits, teach independent  ADL function

Summary

(Gail fidler)

1. the human need to be competent and to achieve

2. the development aspects of work and play

3. the nature of occupational role

4. the relationship of health and human adaptation.

*Human beings have a vital need to produce, to create, to master, and to improve their environment; that is, to be competent and to achieve in their daily occupation.

*human beings need to function in occupational roles, which are the vehicles for competency*

historical contrast

(Mary Reilly)

-her theory is very much against the medical model.

-thought it was great medicine but that our task as an Ot was to help the person after they have dealt with all of their medical problems.

Occupational behavior Defined

(Mary Reilly)

Function

(Mary Reilly)

dysfunction (Mary Reilly)

- lack occupational fulfillment, competency (ability to manage their environment).

-as a result their roles suffer and they are unable to carry out the same things that they did in the past.

change/motivation

(Mary Reilly)

- intrinsic drive to do things.

-using the persons internal resources, interests to moviate them.

-use occupations in the clinic setting to get them to do it in a therapeutic way.

OT Clinical Practice

(Mary Reilly)

ASSESSMENT

1. interview: occupational history, play assessment scales, interest checklist

2. evaluation results: identify patterns of soccuess and failure, learning style, level of function, provide data for plan of treatment.

OT clinical practice

(Mary Reilly)

INTERVENTION STRATEGIES

1. the program should reflect the developmental stages present in the acquistion of life skills.

2. the program should provide natural and legitimate decision making areas for patients.

*she wanted to use occupations as interventions*

3.  the program milieu must acknowledge competencies, arouse curiosities, deepen apprectiation and demand behavior across the full spectrum of human abilities

4. the program must have concerns for work, play, and rest throughout the days, evenings and weekends.

5. the program must provide opportunities for the practicing of life skills in a balanced pattern of daily living which takes into account individual interests and abilites and tailors events to age, sex and occupational roles.

OT Clinical Practice

(Mary Reilly)

 EXPECTED RESULTS

1. learned, relearned or modified life skills

2. increased decision making skills

3. increased a sense of competency

4. developed a balanced daily living pattern within the daily life space

5. developed healthy adaptive behavior.

-OTs first paradigm

- OT founders reapplied moral treatment ideas (the importance of occupation in human life, addressed problems of occupational engagment, and used occupation as a therapeutic measure.)

-drew on disability studies and systems theory.

-interaction of the person, environment and technology

-client-centered.

-increased technology for remediating impairments

-understanding of how body structures influenced performance

-development of device and environmental adaptations

-focused on intrapsychic impairments/conflicts/and psychodymaic conflicts.

-this paradigm occured during the 1940s and 1960s. aka the Rehabilitation movement.

-worked well during this time becasue alot of soilders were returning home from war, more people began to survive diseases and injuries.