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  • Over 500,000 wounded American soldiers during WWII required massive influx of healthcare professionals, including Occupational Therapists.
  • Focus changes for Occupational Therapists from use of arts and crafts to rehabilitation techniques for activities of daily living, ergonomics, and vocational rehabilitation
  • Occupational Therapists get involved in prosthetic training for wounded soldiers, utilizing adaptive tools as well as strength and conditioning exercises.
  • Rapid change in the scientific practice of physical disability rehabilitation in 1940’s caused change and reorganization of educational curriculum.
  • First textbook written principally for Occupational Therapists published 1947.
  • Amount of accredited schools increases dramatically over this period, with 13 schools in 1938 and 26 by 1960.

People:

Mary Reilly

  • Clinician in the U.S. Army Medical Corps during the war
  • Earned her doctorate in education
  • Served as chief of the Rehabilitation Department at the Neuropsychiatric Institute at University of California, Los Angeles
  • Professor at USC
  • Believed that occupational behavior should serve as the foundation for occupational therapy
  • Developed the Occupational Frame of Reference -- takes a holistic view of humans and their daily occupations
  • Reilly’s advocacy for an occupational behavior frame of reference emphasized that promoting the field's contribution to human productivity through occupation was of paramount importance.
  • She emphasized that important occupational skills began in children as forms of play

Jean Ayres

  • OT and licensed educational psychologist
  • Applied neuroscience ot practice
  • Attended USC
  • Ayres developed tools for practice including assessments of integrated sensory processing, later forming a battery known as the Sensory Integration and Praxis Tests
  • In 1976 Ayres founded the Ayres Clinic, in which she combined teaching, research and practice to develop her practice model of sensory integration

Gail Fidler

  • Teacher and OT with a background in psychology
  • Emphasized the use of occupation as a means for emotional expression
  • Influenced by her studies of interpersonal theory, self-esteem, and ego development
  • Leader in mental health occupational therapy
  • Studied with mentor Helen Willard
  • Worked in a settlement house while a student at the Philadelphia School of Occupational Therapy
  • Her husband and her wrote Introduction to Psychiatric Occupational Therapy -- a book that promotes the application of ego theory and therapeutic use of self in practice

Ann Mosey

  • Developed the object relations/psychodynamic frame of reference that offered concepts integral to understanding the use of activities and groups in therapy

Lorna Jean King

  • Applied sensory integrative theories to persons with schizophrenia

Claudia Allen

  • Developed theories of cognition to guide therapy for persons with chronic mental illness
  • Kielhofner and Burke (1977) advocated an occupational therapy paradigm to refocus on human adaptation and occupation
  • The core concepts of this work later became the foundation of a widely adopted Model of Human Occupation (MOHO)

Elizabeth Yerxa

  • Successor to Mary Reilly
  • Emphasized the importance of advancing theory to the benefit of practice
  • Asserted the need for occupational therapists to take steps toward professionalism, produce research, and focus on the unique assets of the profession, including purposeful activity and practice of authentic occupational therapy
  • Involved in active promotion of research efforts and in promoting the development of occupational science as an academic discipline and foundation for practice
  • Retired in 1988
  • Recognized as a distinguished professor emerita at the USC

History of Occupational Therapy

2000- Present: Era of Evidence

1700-1899: Pre-history

1960-1979: OT Theory Evolves

1920-1939: Growth and Stabilization

Key Areas of Practice

Military Occupational Therapy

Productive Aging

Children and Youth

Adolf Meyer

Moral Treatment

Influential People

  • A newly emerging area of practice for occupational therapy practitioners is attending to the needs of the aging population. The demands for their services are steadily increasing. (i.e. low vision rehabilitation, treatment for Alzheimer's disease, caregivers, etc.)  
  • Within the pediatric department of occupational therapy, the clients range from infants to adolescents. Opportunities within this area of practice are most commonly found in schools and clinics. (i.e. childhood obesity, bullying, etc.)

Evidence Based Practice

  • Practitioners believed that persons who were "mentally deranged" could best recover through engagement in typical daily routines

  • Considering the clients of this area of practice are the next generation, there is pressure set on helping a child through their obstacles/ conditions. These obstacles/ conditions ranges from developmental disabilities to brain injuries.

  • direct patient care, readiness training, wellness education and injury prevention to the soldiers in need.
  • Occupational therapists have the opportunity to work in various settings, such as well-equipped U.S. Army medical centers, community hospitals, and clinics or field medical units with jobs ranging from being a private practitioner to conducting battlefield units in assessing the health of active soldiers.
  • Military promotes army medicine by putting much value on the work of every position available. Gives website visitors feel they will make a difference no matter what. Opportunity can be found in just about all military branches.

  • This area of practice specializes in encouraging participation in, as well as modifying one’s daily tasks and environments to practice fall prevention and home safety. Productive aging is motivated by the goal of improving the quality of life for older adults.

Social Justice

Claudia Allen

Gail Fiddler

Mary Reilly

A. Jean Ayres

based on all components that come with experience. One’s research results, clinical expertise, and a guideline of client preferences, beliefs, and values.

  • Chief psychiatrist at Johns Hopkins Hospital
  • Incorporated community based activities and services to develop peoples everyday living skills.
  • Saw occupational therapy as an important connection between activities of an individual and their mental health
  • A method to respect and enhance the lives of individuals with mental illness
  • Developed in France by Phillip Pinel in the 19th century.
  • Adopted my american asylums

Mental Health

  • In 2011, the American Occupational Therapy Association (AOTA) put an emphasis on the potential and importance of veteran and wounded warrior care. The demand of this field steadily increases due to the constant increase in veterans.
  • The World Health Organization (WHO) declared mental illness as a leading cause of disability bringing the topic of mental health to medical field’s attention within the last few years. (i.e. depression, recovery and peer support, veterans’ and wounded warriors mental health, etc.)

  • There was a respect and recognition of human individuality and rights for the mentally ill
  • There was acknowledgment of a basic human need to be engaged in creative ad recreational activity as a member of a community
  • This area of practice focuses on a client’s mental health wellness. This may include assisting a client in coping with mental disabilities at home, work, and school. The goal is to encourage meaningful and productive daily routines, and social skills.

Basic Information:

  • President Wilma West AOTA - the board supported the idea of reorganization and expansion: in 1965 the American Occupational Therapy Foundation (AOTF) was established to advance the science of the field and improve public recognition -- emphasis on science, theory development, and legitimacy
  • Practice of OT was heavily influenced by medical rehabilitation, which continued post- World War II mechanistic paradigm emphasizing neuromotor and musculoskeletal systems and their impact on function
  • A. Jean Ayres used neuroscience to study perceptual motor issues in children and develop and apply a theory of sensory integration (expanded her work on Bobaths and Rood)
  • Influences on practices shifted from the holistic mind-body occupation based philosophies to those with bottom up approaches focusing on the underlying source of the problem, often with emphasis on reflex integration and motor function
  • Education for All Handicapped Children Act - protects the rights of handicapped children
  • Medicare and Medicaid laid the foundation for expanded services to the elderly, those with disabilities, and the poor -- mandated access to education for all children
  • These laws, governing provision for health care and educational services to expanded populations, led to the expansion of work areas for occupational therapists as the need for therapists in the education system continued to grow
  • ADL tools and adaptations were developed to accommodate for dysfunctions
  • In 1963 congress passed the Community Mental Health Act, which provided funding for community mental health centers. This helped to deinstitutionalize America by placing the mentally ill in the care of the community rather than a hospital.

AOTA Centennial Vision

Lorna J. King

Ann Mosey

Elizabeth Yerxa

Hull House

Health Promotion and Prevention

It is the goal of the Association to ensure that individuals, policymakers, populations, and society value and promote occupational therapy’s practice of enabling people to improve their physical and mental health, secure well-being, and enjoy higher quality of life through preventing and overcoming obstacles to participation in the activities they value.”

In the Past:

  • Established by Jane Addams and Ellen Gates Starr in 1889
  • Based on Tonybee Hall in England
  • "a community of university women"
  • Provided social and educational opportunities for working class people and the community

January 2006: association leadership of AOTF went on strategic visioning retreat to make up a guideline that will cause growth in the profession of occupational therapy. In the document were some goals and barriers were identified, along with four strategic paths.

  • Occupational Therapists promote a sense of control and improvement in one’s physical, social, and mental health.
  • In order exercise health promotion and prevention, occupational therapists help their clients by identifying and setting goals and aspirations
  • They push their clients to satisfy their needs and goals, and helping them change/ cope with their environment.
  • the greeks and Romans prescribed their patients with mental illness with exercise, travel, and music
  • In medieval times people with mental illness lost all their humanity and were treated like prisoners
  • Building the capacity to fulfill the profession’s potential and mission.

    This includes:

  • Ensuring an adequate and diverse workforce for multiple roles
  • Preparing OTs and OTAs for the 21st century
  • Increasing research capacity and productivity
  • Strengthening our capacity to influence and lead
  • Demonstrating and articulating our value to individuals, organizations and communities.

This includes:           

  • Meeting societal needs for health and well-being
  • People understanding who we are and what we do
  • Building an inclusive community of members
  • Linking education, research, and practice                       

                       

1980-1999: Era of Completing Models

1940-1959: WWII and Medicalization

1900-1919: Era of the Founders

Influential People

Influential People

Americans with Disabilities Act of 1990 (ADA)

Gary Kielhofner

Florence Clark

Reconstruction Aides

Lena Hitchcock

  • one of the first reconstruction aids to arrive in Paris during the summer of 1918

William Rush Dunton

  • Psychiatrist at Sheppard Enoch Pratt Hospital
  • Intrigued by the healing of his patients through purposeful activities
  • Coined the term Occupational Therapy in 1914

War Changes Role of Occupational Therapists

  • Known for her work in occupational science and Lifestyle Redesign
  • Has served as AOTA president and vice president
  • Her research programs include healthy aging and the prevention of pressure ulcers in persons with spinal chord injuries.
  • Developed the model of Human Occupation
  • It is one of the most used models in Occupational therapy research and practice
  • The model presented practitioners with a conceptual framework and practical tools to guide their assessment and reasoning process, effect change, and measure the impact of their intervention

Herbert J. Hall

  • Ran a workshop in Massachusetts for nervous invalids
  • prescribed occupation based on the work theory of using arts and crafts to promote self esteem, employment potential, and better health
  • wrote "Handicrafts for the Handicapped"
  • Prohibits discrimination of disabled individuals in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public
  • Amended in 2008 to change definition of "disability", broadening it to include people with impairments like cancer, epilepsy, and diabetes

Susan Cox Johnson

  • designer and arts and crafts teacher
  • known for her work at the Blackwells Island Hospital
  • director of the occupations committee for the NY state department of public charities
  • Taught OT at Columbia University

Ann Wilcock

Susan Tracy

  • Noticed the benefits of occupation for relieving nervous tension in her bed ridden patients
  • Offered the first courses in occupational nursing at the Adams Nervine Asylum

Elizabeth Townsend

Influential People

  • The war department in 1917 appointed civilian women to serve in hospitals over seas
  • They provided treatment to "reconstruct" disabled soldiers
  • Referred to as Bluebirds because of their uniforms
  • Worked along side nurses teaching handicrafts and vocational skills to distract patients and increase physical activity
  • enabling occupation

Thomas B. Kinder

  • Vocational secretary of the Canadian military hospital commission
  • developed a program to engage bed ridden soldiers in occupations
  • Developed the occupational perspective on health
  • Stated that there are 4 dimensions of occupation
  • doing
  • becoming
  • being
  • belonging

George Edward Barton

  • opened the Consolidation House to rehabilitate himself and others
  • First president of the National Society of the Promotion of Occupational Therapy

Individuals with Disabilities Education Act (IDEA)

Work Cure VS. Rest Cure

The National Society for the Promotion of Occupational Therapy

The Balanced Budget Act of 1997

Occupational Therapy Education Evolves

Work Cure

Reductionistic Approach

  • Introduced by Richard Cabot
  • To treat morbid thoughts of his patient he prescribed useful activities such as taking a college course of managing an office
  • the most important goal was to relearn the skills of "healthy people"
  • allowed patients to inhibit their negative thoughts
  • resulted in restored moral and spiritual efficiency

Claire Spackman & Helen Willard:

Co-edited first principally Occupational Therapy textbook. Spackman also served as WFOT President from 1957-62, and Willard served as AOTA President from 1958-61.

Rest Cure

Role of Occupational Therapist

  • Proposed by neurologist S. Weir Mitchell
  • A regimen of forced bed rest, restricted diet, and a combination of massage and electrical muscle stimulation in place of exercise
  • Created to treat the overworked

Had 6 total founding members:

  • George Edward Barton
  • the first president of the society
  • Isabel Newton
  • assistant and future wife of Barton
  • appointed first secretary
  • William Rush Dunton
  • Susan Cox Johnson
  • Thomas B. Kinder
  • Eleanor Clarke Slagle
  • appointed Vice President of the society
  • went on to hold every post
  • A theory that reduces complex ideas into simpler parts
  • Functional performance can be restored by addressing system limitations
  • Originally known as the Education of Handicapped Children Act, passed in 1975.
  • Passed and name change in IDEA in 1990.
  • Updates were made in 1997 and 2004.
  • Four-part legislation that ensures students with a disability are provided with Free Appropriate Public Education (FAPE) that is tailored to their individual needs.

A 1918 government bulletin stated that "occupational therapy is the science of healing by occupation"

Occupational Therapy schools opened across the country in:

  • Milwaukee, WI
  • Boston, MA
  • St.Louis, MO
  • Philadelphia, PA

This was the first step in taking handicraft ladies to college educated therapists

  • enacted largely to control Medicare’s sub acute care costs.
  • However, it reduced positions and led to a decrease in applications to occupational therapy programs,
  • a few of which were eventually closed a s a result of low enrollment.
  • Founded at George Edward Bartons Consolation House on March 15, 1917

After the war the popularity of reconstruction aides secured a spot for rehabilitation workers within American medicine

Natalie Milliken, Jillian Leb, Kaylene Fernandez, Jake Mozer, Meredith West

Intro to Occupational Science

Influential People

Ruth Robinson

  • AOTA president in 1955
  • Promoted the need for occupational therapy assistants
  • OTs go from subprofessionals to professionals

Eleanor Clark Stagle

  • Founding member of AOTA
  • Directed special courses at Favill School,

which was the first OT school

  • Served as first vice president

Karel and Berta Bobath

  • Developed neurodevelopmental treatment

(NDT) approach

  • Also known as the Bobath approach

Margaret Rood

  • Started occupational therapy education program
  • Organizer and director of department of OT at USC
  • Helped initiate War Emergency Programs to train OT to serve in WWII

Societal Influences

Psychobiology

  • the study of the mind, emotions and mental processes

Influence of Organized Medicine

  • Made occupational therapy more closely aligned with other areas of study
  • Created more a scientific approach to the field of occupational therapy
  • Occupational therapy programs began to be created

Emergence of Physical Medicine and Rehabilitation

  • WWII made occupational therapists go from treating the mentally ill to treating patients with physical disabilities
  • Many wounded soldiers returned from the war disabled and occupational therapists took on the role of helping them return to be working members of society
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