Occupational therapy is a holistic, patient-centered, occupation-based approach to life skill development. This health profession helps people whose lives have been altered by physical or mental disease, injury, or other health problems. People of any age can benefit from occupational therapy to prevent injury and improve skills needed to perform everyday tasks or "occupations" at home, work, or school. Examples include activities of daily living such as dialing a phone, using a computer, writing a check, and driving a car.
Occupational therapists first came onto the scene during World War I, when practitioners worked with soldiers suffering from shell shock, amputations, and other injuries. Also in the early 20th century, occupational therapists treated persons with tuberculosis and polio.
Today, the role of occupational therapists is varied and broad. For the last several decades, occupational therapists have treated patients suffering from physical and developmental disabilities such as brain injury, spinal cord injury, repetitive stress injury, stroke, Alzheimer's, diabetes, attention deficit disorder, mental retardation, and Parkinson's, among others. At the turn of the new millennium, however, practitioners began to prove their worth in areas such as vision treatment, mental health, ergonomics consulting, and home modification.
Through activities of daily living (ADL) evaluations, it is determined by the practitioner how independent a client is in performing his or her daily tasks at home, at work, and within his or her social environment. After evaluation, an occupational therapist may implement an intervention to facilitate a more independent lifestyle. The goal of occupational therapy practitioners is to facilitate the patients physical independence. One way that they do this is by implementing exercises that aid in mobility. When a patient has impaired vision, a therapist might analyze lighting and contrast needs in the home, and equip the patient with tools to make the home and work environment more functional. Such tools might include a magnifying glass, or auxiliary lighting. In ergonomics consulting, a therapist might advise businesses and industries about functional and comfortable work stations that minimize repetitive stress injuries caused by repetitive movements, such as typing or assembly line work. Interventions that help patients—such as those with developmental disabilities, or those in mental health settings—to function on a daily basis, such as stress management and communication skills, might also be facilitated by occupational therapists.
Occupational therapy practitioners may work in a variety of settings; the scope of their practice may be vast. Traditional work settings are long-term-care (LTC) and skilled nursing facilities (SNFs), outpatient clinics, and other nursing homes, in which practitioners provide direct care to patients with physical and developmental problems (e.g., arthritis, hand injuries, and dementia). Occupational therapists and occupational therapy assistants have found their place in mental health facilities, home health agencies, and, more recently, communitybased settings and private practice. No matter what the setting in which a practitioner practices, the approach is patient-centered; the patient's needs and the environment
in which the patient lives are considered when developing a treatment plan.
Many occupational therapy practitioners work with children in the school systems. The focus of a therapist in an educational environment may be to implement a handwriting intervention program, with the goal of improving finger dexterity in young children. According to a compensation survey of its members that the American Occupational Therapy Association (AOTA) conducted in 2000, nearly a quarter of members who responded are employed by school systems. Practitioners reported that they are also finding more opportunities in communitybased settings, such as workplace ergonomics consulting and work rehabilitation programs.
Education and training
Current practitioners are credentialed as either occupational therapists, considered professionals after completing an accredited bachelor's degree program, or as occupational therapy assistants, who are considered at the technical level after completing a two-year associate program.
Prior to graduation, students must complete a supervised fieldwork program through their college or university program, and pass a national certification exam administered by the National Board of Certification in Occupational Therapy (NBCOT). The NBCOT is currently developing a recertification program.
The Accreditation Council for Occupational Therapy Education (ACOTE), following a resolution by the AOTA's Representative Assembly, moved to require a master's degree upon entry into the field of occupational therapy. By the year 2007, all educational institutions offering occupational therapy programs must do so under the standards of ACOTE's post-baccalaureate requirements. However, there are many practitioners in the field who have already earned master's and doctorate degrees. As of 2001, the number of practitioners with advanced degrees had nearly doubled (since 1990).
The profession of occupational therapy is regulated in every state; in 43 states, as well as the District of Columbia, Puerto Rico, and Guam, occupational therapists are required to be licensed. Licensure is important because
it defines the scope of practice for therapists and provides guidance to facilities and health care providers on the appropriate application of occupational therapy services.
The field of occupational therapy has been playing catch-up with its allied health counterparts, such as physical therapy and speech–language pathology. More sophisticated and specialized education was necessary for occupational therapists to remain competitive and prove their worth when interacting with consumers and other medical professionals. In the 2001 market, practitioners must be able to employ critical reasoning and develop innovative practice models.
Advanced education and training
Continuing education courses and additional training is necessary for practitioners to remain competent within the field; this must be done on a regular basis. Practitioners can utilize AOTA's continuing education courses, online courses, and annual conference and exposition workshops, as well as educational sessions that are offered by leaders in occupational therapy.
In 2000, AOTA's Council on Continued Competence in Occupational Therapy (CCCOT) implemented the Continuing Competence Plan for Professional Development, a comprehensive plan that guides practitioners in developing and maintaining competent skills. The NBCOT, through which practitioners must become certified and eventually recertify, agreed to work in coordination with the AOTA to develop a recertification program that agrees with the principles set forth in the CCCOT's plan.
As health care delivery has changed dramatically with the advent of managed care, the roles of occupational therapists and occupational therapy assistants have expanded, due mostly in the United States to Medicare provider payment cutbacks mandated by the Balanced Budget Act (BBA) of 1997. Many jobs were cut in SNFs, leaving occupational therapists out of work. This change forced practitioners to consider other markets that might values their services.
The occupational therapy profession, however, was granted a reprieve when the U.S. Congress made several changes to the Balanced Budget Act. The Balanced Budget Refinement Act of 1999 called for a suspension of a capitation on rehabilitation services. Congress agreed to suspend the capitation because of the controversy surrounding combining occupational therapy, physical therapy, and speech-language pathology.
For occupational therapy to survive, new markets had to emerge. Practitioners proved their worth in less traditional roles and work settings. While therapists still have a place in LTC facilities, they are carving a niche in school systems—the most popular work setting, according to a 2000 survey conducted by AOTA—as well as business-to-business consulting firms that specialize in ergonomics, home modification, and/or assistive devices, wellness education programs, community-based mental health programs, and a variety of specialties in private practice.
It was reported by the U.S. Department of Labor's 2001 Occupational Outlook Handbook that the occupational therapy field is expected to grow at a faster rate
The increasing demand for occupational therapists is expected, in large part, because of the emerging markets, as well as the increase in those requiring the type of services occupational therapists provide. As baby boomers (those born between 1945 and 1965) age, occupational therapy practitioners will have an even bigger market for home modification, so that the elderly, for example, can remain in their homes longer than normally expected. Advancement in medical technology continues to allow people to live longer, despite serious illness and disability, and occupational therapists can facilitate their independence in daily living and working.
Activities of daily living (ADL)—Activities of daily living are an individual's skills and practices that determine how well he or she can function in daily life and how well he or she relates to and participates in his or her environment.
Alzheimer's Disease—A progressive, neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions, such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Arthritis—Inflammation of one or more joints.
Attention deficit disorder (ADD)—A condition characterized by an attention span that is less than expected for the age of the person. There is often age-inappropriate hyperactivity and impulsive behavior, as well.
Ergonomics—The study of the relationship between people and their working environment.
Home modification—Altering the physical environment of the home so as to remove hazards and provide an environment that is more functional for the patient. Examples of home modification include the installation of grab bars and no-slip foot maps in the bathroom, to prevent falls.
Parkinson's disease—A disorder of the brain characterized by shaking and difficulty with walking, movement, and coordination. The disease is associated with damage to a part of the brain that controls muscle movement.
Stroke—A group of brain disorders involving loss of brain functions that occur when the blood supply to any part of the brain is interrupted.
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The American Occupational Therapy Association, Inc. 4720 Montgomery Lane, Bethesda, MD 20824-1220. (301) 652-2682. <http://www.aota.org>.
The National Board for Certification of Occupational Therapy, Inc. 800 S. Frederick Ave., Ste. 200, Gaithersburg, MD 20877-4150. (301) 990-7979. <http://www.nbcot.org>.
The U.S. Department of Labor, Bureau of Labor Statistics, Division of Information Services. 2 Massachusetts Ave. NE, Room 2860, Washington, DC 20212. (202) 691-5200. <http://www.bls.gov>.
Meghan M. Gourley