Hello everyone: I have yet to write-in concerning this issue that has been heavily debated, but it is one that concerns me. I, for one, agree with Ron. This subject is the focus of my Master's thesis. I am researching whether occupational therapists working in hand therapy are using occupation in practice and the reasons why they are or are not. I cannot say what my research findings were, but I can give information on articles that reference occupation as best practice for occupational therapy and a means to distinguish our profession from that of physical therapy. Yes, it is imperative that we do this in order to stay a viable service. Physical therapy has been biting at our heels to take over the domain of function. We must utilize our basic knowledge of occupation and it's effect on health (Reilly 1962- Man, through the use of his hands, as energized by mind and will, can effect the state of his own health)as our treatment intervention and goal. I know that occupation is often misunderstood by other professionals (Doctors, physical therapists, nurses, etc.), and even our own profession, and therefore difficult to justify as intervention. Although this is true, it just goes to prove that we should be providing education on the definition of occupation (AOTA, 1995, AJOT, 49, pp. 1015-1018) and the benefits that it can have on a person's health (many research studies performed by Nelson and colleagues and also Trombly and colleagues have proven these benefits). These studies prove that occupation used as treatment is better at incre! ! asing physical performance facto rs (perceived level of exertion, heart rate, number of repetitions, blood pressure, range of motion, and duration of task), pain tolerance, motor learning, movement kinematics (reaction time, movement time, distance reached, velocity of reach, smoother movement, and direct movement), intrinsic motivation, and affective responses than isolated exercise or imagery-based occupation is. I can provide references for these studies if anyone is interested. Cooper and Evarts (June 1998, OT Practice) state that when occupational therapists working in hand therapy place emphasis on performance components rather than therapeutic occupation, they are using a reductionistic approach rather than a wholistic approach. The authors assert that occupational therapy in upper-extremity rehabilitation reflect a practice that looks and behaves like occupational therapy. In other words, best practice in upper-extremity rehabilitation is achieved when occupational therapists place therapeutic occupation and individualized attention to the needs of the occupational human at the center of their interventions. In regards to proof that occupation can be addressed in hand therapy to increase function and independence, read Toth-Fejel, Toth-Fejel, and Hedricks (1998, AJOT, 52, pp. 381-385) for a description of a way to successfully incorporate occupation-centered practice into hand therapy. Also, read the Chisholm, Dolhi, and Schreiber continuing education article in the January 2000 OT Practice on creating occupation-based opportunities in a medical model clinical practice setting. I will end with an article by Gray that I think that every occupational therapist practicing in a physical disability setting should read. Gray (1998, AJOT, 52, pp. 354-364) wrote an article entitled "Putting Occupation into Practice: Occupation as Ends, Occupation as Means." She stated that the problem with component-driven approaches bear the assumption that changing underlying components will automatically create changes in occupational performance. She also states that it is established knowledge that improvement of underlying performance components may not lead to desired changes in engagement in occupation (Trombly, 1995, Theoretical foundations for practice, In C. A. Trombly's book- Occupational Therapy for Physical Dysfunction). The client may leave occupational therapy with unaddressed occupational problems. Gray states that a second problem can occur with component-based practice when the client learns decontextualized skills that do not easily or readily transf! ! er to his or her daily activitie s. The third problem that Gray addresses is that component driven practice deprives the client of the other beneficial outcomes of occupational treatment. Namely, occupation, when it is applied as activity with wholeness, purpose, and meaning to the person, can also affect him or her psychologically, emotionally, and socially in ways that purposeful activity unrelated to their person cannot. I know that in hand therapy, certain things must be taken care of prior to the use of occupation in treatment. This includes, splinting, physical agent modalities, scar massage, etc. But, in best practice, these things should be done in preparation for occupational activity in treatment. I know that occupation can be very difficult to incorporate into hand therapy treatment or justify to our clients, our professional colleagues, or ourselves, but it is pertinent that we do so in order to perform best practice occupational therapy. If you look at the situation in terms of the fact that if you are not performing occupation in treatment, you are not doing occupational therapy, does that make you feel uncomfortable or angry? If so, then you should examine how you are different from the other professions around you and how easy it may be for those persons (especially physical therapy, because both are trained to do hand therapy on a physical-component level) to take over what you are doing and wipe occupational therapy for the physically disabled, especially hand therapy, out of existence. I hope that I have not offended anyone, and I have made a point not to address anyone specifically. But I do hope that I have raised some interesting points and hopefully backed them up with published studies and lectures. Please feel free to criticize all you want, because I, for one, am new to the actual practice of OT (recently graduated), and I realize that the real world is different from the book (academic) world. If anyone would like more references or has questions about the references that I have mentioned, please ask. Best regards, Lorie, OT --------- *Unsubscribe by sending a message to [EMAIL PROTECTED] In the message's body, put the following text: unsubscribe list OTnow messages are archived at [EMAIL PROTECTED] ---------
