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Occupational Therapy Theories

Practice Frame- Work OT 203-1 -Historical Impact on Theory Organization of Knowledge: Paradigm to Frame of Reference
STUDY
PLAY
Occupational Therapy's Domain
Supporting health and participation in life through engagement in occupation.
Domains
These are the areas of life an OT can offer assistance with. 6. AACCPP
Areas of Occupation
Client Factors
Performance Skills
Performance Patterns
Context and Environment
Activity Demands
Areas of occupation
ADLs
IADLs
Rest and sleep
Education
Work
Play
Leisure
Social Participation
Client factors
Values, beliefs, and spirituality
Body Functions
Body Structures
Performance skills
Sensory Perceptual Skills
Motor and Praxis Skills
Emotional Regulation Skills
Cognitive Skills
Communication and Social Skills
Performance patterns
Habits
Routines
Roles
Rituals
Context and Environments
Cultural
Personal
Physical
Social
Temporal
Virtual
Activity Demands
Objects used and their properties
Space Demands
Social Demands
Sequencing and timing
Required Actions
Required Body Structures
Outcomes
Occupational performance
Adaptation
Health and wellness
Participation
Prevention
Self Advocacy
Role Competence
Quality of life
Occupational justice
Types of Interventions
Therapeutic use of self
Therapeutic activities
Consultation
Education
Advocacy
1786
Philippe Pinel worked with the mentally ill in Paris
1798
Dr. B. Rush used 'work activity' in Philadelphia
1800's
Samuel Tukes proposed humane/moral treatment for the mentally ill in York, England in response to 'inhumane' treatment of the 'insane
Mary Reilly Quote
"Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health."
1892 Adolph Meyer proposed
'rhythms' of rest - play - work, and return to humanism
Highlighted the difference between opportunity and prescription
1905 Susan Tracy -
known as the 1st OT - instituted a training course and in 1910 published her text Study in Invalid Occupation
1920's
Humanism - 1920's Meyer
Habit Training and Reconstruction
Mechanistic viewpoints
1940's and 1950's with inclusion of activity analysis and rehab models of practice
1917
National Society for the Promotion of OT
1923
Standards for Education in OT
1930's
1940's
Registry established (OTR)
Examination (NBCOT)
1960's
1970's and 80's
COTA's came into being

legislated health care and OT roles
1980's
1990's
birth of occupational science
ADA
2001
2002
2008
2001 WHO revises International Classification of Function
2002 AOTA Publishes the 1st edition of the Occupational Therapy Practice Framework: Domain and Process
2008 2nd edition of the OT Frameworks
Process
The way a practitioner sets up there practice to provide best services.
Evaluation
Intervention
Outcome
Theory
Theory helps to describe, explain and predict behavior and/or relationships between concepts and events
A theory can be classified as a: paradigm, model or frame of reference
Paradigm
'describes a philosophical viewpoint,' is a shared vision and a 'force for unity;' provides a professional identity.
Mosey (OT) proposed that the paradigm contains: philosophy, values, ethical code (ethics), theoretical base, legitimate tools and domain of concern.
The paradigm for OT reflects systems theory which proposes that 'a system is an entity that maintains its existence and functions as a whole through interaction of its parts.'

a paradigm describes a philosophical viewpoint, is a shared vision and force for unity, and provides a professional identity.
According to Mosey - a paradigm contains:\
Philosophy
Values
Ethical code
Theoretical base
Legitimate tools
Domain of concern
Model
attempts to explain the relationship of occupation, person and environment, organizes and categorizes ideas and approaches to thinking about complex problems.
Models do not focus on any specific disability, age group or practice area
Frame of Reference
is a theory of compatible concepts that guides a plan of action for assessment and intervention within a specific OT domain - these usually do focus on specific disabilities, or ages or practice areas.
F'sOR contain: (1) narrowed theoretical base (2) function-dysfunction continua (3) guidelines for evaluation and intervention and (4) research substantiation
emergent properties
Systems function as a whole, so they have properties above and beyond the properties of the parts that comprise them. These are known as emergent properties - they emerge from the system when it is working; they are often unpredictable and are not found in individual parts of the system but in the interaction of those parts.
Legitimate Tools
OT's tools are:
nonhuman environment,
conscious use of self,
teaching-learning process,
purposeful activities,
activity groups
and activity analysis and synthesis.
Purposeful activity
Involves interaction with environment.
matches clients goal
mastery
Conscious use of self
Characteristics:
(1) planned interaction
(2) manipulative
(3) heighented sensitivity of how 'i' impact others
(4) use both verbal and non-verbal communication

Anticipated outcomes:
(1) . relieve fear and/ or anxiety
2. provide reassurance
3. obtain or provide necessary info
4. give advise
5. assist the individual in gaining more appreciation, expression and/or functional use of latent inner resources
Activity groups
"provide a laboratory for living: a microcosm of life, learning and work."
Difference between verbal and activity groups, activity groups: (1) : 1. centrality of activity. 2. immediacy of events, 3. circumscribed focus

Functional group (purposeful action promotes adaptation through engagement in occupation) means:
1. maximum involvment through group centerned action.
2. maximum sence of individual and group ID
3. a flow experiance ( so involved that you loose track of time)
4. spontaneous involvment of members
5. member support and feedback

Activity groups provide:
(1) structure
2. opportunity to express ideas and feelings
3. use of the non human environment
4. method of concretizing behavior ( say exactly what the problem is)
5. tangible means of measuring progress

Cohesiveness
Interpersonal learning
Instillation of hope
Metaphysics
- nature of man: mind body relationship, hierarchy vs heterarchy. Monism vs dualism
Epistemology
= questions of truth: how do we know things to be true? Must we experience something to beilve its true?
Axiology
= study of values 1. aesthetics, what is beautiful and desiarble. 2. ethics - code of conduct
Ethics
Ethics = study of that which is moral, good, or of value in life and actions (Mosey)

The primary goal of ethics is to develop a good character as such ethics is to develop....

Ethics help us to harmonize our interests and roles and avoid abuses of power.
KOHLBERG'S SIX STAGES
Level 1. Preconventional Morality
Stage 1. Obedience and Punishment Orientation.
Stage 2. Individualism and Exchange.
Level II. Conventional Morality
Stage 3. Good Interpersonal Relationships.
Stage 4. Maintaining the Social Order.
Level III. Postconventional Morality
Stage 5. Social Contract and Individual Rights.
Stage 6: Universal Principles.
Gilligan/In a Different Voice - relationships and caring - gender
Individual survival
Self sacrificial caring for others
Morality of non-violence; caring as a universal obligation
Virtues of health care professionals due to 'unique societal role':
Benevolence
Competence
Objectivity
Caring
Compassion
Principles used in clinical ethics:
Autonomy -
Beneficence -
Nonmaleficence -
Fidelity -
Justice -
Veracity -
Paternalism/parentalism -
Core Values and Attitudes of OT
Core Values and Attitudes of OT
Altruism -
Equality -
Freedom -
Justice -
Dignity -
Truth -
Prudence
Ethical dilemmas
occur when we face a situation in which the right or correct action is not clear - this may mean there is more than 1 right action.
Ethical conflicts
occur when our values clash with others causing us to feel uneasy, upset and/or perplexed.