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Terapi okupasi
Berdasarkan Organisasi Okupasi Terapi Dunia (WFOT, 2012), Okupasi
Terapi adalah profesi kesehatan yang yang bertujuan meningkatkan derajat
kesehatan dan kesejahteraan melalui aktivitas. Tujuan utama dari
Okupasi Terapi adalah memungkinkan individu untuk berperan serta dalam
aktivitas keseharian. Okupasi terapis mencapai tujuan ini melalui kerja
sama dengan kelompok dan masyarakat untuk meningkatkan kemampuan mereka
untuk terlibat dalam aktivitas yang mereka inginkan, butuhkan, atau
harapkan untuk dikerjakan, serta dengan mengubah aktivitas atau
lingkungan yang lebih baik untuk mendukung keterlibatan dalam aktivitas.
Dalam memberikan pelayanan kepada individu , okupasi terapi
memerhatikan aset (kemampuan) dan limitasi (keterbatasan) yang dimiliki
individu, dengan memberikan aktivitas yang
purposeful (bertujuan) dan
meaningful
(bermakna). Dengan demikian diharapkan individu tersebut dapat mencapai
kemandirian dalam aktivitas produktivitas (pekerjaan/pendidikan),
kemampuan perawatan diri (
self care), dan kemampuan penggunaan waktu luang (
leisure).
Occupational therapy
From Wikipedia, the free encyclopedia
According to the World Federation of Occupational Therapy,
“occupational therapy is a profession concerned with promoting health
and well being through engagement in occupation."
[1] Occupational therapy
(also abbreviated as OT) is a holistic health care profession that aims
to promote health by enabling individuals to perform meaningful and
purposeful activities across the lifespan. Occupational therapists are
health professionals that use treatments to develop, recover, or
maintain the daily living and work skills of their patients with a
physical, mental or developmental condition.
[2]
Under the supervision of occupational therapists, occupational therapy
assistants may contribute to the treatment process. Occupational therapy
is a client-centered practice in which the client has an integral part
in the therapeutic process. The occupational therapy process includes an
individualized evaluation during which the client/family and
occupational therapist determine the individual’s goals; a customized
intervention to improve the person’s ability to perform daily activities
and reach his/her goals; and an outcomes evaluation to monitor
progression towards meeting the client’s goals.
[3]
Occupational therapy interventions focus on adapting the environment,
modifying the task, teaching the skill, and educating the client/family
in order to increase participation in and performance of daily
activities.
History of occupational therapy
The earliest evidence of using occupations as a method of therapy can
be found in ancient times. In c. 100 BCE, Greek physician Asclepiades
initiated humane treatment of patients with mental illness using
therapeutic baths, massage, exercise, and music. Later, the Roman Celsus
prescribed music, travel, conversation and exercise to his patients.
However by medieval times the concept of humane treatment of people
considered to be insane was rare, if not nonexistent.
[4]
In 18th century Europe, revolutionaries such as Philippe Pinel and
Johann Christian Reil reformed the hospital system. Instead of the use
of metal chains and restraints, their institutions utilized rigorous
work and leisure activities in the late 18th century. This was the era
of Moral Treatment, developed in Europe during the Age of Enlightenment,
where the roots of occupational therapy lie.
[5]
Although it was thriving abroad, interest in the reform movement waxed
and waned in the United States throughout the 19th century. It
re-emerged in the early decades of the 20th century as Occupational
Therapy.
The Arts and Crafts Movement that flourished between 1860 and 1910
also impacted occupational therapy. In a recently industrialized
society, the arts and crafts societies emerged against the monotony and
lost autonomy of factory work .
[5]
Arts and crafts were utilized as a way of promoting learning through
doing and provided an outlet for creative energy and a way of avoiding
the boredom that was associated with long hospital stays, both for
mental illness and for tuberculosis.
The health profession of occupational therapy was conceived in the
early 1910s as a reflection of the Progressive Era. Early professionals
merged highly valued ideals, such as having a strong work ethic and the
importance of crafting with one’s own hands with scientific and medical
principles.
[4]
The National Society for the Promotion of Occupational Therapy, now
called the American Occupational Therapy Association (AOTA), was founded
in 1917 and the profession of Occupational Therapy was officially named
in 1920.
Occupational therapy is basically used for the people who are having
an issue related to health because of their profession. This therapy is
used to keep you health through out hectic schedules, this will help you
to be healthy physically as well mentally. With the help of this
therapy people use to keep their kids health which help them to remind
things and physical fit, so that can participate in the daily aspects by
themselves. This therapy is being used for the people of all ages. In
this therapy play way methods and self care modes are being used to cure
the disability of people.
The emergence of occupational therapy challenged the views of
mainstream scientific medicine. Instead of focusing on purely physical
etiologies, occupational therapists argued that a complex combination of
social, economic, and biological reasons cause dysfunction. Principles
and techniques were borrowed from many disciplines—including but not
limited to
nursing,
psychiatry,
rehabilitation,
self-help,
orthopedics, and
social work—to
enrich the profession’s scope. Between 1900 and 1930, the founders
defined the realm of practice and developed supporting theories. By the
early 1930s, AOTA had established educational guidelines and
accreditation procedures
[6]
In a short 20-year span, they successfully convinced the public and
medical world of the value of occupational therapy and established
standards for the profession.
[4]
World War I forced the new profession to clarify its role in the
medical domain and to standardize training and practice. In addition to
clarifying its public image, occupational therapy also established
clinics, workshops, and training schools nationwide. Due to the
overwhelming number of wartime injuries, “reconstruction aides” (an
umbrella term for occupational therapy aides and physiotherapy aides,
now known as physical therapists) were recruited by the Surgeon General.
Between 1917 and 1920, nearly 148,000 wounded men were placed in
hospitals upon their return to the states. This number does not account
for those wounded abroad. The success of the reconstruction aides,
largely made up of women trying to “do their bit” to help with the war
effort, was a great accomplishment. Post-war, however, there was a
struggle to keep people in the profession. Emphasis shifted from the
altruistic war-time mentality to the financial, professional, and
personal satisfaction that comes with being a therapist. To make the
profession more appealing, practice was standardized, as was the
curriculum. Entry and exit criteria were established, and the American
Occupational Therapy Association advocated for steady employment, decent
wages, and fair working conditions. Via these methods, occupational
therapy sought and obtained medical legitimacy in the 1920s.
[4]
Occupational therapy. Toy making in psychiatric hospital. World War 1 era.
The profession has continued to grow and expand its scope and
settings of practice. Occupational science, the study of occupation, was
created in 1989 as a tool for providing evidence-based research to
support and advance the practice of occupational therapy, as well as
offer a basic science to study topics surrounding "occupation".
[7]
Evolution of the philosophy of occupational therapy
The
philosophy
of occupational therapy has changed over the history of the profession.
The philosophy articulated by the founders owed much to the ideals of
romanticism,
[8] pragmatism[9] and
humanism which are collectively considered the fundamental ideologies of the past century.
[10][11][12]
One of the most widely cited early papers about the philosophy of
occupational therapy was presented by Adolf Meyer, a psychiatrist who
had emigrated to the United States from Switzerland in the late 19th
century and who was invited to present his views to a gathering of the
new Occupational Therapy Society in 1922. At the time, Dr. Meyer was one
of the leading psychiatrists in the United States and head of the new
psychiatry department and Phipps Clinic at Johns Hopkins University in
Baltimore, Maryland.
[13][14]
William Rush Dunton, a supporter of the National Society for the
Promotion of Occupational Therapy, now the American Occupational Therapy
Association, sought to promote the ideas that occupation is a basic
human need, and that occupation is therapeutic. From his statements came
some of the basic assumptions of occupational therapy, which include:
- Occupation has a positive effect on health and well-being.
- Occupation creates structure and organizes time.
- Occupation brings meaning to life, culturally and personally.
- Occupations are individual. People value different occupations.[15]
These philosophies have been elaborated on over time in order to form
the values that underpin the Codes of Ethics issued by each national
association. However, the relevance of occupation to health and
well-being remains the central theme. Influenced by criticism from
medicine and the multitude of physical disabilities resulting from
World War II, occupational therapy adopted a more
reductionistic
philosophy for a time. While this approach led to developments in
technical knowledge about occupational performance, clinicians became
increasingly disillusioned and re-considered these beliefs.
[16][17] As a result, client centeredness and occupation have re-emerged as dominant themes in the profession.
[18][19][20]
Over the past century, the underlying philosophy of occupational
therapy has evolved from being a diversion from illness, to treatment,
to enablement through meaningful occupation.
[15] This became evident through the development and widespread adoption of the
Canadian Model of Occupational Performance.
The two most commonly mentioned values are that occupation is essential for health and the concept of
holism.
However, there have been some dissenting voices. Mocellin in particular
advocated abandoning the notion of health through occupation as
obsolete in the modern world and questioned the appropriateness of
advocating holism when practice rarely supports it.
[21][22][23]
The values formulated by the American Occupational Therapy Association
have also been critiqued as being therapist centred and not reflecting
the modern reality of multicultural practice.
[24][25]
Central to the philosophy of occupational therapy is the concept of
occupational performance. In considering occupational performance the
therapist must consider the many factors that comprise overall
performance. This concept is made more tangible using models such as the
person-environment-occupation model proposed by Law et al. (1996).
[26]
This approach highlights the importance of satisfactions in one's
occupations, broadening the aim of occupational therapy beyond the mere
completion of tasks to the holistic achievement of personal well-being.
In recent times occupational therapy practitioners have challenged
themselves to think more broadly about the potential scope of the
profession, and expanded it to include working with groups experiencing
occupational deprivation which stems from sources other than disability.
[27] Examples of new and emerging practice areas would include therapists working with
refugees,
[28] and with people experiencing
homelessness.
[29]
The expanded version of the
Canadian model of occupational performance and engagement
(CMOP-E) encourages occupational therapists to think beyond just
occupational performance and address other modes of occupational
interaction such as occupational deprivation, competence, and justice.
The broader notion of occupational engagement encompasses all that we do
to become occupied and is congruent with how occupational therapists
address issues of occupational enablement today.
[15]
Enabling occupation
Best practice in occupational therapy seeks to offer effective,
client-centred services that enable people to engage in occupations of
life. The Canadian Model of Client Centered Enablement (CMCE) embraces
occupational enablement as the core competency of occupational therapy
[15] and the Canadian Practice Process Framework (CPPF)
[15] as the core process of occupational enablement.
Occupational therapy process
An
Occupational Therapist
works systematically through a sequence of actions known as the
occupational therapy process. There are several versions of this process
as described by numerous writers, although all include the basic
components of evaluation, intervention, and outcomes. Creek
[30] has sought to provide a comprehensive version based on extensive research which has 11 stages.
The Canadian Practice Process Framework (CPPF),
[15] has eight action points and three contextual elements.
Fearing, Law, and Clark
[31]
suggested a 7 stage process. A central element of this process model is
the focus on identifying both client and therapists strengths and
resources prior to beginning to develop the outcomes and action plan.
The Occupational Therapy Practice Framework: Domain and Process (2nd
edition) (AOTA, 2008) presents a 3 stage process, and includes
interrelated constructs that define and guide practice.
Areas of practice in occupational therapy
The role of Occupational Therapy allows OT’s to work in many
different settings, work with many different populations and acquire
many different specialties. This broad spectrum of practice lends itself
to difficulty categorizing the areas of practice that exist, especially
considering the many countries and different healthcare systems. In
this section, the categorization from the American Occupational Therapy
Association is used. However, there are other ways to categorize areas
of practice in OT, such as physical, mental, and community practice
(AOTA, 2009). These divisions occur when the setting is defined by the
population it serves. For example, acute physical or mental health
settings (e.g.: hospitals), sub-acute settings (e.g.: aged care
facilities), outpatient clinics and community settings.
In each area of practice below, an OT can work with different populations, diagnosis, specialities, and in different settings.
Occupational therapy during WWI: bedridden wounded are knitting.
Children & Youth
Occupational therapists work with infants, toddlers, children, and
youth and their families in a variety of settings including schools,
clinics, and homes.
[32]
Occupational therapists assist children and their caregivers to build
skills that enable them to participate in meaningful occupations.
Occupational therapists also address the psychosocial needs of children
and youth to enable them to participate in meaningful life events. These
occupations may include: normal growth and development, feeding, play,
social skills, and education.
[33]
Occupational therapy with Children and Youth may take a variety of forms:
[32][33]
- Promoting a wellness program in schools to prevent childhood obesity
- Facilitating hand writing development in school-aged children
- Promoting functional skills for living in children with developmental disabilities
- Providing individualized treatment for sensory processing difficulties
- Addressing psychosocial needs of a child and teaching effective coping strategies
Health & Wellness
The practice area of Health and Wellness is emerging steadily due to
the increasing need for wellness-related services in occupational
therapy. A connection between wellness and physical health, as well as
mental health, has been found; consequently, helping to improve the
physical and mental health of clients can lead to a general increase in
wellness.
[34]
As a practice area, health and wellness can include a focus on the following:
[34][35]
- Prevention of disease and injury
- Prevention of secondary conditions
- Promotion of the well-being of those with chronic illnesses
- Reduction of health care disparities
- Enhancement of factors that impact quality of life
- Promotion of healthy living practices, social participation, and occupational justice
Mental Health
According to the World Health Association, mental illness is one of the fastest growing forms of disability.
[36]
There is a focus on prevention and treatment of mental illness in
populations including children, youth, the aging, and those with severe
and persistent mental health issues.
[37]
Occupational therapists provide mental health services in a variety of
settings including hospitals, day programs, and long-term-care
facilities.
[38]
Occupational therapists help individuals with mental illness acquire
the skills to care for themselves or others including the following:
[39]
- schedule maintenance
- routine building
- coping skills
- medication management
- employment
- education
- community access and participation
- social skills development
- leisure pursuits
- money management
- childcare
Productive Aging
Occupational therapists work with older adults to maintain
independence, participate in meaningful activities, and live fulfilling
lives. Some examples of areas that occupational therapists address with
older adults are driving, continuing to live at home, low vision, and
dementia or
Alzheimer’s Disease (AD).
[40]
When addressing driving, driver evaluations are administered to
determine if drivers are safe behind the wheel. To enable independence
of older adults at home, occupational therapists perform fall screens
and evaluate older adults functioning in their homes and recommend
specific home modifications. When addressing low vision, occupational
therapists modify tasks and the environment.
[41]
While working with individuals with AD, occupational therapists focus
on maintaining quality of life, ensure safety, promote independence, and
utilize retained abilities.
[42]
Rehabilitation
Occupational therapists address the needs of rehabilitation,
disability, and participation. Occupational therapists provide treatment
for adults with disabilities in a variety of settings including
hospitals (acute rehabilitation, in-patient rehabilitation, and
out-patient rehabilitation), home health, skilled nursing facilities,
and day rehabilitation programs. When planning treatment, occupational
therapists address the physical, cognitive, psychosocial, and
environmental needs involved in adult populations across a variety of
settings.
Occupational therapy with adult rehabilitation, disability, and participation may take a variety of forms:
- Working with adults with autism at day rehabilitation programs to
promote successful relationships and involvement in the community[43]
- Increasing the quality of life for a cancer survivor or individual
with cancer by engaging them in occupations that are meaningful,
providing therapy for lymphedema management, implementing anxiety and
stress reduction methods, and fatigue management[44]
- Training individuals with hand amputations how to put on and take
off a myoelectrically controlled limb as well as training for functional
use of the limb[44]
- Using and implementing new technology such as speech to text software and Nintendo Wii video games[45]
- Communicating via telehealth methods as a service delivery model for clients who live in rural areas[46]
- Providing services for those in the armed forces such as cognitive
treatment for traumatic brain injury, training and education towards the
use of prosthetic devices for amputations, and treatment for
psychological distress as a result of post-traumatic stress disorder[47]
Travel Occupational Therapy
Because of the rising need for occupational therapists,
[48]
many facilities are opting for travel occupational therapists—who are
willing to travel, often out of state, to work temporarily in a
facility. Assignments may run as short as 8 weeks or as long as 9
months, but typically last 13–26 weeks in length.
[49]
While the average wages of a permanent occupational therapist in the
United States are approximately $68,000/year, traveling occupational
therapists enjoy much higher wages—approximately $113,600/year.
[50]
They also enjoy benefits such as free housing, health/medical
insurance, travel reimbursement, loyalty bonuses, and a 401k plan. Most
commonly (43%), travel occupational therapists enter the industry
between the ages of 21-30.
[50]
Work & Industry
Occupational therapists may also work with clients who have had an
injury and are trying to get back to work. Testing may be completed to
simulate work tasks in order to determine best matches for work,
accommodations needed at work, or the level of disability. Work
conditioning and hardening are approaches used to restore performance
skills needed on the job that may have changed due to an illness or
injury. Occupational therapists can also prevent work related injuries
through ergonomics and on site work evaluations.
[51]
Emerging Practice Areas
As society changes, individuals' occupational needs change as well.
In order to ensure occupational therapy stays modern, the American
Occupational Therapy Association develops a list of emerging practice
areas in which occupational therapists may play a role. The following
are the most current emerging practice areas. To learn more about these
areas, please visit
http://www.aota.org/Practitioners/PracticeAreas/EmergingAreas.aspx.
Children & Youth
- A Broader Scope in Schools
- Autism
- Bullying
- Childhood Obesity
- Driving for Teens With Disabilities
- Transitions for Older Youths
Education
- Distance Learning
- Re-entry to the Profession
Health & Wellness
- Chronic Disease Management
- Obesity
- Prevention
Mental Health
- Depression
- Recovery and Peer Support Model
- Sensory Approaches to Mental Health
- Veterans’ and Wounded Warriors’ Mental Health
Productive Aging
- Community Mobility and Older Drivers
- Aging in Place and Home Modifications
- Low Vision
- Alzheimer’s Disease and Dementia
Rehabilitation
- Autism in Adults
- Cancer Care and Oncology
- Hand Transplants and Bionic Limbs
- New Technology for Rehab
- Telehealth
- Veteran and Wounded Warrior Care
Work and Industry
- Aging Workforce
- New Technology at Work
Occupational therapy approaches
Services typically include:
- Teaching new ways of approaching tasks[52]
- How to break down activities into achievable components e.g. sequencing a complex task like cooking a complex meal[52]
- Comprehensive home and job site evaluations with adaptation recommendations.
- Performance skills assessments and treatment.
- Adaptive equipment recommendations and usage training.
- Environmental adaptation including provision of equipment or designing adaptations to remove obstacles or make them manageable[52]
- Guidance to family members and caregivers.[53]
- The use of creative media as therapeutic activity
Activity analysis
Activity analysis has been defined as a process of dissecting an
activity into its component parts and task sequence in order to identify
its inherent properties and the skills required for its performance,
thus allowing the therapist to evaluate its therapeutic potential
[54]
Theoretical Frameworks
Occupational Therapists use a number of theoretical frameworks to
frame their practice. Note that terminology has differed between
scholars. Theoretical bases for framing a human and their occupation
being include the following:
Frames of Reference/Generic models
Frames of reference or generic models are the overarching title given
to a collation of compatible knowledge, research and theories that form
conceptual practice.
[55] More generally they can be defined as "those aspects which influence our perceptions, decisions and practice".
[56]
Occupational Therapy Frame of References/Models:
- Person Environment Occupation Performance Model (PEOP) (Charles Christiansen & Carolyn Baum)
- Occupational Therapy Intervention Process Model (OTIPM) (Anne Fisher and others)
- Occupational Performance Model (OPM)
- Model of Human Occupation (MOHO) (Gary Kielhofner and others)
- MOHO was first published in 1980. It explains how people select,
organise and undertake occupations within their environment. The model
is supported with evidence generated over thirty years and has been
successfully applied throughout the world.[57]
- Canadian Model of Occupational Performance and Engagement (CMOP-E)
- Occupational Performances Model - Australia (OPM-A) (Chris Chapparo & Judy Ranka)
- The OPM(A) was conceptualized in 1986 with its current form launched
in 2006. The OPM(A) illustrates the complexity of occupational
performance, the scope of occupational therapy practice, and provides a
framework for occupational therapy education.[58]
- Kawa (River) Model (Michael Iwama)
- Functional Information-Processing Model
- Biomechanical Frame of Reference
- The Biomechanical Frame of Reference is primarily concerned with
motion during occupation. It is used with individuals who experience
limitations in movement, inadequate muscle strength or loss of endurance
in occupations. The Frame of Reference was not originally compiled by
Occupational Therapists, and Therapists should translate it to the
Occupational Therapy perspective,[59] to avoid the risk of movement or exercise becoming the main focus.[60]
- Rehabilitative (compensatory)
- Neurofunctional (Gordon Muir Giles and Clark-Wilson)
- Cognitive Disabilities
- Dynamic Systems Theory
- Sensory Integration
- Lifestyle Performance Model (Fidler)
- Client-Centered Frame of Reference
- This Frame of Reference is developed from the work of Carl Rogers.
It views the client as the center of all therapeutic activity, and the
client's needs and goals direct the delivery of the Occupational Therapy
Process.[61]
- Cognitive-Behavioural Frame of Reference
- Psychodynamic Frame of Reference
- Ecological of Human Development Model
- Recovery Models & Self-Management Models
- Curtin pARTicipation Model
- Knowledge Translation of Self-Management Models[62]
- Life-Skills Tree Model[63]
- Occupational Therapy - Mahidol Clinical System (OT-MCS) Model[64]
==
Occupational therapy and ICF
The
International Classification of Functioning, Disability and Health (ICF)
is a framework to measure health and ability by illustrating how these
components impact one’s function. This relates very closely to the
Occupational Therapy Practice Framework as it is stated, “The
profession’s core beliefs are in the positive relationship between
occupation and health and its view of people as occupational beings”.
[65] The
ICF is also built into the 2nd edition of the practice framework. Activities and participation examples from the
ICF overlap Areas of Occupation, Performance Skills, and Performance Patterns in the framework. The
ICF
also includes contextual factors (environmental and personal factors)
that relate to the context in the framework. In addition, body functions
and structures classified within the ICF help describe the client
factors as described in the OT framework
[66]
Further exploration of the relationship between occupational therapy
and the components of the ICIDH-2 (revision of the original
International Classification of Impairments, Disabilities, and Handicaps
(ICIDH); later becoming the
ICF) was conducted by McLaughlin Gray.
[67] First, the
ICF
is an international framework and provides an opportunity for the
occupational therapy field to become better known across the globe.
Second, the
ICF
provides occupational therapists with a global language to describe
their expertise to the larger international health care community. The
ICF
uses a positive, holistic language emphasizing skills, capacities, and
strengths of an individual rather than focusing on one’s deficits and
disabilities. This is similar to the outlook of occupational therapists.
Third, the
ICF
includes environmental and personal contextual factors which are
incorporated into the theory behind occupational therapy. It is
important to take into consideration an individual’s personal,
environmental, and occupational factors to develop an effective
intervention.
[14] The last notable application of the
ICF
to occupational therapy is the recognition of cultural patterns in
occupation. Culture has significance on an individual’s activities and
participation and it is important to keep this in mind when treating an
individual.
Although the
ICF
can be very useful for occupational therapists, it is noted in the
literature that occupational therapists should use specific occupational
therapy vocabulary along with the
ICF in order to ensure correct communication about specific concepts.
[68] The
ICF
might lack certain categories to describe what occupational therapists
need to communicate to clients and colleagues. It also may not be
possible to exactly match the connotations of the
ICF categories to occupational therapy terms. The
ICF is not an assessment and specialized occupational therapy vocabulary should not be replaced with
ICF terminology
[69] The
ICF is an overarching framework for current therapy practices.
See also
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