Hi Ron:
Thank you for your detailed comments and analysis in response to my post.
Unfortunately I haven't read the OT
Practice article you referred to, so I am in the dark on the contents of this article.
However, I do want to
emphasise that at no point am I suggesting a "define practice as you please" approach
to OT practice. In fact
so far, as best as I can recall, in the context of this discussion thread until now no
attention had been called
to what the literature might state. There had been no mention of an "evidence-based
practice", which I most
firmly believe in. Certainly any OT's practice (or for that matter any health care
professional's practice)
needs to derive from a researched, peer reviewed perspective, in my opinion. However,
I also believe that the
relationship between practice and theory development is a kind of a "chicken or the
egg" type of situation. The
way that I have resolved this issue for myself (i.e. whether theory drives practice or
vice versa), is by
identifying the kind of relationship that practice has to theory. Certainly, I want
to test what theories say,
in fact I even want to challenge them. To use an analogy from the world of business,
which is where I worked
before becoming an OT, product development/marketing is informed by R & D, and vice
versa. I believe that the
relationship between theory driven OT practice and OT practice per se is similar. One
drives the other.
However, I personally believe that I am not going to *only* be guided by what theory
states. In fact the
real-world practice of any health care profession is larger than its theories. In
fact at the risk of seeming
to reinvent the wheel here let me say that theories themselves are rooted in
well-researched (hopefully :-)))
research questions deriving from real-world practice. Without the challenges of
real-world practice generating
research questions, I don't think any professions' body of knowledge would have grown.
The basic point I wish
to make is, that it is good to use theories as a guide, but one cannot be enslaved by
them.
As for whether there is research out there on the "UE PT" issue is open to question,
but I seriously doubt if
there is. And in my opinion fragmenting the OT profession by seeking to make concrete
its core base is a
contradiction in terms. Because I believe we already have a clear professional core,
or hallmark of the
profession, and this (to put it in my own words) lies in promoting client function and
performance, or in
certain cases to limit/control the effects of disability or illness. Defined by what
is meaningful to client
needs, expectations, and wants, interpreted in terms of the client's environment. How
one interprets this
depends upon the OT, and the setting in which s/he works.
Incidentally Ron, you referred to Occupation as being he "nuts and bolts" of
occupational performance. In some
contexts they are viewed as the same, since "Occupation is everything that people do
to occupy themselves...."
(CAOT, 1997), but occupation is the overarching concept and generally not viewed as a
sub-concept or
sub-component of any other variable. Possibly I may have misinterpreted what you
meant, when you said that
"Actual Occupation" is the nuts and bolts of occupational performance.
A good source to clarify any misconceptions of the role of theory in OT, and where
Occupation really fits in
check out a book called "The Theoretical Basis of Occcupational Therapy: An Annotated
Bibliography of Applied
Theory in the Professional Literature" by McColl, Law and Stewart (1993) published by
SLACK Inc. Chapter 1 of
this book, in my opinion, is invaluable in clarifying where the concept of Occupation
is located in the context
of various levels of theories. Its "Taxonomy for Theory in Occupational Theory" may
help in resolving a lot of
the questions that have been generated here.
Ron Carson wrote:
> Hello Biraj:
>
> Thanks for your comments.
>
> I have a couple comments/questions on your post.
>
> ---------- On 2/25/2001, Incandescent Said:
>
> I> In my opinion each OT interprets the idea of "occupation" in their own
> I> way, and based on what is meaningful for the client.
>
> When talking about occupation, there is a certain duality which is helpful
> to understand. AS I see it, occupation, is both an actual doing and a
> theoretical doing.
>
> "Actual occupation" is the 'nuts and bolts' of occupational performance.
> Following the Canadian Model of Occupational Performance (CMOP),
> occupational performance requires:
>
> 1. Person (spiritual, physical, cognitive and affective components),
>
> 2. Occupation
>
> 3. Environment
>
> By definition, OT's are skilled in facilitating clients to discover and
> engage in actual occupation.
>
> "Theoretical occupation" are theories of human development,
> self-actualization, psychology, sociology, adaptation, anthropology, etc.
> These are theories which educate OT's about occupation's importance to
> living, role competence, growth and development, health, quality of life,
> etc. Theoretical occupation is the source for occupation-based Frames of
> References. Theoretical occupation is what give OT's their uniqueness and
> speciality in health care. Theoretical occupation is the foundation of all
> that we should be doing in practice, education and research.
>
> I think OT's and clients should freely interpret actual occupation (what
> does the client want to do and why) but should ONLY interpret the
> theoretical doing after careful scrutiny of the myriad of theories and
> concepts relating to human occupation.
>
> If I'm reading your statement correctly, you are suggesting that the actual
> doing of occupation is based on clients' and therapists' interpretations of
> importance and meaning. Is this correct? If so, I totally agree. But I still
> come back to the argument that therapists understanding of theoretical
> occupation should be rooted in existing theory and remain relatively
> unchanged.
>
> I> In fact the idea of occupation is virtually transparent in actual
> I> practice. And generally one cannot categorically distinguish any OTs
> I> practice as being occupation-based or otherwise, without either talking
> I> to the OT and understanding her/his reasoning, or without knowing the
> I> client clinically.
>
> While I certainly agree that it may be impossible to understand a
> practitioners theoretical base by simple treatment observation, what may be
> most important is does the practitioner know their theoretical base
>
> I> Personally, I don't see anything wrong if an OT practice focuses on Upper
> I> Extremity dysfunction. In fact I don't even think that it is in any way
> I> contradictory to "occupation-based" practice of OT. Occupation-based
> I> practice is largely a matter of how the OT views client's goals, and the
> I> intervention/treatment approach the OT may adopt.
>
> This definition doesn't rhyme with anything I have read about
> occupation-based practice.
>
> I> I don't recall *ever* seeing any evidence in the literature which either
> I> considers U/E focus in OT as compromising the role of OT, or undermining
> I> the OT profession as a whole.
>
> You raise a good point. (Maybe someone on the list can provide references to
> such articles) And I agree, but there are several articles about OT
> reinventing itself in the coming years. Most recently:
>
> OT Practice, 5(1):12-5, 2000 Jan 3. "Occupation-based practice: reinventing
> ourselves for the new millennium"
>
> Few, if any of these articles about reinvention indicate that UE focus or
> component focus is our future "bread and butter".
>
> I> And I cannot imagine where the idea or concept of "UE PT" may have
> I> originated from. To even suggest that UE (or for that matter any
> I> performance component) is exclusively linked to any particular profession
> I> other than OT (in this case PT), actually diminishes the OT role.
>
> Biraj, I agree but I also believe that a profession MUST have an expertise.
> That is one of the hallmarks of a profession - it does something better than
> any other profession. So, in your opinion, what is OT's expertise?
>
> I> And I realize that by saying this I might be turning this discussion over
> I> on its head. However, I think all OTs need to practice their profession
> I> based on their own understanding of what OT means to them. Just as the OT
> I> profession is not prescriptive with its clients, we cannot be
> I> prescriptive with any particular definition of OT where our own fellow
> I> OTs are concerned.
>
> While respecting your opinion I am not sure I can agree. Within all
> professions, their is an ever-changing but none the less stated, domain of
> concern. Often, professional domain of concern is spelled out in State
> practice acts but they are also delineated with the profession's Practice
> guidelines. Behavior or treatment falling outside the profession's domain is
> at best considered unethical and at worse illegal. [This is why I previously
> indicated that an OT stating that what they are doing may be seen as PT is
> opening themselves up to litigation.]
>
> As members of a professional organization we are free to interpret practice
> only as how the profession is defined by credentialling agencies (NBCOT,
> AOTA, State practice acts, etc). We are not free (legally anyway) to
> practice 'as how we see fit). There must be obvious limitations to what OT
> can and can not do. Within this obviously broad range, we do have room to
> interpret what is and what isn't OT. Once again, go outside the end-points
> of the professional continuum and one is not practicing OT.
>
> Ron
>
> I> Regards,
>
> I> Biraj
>
> I> Ron Carson wrote:
>
> >> Hello Donna:
> >>
> >> I am sorry but I have difficulty understanding how
> >> "[taking] on roles similar to what some refer to as UE PT" is good for our
> >> profession. While it may be good for the pocketbooks of those OT practicing
> >> like PT's, I don't understand how it's good for the profession. To
> >> me, OT's practicing like UE PT's are hindering the profession, not expanding
> >> it.
> >>
> >> Ron
> >>
> >> ----------
> >> On 2/24/2001, [EMAIL PROTECTED] Said:
> >> Mac> Evan, I must agree with your point of view on this matter......when I
> >> Mac> graduated in '99 as a COTA, there were very few jobs available. Our
> >> Mac> professors told us it was our responsibility to "be creative" in finding some
> >> Mac> kind of niche in order to get into the profession. Many of my fellow
> >> Mac> graduates have had to take on roles similar to what some refer to as UE PTs,
> >> Mac> home health care, therapeutic rec, and various other off-sets of OT. As long
> >> Mac> as we keep in mind our philosophy in treating the whole person, and
> >> Mac> maintaining/improving function, I believe we are expanding the perspective of
> >> Mac> what OT is and how valuable it is in all settings. Every one of us has to be
> >> Mac> an advocate for OT every chance we get..........Donna
> >>
> >> ---------
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