THE ISSUE Is

Occupational Science is Multidimensional

T
he development of a science of
occupation is one of the goals of
the profession of occupational
therapy. Disagreement exists, however, as
ro the definition of occupational science
and therefore as to what is considered le-
gitimate cx:cupational therapy research.
An overly restrictive interpretation of the
term occupational science wiU affect the
funding and publication of research stud-
ies, resulting in porenrially valuable
knowledge being lost ro the profession.
We believe that occupational sci-
ence comprises nor only the study of
occupation (self-care, work, leisure) but
also the componems of funcrion related
to occupational performance (e.g.,
movement, cognition, emotion). Fur-
thermore, we propose that research in
occupational science should nor be re-
stricted [0 treatmems involving pur-
poseful aerivity. To address fully the do-
main of occupation, we must study
facilit:uOlY agents that are nor tradition-
ally called purposeful aCliuity.
Definition of Purposeful
ACLivity
We believe that the use of purposeful ac-
tivity, including occupation, is the core of
occupational therapy, that is, the thera-
peutic kernel of whar makes change in
patients. We have three provisos, how-
ever: First, that the definitions of pur-
poseful activity must be multidimen-
sional; second, that purposefulness and
meaningfulness are anribmes of persons
and nor of acrivities; and third, thar it be
recognized that legitimate occupational
therapy services include techniques mher
than purposeful activity.
The Multidimensional Nature of
Purposeful Activity
The debate over the idenrification of
purposeful activity as the core of occu-
Anne Henderson,
Sharon Cermak,
Wendy Coster,
Elizabeth Murray,
Catherine Trombly,
Linda Tickle-Degnen
pational therapy (American Occupation-
al Therapy Association [AOTAJ, 1979)
arose in pan from misinterpretation of
the term purposeful actiuit)! and in pan
from differing occupational therapy phi-
losophies. For example, some pracri-
tioners saw purposeful activity as syn-
on)!mous with crafts (West, 1984).
Hinojosa, Sabari, and RosenteJd's
(1983) position paper began the pro-
cess of clarifying the meaning of the
term purposeful activity. but struggles
for a bener definition cominue
(Breines, 1984, 1989; Nelson, 1988;
Steinbeck, 1986). We believe that wide
acceptance of purposeful activity as the
core of OCCupational therapy is contin-
gem on definitions that recognize the
multilevel nature of aeriviries used in
the field. The multidimensional narure
of occupational therapy is well recog-
nized (Allen, 1987; Breines, 1989; Kiel-
hofner, 1983, 1988; Llorens, 1981). Ac-
tivity used in therapy ranges from
concern with life tasks of work and lei-
sure (i.e., high level) to Single-action
skills such as reaching for or rouching
something (i.e., Jow level). The level of
activit)! chosen, from simple to complex,
is determined by the presenting clinical
problem as well as by the therapisr's
frame of reference. Thus, adaptive living
skills, which are high-level acrivities, are
used in chronic disability, panicularly
within the occupational behavior frame
of reference. Practice in acute physical
disabilities, however, also emphasizes
low-level acrivjties (AJlen, 1987). In any
area of practice, whenever activity is used
ro remediate motor, cognitive, perceptu-
al, or socioemotional disability, that is,
when therapy is directed toward enhanc-
ing components of performance, simple
activities or parts of activities, including
exercise, may be the most appropriate.
The Meaning ofActivity
Low-level aCtiVity, such as single-aCtion
movements or exercise, are often decried
as nm meaningful and therefore are
viewed as inappropriate tools of cx:cupa-
tionaI therapy. We believe aU aCtiVities are
potentially meaningful. The meaning of
an activity changes, however, with the
person, the treatment context, and the
timing of its use. The meaningfulness
may be in the enjoyment of the activity
process, for example, in a game or play;
it may be in the production of a produCt,
as in crafts; it may be in the gratification
of succeeding in a task such as dressing;
or it may be in the satisfaction of increas-
ing strength or mmor skiU. The meaning
or lack of meaning does not lie with the
activity but with the person for whom it
is chosen and with the context in which
it is done.
FaC/htatolY Agents
There are many non-occupational tech-
niques that are legitimate and necessary
adjuncts to occupational therapy ser-
vice, including interpersonal interaction,
orthmics, physical agents, family coun-
seling, biofeedback, and the shaping of
behavior. Such techniques would nOt be
defined as occupation, but they prepare
foe or are facilitatory to occupation
(Kielhofner, 1983); they are not the
core but are important [0 good occupa-
tional therapy practice in many areas.
The meaningfulness of these techniques
to the patient lies in their power to en-
hance the effecriveness of an activity or
to facilitate performance.
Aprit 1991, Volume 45, Number 4
370
PDF Editor
Summary
We believe that the conceptualization of
purposeful activity should be congruent
with the uses of activity in occupational
therapy practice. Definitions of pur-
poseful activity should then encompass
the breadth of activities from single ac-
tions or movements to adaptive living
skills and should encompass historic
and traditional as well as contemporary
uses of activity in the profession. From
the profession's beginnings, the occupa-
tional therapy process has included the
use of activity focused on the increasing
of competence in daily occupations of
work, self-care, and leisure and on the
use of activity to reduce pathology and
restore function. We believe the bound-
aries of the use of activity should con-
tinue to be flUid. Definitions of aCtivity
should be used for orientation, not for
limitation, and should captLIre the rich-
ness of our profession.
o cupattonal 'cience
We believe that the definition of what is
proper occupational therapy research
should reflect contemporalY practices
that are widespread in occupational
therapy. Just as the definitions of pur-
poseful activity should be congruell[
with definitions of occupational therapy,
so should definitions of what is rroper
occupational therapy research be con-
gruent with definitions of purposeful ac-
tivity and of occupational therapy
Reilly (1960) said that our most
fundamental area of research is and al-
ways will be the nature and meaning of
activity. We see the natLIre of activity as
not only including the characteristics of
an activity that make it meaningful to a
person but also the complex of human
subskills that are needed to engage in
an activity. The stLIdy of purposeful ac-
tivity must include not only the occupa-
tional natLIre of man in his environment
but also the effect of disease and injury
on specific activities and the effect of ac-
tivity on dysfunction.
The research of the AOTNAmeri-
can Occupational Therapy Foundation
Neurobehavioral Rehabilitation Re-
search Center of the Occupational Ther-
apy Department, Boston University, Sar-
gent College, is directed [Oward an
understanding of the relationship be-
tween purposeful activity and health.
One focus is on the subskills of activity,
The Amel-ican Journal of Occupational Therapy
that is, the components of performance
as well as facilitatory procedures used in
therapy. We seek to better define and
measure the deficits in various clinical
populations in order to clarify the goals
of treatment. Much of our knowledge of
disabilities and components of activities
is gleaned from [he research of other
disciplines. Researchers in other disci-
plines, however, conduct their stLIdies
with different aims. The basic research
questions of concern to occupational
therapy are not asked by these re-
searchers. We are concerned with the
questions that will otherwise go unan-
swered. Some of our questions are basic
and directed toward a better under-
standing of the effect of disease and in-
jury on occupational performance, such
as, (a) What are the componell[s of oc-
cupational performance? (b) How do
the performance componell[s change
with disease or injury and how do the)'
change as funCtion is restored? and (c)
What aspects of disability provide bar-
riers to life experiences?
The applied science questions be-
gin with the assumption that occupa-
tional therapy facilitates the mechanism
of change from dysfunCtiOn toward
funcrion and that there is a need to in-
vestigate the assumptions about how
this OCClH"S. What are the critical thera-
peutic aspects? What are the assump-
tions of treatment and are they valid?
What aspects of the therapeutic process
beyond aCtivity affeCt goal anainment?
How does the context of treatmell[, in-
cluding therapeutic ill[eracrion, affect
therapeutic change?
A research focus on componell[s of
performance or aspects of disability has
been labeled reductionist and therefore
"had" and "not occupational therapy." A
focus on the understanding of compo-
nents of behavior, howevel', does not
imply that we have reduced occupation
and activity to nothing more than their
components. We believe, rather, that a
hetter understanding of the compo-
nents of function will help to construct
better models of occupational science
and to analyze how the components
contribute to occupation and purpose-
ful activity.
\'(Ie believe that life skills and corn-
ponell[ skills, activity and enabling
agents, remediation and adaptation, are
all a pan of the fabric of occupational
therapy and thus proper subjects for oc-
cupational therapy resealch....
Ackmm ledgmen ts
This paper was supponed in part by the
Neurobehavioral Rehabilitation Research
Center, Boston University, Boston, Massachu-
setts, a center for scholarship and research
in occupational therapy funded by the Ameri-
can Occupational Therapy Association and
the American Occupational Therapy
Foundation.
rences
Allen, C. K. (1987). Activity: Occupation-
al therapy's treatment method- 1987 Elea-
nor Clarke Slagle LeCture. American journal
of Occupational Therapl', 41, 563-575.
American Occupational Therapy Associ-
ation. (1979). The Philosophical Base of Oc-
cupational Therapy (Resolution 531-79) [In-
ternal documentJ (Available from the
American Occupational Therapy Association,
PO Box 1725, Rockville, MD 20849-1725)
13reines, E (1984). The Issue Is -An at-
tempt to define purposeful auiviw Ameri-
call journal of Occupational TherapJl, 38,
543-544
Breines, E. 13. (1989). The Issue Is-
Making a difference: A premise of occupation
health. American journal of Occupa-
tional Tberapy, 43. 51-52.
Hinojosa,]., Sabari, J., & Rosenfeld, M. S.
(1983). Guidelines and Position
poseful activities. American jounwl of Oc-
cupalional Therapv. 37, 805-806.
Kit:lhofner. G. (]983). A paradigm for
practice: The hierarchical organization of oc-
cupational therapy knowledge. In G. Kiel-
hofner (Ed.), Heald, rbruugh occupalion
(pp. 55-91). Philadelphia: F. A. Davis.
Kielhofner, G (1988).
therapy-Base in occupation. In H L. Hop
kins & t-I. D. Smith (Eds.), Willard and
Spackman's occupalionallherap)' (7th ed.,
pp. 84-92). Lippincott.
Llorens, L. (1981). On the meaning of
aClivil)' in occupational journal of
the New L.ealand Associales of Occupmional
Tberapists. 32. 5-6.
Nelson. D. L. (1988). Occupation: Form
and performance. American journal ofOc-
cupCllional Therapy, 42, 633-641
Reilly, M. (1960) Research potentialit\'
of occupational therap\'. American journal
of Occupational TberapJ', t4, 206.
Steinbeck, T. !'vI. (19H6). Purposeful ac-
tivitv and performance. Americanjownal oj
Occupational Therapy, 40. 529-554
West, W. L. (1984).1\ reaffirmed philos-
ophy and prauice of occupational therapy
for the ]9805. American jounwl ofOccujJa-
tionaI Therapy. 38. 15-23
Anne Henderson, phi). OTR/L, is Professor
Emerilus of Occupational Therapy!
Sargenr College, Boston University,
635 Commonwealth Avenue, Boston,
iVlassachusetts 02215, and Research
Faculty Member, Neurobehavioral Re-
habilitation Research Center, Boston
University.
371
PDF Editor
Sharon Cermak. f:.dD. OTR/L. is Associale
Professor of Occupational Therapy,
Sargent ColleRe, Basion University, Bos-
ton, /\lJassachuselts, and Director,
Neumbehavioral Rehabililalion Re-
search Cenler, Boston UniversiZy
Wendy Coster, t'bD. OTRII., is Assislant
Professor o/Occupalional Therapy,
Sargent College, Boslon UniversiZy, Bos-
ton, Massachusells, and Research Fac-
ulty Member, Neurobehavioral Reha-
bilitation Research Cenler, Boston
UniversiZy
Elizabeth Murray, SeD, OTR/I., is Assistant
Professor of Occupalional Therapy,
Sargenl College, Basion University, Bos-
Advanced Therapy
BTE ,
Department of Veterans Affairs
Fred Sammons
G E. Miller
Hygenic Corporation
Olympic Medical
ton, Massachusells; Research Faculty
i\!/emher, Neurobehavioral Rehabilita-
tion Research Center. Boslon Universi-
ty; and Assistant Director of Occupa-
lional Therapy, Eunice Kennedv
Shriver Cenler, Wallham, Massachusetts
Catherine Trombly,HA. orR/t.. is Profes-
sor of Occupational Therapy, Sargent
College, Basion Uniuersity, Basion, Mas-
sachusetls, and Acting Director, Neu1'0-
behavioral Rehahilitation Research
Center, Basion Universily.
Linda Tickle-Degnen, Pbl). OTR/I., is Assis-
tant Professor of Occupational Ther-
apy, Sargenl College, Basion University,
Basion, Massachuselts, and Research
Index to Adverti ers
Page
Facultv Mem.ber. Neurobehavioral Re-
hahilitation Research Center, Boston
Universily
This article was accepted for publication Oc-
Lober 15, 1990.
Tilt.' ISSUt.' IS provides a/urumfur debate
and discussion of occupationaltberapy is-
sues and related topics. Tbe Contribu/inK
tdi/ur uf tbis sec/ion, Julia Van Deusen,
s/rives /0 baw bo/b sides of an issue ad-
dressed. Readers are encouraged to submi/
manuscrtpts discussing opposite palms of
lJiew ur new topics. All manuscrip/s are sub-
ject tu peer relJiew. Submit tbree copies to
t'laine Viseltear, Editor
Puhlisbed articles refleci tbe opinion
0/ tbe autbors and are selected on tbe basis
ul'interest to tbe prol'ession and quality of
tbe discussiun.
Page
,.. , 299 Psychological Corporation 289
Cover 3
S&S Arts & Crafts 330
377
Cover 4
Cover 2
Smith & Nephew Rolyan
Southpaw Enterprises
290
339
380-381
Tandy Leather Company 330
339
Vocational Research Institute _ 323
Physical Medicine Research Foundation 338 WFR Aquaplast 294
372
Apn'l 1991, Volume 45, Number 4
PDF Editor