Hello Terrianne: I graduate in 1997. I have no recollection of the word "occupation" being used.
When I started teaching in 2000, the first course I developed and taught was "Human Occupation". Students were introduced to different concepts of human occupation, not from a treatment perspective but from a theoretical perspective. Some student's remained clueless about occupation and OT, but most said understanding human occupation helped them better understand OT. When AOTA's practice framework was 1st published in 2002, I think, occupation was one of the main focuses. And with that document, OT's, suddenly became experts in human occupation. Personally, I don't think it's possible to be an expert in something without having spent considerable time studying and applying theory and concepts of what is claimed as expertise. Also, I do NOT believe that OT must use occupation as a means, but I do think when improved occupational performance is the desire outcome, occupation as a means is the natural treatment choice. Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Terrianne Jones <[EMAIL PROTECTED]> Sent: Monday, September 01, 2008 To: OTlist@OTnow.com <OTlist@OTnow.com> Subj: [OTlist] Elbow Break, Referral... TJ> Hello Chis, Ron and others: Thanks for the stimulating discussion, TJ> which is really an already articulated issue discussed years ago by TJ> Grey, Wilcock, and others., the occupation as end versus occupation as TJ> mean argument. TJ> My own belief is that just because an OT does something TJ> does not make it 'occupational therapy'. Further, the basis of a true TJ> profession is that it is theory driven and in a constant reflective TJ> state to assess what is current best knowledge. Educational programs TJ> change to reflect current best practice for entry level. If you look TJ> back over the history of the profession, we have again and again added TJ> content and dropped content to meet the continual challenge of staying TJ> current. TJ> Our biggest mistake in my opinion was losing our connection TJ> to the fundamental philosophy of occupation as means during the 70's TJ> thru the early 90's. Most of us practicing with 15-20 years experience TJ> are the victims of the over emphasis on the medical model which held up TJ> the occupation as end argument, at the expense of occupation TJ> as the means of the profession. We got away with it because at the time TJ> no one else was explicitly concerned with overall function like we TJ> were. However, when things tightened up and everyone became concerned TJ> with function, we started losing ground because we cannot complete on TJ> fixing parts, even if the justification behind it it that the client TJ> will in the end be able to engage in occupation. TJ> The goal today is TJ> to graduate therapists grounded in occupation who can also work with TJ> body structures and functions to facilitate engagement in TJ> occupation,not just isolated occupational performance. TJ> Below TJ> is a reference list from a doctoral course paper I wrote about about TJ> this subject--older but still very interesting articles. TJ> Terrianne Jones, MA, OTR/L TJ> Faculty TJ> University of Minnesota TJ> Program in Occupational Therapy TJ> Fischer, (1998). Uniting practice and theory in an occupational TJ> framework. In R. Padilla Ed.), A professional legacy: the TJ> Eleanor Clark Slagle Lectures in occupational therapy, TJ> 1955-2004 (2nd ed., pp. 554-575). Bethesda, MD: AOTA press. TJ> Friedland, J. (1998). Occupational therapy and rehabilitation: an TJ> awkward alliance. In R. P. Cottrell (Ed.), Perspectives on TJ> purposeful activity: foundation and future of occupational TJ> therapy (2nd ed., pp. 69-75). Bethesda, MD: AOTA press. TJ> Gutman, S. (1998). The domain of function: Who’s got it? Who’s TJ> competing for it? In R.P. Cottrell (Ed.), Perspectives for TJ> occupation based practice (2nd ed., pp. 555- 560). Bethesda MD: AOTA press. TJ> Meyer, A. TJ> (1920). The philosophy of occupational therapy. In RP Cottrell (Ed.), Perspectives TJ> for occupation based practice (2nd ed., pp. 25-28). Bethesda MD: TJ> AOTA press. TJ> Nelson, D. (1997). Why the profession of occupational therapy TJ> will flourish in the 21st century. In R. P. Cottrell (Ed.), TJ> Perspectives for occupation-based practice (2nd ed, pp. TJ> 113-126). Bethesda, MD: AOTA Press. Peloquin, S. (1991). TJ> Occupational therapy service: individual and collective TJ> understandings of the founders. American Journal of Occupational Therapy, 45, 33-744. TJ> Reilly, M. TJ> (1962). Occupational therapy can be one TJ> of the great ideas of 20th century medicine. In RP Cottrell (Ed.), Perspectives TJ> for occupation based practice (2nd ed.pp. 77-84). Bethesda MD: TJ> AOTA press. TJ> TJ> Trombly, C. TJ> (1995). Occupation: purposefulness and meaningfullness as therapeutic TJ> mechanisms. In RP Cottrell (Ed.), Perspectives TJ> for occupation based practice (2nd ed., pp. 159-171). Bethesda MD: TJ> AOTA press. TJ> TJ> West, W. TJ> (1984). A reaffirmed philosophy and TJ> practice of occupational therapy for the 1980’s. The American Journal of Occupational TJ> Therapy, 38, 15-23. TJ> TJ> Wilcock, TJ> A. (1998). An occupational perspective TJ> of health. Thorofare: Slack Incorporated. TJ> TJ> Yerxa, E. TJ> (1991). Seeking a relevant, ethical and realistic way of knowing for TJ> occupational therapy. The American Journal of Occupational Therapy 45, TJ> 19 TJ> Gray, J. (1998). Putting occupation into practice: occupation as TJ> ends, occupation as means. In R.P. Cottrell (Ed.), TJ> Perspectives for occupation based practice (2nd ed., pp. TJ> 149-158).Bethesda MD: AOTA press. Gutman, S. (1998). The domain TJ> of function: Who’s got it? Who’s competing for it? In R.P. TJ> Cottrell (Ed.), Perspectives for occupation based practice (2nd TJ> ed., pp. 555- 560). Bethesda MD: AOTA press. TJ> Howard, S. TJ> (1991) How high do we jump? The effect TJ> of reimbursement on occupational TJ> therapy. In R.P. Cottrell (Ed.), Perspectives for TJ> occupation based practice (2nd ed., pp. 519-526). Bethesda MD: AOTA press. TJ> TJ> To: OTlist@OTnow.com TJ> Date: Sunday, August 31, 2008, 7:48 PM TJ> Who says we are practicing PT, and not OT?.? My credentials states OTR/L so TJ> therefore it is OT.? I don't know about you, but taking ROM measurements and TJ> treating the UE was taught in the OT education in which I went to school.? How TJ> do you comment on the OT guide to practice and our practice acts?? In my opinion TJ> it is dangerous to be that?narrow in our definition in what we do as OTs.? I TJ> certainly understand and respect your opinions, because they do make sense on TJ> paper, but when actually practicing we do have to address body TJ> functions/structures at times to help the patient make further progress.? I TJ> noticed a post that you made?in the AOTA listserve under the physical section.? TJ> In it you were giving advise about an individual with guillen barre (spelling?), TJ> and you of course talked about ADL performance, but then you gave an example of TJ> practicing sit to stands and unilateral reaching without being in the context of TJ> an ADL.? Isn't this the same as helping a patient with their arm functions TJ> through ther ex to facilitate a positive outcome with functional reaching?? TJ> Thanks again for the great discussion. TJ> Chris Nahrwold MS, OTR TJ> St. John's Hospital TJ> Anderson, Indiana TJ> -----Original Message----- TJ> From: Ron Carson <[EMAIL PROTECTED]> TJ> To: L Sloan <OTlist@OTnow.com> TJ> Sent: Sun, 31 Aug 2008 6:09 am TJ> Subject: Re: [OTlist] Elbow Break, Referral... TJ> If the goal is increased ROM or decreased pain, why include the TJ> "functional" component? It seems obvious to me that if ROM/pain TJ> are TJ> the ONLY things preventing the patient from doing self-care, then TJ> positively impacting these area will directly improve self-care. So, TJ> why even include the the "function". TJ> If the goal is occupation, then I see no reason for the ROM/pain TJ> component. As and OT, I strongly believe that occupation should be the TJ> goal, but occupation is not always the goal of the patient or MD. And TJ> it's these situations where OT is out on a limb, because we are truly TJ> practicing OT, but PT. TJ> Ron TJ> -- TJ> Ron Carson MHS, OT TJ> ----- Original Message ----- TJ> From: L Sloan <[EMAIL PROTECTED]> TJ> Sent: Saturday, August 30, 2008 TJ> To: OTlist@OTnow.com <OTlist@OTnow.com> TJ> Subj: [OTlist] Elbow Break, Referral... LS>> How About.... LS>> Patient will demonstrate increased active range of motion to ____ LS>> during upper and lower body dressing activities.....or... LS>> Patient will demonstrate increased AROM to ___ to allow patient LS>> to complete upper and lower body selfcare activities safely... LS>> Patient will demonstrate a decrease in pain from ___ to ___ to LS>> enable her to complete her dressing activities. LS>> ??? Lisa LS>> ----- Original Message ---- LS>> From: Ron Carson <[EMAIL PROTECTED]> LS>> To: OTlist <OTlist@OTnow.com> LS>> Sent: Saturday, August 30, 2008 3:48:47 PM LS>> Subject: [OTlist] Elbow Break, Referral... LS>> Received? a? new referral for a elbow fracture. I shouldn't have TJ> taken LS>> it but I did. LS>> And? here? is? the? dilemma? facing our profession. The patient is 95, LS>> previously living independently. Fractured elbow in a fall. Now living LS>> with? daughter.? She? is? in a large amount of pain. Obviously, she is LS>> dependent? for? most of her occupations. She currently uses a cane but LS>> is not safe. LS>> The? patient's? immediate concerns are her elbow. When pressed, she TJ> of LS>> course wants to go back home, but that is not an immediate goal. LS>> So what do I write for goal TJ> s? For example should I write: LS>> ? ? ? ? Patient will self-report pain as 3 out of 10 LS>> ? ? ? ? Patient's will increase active elbow extension to -20 TJ> degrees LS>> These? goals seem to direct the patients and doctor's concerns but TJ> are LS>> not occupationally oriented. So, should I write: LS>> ? ? ? ? Patient will safely and independently dress lower body LS>> ? ? ? ? Patient? will safely and independently ambulate to the bathroom LS>> ? ? ? ? using the least restrictive mobility aid LS>> I like these goals but they don't address the immediate concerns. LS>> Ron LS>> -- LS>> Ron Carson MHS, OT LS>> -- LS>> Options? LS>> www..otnow.com/mailman/options/otlist_otnow.com LS>> Archive? LS>> www.mail-archive.com/otlist@otnow.com LS>> TJ> -- TJ> Options? TJ> www.otnow.com/mailman/options/otlist_otnow.com TJ> Archive? TJ> www.mail-archive.com/otlist@otnow.com TJ> -- TJ> Options? TJ> www.otnow.com/mailman/options/otlist_otnow.com TJ> Archive? TJ> www.mail-archive.com/otlist@otnow.com TJ> --- On Sun, 8/31/08, [EMAIL PROTECTED] <[EMAIL PROTECTED]> wrote: TJ> From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> TJ> Subject: Re: [OTlist] Elbow Break, Referral... TJ> To: OTlist@OTnow.com TJ> Date: Sunday, August 31, 2008, 7:48 PM TJ> Who says we are practicing PT, and not OT?.? My credentials states OTR/L so TJ> therefore it is OT.? I don't know about you, but taking ROM measurements and TJ> treating the UE was taught in the OT education in which I went to school.? How TJ> do you comment on the OT guide to practice and our practice acts?? In my opinion TJ> it is dangerous to be that?narrow in our definition in what we do as OTs.? I TJ> certainly understand and respect your opinions, because they do make sense on TJ> paper, but when actually practicing we do have to address body TJ> functions/structures at times to help the patient make further progress.? I TJ> noticed a post that you made?in the AOTA listserve under the physical section.? TJ> In it you were giving advise about an individual with guillen barre (spelling?), TJ> and you of course talked about ADL performance, but then you gave an example of TJ> practicing sit to stands and unilateral reaching without being in the context of TJ> an ADL.? Isn't this the same as helping a patient with their arm functions TJ> through ther ex to facilitate a positive outcome with functional reaching?? TJ> Thanks again for the great discussion. TJ> Chris Nahrwold MS, OTR TJ> St. John's Hospital TJ> Anderson, Indiana TJ> -----Original Message----- TJ> From: Ron Carson <[EMAIL PROTECTED]> TJ> To: L Sloan <OTlist@OTnow.com> TJ> Sent: Sun, 31 Aug 2008 6:09 am TJ> Subject: Re: [OTlist] Elbow Break, Referral... TJ> If the goal is increased ROM or decreased pain, why include the TJ> "functional" component? It seems obvious to me that if ROM/pain TJ> are TJ> the ONLY things preventing the patient from doing self-care, then TJ> positively impacting these area will directly improve self-care. So, TJ> why even include the the "function". TJ> If the goal is occupation, then I see no reason for the ROM/pain TJ> component. As and OT, I strongly believe that occupation should be the TJ> goal, but occupation is not always the goal of the patient or MD. And TJ> it's these situations where OT is out on a limb, because we are truly TJ> practicing OT, but PT. TJ> Ron TJ> -- TJ> Ron Carson MHS, OT TJ> ----- Original Message ----- TJ> From: L Sloan <[EMAIL PROTECTED]> TJ> Sent: Saturday, August 30, 2008 TJ> To: OTlist@OTnow.com <OTlist@OTnow.com> TJ> Subj: [OTlist] Elbow Break, Referral... LS>> How About.... LS>> Patient will demonstrate increased active range of motion to ____ LS>> during upper and lower body dressing activities.....or... LS>> Patient will demonstrate increased AROM to ___ to allow patient LS>> to complete upper and lower body selfcare activities safely... LS>> Patient will demonstrate a decrease in pain from ___ to ___ to LS>> enable her to complete her dressing activities. LS>> ??? Lisa LS>> ----- Original Message ---- LS>> From: Ron Carson <[EMAIL PROTECTED]> LS>> To: OTlist <OTlist@OTnow.com> LS>> Sent: Saturday, August 30, 2008 3:48:47 PM LS>> Subject: [OTlist] Elbow Break, Referral... LS>> Received? a? new referral for a elbow fracture. I shouldn't have TJ> taken LS>> it but I did. LS>> And? here? is? the? dilemma? facing our profession. The patient is 95, LS>> previously living independently. Fractured elbow in a fall. Now living LS>> with? daughter.? She? is? in a large amount of pain. Obviously, she is LS>> dependent? for? most of her occupations. She currently uses a cane but LS>> is not safe. LS>> The? patient's? immediate concerns are her elbow. When pressed, she TJ> of LS>> course wants to go back home, but that is not an immediate goal. LS>> So what do I write for goal TJ> s? For example should I write: LS>> ? ? ? ? Patient will self-report pain as 3 out of 10 LS>> ? ? ? ? Patient's will increase active elbow extension to -20 TJ> degrees LS>> These? goals seem to direct the patients and doctor's concerns but TJ> are LS>> not occupationally oriented. So, should I write: LS>> ? ? ? ? Patient will safely and independently dress lower body LS>> ? ? ? ? Patient? will safely and independently ambulate to the bathroom LS>> ? ? ? ? using the least restrictive mobility aid LS>> I like these goals but they don't address the immediate concerns. LS>> Ron LS>> -- LS>> Ron Carson MHS, OT LS>> -- LS>> Options? LS>> www..otnow.com/mailman/options/otlist_otnow.com LS>> Archive? LS>> www.mail-archive.com/otlist@otnow.com LS>> TJ> -- TJ> Options? TJ> www.otnow.com/mailman/options/otlist_otnow.com TJ> Archive? TJ> www.mail-archive.com/otlist@otnow.com TJ> -- TJ> Options? TJ> www.otnow.com/mailman/options/otlist_otnow.com TJ> Archive? TJ> www.mail-archive.com/otlist@otnow.com TJ> -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
