Occupational Therapy

Occupational therapists prevent dysfunction and maintain and restore function for people with HIV/AIDS in the areas of work, selfcare and play/leisure. These occupational areas are assessed and treated from psychosocial, physical and environmental perspectives. This article examines occupational therapy assessment and treatment for people with HIV/AIDS with the primary focus on adaptive equipment, energy conservation, habits and time management, and work.     

Beyond good practice: Issues in working with people with intellectual disability and high support needs

Many more people with an intellectual disability now live in the community as a result of de-institutionalization. Occupational therapy is one service that assists people with intellectual disabilities to participate as fully as possible in their local communities. Despite the potential benefits of occupational therapy, there is little written about the types of interventions used and the effectiveness of their outcomes with people with intellectual disabilities. The present interview study about current occupational therapy practice with people with intellectual disabilities and high support needs was conducted with experienced Australian clinicians. Positive outcomes for clients with high support needs were achieved in two ways: (i) by what therapists do; and (ii) by the features of the therapy relationship. In addition, interventions that indirectly empowered clients and changed others' perceptions were seen to have the most positive effect. The findings are discussed with regard to current occupational therapy literature and implications for occupational practice and education are presented.     

Occupational therapy practitioners' comfort level and preparedness in working with individuals who are gay, lesbian, or bisexual

Occupational therapists and other allied health professionals face diversity with their clients, including sexual orientation. The purpose of this study was to determine the preparedness and comfort level of occupational therapy practitioners in working with gay, lesbian, and bisexual clients. A 23-item survey was mailed to 1,051 practitioners in a midwestern state. Eighty-eight were undeliverable and 373 usable surveys were returned, yielding a 39% response rate. Most respondents felt prepared and comfortable to work with clients who are gay, lesbian, or bisexual, and 48% agreed that sexuality influences occupational choices. Twenty-nine percent agreed that sexual orientation influences occupational therapy treatment. Less than 20% of the respondents, however, received education and used inclusive language in their documentation, and only 14% reported having resources and support services for clients who are gay, lesbian, or bisexual. Effective education and policy-making strategies are necessary to ensure an accepting therapeutic environment and respect for the role of sexual orientation in the intervention process.     

Occupational Therapy and the Patient with Pain

The characteristics, implications, consequences and costs of pain, particularly those of chronic benign pain syndrome, are presented, and current approaches to treatment are briefly discussed. Contributions which occupational therapists are uniquely qualified to offer are described. Occupational therapists are grounded in the concept that mind, body and spirit are integrally related and that the patient must participate actively in the planning and implementation of any treatment program. The occupational therapist is a specialist in role functions and is skilled in assisting clients to plan and re-create structure for their lives that has been lost by virtue of their illness, disability, or pain. The occupational therapist provides an environmental laboratory in which people can experiment with new behaviors and attitudes to restructure and regain control of their lives and to reestablish hope, competence, confidence and success as part of their daily activities. These concepts are basic to the successful treatment of the patient with chronic benign pain syndrome.     

The Value of Hypermedia Based Computerised Educational Materials for Client Education: Occupational Therapists' Perceptions

This preliminary investigation explored occupational therapists' perceptions of the value of Hypermedia-based computerised educational materials for client education. Occupational therapists employed in physical rehabilitation agencies in metropolitan Adelaide participated in the study. Client education was an important role for the therapists, taking up more than half client contact time. Therapists indicated that Hypermedia-based computer education materials had a potential role in teaching clients joint protection principles and diagnostic and prognostic information about certain conditions but were unsure if such materials would be an efficient medium.     

Occupational narratives and the therapeutic process

Clients' occupational narratives reveal the overall meaning of life events, signifying their place in a plot that integrates past, present and future. Occupational narratives have also been demonstrated to predict how clients respond to therapy. A closer examination of the details of occupational narratives and how they unfold in the therapeutic context has the potential to give new insights into the experience of therapy by clients. This paper presents narratives of two clients in a vocational program for persons living with AIDS. Comparing their occupational narratives enables us to shed light on the differences between narratives that account for different client outcomes and the extent to which narratives can be impacted upon through occupational therapy intervention.     

ICIDH-PR: A potential model for occupational therapy

Occupational therapists frequently work with clients who are challenged by chronic disabilities that may often lead to handicaps. Consequently, chronicity and possible resulting handicaps are matters of concern for occupational therapists in all domains, including: practice, research and education. In 1980 the World Health Organization put forth a classification scheme to capture the long-term consequences of disease: the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). Its use within occupational therapy was advocated. They showed that the constructs of this classification system mirrored those of occupational therapy's occupational performance model. More recently, a proposal for the revision of the ICIDH (ICIDH-PR) has been advanced. This proposal is consistent with the enablement and occupational competence models. Within this proposed model, occupational therapy is concerned with enabling clients to interact optimally within their chosen environments. This paper presents a brief review of a selected portion of the international literature on the ICIDH and introduces the proposed revision of the ICIDH for occupational therapy. The structure of this proposed classification is compared with the occupational therapy models. The implications that the use of the ICIDH-PR will have for occupational therapy are also addressed.     

Juvenile fibromyalgia syndrome: The role for occupational therapists

Juvenile fibromyalgia syndrome, a form of nonarticular rheumatism, is a clinical condition affecting children and adolescents. To date, it has received little or no attention in the professional literature. Occupational therapists have an important role to play in the assessment and management of this paediatric client group. A literature review, the clinical symptoms, prognosis and possible aetiology of this clinical syndrome are presented. The potential role for occupational therapists with paediatric clients diagnosed with juvenile fibromyalgia syndrome is then briefly described.     

Clients’ Perspectives of the Effectiveness of Home Modification Recommendations by Occupational Therapists

Abstract

This study investigates the effectiveness of home modifications from clients’ perspectives. Ten participants who received home assessments and modification recommendations were recruited from a rehabilitation agency. The dimension of home measure and qualitative interviews was conducted. The interviewers were transcribed verbatim and analyzed thematically. Participants found home modifications improved their safety, accessibility, privacy, and occupational performance, especially in performing self-care activities. Occupational therapists provided sufficient information and actively involved clients/carers in the decision-making process, which contributed to clients’ perspectives of satisfaction and effectiveness with completed modifications.     

The Contribution of Occupational Therapy to Alcohol and Drug Rehabilitation: A Descriptive Review

Occupational therapists work as members of multidisciplinary teams in the assessment and treatment of people experiencing alcohol and drug related difficulties. In the context of “team” treatment, the role of the occupational therapist often appears unclear. Although there is a paucity of available literature regarding occupational therapy roles and functions in this field, the importance of activity based interventions to promote the development of living skills and for facilitating lifestyle changes is well documented. Occupational therapists employed at Pleasant View Centre, Victoria, aim to assist people with addiction problems in reducing or abstaining from drug use within a psychosocial framework. They assist clients in both the detoxification and rehabilitation phases of treatment and provide appropriate follow-up and support. Occupational therapists contribute both their group and individual counselling skills and, in addition, provide a unique focus on maximsising self-efficacy and competence to perform life skills. They provide activity based programmes which enhance existing skills and the acquisition of new skills. The complex nature of addiction requires a diverse range of orientations and skills to which the occupational therapist contributes a philosophy and practice of learning skills for living through “doing” and activity.     

The Four-Quadrant Model of Facilitated Learning (Part 1): Using teaching–learning approaches in occupational therapy

Occupational therapists routinely use teaching–learning approaches to support clients in their acquisition of skills supporting occupational performance goals. This paper is the first of a two-part presentation that positions teaching–learning in occupational therapy through a discussion of the Four-Quadrant Model of Facilitated Learning (4QM). The 4QM provides a means of informing clinical reasoning when using teaching–learning approaches in occupational therapy. Although developed to actualise teaching–learning approaches with children, it has the potential to be applied more broadly. This first paper explores the relationship between occupational therapy principles and the use of teaching–learning approaches. It draws on current literature to understand the use of learning strategies as therapeutic tools. In this context, the 4QM is presented as a way of organising occupational therapy intervention when a teaching–learning approach is used.     

HIV Infection: Educational Programs and Policies for School Personnel

Acquired Immunodeficiency Syndrome (AIDS) challenges schools as the frontline defense against this epidemic. School personnel should become knowledgeable about human immunodeficiency virus (HIV) infection and get involved in presenting quality HIV/AIDS education programs. This paper provides an epidemiological update on AIDS as it relates to the school-age population. Evidence establishing modes of transmission is emphasized, and recommendations are presented for handling students infected with HIV. Information is provided to assist school staff implement HIV/AIDS education programs, including core concepts to be emphasized.     

Responsiveness of the Swedish Version of the Canadian Occupational Performance Measure

In a client-centred approach, clients and therapists work together to define the occupational performance problem, the focus of and need for intervention and the preferred outcomes. Application of specific theories or techniques to involve clients in goal-setting may influence the therapist to use a client participation approach. The Canadian Occupational Performance Measure (COPM) presents a structure for formulating the treatment goals identified by the client in co-operation with the therapist. The aim of this study was to test the responsiveness of the Swedish version of the COPM. After translation into Swedish, the COPM was introduced to 21 occupational therapists who performed data collection. A sample of 108 clients within geriatric, neurologic and orthopaedic rehabilitation identified 418 problems at initial scoring and reassessment. Inclusion criteria for patients were the need for rehabilitation interventions and the ability to communicate well enough in an interview. The results indicate that the Swedish version of the COPM is responsive to change, with 73% of the problems identified having a change in score of 2 points or more.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Community occupational therapists' clinical reasoning: identifying tacit knowledge

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community‐dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

一起艾滋病职业暴露事件的调查分析

目的通过对2009年西安市一起同一艾滋病暴露源引起两家医院多名医护人员发生职业暴露的类型、经过、危险程度及暴露后的预防措施分析,探讨职业暴露发生的潜在原因及对策。方法依据《医务人员HIV职业暴露防护工作指导原则(试行)》和《全国艾滋病检测技术规范(2004年版)》对此起职业暴露进行调查、评估和随访监测。结果经过职业暴露评估,2名医护人员为一级暴露,未服用预防性药物,6个月的临床医学观察期满后无1例感染。结论医护人员仍对艾滋病职业暴露缺乏足够的认识和重视,必须加强医务人员的职业暴露风险意识。     

An Investigation of Moral Distress Experienced by Occupational Therapists

This study used a quantitative survey design to investigate the existence of moral distress among occupational therapists. The Moral Distress Scale-Revised (MDS-R-OHPA) was distributed to a random sample of 600 members of the American Occupational Therapy Association (AOTA). The results of this explorative study found that occupational therapists reported moderate levels of moral distress with occupational therapists working in geriatric settings reporting higher levels of moral distress than occupational therapists who work in physical disability settings, although the difference was not statistically significant. However, occupational therapists who were considering leaving their current position reported the highest levels of moral distress. These initial findings are discussed as well as the need for further research.     

Test of Visual Perceptual Skills--Revised: An Overview and Critique

Paediatric occupational therapists frequently assess and treat children and youth presenting with visual perceptual problems. Difficulties in this skill area can have a negative impact on a number of occupational performance and functional skill areas for children and youth including their ability to successfully complete activities of daily living, participate in play/recreational activities, complete school-related work and accomplish age-related developmental tasks. Therefore, it is important for occupational therapists to utilize visual perceptual assessments that possess sound measurement properties (such as validity, reliability, responsiveness and clinical utility). The Test of Visual Perceptual Skills--Revised is an instrument frequently used by paediatric occupational therapists to evaluate children and youth presenting with visual perceptual dysfunction. Occupational therapists need to be cognizant of the measurement properties of the assessments they use in order to provide the best quality care for the paediatric clients they serve. Therefore, a review and critique of the Test of Visual Perceptual Skills--Revised is presented.     

Occupational Therapy and Rehabilitation Engineering

Occupational therapists in clinical settings are often challenged with difficult problems in the selection, application and modification of complex mechanical, electrical or structural aids for persons with severe disability who wish to improve their levels of independence. At the Rehabilitation Institute of Chicago, solutions to such situations are facilitated by interaction between the occupational therapist and the rehabilitation engineer. In this paper, following the identification of the population served and their specialized needs, the working relationship between the occupational therapist and rehabilitation engineer will be discussed through presentation of two case studies. Various commercially available equipment will be considered along with modifications possible, and finally, customer design solutions will be given for some problems. Given the growing store of resources for assisting clients who have special needs, many creative systems can be developed in therapists and engineers combine their respective knowledge and skills in problem solving.