Occupational therapy
Occupational therapy, also known as ergotherapy, is a healthcare profession. Ergotherapy is derived from the Greek ergon which is allied to work, to act and to be active. Occupational therapy is a health profession that helps people take part in the everyday activities, or occupations, that are important for daily life. These occupations include self-care tasks, work, school, social participation, and leisure activities.
Occupational therapists work with people who experience illness, injury, disability, or age-related changes that limit their ability to function independently. They assess a person’s needs, set goals, and use everyday activities as therapeutic tools. Therapists may also modify tasks, recommend adaptive equipment, or adjust the physical or social environment to support participation.
Occupational therapy began developing into a formal health profession in the early twentieth century. Occupational science, the academic study of humans as 'doers' or 'occupational beings', was developed by interdisciplinary scholars, including occupational therapists, in the 1980s.
The World Federation of Occupational Therapists defines occupational therapy as a "client-centred health profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement."
Occupational therapy is classified as an allied health profession in many countries. In the United Kingdom, occupational therapists are regulated by the Health and Care Professions Council as part of a group of professions that form the third-largest clinical workforce in the National Health Service. In England, allied health professions are the third largest clinical workforce in health and care. Fifteen professions, with 352,593 registrants, are regulated by the Health and Care Professions Council in the United Kingdom.
History
The earliest evidence of using occupations as a method of therapy can be found in ancient times. In c. 100 BCE, Greek physician Asclepiades treated patients with a mental illness humanely 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 use of these interventions with people with mental illness was rare, if not nonexistent.Moral treatment and graded activity
In late 18th-century Europe, doctors such as Philippe Pinel and Johann Christian Reil reformed the mental asylum system. Their institutions used rigorous work and leisure activities. This became part of what was known as moral treatment. Although it was thriving in Europe, interest in the reform movement fluctuated in the United States throughout the 19th century.In the late 19th and early 20th centuries, the establishment of public health measures to control infectious diseases included the building of fever hospitals. Patients with tuberculosis were recommended to have a regime of prolonged bed rest followed by a gradual increase in exercise.
This was a time in which the rising incidence of disability related to industrial accidents, tuberculosis, and mental illness brought about an increasing social awareness of the issues involved.
The Arts and Crafts movement that took place between 1860 and 1910 also impacted occupational therapy. The movement emerged against the monotony and lost autonomy of factory work in the developed world. Arts and crafts were used to promote learning through doing, provided a creative outlet, and served as a way to avoid boredom during long hospital stays.
From the late 1870's, Scottish tuberculosis doctor Robert William Philip prescribed graded activity from complete rest through to gentle exercise and eventually to activities such as digging, sawing, carpentry and window cleaning. During this period a farm colony near Edinburgh and a village settlement near Papworth in England were established, both of which aimed to employ people in appropriate long-term work prior to their return to open employment.
Development into a health profession
In the United States, 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.American social worker Eleanor Clarke Slagle is considered the "mother" of occupational therapy. She advocated "habit training" as a primary occupational therapy model, asserting that meaningful routines can shape a person's well-being by creating structure and balance between work, rest and leisure. Slagle was a leader in the development of occupational therapy as a profession, becoming director of a department of occupational therapy at The Henry Phipps Psychiatric Clinic in Baltimore in 1912, and establishing the first occupational therapy training program for the disabled in the Henry B. Favill School of Occupations at Hull House in Chicago in 1915.
World War I
British-Canadian teacher and architect Thomas B. Kidner was appointed vocational secretary of the Canadian Military Hospitals Commission in January 1916. He was given the duty of preparing soldiers returning from World War I to return to their former vocational duties or retrain soldiers no longer able to perform their previous duties. He developed a program that engaged soldiers recovering from wartime injuries or tuberculosis in occupations even while they were still bedridden. Once the soldiers were sufficiently recovered they would work in a curative workshop and eventually progress to an industrial workshop before being placed in an appropriate work setting. He used occupations as a medium for manual training and helping injured individuals to return to productive duties such as work.The entry of the United States into World War I in April 1917 was a crucial event in the history of the profession. Up until this time, occupational therapy was not formalised into a profession. U.S. involvement in the war led to an escalating number of injured and disabled soldiers, which presented a daunting challenge to those in command.The inaugural meeting of the National Society for the Promotion of Occupational Therapy was held in Clifton Springs, New York, 15-17 March 1917. The meeting was attended by six founders: George Edward Barton, William Rush Dunton, Eleanor Clarke Slagle, Thomas B Kidner, Susan Cox Johnson and Isabel Gladwin Newton Barton. Susan E. Tracy and Herbert James Hall, did not attend but are considered near founders of the Society.
The military enlisted the assistance of NSPOT to recruit and train over 1,200 "reconstruction aides" to help with the rehabilitation of those wounded in the war.
Dunton's 1918 article "The Principles of Occupational Therapy" appeared in the journal Public Health, and laid the foundation for the textbook he published in 1919 entitled Reconstruction Therapy.
Dunton struggled with "the cumbersomeness of the term occupational therapy", as he thought it lacked the "exactness of meaning which is possessed by scientific terms". Other titles such as "work-cure", "ergo therapy", and "creative occupations" were discussed as substitutes, but ultimately, none possessed the broad meaning that the practice of occupational therapy demanded in order to capture the many forms of treatment that existed from the beginning. NSPOT formally adopted the name "occupational therapy" for the field in 1921.
Inter-war period
There was a struggle to keep people in the profession during the post-war years. 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.The emergence of occupational therapy challenged the views of mainstream scientific medicine. Instead of focusing purely on the medical model, 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 physical therapy, nursing, psychiatry, rehabilitation, self-help, orthopedics, and social work—to enrich the profession's scope.
The 1920s and 1930s were a time of establishing standards of education and laying the foundation of the profession and its organization. Eleanor Clarke Slagle proposed a 12-month course of training in 1922, and these standards were adopted in 1923. In 1928, William Denton published another textbook, Prescribing Occupational Therapy. Educational standards were expanded to a total training time of 18 months in 1930 to place the requirements for professional entry on par with those of other professions. By the early 1930s, AOTA had established educational guidelines and accreditation procedures.
Margaret Barr Fulton became the first US qualified occupational therapist to work in the United Kingdom in 1925. She qualified at the Philadelphia School in the United States and was appointed to the Aberdeen Royal Hospital for mental patients where she worked until her retirement in 1963. US-style OT was introduced into England by Dr Elizabeth Casson who had visited similar establishments in America. In 1929 she established her own residential clinic in Bristol, Dorset House, for "women with mental disorders", and worked as its medical director. It was here in 1930 that she founded the first school of occupational therapy in the UK.
The Scottish Association of Occupational Therapists was founded in 1932. The profession was served in the rest of the UK by the Association of Occupational Therapists from 1936.