A model of human occupation, part 2. Ontogenesis from the perspective of temporal adaptation

Occupational therapy's oversight: How science veiled our humanity

BACKGROUND

Occupational therapy's connection to positivist science predates the profession's formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being.

AIMS/OBJECTIVES

This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession's preoccupation with positivist science has obscured.

METHODS

This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time.

CONCLUSION

Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm.

SIGNIFICANCE

The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

"Metacognitive Reflection and Insight Therapy" (MERIT) for the Occupational Therapy Practitioner

Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.

Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice

This position statement describes the role and importance of occupational therapy practitioners in integrating inclusive environments into their professional services and into their underlying science. Primary documents that define the occupational therapy profession clearly support its role in creating and ensuring inclusive environments.

Cognitive stimulation program in mild cognitive impairment A randomized controlled trial

Non-pharmacological cognitive interventions in mild cognitive impairment have demonstrated promising results in preventing or delaying cognitive impairment and functional disability. Cognitive stimulation seems to improve and maintain cognitive and social activity.

The making of occupation-based models and diagrams: History and semiotic analysis

BACKGROUND.

Models provide a structure for organizing knowledge and facilitating learning and are upheld by occupational therapy as epitomizing the cornerstones of its practice.

PURPOSE.

This article briefly examines the scientific history of occupation-based model development in the 1950s before addressing the process of conceptual model making in occupational therapy. Using the theory of semiosis, it explains and takes a critical perspective on conceptual model building in occupational therapy.

KEY ISSUES.

Since the surge of development in the mid-1970s, models have grown and undergone some revision. However, while the profession has often contested the definitions of its core terms, it has not challenged the accepted models and diagrams that present the constituents of practice.

IMPLICATIONS.

Examining the processes of conceptual model development from a critical, semiotic point of view foregrounds models in the historico-theoretical literature and brings into scrutiny a model's relevancy in current practice.

A controlled study analyzing the temporal activity patterns of individuals with stroke compared to healthy adults

Introduction

The understanding of the temporal pattern of individuals can add a wider perspective to interventions. Therefore, the present study is aimed toward analysis of the temporal activity pattern of individuals with stroke compared to healthy adults.

Method

This study is a prospective, case–control, analytic research study. The study sample comprised 50 individuals with stroke and 50 individuals without disease, for 80% power with a 5% type 1 error. The Modified Occupational Questionnaire was administered to assess the temporal activity pattern. Individuals identified the activities performed at each hour of the day and data was analyzed.

Results

The temporal activity pattern of individuals with stroke differed from healthy controls; education and play activities were not part of stroke participants’ daily routines. Also, participation in work, leisure and social participation activities was significantly different for people with stroke compared to healthy controls ( p < 0.01 ). The study group assigned very low values to the activities; the value perceived by individuals differed significantly between groups ( p < 0.01 ).

Conclusion

Clinicians are in a position to enable individuals’ time use and help to engage them in meaningful activity. Individuals with stroke may benefit from a program focusing on the temporal aspect of activities.

The Model of Human Occupation: An Overview of Current Concepts

The model of human occupation has evolved since it was first published. A number of important changes and refinements have been made. These changes reflect research findings, new interdisciplinary theory and insights encountered in practice. This article provides an overview of the current theoretical arguments. These concepts attempt to offer a way of understanding how human occupation is motivated, organised, performed and influenced by the environment. This is followed by a discussion of how occupational therapists can use this framework in their clinical practice.

The Model of Human Occupation: A Developing Conceptual Tool for Clinicians

This article discusses the evolution and current development of the model of human occupation, a conceptual tool designed to enhance the clinical reasoning skills of occupational therapists. A brief overview is provided of a number of conceptual forces in American occupational therapy which preceded and led up to the development of the model; this is followed by a description of the model, its intended clinical use and its implications for British occupational therapy.

The Use of Conceptual Models in Clinical Practice

This paper is an introduction to the use of conceptual models in clinical practice. Theoretical terminology is defined using common examples in occupational therapy. The significance of models to clinicians, administrators, and researchers is discussed. Characteristics of a rigorous model are presented in order that the existing models may be assessed for their effectiveness in guiding practice.

Advancing the use of theory in occupational therapy: A collaborative process / Promouvoir l’application de la théorie en ergothérapie : un processus de collaboration

Background.

Theory is important to the growth and evolution of occupational therapy. However, use of theory remains challenging for many therapists.

Purpose.

The aim was to develop a process that occupational therapists could apply to advance theory in practice.

Method.

Based on a review of the literature and using a qualitative instrumental case study design, 18 student occupational therapists and eight fieldwork educators completed online modules on the theory advancement concepts generated from the literature, wrote journals, and/or participated in online discussions during fieldwork. Following fieldwork, educators were interviewed and students participated in focus groups exploring their experiences. Directed content analysis was used to analyze the data.

Findings.

Based on the data collected, we developed the Theory Advancement Process (TAP). The TAP is composed of four primary contexts, a climate of collaborative relationships with four key elements, and four essential processes.

Implications.

The TAP presents a collaborative process for students, faculty, and therapists to work together to advance the use of theory in practice.

Measurement of time processing ability and daily time management in children with disabilities

BACKGROUND

Improvement is needed in methods for planning and evaluating interventions designed to facilitate daily time management for children with intellectual disability, Asperger syndrome, or other developmental disorders.

OBJECTIVES

The aim of this study was to empirically investigate the hypothesized relation between children's time processing ability (TPA), daily time management, and self-rated autonomy. Such a relationship between daily time management and TPA may support the idea that TPA is important for daily time management and that children with difficulties in TPA might benefit from intervention aimed at improving daily time management.

METHODS

Participants were children aged 6 to 11 years with dysfunctions such as attention-deficit/hyperactivity disorder, autism, or physical or intellectual disabilities (N = 118). TPA was measured with the instrument KaTid. All data were transformed to interval measures using applications of Rasch models and then further analysed with correlation and regression analysis.

RESULTS

The results demonstrate a moderate significant relation between the parents' ratings of daily time management and TPA of the children, and between the self-rating of autonomy and TPA. There was also a significant relation between self-ratings of autonomy and the parents' rating of the children's daily time management. Parents' ratings of their children's daily time management explain 25% of the variation in TPA, age of the children explains 22%, while the child's self-rating of autonomy can explain 9% of the variation in TPA. The three variables together explain 38% of the variation in TPA. The results indicate the viability of the instrument for assessing TPA also in children with disabilities and that the ability measured by KaTid is relevant for daily time management.

CONCLUSIONS

TPA seems to be a factor for children's daily time management that needs to be taken into consideration when planning and evaluating interventions designed to facilitate everyday functioning for children with cognitive impairments. The findings add to the increasing knowledge base about children with time processing difficulties and contribute to better methods aimed at improving these children's daily time management. Further research is needed to examine if there are differences in TPA related to specific diagnosis or other child characteristics.

What Happened to the Time? The Relationship of Occupational Therapy to Time

Introduction:

Time has a reciprocal relationship with occupation: each helps to define and give meaning to the other. This paper explores how this interconnection has been embraced within occupational therapy.

Method:

Literature from a variety of disciplines was critically reviewed, in order to discern how occupational therapy has engaged with the temporal dimensions of occupation since its inception and the relevance of time to current practice.

Findings and discussion:

Although theoretical discussions demonstrate the importance of aspects of time within occupation, there has been only limited translation of these into occupational therapy practice. Aspects of time use, tempo and temporality are discussed in relation to their application to clinical practice. As the pace of life increases and humanity's relationship with time changes, this presents the profession with both challenges and opportunities.

Conclusion:

Time is a vital aspect of occupation. Occupational therapists need to return to core values of time awareness, rhythm and balance, because the profession once again needs to find time.

Déterminants de la valeur accordée à l'autonomie dans les activités de la vie quotidienne par les aînés en perte d'autonomie

The value that the elderly put on being autonomous is an intrinsic characteristic of the aging population that can have a decisive influence on their motivation to maintain or recover their autonomy. This study was designed to examine the importance that elderly people who have lost their autonomy put on the ability to perform themselves five activities of daily living: eating, washing, dressing, eliminating and moving around. It also explores the influence of age, sex, place of residence, level of physical autonomy, feeling of well-being and socio-economic status on the value put on autonomy. A non-probabilistic sample of 68 elderly subjects was interviewed and the value put on autonomy was evaluated using two instruments: Osgood, Suci and Tannenbaum's differential semantic, and Torrance's time trade-off technique. The results suggest that the subjects consider physical autonomy very important. Educational level and the degree of physical autonomy were the main factors linked to importance. However, no link with age or place of residence (institution vs. home) was found.

Health care systems models and occupational therapy

Health care system models featuring four alternative future scenarios are discussed relative to occupational therapy. Five prevailing theoretical models of occupational therapy practice and three practice systems are described as they interact for service provision. Occupational therapy as an open system is presented as possessing the potential to successfully embrace and negotiate changes a in the health care system as projected for the future.

Occupational therapy in long term psychiatry: what's new?

This paper summarizes the results of a survey of the role of occupational therapy in provincial psychiatric hospitals in Ontario. Occupational therapy was found to provide major programming in three areas: 1) functional skills assessment and training, 2) life skills assessment and training and, 3) self awareness and personal growth. Subjects used a variety of frames of reference, but models based upon Glasser's Reality Therapy predominated. A complementary relationship was found between occupational therapy and vocational and recreational services, with occupational therapy playing a clinical or therapeutic role, while vocational and recreational services provided normalizing experiences. A comparison of occupational therapy programming in the institutions surveyed, with programming reported in the recent occupational therapy literature indicated that techniques and media utilized paralleled those used in acute and community psychiatric programs.