Occupational therapy programs tables of content

Reference
American Occupational Therapy Association, (1986). Uniform terminology system for reporting occupational therapy services. In Reference manual of the official documents of the American Occupational Therapy Association, Inc. (pp VIII, 12-VIII 18). Rockville, MD: Author.
Prepared by members of the Commission on Practice with contributions from Annette van Boldrick, OTR, Marcia S. Cox, OTR/L, Marilyn Dennis Daniel, MPA, OTR, Mary Godfrey, OTR, Janis Hunter, OTR, Christy L. A. Nelson, MS, OTR, Lillian Hoyle Parent, MA, OTR, FAOTA, Margaret Phillips, MS, OTR, Dianna Puccetti, OTR and Laura Schluter, OTR for the Commission on Practice (L. Randy Strickland, EdD, OTR, FAOTA, Chair).

Approved by the Representative Assembly April 1989.

Previously published and copyrighted by the American Occupational Therapy Association in 1989 in the American Journal of Occupational Therapy, 43, 805.

Human Immunodeficiency Virus (Position Paper)

The American Occupational Therapy Association asserts that occupational therapy addresses the occupational performance needs of all referred persons to assure their maximum independence in activities of daily living, work, and play/leisure. The Association believes that occupational therapy practitioners have a professional and ethical responsibility to provide such services upon referral. People diagnosed with human immunodeficiency virus (HIV) may be among those referred.
HIV is characterized by a suppression of the body’s immune system that makes the person susceptible to various opportunistic infections. Examples of such infections include: Pneumocystis carinii pneumonia and Kaposi sarcoma. Other manifestations of the virus might include cognitive deficits, depression, adjustment disorders, neurological impairment, developmental delay, acquired immunodeficiency syndrome (AIDS), and AIDS-related complex (ARC), HIV infection can occur in people of any age.
Occupational therapy interventions for people diagnosed with HIV are based on each person’s assessed needs and resources. In providing service, occupational therapy practitioners educate themselves regarding the disease, complete an assessment to determine areas of dysfunction, and implement a treatment plan. The provision of support services to people infected with HIV requires the involvement of families and others. Treatment programming does not require changes to established occupational therapy practices and principles. Occupational therapy is based on the belief that purposeful activity, including both interpersonal and environmental components, facilitates functional performance and the prevention or mediation of dysfunction.
To protect the person with HIV from superimposed infection, occupational therapy practitioners adhere to appropriate infection control procedures as defined by their facility and by local, state, and federal regulators. When such precautions are implemented, the persons with HIV are not at risk of infection and do not present a health risk to others.
In treating people diagnosed with HIV, occupational therapy practitioners are sensitive to the need for confidentiality and to the physical, psychological, social, and economic consequences of the disease. For many people with HIV, occupational therapy is a vital service that increases their level of independence, facilitates their psychological adjustment to the disease process, and improves their quality of life.
Related Readings
AIDS: The facts: AIDS: Prevention is your business: Women beware: AIDS information for women: Could I get it: AIDS information for teenagers: AIDS and IV drug user. (1986). (Brochures available from DCN/RAMSCO Publishing Company, PO Box N. Laurel , MD 20707).
American Council on Science and Health. (1988). Answers about AIDS. New York: Author.
American Occupational Therapy Association. (1979). 1979 Representative Assembly–59th Annual Conference (Minutes). American Journal of Occupational Therapy 33, 781-813.
American Occupational Therapy Association. (1986). Principles of occupational therapy ethics. In Reference manual of the official documents of the American Occupational Therapy Association, Inc. (pp IV1–IV8) Rockville, MD: Author
Bureau of Health Care Delivery and Assistance. Division of Maternal and Child Health. (1987). Report of the surgeon general’s workshop on children with HIV infection and their families. (DHHS Publications No. HRS-D-MC 87-1). Rockville, MD: US Department of Health and Human Services, Public Health Service, Health Resources and Service Administration.
Centers for Disease Control. (1983a). Acquired immunodeficiency syndrome (AIDS): Precautions for health care workers and allied professionals, Mortality and Morbidity Weekly Report 32, 450-451.
Centers for Disease Control (1983b). Guidelines for infection control in hospital personnel (Order No. 85923402). Springfield, VA: US Department of Commerce, National Technical Information Service.
Crocker, A.C., & Cohen, H.J. (1988). Guidelines on developmental services for children and adults with HIV infection. Silver Spring, MD: American Association of University Affiliated Programs for Persons with Developmental Disabilities.
Denton, R. (1987). AIDS: Guidelines for occupational therapy intervention. American Journal of Occupational Therapy , 41 427-432.
Health Resources and Services Administration, (1988). AIDS health care delivery. Washington, DC: US Department of Health and Human Services, Public Health Service.
National Institute of Mental Health (1986). Coping with AIDS: Psychological and social considerations in helping people with HTLV-III infection (DHHS Publication No. ADM 85-1432). Washington, DC: US Government Printing Office.
Nolinske, T. (Ed.) (1987, September). Special issue on AIDS. Physical Disabilities Special Interest Section Newsletter.
Ziegler, J.B., Johnson, R.O., Cooper, D.A. & Gold, J. (1985). Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet, i 301-304.
Database
National Library of Medicine and NIH Office3 of AIDS Research, AIDSLINE (a MEDLAR database). Bethesda, MD: National Library of Medicine (800-63808480 or 301-496-6193).
Prepared by James Scussel, MA, OTR, with contributions from Rita Handley, MOT, OTR, and Sara Brayman, MS, OTR, for the Commission on Practice (L. Randy Strickland, EdD, OTR, FAOTA, Chair).
Approved by the Representative Assembly April 1989.
Previously published and copyrighted by the American Occupational Therapy Association in 1989 in the American Journal of Occupational Therapy, 43 803-804.

Occupational Therapy and Hospice (Position Paper)

The American Occupational Therapy Association believes that people can lead productive and meaningful lives despite a terminal illness and that occupational therapy provides an essential service in this process. Hospice philosophy states that:
dying is a normal process whether or not resulting from disease. Hospice exists neither to hasten nor to postpone death. Rather hospice exists to affirm LIFE by providing support and care for those in the last phases of incurable disease so that they can live as fully and comfortably as possible. Hospice promotes the formation of caring communities that are sensitive to the needs of patients and their families at this time in their lives so that they may be free to obtain that degree of mental and spiritual preparation for death that is satisfactory to them. (National Hospice Organization, 1981. P3)
Complementary to this, the philosophical base of occupational therapy (AOTA, 1979) includes these premises: (a) “Man is an active being whose development is influenced by the use of purposeful activity” (p. 785); (b) “human beings are able to influence their physical and mental health and their social and physical environment through purposeful activity” (p. 785), and (c) “human life includes a process of continuous adaptation (which) promotes survival and self-actualization” (p. 785) and that when adaptation is impaired, dysfunction may result.
The concepts of mastery (the ability to take command of oneself) and adaptation (the ability to make changes to maintain mastery) are basic to the practice of occupational therapy. Through energy conservation techniques (e.g., sitting to shower rather than standing), environmental modification (e.g., using a ramp rather than stairs), and purposeful activities (e.g., using a specially adapted pen to write a letter), occupational therapy personnel are able to assist the patient and the patient’s family in allaying the problems related to the loss of control, the loss of role, the loss of dignity, and feelings of isolation and withdrawal. Purposeful activity engages both the mind and body and serves as a means of personal expression, a connecting point between individuals, and a means of maintaining independence and integrity.
The philosophy of hospice and the philosophical base of occupational therapy share the goal of helping people with life-threatening diseases adapt to changing life situations in order to live as fully and comfortably as possible. Both acknowledge the importance of the physical and social environments and seek to promote caring communities and a therapeutic milieu for the terminally ill and their care givers. In terminal illness, it is essential that the patient’s physical and social environment be adapted according to changing abilities, needs, and choices. The technological advances in today’s health care ca be viewed or experienced as impersonal. Enhancing personal relationships and assisting the patient in maintaining independence and integrity and some control of the environment is one of the dominant roles of occupational therapy.
As the disease process affects the abilities and function of the patient, occupational therapy assists the patient in maintaining involvement in daily life tasks and roles in the areas of work, (e.g., being able to type), leisure (e.g., being able to play cards), and self-care (e.g., being able to brush one’s teeth). A program plan, including goals, is developed by the therapist, patient, and family, and it is then integrated with the overall plan of the hospice team. Changes in functional ability may occur quickly, requiring continuous adjustments in type, pace, and number of activities. These adaptations allow the patient satisfying participation in activities which foster a sense of competence and personal mastery. While the patient is helped to maintain a maximum level of mastery, the family and care givers are also helped to maintain positive and realistic expectation as they adjust to the disease process and its impact on life-style.
Occupational therapy personnel, as part of the hospice team, assist with the overall personal, emotional, and social adjustments of both the patient and the family during the period of terminal illness. After the patient’s death, they can provide support for the bereaved family in resuming roles and inn assuming new roles after the loss of their family member.
AOTA fully supports the development of hospice services and believes that the service of occupational therapy are essential to the hospice team if the hospice tenet of quality of life is to be realized. Occupational therapy assists in providing a comprehensive plan of care that adequately addresses issues relating to the patient and the family in the daily living activities of work, leisure, and self-care. By involving the patient and family in the adaptation process, the quality of life is enhanced and the patient is able to retain some degree of meaning and mastery of his or her own life in the presence of advancing functional loss.
References
American Occupational Therapy Association, (1979). (Minutes of the) 1979 Representative Assembly–59th Annual Conference. American Journal of Occupational Therapy, 33. 780-813.
National Hospice Organization. (1981). Hospice philosophy. In  Standards of a hospice program of care. Alexandria VA: Author.
Related Readings
Delrich, M. (1974). The patient with a fatal illness. American Journal of Occupational Therapy, 28. 429-432.
Gamage, S.L., McMahon. P.S. & Shanahan, P.M. (1976). The occupational therapist and terminal illness: Learning to cope with death, American Journal of Occupational Therapy, 30. 294-299.
Pizzi, M. (1984). Occupational therapy in hospice care. American Journal of Occupational Therapy, 38. 252-257.
Tigges, K. (1983). The treatment of the hospice patient: From occupational history to occupational role. American Journal of Occupational Therapy, 37. 235-238.

Prepared b the Commission on Practice, with contributions from the Hospice Task Force (K. Ann Evans, EdD, OTR, FAOTA, COP, liaison to the Hospice Task Force, Nancy W. Lund, MS, OTR/L, Michael Pizzi, OTR/L. Barbara Thompson, OTR/L and Kent Nelson Tigges, MS, OTR, FAOTA) for the Commission on Practice (Esther bell, MA, OTR, FAOTA, chair, and Cynthia F. Epstein, MA, OTR, FAOTA, project coordinator).

Approved by the Representative Assembly April 1986.
Reviewed by the Commission on Practice September 1991.
Previously published and copyrighted by the American Occupational Therapy Association in 1986 in the American Journal of Occupational Therapy, 40. 839-840.

POSITION PAPER: PURPOSEFUL ACTIVITY
The American Occupational Therapy Association (AOTA) submits this paper to clarify the use of the term purposeful activity, a central focus of occupational therapy throughout its history. People engage in purposeful activity as part of their daily life routines, in the context of occupational performance (AOTA, 1979). Occupation refers to active participation in self-maintenance, work, leisure, and play. Purposeful activity refers to goal-directed behaviors or tasks that comprise occupations. An activity is purposeful if the individual is an active, voluntary participant and if the activity is directed toward a goal that the individual is an active, voluntary participant and if the individual considers meaningful (Evans, 1987; Gilfoyle, 1984; Mosey, 1986; Nelson, 1988). The purposefulness of an activity lies with the individual performing the activity and with the context in which it is done (Henderson et al., 1991). The meaning of an activity is unique to each person, influenced by his or her life experiences (Mosey, 1986; Petretti, 1982), life roles, interests, age, and cultural background, as well as the situational context in which the activity occurs. Occupational therapy practitioners (i.e., registered occupational therapists and certified occupational therapy assistants) are committed to the use of purposeful activity to evaluate, facilitate, restore, or maintain individuals’ abilities to function in their daily occupations.
Occupational therapists use activities to evaluate an individual’s capacities to meet the functional demands of his or her environment and daily life. On the basis of an evaluation, the occupational therapy practitioner, in collaboration with the individual, designs activity experiences that offer the individual opportunities for effective action. Purposeful activities assist and build upon the individual’s abilities and lead to achievement of personal functional goals.

Purposeful activity provides opportunities for persons to achieve mastery of their environment, and successful performance promotes feelings of personal competence (Fidler & Fidler, 1978). A person who is involved in purposeful activity directs attention to the goal rather than to the processes required for achievement of the goal. Engagement in purposeful activity within the context of interpersonal, cultural, physical, and other environmental conditions requires and elicits coordination among the individual’s sensory motor, cognitive, and psychosocial systems. Purposeful activity may involve the independent use of complex cognitive processes, such as premeditation, reflection, planning, and use of symbolic cues. Conversely, it may involve less complex processes and take place in an environment of external structure, support and supervision (Allen, 1987; Henderson et al., 1991). Engagement in purposeful activity provides direct and objective feedback of performance both to the occupational therapy practitioner and the individual.

The therapeutic purposes for which purposeful activity is used include mastery of a new skill, restoration of a deficient ability, compensation for functional disability, health maintenance, or prevention of dysfunction. To use purposeful activity therapeutically, an occupational therapy practitioner analyzes the activity from several perspectives. First, the activity is examined to identify its component parts to determine which skills and abilities are necessary to complete the task. Second, it is examined in terms of context in which it will be performed. Third, the practitioner considers the person’s age, occupational roles, cultural background, gender, interests, and preferences that may influence the meaningfulness of the activity for the individual. All this information is considered together to assist the occupational therapy practitioner in synthesizing (i.e., adapting, grading, and combining) activities for therapeutic purposes for a particular individual.
Purposeful activities cannot be prescribes on the basis of analysis of their inherent characteristics along; rather, by definition, prescription of purposeful activity is individual-specific. An occupational therapy practitioner grades or adapts a chosen activity for an individual to promote successful performance or elicit a particular response. Grading activities challenges the patient’s abilities by progressively changing the process, tools, materials, or environment of a given activity to gradually increase or decrease performance demands. These incremental modifications are made in response to the individual’s dynamic changes and provide opportunities for gradual development of skill and related therapeutic benefits. The grading of activities is accomplished by modifying the sequence, duration, or procedures of the task; the individual’s position; the position of the tools and materials; the size, shape, weight, or texture of the materials; the nature and degree of interpersonal contact; the extent of physical handling by the occupational therapy practitioner during performance; or the environment in which the activity is attempted. Supportive or assertive devices or techniques may be used to enhance the effectiveness of an activity or to facilitate performance (Henderson et al., 1991; Petretti & Pasquinelli, 1990). Such techniques or devices are considered facilitative or preparatory to performance of purposeful activity and engagement in occupations.
If the therapy goal is to enhance a performance component so that tan individual can engage in an occupational performance area, the selected activity and environmental conditions are manipulated to present graded challenges to the specific skills required. When an individual’s successful completion of a task is a priority, occupational therapy practitioners adapt the task to the environment to facilitate performance. Adaptation is a process that changes an aspect of the activity or the environment to enable successful performance and accomplish a particular therapeutic goal. Adaptation of a task may require the use of assistive devices and techniques or grading strategies.
Occupational therapy education provides the necessary background for using activities as therapeutic modalities by instructing the student about behavioral and biological sciences related to the use and meaning of activity, about the nature of purposeful activity, about the process of activity analysis and synthesis, and about the application of activity to therapeutic problems within occupational therapy frames of reference.
In summary, purposeful activity occurs within the context of work, self-care, play, and leisure activities and is used therapeutically to evaluate, facilitate, restore, or maintain individuals’ abilities to function competently within their daily occupations. The occupational therapy practitioner’s commitment to those whom he or she serves is to guide them in the use of purposeful activities so as to empower them to enhance the quality of their being in the daily reality where they live as parents, children, students, homemakers, workers, or retirees (Reilly, 1966).•
References
Allen, C. K. (1987). 1987 Eleanor Clarke Siagle Lecture – Activity: Occupational therapy’s treatment method. American Journal of Occupational Therapy, 41, 563-575.
American Occupational Therapy Association, (1979), Resolution C, 531-79: The philosophical base of occupational therapy. American Journal of Occupational Therapy, 33, 785.
Evans, K. A. (1987). Nationally Speaking–Definition of occupation as the core concept of occupational therapy, American Journal of Occupational Therapy, 41, 627-628.
Fidler, G.S. & Fidler, J. W. (1978). Doing and becoming: Purposeful action and self-actualization. American Journal of Occupational Therapy, 32, 305-310.
Gilfoyle, E. M. (1984). Eleanor Clarke Slagle Lectureship 1984–Transformation of a profession. American Journal of Occupational Therapy, 38, 575-584.
Henderson, A., Cermak, S., Coster, W., Murray, E., Trombly, C., & Tickle-Degnen, L. (1991). The issue is–Occupational science is multidimensional. American Journal of Occupational Therapy, 45, 370-372.

Mosey, A.C. (1986). Psychosocial components of occupational therapy. New York: Raven.

Nelson, D.L. (1988). Occupation: Form and performance. American Journal of Occupational Therapy, 42, 633-641.
Pedretti, L.W. (1982, May). The compatibility of current treatment methods in physical disabilities with the philosophical base of occupational therapy. Paper presented at the 62^nd Annual Conference of the American Occupational Therapy Association, Philadelphia, PA.
Pedrett, L. W. & Pasquinelli, S. (1990). A frame of reference for occupational therapy in physical dysfunction. In L.W. Pedretti & B. Zoltan (Eds.) Occupational therapy practice skills for physical dysfunction (pp. 1-17). St. Louis: Mosby.
Reilly, M. (1966). The challenge of the future to an occupational therapist. American Journal of Occupational Therapy, 20, 221-225.
Prepared by Jim Hinojosa, PhD, OTR, FAOTA, Joyce Sabari, PhD, OTR, and Lorraine Pedretti, MS, OTR, with contributions from Mark S. Rosenfeld, PhD, OTR, and Catherine Trombly, ScD, OTR/L, FAOTA, for The Commission on Practice (Jim Hinojosa, PhD, OTR, FAOTA, Chairperson).
Approved by the Representative Assembly April, 1983. Revised and approved by the Representative Assembly June 1993.

Statement:

The Role of Occupational Therapy in the Independent Living Movement
The American Occupational Therapy Association asserts that occupational therapy practitioners can serve a vital role in independent living programs. Independent living is defined as

control over one’s life based on the choice of acceptable options that minimize

reliance on others in making decisions and in performing everyday activities. This

includes managing one’s affairs, participating in day-to-day life in the community,

fulfilling a range of social roles, and making decisions that lead to self-determination

and the minimization of physical and psychosocial dependence upon others.

(Frieden & Cole, 1985, p. 735)

Occupational therapy enables individuals to meet their intrinsic needs for purposeful activity and autonomy.

The independent living model differs from the medical model in that it is consumer oriented and directed, not governed by health care professionals. Rather than focusing on professional intervention and treatment in an effort to change the individual with a disability, the independent living model focuses on changing the community (i.e., eliminating architectural barriers and negative attitudes toward individuals with disabilities) and maximizing consumer control. Consumers choose the services they need and select who will provide them. Furthermore, the independent living model is community based, working toward the development of nonmedically controlled services to address the consumer’s goals so that institutionalization is not necessary. By definition, Centers for Independent Living are nonresidential, though some do have residential components.
The philosophy of the independent living movement parallels that of occupational therapy in that both advocate for the right of the individual to live as independently as possible in the community and both work to promote environments and attitudes that will facilitate that process. Occupational therapy practitioners are uniquely qualified to provide services in independent living settings, as they have an understanding of the dynamic interplay between the individual and the environment, and can suggest and implement modifications to enhance the individual’s ability to function in a given environment. In the independent living model, the consumer identifies his or her own goals. Responding to the consumer’s stated needs, and in collaboration with the consumer, the occupational therapy practitioner observes and assesses the consumer’s capacity to perform various activities, considers the demand of the environment, and assists the consumer in accomplishing goals. The focus is on adaptation and modification of the consumer’s strategies and the environment rather than the remediation of an underlying impairment.
The occupational therapy practitioner working in an independent living setting may assume a variety of roles. The practitioner might work as a consultant, an advocate, a director, a case manager, and often as a provider of “traditional” occupational therapy services in the consumer’s home and community. While some independent living settings serve only individuals with a particular diagnosis, many serve individuals with multiple functional limitations. The role of the occupational therapy practitioner employed in an independent living setting is multidimensional. While the occupational therapy practitioner must be able to practice independently on an advanced level, he or she must also be familiar with the range of services available in order to make appropriate referrals to community resources. The role of the occupational therapy practitioner employed in an independent living setting is complex and is not considered entry-level practice. Although specific state regulations may dictate the parameters of certified occupational therapy assistant practice, the American Occupational Therapy Association supports the autonomous practice of the advanced certified occupation therapy assistant practitioner in the independent living setting. In cases where a certified occupational therapy assistant would practice autonomously, it is the certified occupational therapy assistant’s responsibility to recognize situations that require consultation with or referral to a registered occupational therapist.
An occupational therapy practitioner in an independent living setting is not likely to receive referrals from physicians. The practitioner would more likely be assigned to serve a consumer who requests or selects an occupational therapy practitioner’s services based on his or her needs and the practitioner’s expertise. Occupational therapy practitioners must, therefore, follow their states’ regulations regarding working with or without physicians’ referrals. The following examples illustrate occupational therapy practice in an independent living setting.