OCCUPATIONAL THERAPY

Occupation is variously defined as 'any activity which engages a person's resource of

time and energy and is composed of skills and values (Lalitha: 1995). Occupational therapy is a
potent and uniquely valuable approach to health care that enables people to take control of their
own lives and overcome their own disabilities. The essence of occupational therapy lies in the
use of activities of every description as the treatment medium, with a minimum aim of improving
the quality of life and a maximum aim of complete rehabilitation.

DEFINITION

Occupational therapy is the application of goal oriented, purposeful activity in the

assessment and treatment of individuals with psychological, physical or developmental
disabilities.

AIMS

 Promotion of recovery
 Mobilization of total assets of the patient.
 Prevention of hospitalisation
 Creation of good habits of work and leisure

GOAL

The main goal is to enable the patient to achieve a healthy balance of occupations through
the development of skills that will allow him to function at a level satisfactory to himself and
others.

SUBGOALS

 Assess the patient's needs in terms of the occupational role required of him.
 To identify the skills needed to support those roles.
 To remove or minimize behaviours that interfers with occupational performance.
 To improve role performance
 To assist the patient to develop, relearn or maintain skills to a level of competence that
will allow satisfactory performance of occupational role.
THE OCCUPATIONAL THERAPY PROCESS

The occupational therapy process fall into three main stages

 Assessment
 Treatment/intervention
 Evaluation

Selecting a model is also an integral step that must occur at the beginning of the process.

1. SELECTING A MODEL
 A model is selected to translate the occupational therapy paradigm into practice in a
particular work setting or with an individual client.
 Each stage of assessment and treatment is related to the chosen model, but its
appropriateness can only be judged by valuating the outcome of the process
 Selection of an appropriate model is the first stage of occupational therapy process. Many
factors influence the choice of model used in particular area of practice
 The four models with in cach frame of reference are briefly mentioned here;
 a) Activity therapy: It is from the adaptive performance frame of reference. This
model, first presented by Mosey in the early 1970's was one of the first attempt to
bring together theories, goals of intervention and methods in a unifying
framework
 b) Occupational therapy as a communication process It is from the
psychodynamic frame of reference, this model was developed by Fiddler and
Fiddler in the 1960's. When individual and group psychotherapy were being
widely used for the treatment of all types of psychological dysfunction.
 c) Facilitating growth and development from the development frame of
reference: This model is based on the theories of human development aspect of
development theory which are drawn for most occupational therapy models.
 d) A model of human occupation- it is from the occupational behaviour frame of
reference. This model, first presented by Kielhofner, Burke and Igli in 1980, is
based on general system theory, theories of motivation and role therapy.
 2. ASSESSMENT
Assessment is the basis for all intervention and must be both thorough and valid in
order to ensure that treatment is appropriate.
a) Initial assessment
b) Detailed assessment
Initial assessment is a screening process to determine the main problem area of the client
and whether or not occupational therapy can be of any value in this case. Effective
assessment will, lead directly to settling long term, intermediate and short term goals.
3. TREATMENT
Treatment in 3 stages which may be repeated as necessary, depending on the clients
progress
 Formulation of treatment plan
 Treatment implementation.
 Treatment review
4. EVALUATION

The circular process of occupational therapy is completed by the 3 stages of evaluation.

 Final treatment review

 Evaluation of process
 Review of model

The final review of the client's progress is used to reach decisions about discharge or
referral to other agencies.

OCCUPATIONAL THERAPY SERVICES

Assessment and treatment service may include:

i. Independent living skills.

ii. Task oriented treatment using creative expressive modalities, crafts, education, leisure
time, play.
iii. Prevocational and work adjustment programs
iv. Sensory motor including neuromuscular and sensory integrative assessment and
treatment
v. Design fabrication and application of orthotic devices
vi. Adaptation to physical environment and guidance
vii. Therapeutic exercises
viii. Discharge planning and community re-entry
ix. Patient or family education

OCCUPATIONAL THERAPY IN A PATIENT UNIT

Usually consists of a wide range of both individual and group experience designed to
meet the patient's social, emotional and occupational needs based on the abilities of the patients.

Beyond this, these programs offer assertiveness training, daily living skills groups and current
event groups. Art range activities, including music, art and clay work, providing ways of training
people together and exploring the self. For chronic long stay psychiatric patients, the therapeutic
interventions are training for physical well bing, daily living skills, social activities. social skill
training.

SETTINGS

Occupational therapy is provided to children, adolescents, adults and elderly patients.

These programs are offered in psychiatric hospitals, nursing home, rehabilitation centres, special
schools, community group homes, community mental health centres, day care centres, halfway
homes and de-addiction centres.

POINTS TO BE KEPT IN MIND INCLUDE THE IMPORTANCE OF:

 Selecting an activity that interests the client

 Starting at the point the client is at and progress slowly
 Providing ample in enforcement for even shall achievements.
 If possible, the selected activity should provide some new experience for the patient
 The activity should be of short duration to foster a feeling of accomplishment
 The activity should utilize the patient's strengths and abilities.

PROCESS OF INTERVENTION

It consists of 6 steps
1. Initial evaluation of what patient can do and cannot do in a variety of situations over a period
of time
2. Development of immediate and long term goals y the patient and therapist together. Goals
should be concrete and measurable so that it is easy to see when they have been attained.
3. Development of therapy plan with planned intervention.
4. Implementation of the plan and monitoring the progress. The plan is followed until the first
evaluation. If found satisfactory it is continued and altered, if not.
5. Review meetings with patient and all the staff involved in treatment.
6. Setting further goals when immediate goals have been achieved; modifying the treatment
program as relevant.

TYPES OF ACTIVITIES

Diversional Activities:

These activities are used to divert one's thoughts from stresses or to fill time. E.g.: organized
games.

Therapeutic Activities; These are used to attain a specific care plan or goal. Eg, basket making.
carpentry.

OCCUPATIONAL THERAPY TO PROMOTE PHYSICAL FITNESS

i. Relaxation training to turn off tensions, includes meditative and hypnotic techniques
ii. Dance
iii. Swimming to enable the physically handicapped to participate as freely as the able-bodied
iv. Yoga to increase concentration, stimulate interest and improve body awareness
v. Keep fit
vi. Walking, jogging and running

Aims of occupational therapy through physical mode

 To improve co-ordination and spatial awareness

 To improve general physical condition
 To develop strength and suppleness and to improve posture and gait
 To improve mood and reduce anxiety
  To provide an outlet for aggressive impulses
 To improve confident and to encourage independent personal care

OCCUPATIONAL THERAPY FOR DEVELOPING COGNITIVE SKILLS

Aims

 To restore the lost skills

 To use remaining skills.
 To make adjustments

Treatment activities

 Crafts, which are useful for developing concentration, creative thinking and planning
 Quizzes and table games
 Art and poetry
 Play-reading or discussion
 Creative writing
 Reality orientation

Activity as treatment

The process of activity and its products have the following values;

 Play and social value

 Stimulates, activates and energizes
 Allows exploration and expession of feelings
 Work value, meets the needs
 Develop skills and knowledge

OCCUPATIONAL THERAPY TO ENHANCE SENSORY INTEGRATION

Aims

 To normalize sensory integration and therefore normalize motor and perceptual

responses.

Technique
  Non-competitive pleasurable activities are used

Treatment activities

 Kicking and throwing balls

 Rolling
 Crawling
 Scooter board
 Hopping
 Skipping
 Jumping

RANGE OFF OCCUPATIONAL THERAPY ACTIVITIES

Task activities

To improve the daily living work or task performance skills

Social activities

To promoting enjoyment and leisure time pursuits

Activities involving communication and sharing

Used exclusively in activity or can form an important part of nearly any activity which
involves group work.

Social skill education

Psychotherapy activities

SUGGESTED ACTIVITIES FOR PSYCHIATRIC DISORDERS

1. Anxiety disorders- simple concrete tasks with not more than 3 or 4 steps that can be learnt
quickly.eg; kitehen tasks, washing, sweeping, mopping, weeding gardens

2. Depressive disorders: simple concrete tasks which are achievable, it is important to

experience success by patient.eg; crafts, weeding gardens.
3. Maniac disorders: Non-competitive activities that allow the use of energy and expression of
feelings. Activities should be limited and changed frequently. Patient needs to work in an area
away from distractions.eg; raking grass, sweeping etc.

4. Schizophrenia (paranoid): non-competitive solitary meaningful tasks that require some

degree of concentration so that less time is available to focus on delusions eg: puzzles, scrabble

5. Schizophrenia (catatonic): simple concrete tasks nin which patient is actively involved.
Patient needs continuous supervision.eg: molding clay

6. Antisocial behaviour: activities that enhance self-esteem and are expressive and creative, but
not too complicated. Patient needs supervision to make sure each task is completed. Eg; leather
work, painting

7. Dementia: group activities to increase feeling of belonging and self-worth. Provid those
activities which promote familiar individual hobbies. Activities need to be structured, requiring
little time for completion and not much concentration. Explain and demonstrate each task 8.
Substance abuse; group activities in which patient uses his talents.

ADVANTAGES: -

 It helps to build a healthier and integrated ego

 It helps to express and deal with needs and feelings
 It assists in a gratification of frustrated basic needs.
 It may strengthen ego defences
 It may reverse psychopathology
 It facilitates personality integration
 It offers opportunities to explore and see valuate self concepts and object concepts
 It develops a more realistic view of the self in relation to action and others.

ROLE OF NURSE

 Co-ordinates with other therapeutic team members in diagnosing the abilities strengths,
and talents, interests IQ levels of the client and in selecting the activity for a specific
client.
 Provides a series of graded experiences to the client
 Educates the client to develop specific new skills
 Encourage socialization and exhibits positive interest to the client
 Guides the client in formulation of new hobbies by strengthening the abilities of the
client
 Appreciates if the clint performs any approved hehaviour Offers tokens for each
accomplishment of the work, based on the principle of positive reinforcement
 Helps the client t develop independent living skills
 Approaches community agencies for job placement of the clients in approvesd social
activities
 Assists in developing good social interaction and relationship

CONCLUSION

There is a dearth of good, reliable studies investigating psychosocial interventions in

substance misuse especially looking at comparative effects of different treatments. However,
there is evidence that some form of counselling is better than none, and that whatever the
form of psychosocial intervention it should be a subject of training within the agency and be
adequately supervised.

BIBLIOGAPHY

1. Mary C Townsend, Psychiatric Mental Health Nursing.6" dition. Davis company,2009.p

2. Sreevani, A Guide to Mental Health and Psychiatric Nursing, 3rd edition, Jaypee Brothers
Publishers, P

3. Dr.K Lalitha, Mental Health Nursing, 2nd edition, Jaypee Brothers publishers,p186-
190.p257-273

4. www.tr.com