About Occupational Therapy

Occupational Therapy - A Gifted Profession 

Preface

This article is a humble effort to upsurge the awareness about the profession ‘Occupational Therapy’ among public, students who are in search for a career related to health care, educators, parents, and educational agencies. Although Occupational therapy is recognized as a distinct value added health care service by many abroad nations, the scenario in India is not in par excellence with other such nations. Presently this profession is not getting adequate recognition among the public, students and policy makers as it deserves. This made us to prepare this section in this blog. We hope that this booklet will enlighten many minds.

In this article following topics are described.

•  Introduction about Occupational Therapy
•  Short History of Occupational Therapy
• Occupational Therapy in Rehabilitation Team
• Scope of Occupational Therapy in

       o Developmental Disabilities & pediatrics Care

          §     Neonatal Care

          §     Dyslexia, autism & behavioral disorders

          §     Pediatric Neurology

       o   Neuro-Rehabilitation & Neuroscience

          §     Cognitive Rehabilitation

          §     Neuro-motor Rehabilitation

       o   Musculoskeletal Care

       o   Mental Health Care

       o   Ergonomics

       o   Geriatric Care

       o   Other Functional areas

•  Occupational Therapy – A Creative Employment Sector
• Scope of Occupational Therapy

Occupational Therapy – Creative Health Care Sector 

Occupational Therapy is relatively a new treatment arena. This allied health profession is platformed on modern health science. An Occupational Therapist (O.T.) can help persons with physical, mental or emotional challenge, to function efficiently in their daily living activities like self-care, leisure & job. Hence this profession has a wide scope to flourish. This article is a short description about this vibrant profession. 

Difference between Occupational Therapy and Physiotherapy 

Occupational Therapy functions on a slightly discretephilosophy from other allied health care fields. 

The word “Occupational” in Occupational Therapy refers to the daily activities ofa person’s routine.This could mean his profession, self-care activities, entertainment and rest. These daily activities can change according to age, gender & job difference. For example, if a person is a tutor or an engineering by his profession, his self-care activities are eating food, taking bath and changing dress himself. His entertainments may be wailing time with family members or himself,or engaging in activites like - watching TV, evening walking, jogging etc. But as far as child is concerned his “profession” and entertainments are engaging in play activities only. 

Satisfaction in a person’s life depends upon the balance in the three areas mentioned above(physical, mental or emotional).Any flucctuations in these areas is directly reflected on the person’s “profession”, daily activities, rest and entertainment. Hence Occupational Therapy aims at finding out fruitful and effective solution and rectify the challenges in these three areas. 

Physiotherapy is also a part of Rehabilitation Team which plays a crucial role. The main function of a physiotherapist is to maximise mobility inphysically challenged and expediting the pain relief through use of physical modalities(wax therapy, ultra sound etc..). 

2. Short History of Occupational Therapy 

A glance into the history conveys that, the method of acquiring physical and mental health through creative jobs was prevalent right from the period of Greek physician Aschlepiades (BC-100).Globally, the idea behind occupational therapy sprouts out in A.D.172, when the Greek physician Galen said “Employment is Nature’s Best medicine and essential to human happiness”. 

Till the earlier 18th century, the society behaved in a very cruel and brutal manner to mental patients. These patients were kept in mental asylums without necessary facilities or care. During this period a French physician named Philippe Pinel (1745 – 1826), provided these persons with opportunity to engage in creative & productive occupations according to their ability. Its result was amazing. Many of these patients acquired the skill to retrieve back in fruitful and effective professions. This provided the world an opportunity to realize the importance of engaging in productive occupations. 

The health profession of occupational therapy was conceived in the early 1910s as a reflection of the Progressive Era. The emergence of occupational therapy, challenged the views of mainstream thoughts about diseases at that time. Instead of focusing on purely physical etiologies, occupational therapists argued that a complex combination of social, economic, and biological reasons cause dysfunction. Between 1900 and 1930, the founders defined the realm of practice and developed supporting theories. 

Later during the period of World War the need for Occupational Therapy rose again. The reason for this was the functional restoration perspective of Occupational Therapy to engage those who are wounded and disabled during the war in fruitful ‘occupation’. Duringthis period, occupational therapists successfully convinced the public and health care system and established standards for our profession. 

Gradually occupational therapy gained attention in other areas of functioning like pediatric rehabilitation, child psychiatry, geriatrics, ergonomics, hand rehabilitation etc… Today, Occupational therapy empowers people of all age with physical, emotional, and psychological problems to lead an independent life with pride in 76 countries world wide. 

(For more details http://en.wikipedia.org/wiki/Occupational_therapy) 

Occupational Therapy in India 

In 1855, Regular ‘Occupation’ based treatment was reported in Madras mental Asylum (No.VII. Report on civil dispensaries, for 1853. Madras. 1855. Report by: Alexander Lorimer). In 1935, Lt. Col. Berkley Hill started Occupational Therapy at the European Mental Hospital, Kanke, Ranchi. (Parkar SR, Dawani VS, Apte JS.History of psychiatry in India. J Postgrad Med 2001;47:73) 

In 1950, Mrs. Kamala V Nimbkar - an American lady - started Occupational Therapy Department at K.E.M. Hospital at Mumbai. In 1950 an Occupational Therapy School was started there. In 1952, All India occupational Therapists Association (AIOTA) was formed. AIOTA is issuing the certification for practicing occupational therapy & it also maintains the OT education standards in India. Today about 25 Occupational Therapy (O.T.) Colleges are functioning in India. 

Unfortunately this potential profession doesn’t have enough publicity as it deserves across the country. The main reason attributed for this scenario is relatively less awareness about this noble profession among policy makers & other health care professionals. (See the article titled “Current status & potential future of OT in India” for more details) 

3. Occupational Therapy in Rehabilitation Team 

Rehabilitation Medicine is a special branch of medical science which helps to raise the quality of living of persons with physical incapacities or mental or emotional problems by bringing them back to a life which is effective and fruitful. 

Unlike other branches of medicine, rehabilitation is being implemented as a “team”. That means patients are treated together by many rehabilitation professionals. 

A rehabilitation team may be led by a Psychiatrist, Physiatrist, Orthopaedician, Neurologist or a Pediatrician.

The following are the members of a Rehabilitation Team. 

1. Occupational Therapist 
2. Physiotherapist 
3. Speech Therapist 
4. Prosthetic & Orthotics Specialist 
5. Psychiatrist 
6. Social Work 
7. Rehabilitation Nurse 
8. Vocational Counsellor 

Here Occupational therapist acts a key role in the decision making & implementation of “Individual specific” treatment program for a person with incapacities.

4. Occupational Therapy- Various Areas of function

Occupational Therapy functions for people of all ages. For e.g. for the physical, emotional & psychological problems of newborn babies, children, students, adults, officials, workers and elderly. Short descriptions of role of OT in these areas are given below. 

4.1) Occupational Therapy in Pediatric Care

In India, 6.88% of the children in the age group 0-6 are estimated to be having physical, mental or intellectual problems. Furthermore, learning disabilities and hyper activity disorder which are often gone unnoticed by parents or medical experts aggravate this problem. The service of rehabilitation professionals like Occupational Therapists is inevitable in bringing upthese children to light from the darkness of disability.

Only 5% of the above mentioned children utilize any sort of rehabilitations facilities.

i) New born Baby Care 

As far as a new born is concerned, his “occupation” is feeding on breast milk and exploring his surroundings. But babies who arepremature,those born with physical disabilities may be having incapability in these areas. In such cases Occupational Therapists help in making them maximum self-sufficient in his/her occupation,by oro-motorexercise (exercise for muscles in the mouth) and multisensory stimulation (stimulation of the sense organs).

ii) Learning disability and Behavioral Disability in Children

Another major field of activity of Occupational Therapists is learning disability and behavioral disability in children. Hyper activity, autism and learning disability/dyslexia are some of the problems found commonly among children these days. Occupational Therapy plays a crucial role in this area.

For example, it has been scientifically proved that Occupational Therapy can bring these children to the mainstream of the society through sensory integration (a method of treatment introduced by Occupational therapists which helps in developing the right response and behavioral pattern in a child with altered ‘sensory integration’ induced disorders (Like Autism, Dyslexia, ADHD etc..) by stimulating and integrating the sense organs).

Such children will be often having better intellectual ability. Even though the exact causes of these problems areunknown, medical experts suggest that changes in modern life style may be the turning point for these problems.

Because of the lifetrends in nuclear families these days, parents are not getting sufficient opportunity to interact or spent time with their children. The above problems are seen mainly in children from such a background.Moreover, problems of children in such families will be noticed at a very late stage. Hence solution to these disabilities gets delayed.

Such children can be brought back to near normal life (fully or partly) through innovative methods in Occupational Therapy such as Play therapy (treatment through plays), sensory integration, behavioral therapy and group therapy. 

The Headmaster had called the parents of Alvin of first standard saying that he will not be allowed to continue in the school. They have already sat in that hot seat many times because of his naughty behavior which often cross the limits. Not listening at all to what is being taught. Not correctly copying even what is written on the board, attacking classmates. There were no mistakes which Alvin didn’t commit.

The reply of parents to the doubt of the class teacher that the child may be having learning disability was like this: All of us in our family are in good positions. We have never made him want. Then how can he be intellectually poor? The teacher had to struggle a lot to clear their misunderstanding and convince them to take the child to a child psychiatrist & pediatric occupational therapist.

There is a sigh of relief on the face of the patents when they are informed that Alvin is concentrating on studies after the therapy.

iii) Pediatric Neurology

An Occupational therapist can help Newborn babies or Children with neurological disorders to overcome their developmental delay, day-to-day activity limitation and thus make them as independent as possible with their condition. These children may be having problems with in dexterous activities like writing, buttoning etc… and in feeding activities. Here occupational therapist will give either remediating or compensatory or at times both way of treatmenttechniquesto overcome these issues. 

In addition, these children will be having problem with free ambulation in the school & home environment. Here Occupational Therapist will suggest home modification, activity modification, or specialized assistive devices to overcome these issues

4.2) Occupational Therapy in Neurological Rehabilitation 

The effect inflicted by stroke, brain injury and weakness of the nervous system upon a person and his family is very grave. Because of these diseases, the ability of a person to do his job gets reduced and his financial liabilities get escalated. The expenses for treatment and care will increase considerably.

Above all, the intellectual, mental and emotional problems created by these diseases on the person, seriously affect the family and relatives. All the treatments in Occupational Therapy is centered around a person’s “occupation”. This is the main factor that distinguishes thisprofession from other health care professions.

For example, a person who has got his brain injured in a road accident may loss his mobility, ability to speak, and to engage back in the profession he was previously in, ability to think either fully or partly. In such a situation the method of functioning of Occupational Therapy will be varied. Some of such treatment methods given below:

i) Cognitive Rehabilitation

Here, the Occupational Therapist retrains that person’s capacity to think, ability to plan, judge a situation and act accordingly, memory power and interest in work. This area differentiates OT - Neurorehabilitation from other allied health science.

Revathy who is an electric & electronics engineer approached OT seeking treatment for memory loss happened after a bike accident. As a result of this accident, Revathy became unable to return to her job, do her routine activities, rememberingeverything or talk effectively. These problems seriously affected the confidence of Revathy. In the OT evaluation it became clear that Revathy is not only having memory loss, but also having depression, indifferent attitude and escalated anger.

Following this, the Occupational Therapist started giving training to Revathy through activities like Memory Games and Cognitive Retraining. “Activity Schedule” was prepared and given to do the daily activities properly. Along with this, Revathy was made familiar through many books and videos how people like her were able to overcome similar situations. Gradually Revathy felt that her memory power is increasing. Along with that,Revathy’s self confidence in her profession also upgraded. Today Revathy is doing her job as efficiently as before.s

ii) Neuro-Motor Rehabilitation

Here the Occupational Therapist finds out the physical disabilities which stand as obstacles whichprevent a person from engaging in his profession, daily activities and entertainments. Then the therapist will endeavor to find solution through scientifically proven and innovative exercises. 

Dr. Vighnesh was a famous nuero physician in the city. His right limbs got weak due to paralysis (Stroke). Even though there was nothing wrong with his intelligence, he was not able to write using his right hand or do his daily activities himself or even walk normally. At this circumstance, the Occupational Therapist gave him training to write with his left hand and suggested changes for using the toilets and bedroom in his home easily. Today Dr. Vighnesh is used to write and do daily activities himself using his left hand. Moreover, he is active in his profession as before.

4.3) Occupational Therapy in Orthopedic Care

In musculoskeletal diseases (eg. fractures and frozen shoulder) and post-surgerical conditions, Occupational Therapy is inevitable in making a person maximum self-sufficient and thus raises the quality of life. 

For example, for a person who got his hands seriously injured in an accident, it will become impossible for him use his hands effectively for his daily activities and other jobs. Here the Occupational Therapist will help him to attain the original ability through Gross Motor & Fine Motor hand function training. 

Pain around shoulder (Frozen shoulder, periarthritis of shoulder etc…)Among Middle aged individuals – especially among ladies – are very common. This will cause severe pain in the shoulder during overhead reaching, day to day activities etc… Ultimately this will make the person less efficient in his/her occupation. Here the occupational therapist will formulate exercises incorporated with functional activities to overcome these issues. 

In addition to all these, the occupational therapist plays a vital role in the “Hand rehabilitation” following plastic surgeries, tendon repair.This is one of the major functional area in occupational therapy.

4.4 Occupational Therapy in Mental Health Care

Mental Health Care is another area which differentiates Occupational Therapy from other rehabilitation professions. It was in this area that Occupational Therapy first started& gained worldwide attention.

As we know, clear reflection of mental health problems will first appear in a person’s “occupation” (profession, self-care and entertainment). Mental health problems considerably reduce the efficiency in engaging “occupation” in many persons.

The main reason for this is the changes in aperson’s interest, concentration and reasoning in the “occupation”. Here the Occupational Therapist will help persons to come back gradually to normal life by engaging them in “occupation” according to their ability and raising their concentration, interest and other skills to do the job. 

4.5) Occupational Therapy in Ergonomics

Ergonomics is a branch of science which examines whether the relation between a person and his occupation is healthy, finds problems in it and suggests solution. The efficiency of a person in his work will be decreased significantly if a smooth relationship doesn’t exist between his profession and his physical and mental health.

Those who don’t experience difficulty sometimes in work and daily activities due to back pain or neck pain are very rare among us. Most of us don’t realize or notice the fact that 70% of this back pain is due to our wrong posture, way of walking or sitting. In other words, it is because we are engaging in our occupation in the wrong manner.

For example, when a software engineer works for about 8-10 hours continuously sitting, his sitting posture, height and size of the computer monitor, shape of the keyboard, size of the mouse, location and other working conditions are the major factors which determines the health and effective functioning of that person.

Here the Occupational Therapist finds out the areas and conditions of a person’s work which are problematic and suggests appropriate solutions for them. Thus condition for engaging smoothly and safely in the “occupation” is ensured for that person. 

This is an area of Occupational Therapy which has got much popularity in foreign countries. Some foreign companies and international companies functioning in India are already seeking this service.

4.6) Occupational Therapy in Geriatric Care

Dementia is a problem commonly found in elderly people. Because of this,elderly are prone for various accidents. They also face difficulties in personal relationships. In such situations, the Occupational Therapist helps that person to be free from these accidents through cognitive retraining activities and environmental modification.

It has been scientifically proved that an Occupational Therapist can reduce falls in the elderly to a great extent through Physical conditioning exercise. 

4.7) Other Functional Areas of Occupational Therapy

An Occupational Therapist functions in many areas apart from the areas mentioned above. Some of those areas are:

1. Splinting (technique that helps in positioning the body part correctly after surgeries and in rheumatism and weakness of limbs) is another unique specialty in Occupational Therapy.

2. It is the Occupational Therapist who scientifically prescribe wheel chair, walking stick and crutches for a person after finding out their physical ability and occupational needs.

3. Hand rehabilitation

4. In Special Schools

5. Barrier free environment designing for disabled(Designing buildings and other things for the disabled in a manner in which they can use them without difficulty)

6. Early Intervention (Determining diseases/problems that are possible to occur in new born babies)

5. Occupational Therapy - A Creative Career

Occupational Therapist helps those who seek their treatment in attaining maximum self-sufficiency in their work and other daily activities. People from all age groups seek treatment of occupational therapists.

Unique Characteristics of Occupational Therapy

> It functions concentrating of modern physiology and psychology.

> This is an employment sector with a lot of employment opportunities

> It is a profession with so many functional & diverse objectives. After a graduation in Occupational therapy, one can work or go for higher studies in novel & diverse practice area. This makes occupational therapy stand apart from other allied health care profession. A small description about occupational therapy education is given below.
> It is a creative profession for those who are creative.

OT Education in India

In India OT degree (BOT), Post graduate diploma (PG DROT), Master degree (MOT) and Ph.D. Courses are available.

Si No	Course	Mode	Duration
1	Bachelor of Occupational Therapy (BOT)	Regular	4½ years
2	Post graduate diploma in OT (PGDROT)	Regular	1 year
3	Masters of Occupational Therapy (MOT)	Regular	2 - 3 years
4	Ph.D.	Regular	3 years
		Part time	5 years

Bachelors of Occupational Therapy (BOT / BOTh)

> Eligibility: Pass in +2/HSC with PCB (Physics, Chemistry & Biology)with minimum mark of 50% in PCB (In some Universities it is 45% whereas in others it is 60%)

> Duration : 4 ½ years (Including 6 months compulsory rotatory internship)

> Syllabus

- Theory: In the first two years basic physiology is being taught. (Like Anatomy. Physiology. Microbiology, pathology, General Medicine, General Surgery, Clinical Neurology, Orthopedics, Psychiatry etc…) In the next two years, the methods through which physical, mental and emotional problems are solved by Occupational Therapy are being taught. In addition there will be a research work also there in the final year.

- Practicals / Clinical: In the last two years the students will be undergoing extensive ‘hands on; training for clinical assessment, treatment planning &implementation, clinical discussion etc...

o Internship: In the six month period of internship, an OT student gets opportunity to gain experience by working under a senior Occupational Therapist. 

Higher Education in Occupational therapy

After a graduation in Occupational therapy, one can work or go for higher studies in novel & diverse practice area. Some of the key areas given below,

A) Post-graduation in Occupational Therapy (MOT)

Duration of this course is 2 year. In this course the candidate will be learning recent advances in one area of specialization. In addition one will be well verse with research. The following specialties are available 

· MOT in Neurosciences

· MOT in Musculoskeletal Disabilities

· MOT in Mental Health

· MOT in Hand Therapy

· MOT in Rehabilitation

· MOT in Community Based Rehabilitation (CBR)

B. Postgraduate Diploma in OT Rehabilitation (PGDR-OT)

Duration of this course is 1 year. In this course the students will be undergoing training for OT specialized assessment with standardized & non-standardized tools, goal setting & treatment interventions. Dissertation submission will help the students to learn research methodology in occupational therapy. Unlike MOT, specialization in one particular area will not be possible with this course.

C. Specialization/higher education in “Special” treatment techniques

An Occupational therapist can do Specialization/higher education in “Special” treatment techniques based on his aptitude & interest. Some of such specialization areas given below,

Splinting:

A splint is a device used for support or immobilization of limbs or other body part. Treatment by use of a splint is usually followed by surgeries to the hand, for arthritic conditions in the hand, paralyzed hand etc… The designing, fabrication, alteration & Check out of the splint used to carried out under the supervision of a qualified occupational therapist.

Sensory Integration:

(a method of treatment which helps in developing the right response and behavioral pattern in a child with altered ‘sensory integration’ induced disorders (Like Autism, Dyslexia, ADHD etc..) by stimulating and integrating the sense organs)

This was introduced by an Occupational therapist and currently it is being practiced worldwide for the treatment of above mentioned disorders. A specialization in this area has wide scope for practice and it is an active research area in Occupational Therapy. Course duration ranges from 3 months to 1 year.

Neurodevelopmental Therapy: 

This is a widely used peaditaric neurology treatment approach to overcome physical developmental delay in differently children. This treatment is mainly executed by Occupational Therapist & Physiotherapist worldwide. Course duration ranges from 3 months to 1 year.

D) Ph.D. in Occupational Therapy

A Candidate with master degree in Occupational Therapy and a minimum of 1 year working experience in the field of Occupational Therapy is eligible to do Ph.D in OT.

There are 2 mode: Regular (Duration - 3 year)Part Time (Duration – 5 year)

E) Other areas of specialization

After obtaining a Bachelor degree in Occupational Therapy, one can do the higher education in the following area which is not directly related to occupational Therapy

1. Masters of Medical Anatomy (Msc)

2. Masters of Medical Physiology (Msc)

3. Master of Public Health (MPH)

4. Masters in Biostatistics & Research Methedology

While Selecting an Occupational therapy College…

One should always consider the following points before selecting an OT college for their study

1. Whether the college is recognized by a University with UGC recognition and whether the university is offering “Full time course”?

2. Whether the college is recogonized by AIOTA (All India Occupationbal Therapist’s Association) and WFOT (World Federation of Occupationbal Therapist’s)?

3. Content of the syllabus: Whether the syllabus is having approximately 5500-6000 hrs of Clinical + Teaching hours?

4. Emphasize given for research activity in the syllabus

5. Infrastructure: Whether the college is closely attached with full-fledged medical college/super specialty hospital?

6. Type of the patient load in the hospital (It is better to choose a hospital where almost all varieties of patients being treated – like Psychiatry, Neonatology, Oncology, Neurology & neurosurgery, Orthopedics etc…-)

7. Teaching Staffs: No. of staffs with Master degree in Occupational Therapy

8. Is there a full-fledged Occupational therapy working with the college? How many clinical staffs are working etc…

9. Library &it’s working time, book issuing facility for students.

10. Emphasize given to the extracurricular activities / facilities

(For more details http://keralaot.org/Colleges.aspx )

Desirable Skills for an Occupational Therapist

· Creativity

· Physical fitness

· Communication Skills

· Learning Aptitude

· Dedication

6. Scope of Occupational Therapy

Occupational Therapists are one of the “most wanted” allied health care professionals in India as well as abroad, especially in western & Middle East countries. In some of the major cities in India even have the lack of adequate Occupational Therapists. Some of the main job sectors are given below.

Scope of OT in India

Under Central  Govt.	Under State Govt.	In Private sector	Private practice
> ESI Hospitals > SSA – Sarva Siksha Abhayan > Rehabilitation Institutes like, Ex. AIIPMR,NIRTAR, NIOH etc.	> P.S.C posts > Govt. Mental health centers > Medical Colleges run by State Govt. > District Rehabilitation Centre	> OT clinic > Hospital > Special School > Early intervention centres > Normal  schools >  International Companies as ergonomic consultant	> Home Visit > Can run own OT clinic (One of the important attraction of this profession)

Scope of OT in Foreign Countries

The job outlook for occupational therapists is very goodin foreign countries according to their official job outlook sites. Some of such reports with their web link is given below

USA: “The job outlook for occupational therapists is very good. Employment of occupational therapists is expected to increase 33 percent from 2010 to 2020, much better than the average for all occupations.” Ref: ‘Occupational Therapist Job Outlook’ Retrieved from http://www.healthguideusa.org/careers/occupational_therapist_job_outlook.htm on 30-1-13

·Australia: “Employment for Occupational Therapists to 2016-17 is expected to grow very strongly. Employment in this small occupation (11 200 in November 2011) rose very strongly in the past five years and rose strongly in the long-term (ten years)” Ref: ‘Occupational Therapy’ Retrieved from http://joboutlook.gov.au/pages/occupation.aspx?code=2524&search=&Tab=prospects on 30-1-13

·       
 Canada:“Job prospects in this occupation are good”. Ref: ‘Analytical text 3143 - Occupational Therapists’Retrieved fromhttp://www.servicecanada.gc.ca/eng/qc/job_futures/statistics/3143.shtml on 30-1-13

· Singapore: “The demand for Occupational Therapist in Singapore is expected to increase” Ref: ‘Occupational Therapist’ Retrieved from

http://www.careercompass.gov.sg/Pages/OccupationDetail.aspx?OccupationName=Occupational+Therapist&SectorID=99 on 30-1-13

Summary

Occupational Therapy is a vibrant creative profession with lots of job opportunities in India & abroad. Moreover this noble profession enables one to help, support & empower the people with physical, psychological, emotional problems by helping them to lead an independent productive life. In short “Occupational Therapy is an Art & Science of Empowering Life”. 

End Note: This article is a part of the original book titled “Occupational Therapy – A Creative Profession” by Phinoj K Abraham MOTh, and Joseph Sunny MOT, published by Kerala Branch of AIOTA, 2013. For the original book you may please visit http://keralaot.org/OT%20Malayalam%20&%20English%20Booklet%20PHINOJ%203-2-13.pdf