- The Washington Times - Monday, October 6, 2003

Occupational therapists help people of all ages in just about every aspect of their daily lives. Increasingly, too, they help people — especially children — who have neurophysiological disorders of the brain.

If such claims seem far-fetched, the problem is partly because of the misleading use of the word occupation. It too often gets confused with vocation, say professionals concerned that the nature of their job is frequently misunderstood.

One reason for the confusion is the growth and expansion of the field in recent years, says Mary Zweifel, executive director of rehabilitation services at George Washington University Hospital. OTs, as they are known, can be found doing outreach work in offices, shelters for the homeless and prisons as well as working in more traditional settings such as schools, hospitals, nursing homes and mental health centers.

Some therapists do preventive work, educating people to promote better habits to ensure well-being; others do corrective work — treating physical or mental disabilities by teaching skills that enable patients to manage their lives better.

“We describe the idea of occupation differently,” says Mary Corcoran, a research therapist who edits the American Journal of Occupational Therapy (AJOT) for the Bethesda-based American Occupational Therapy Association. She also teaches the End of Life Care program at GW’s School of Medicine and Health Sciences. “It’s absolutely anything you do that involves an important role in your life,” she says.

“Think of occupation as a big circle, inside of which is a pyramid. At the top of the pyramid are roles that are both shaped and defined by our culture. To carry out a role, a person needs to learn a number of tasks that are comprised of mental, cognitive and physical abilities — a whole range that makes it possible for you to enact your role. Our goal is to get a person back to performing a role well, or else compensate for how he is doing it — or find another role that is meaningful or satisfying.”

Job credentialing has changed a great deal too, Ms. Corcoran says, to include a new emphasis on acquiring graduate degrees. By 2007, a master’s degree will be required.

The research end is branching out as well. Lucy Jane Miller, a professor at the University of Chicago’s Health Sciences Center and executive director of the Foundation for Knowledge in Development, runs a comprehensive project in the area of OT known as Sensory Integration (S.I.). Its purpose is studying the neurophysiological mechanisms underlying children’s development and how occupational therapy can best remedy disorders when they arise.

“Physical and occupational therapy complement one another,” says Pamela Toto, a therapist working in home health care and an instructor in the University of Pittsburgh’s OT master’s degree program. “Physical therapists are skilled clinicians who look at the body’s skeleton first. Our approach is to look at the person as a whole — physically and emotionally — and what they hope to accomplish.”

Occupational therapy grew out of efforts by psychiatrists following World War I to find ways of helping soldiers with mental illness experience a sense of well-being through meaningful activity. (Female nurses were central to the treatment, which is why a majority of OT professionals are women, says Mary Reitz, who teaches in the OT program at Towson University in Baltimore County.)

The field quickly developed to include patients with physical problems who needed to learn to use their bodies more effectively and where a sense of confidence is key. Traditional methods employed by OTs involve games and devices that, when necessary, strengthen muscles and improve coordination.

Responsibility goes beyond simply improving a patient’s physical well-being, however.

Along with the task of showing an elderly or injured person how to get in and out of a bathtub safely, a therapist working in home care must help the person conquer any fears associated with the activity. The therapist hired by a school that specializes in different ways of learning among people with dyslexia and other processing disorders will be trained to observe behaviors reflecting the way a person — usually a child — absorbs information and sensation. Only then can the therapist figure out the best methods of treatment to help the patient function better.

An estimated half of OT professionals work with children, and many of them are concerned with maturation of the brain and the different ways in which brains develop. According to the Web site www.sinetwork.org, produced by the Colorado-based Foundation for Knowledge in Development (KID), sensory integration dysfunction is suspected in cases in which a child is either underresponsive or overresponsive to sensation; some have trouble with motor skills. Treatment usually takes place in an environment in which there are multiple mobile, tactile, visual, auditory and taste opportunities.

S.I. dysfunction, as it is known, also can apply to adults with strokes, says District therapist Barbara Hanft. “There are many developmental theory bases explaining how children grow and develop, and how to look at those problems and what to do about them,” she says. “S.I. isn’t the only one that OTs are taught.”

OTs try to help with problems before they arise through such projects as National School Backpack Awareness Day, which took place Sept. 24 with the theme “Pack It Light, Wear It Right” chosen by the American Occupational Therapy Association. OTs weighed children with their backpacks in hopes of alerting children, parents and educators to the dangers of neck, shoulder and back pain that can result from improper weight and fit.

Following recent publicity about the dangerous driving habits of some of the elderly population, the association plans to sponsor a continuing-education program for OTs to be certified in assessing older drivers.

OTs who specialize in industrial rehabilitation do both preventive and corrective work. Towson University professors such as Lynne Murphy, who have studied ergonomics (the knowledge of body mechanics), consult occasionally for private companies in improving or documenting conditions on the job or in an office.

“We try to give people recommendations on how they can safely use bodies before they are injured,” she says. Equally, they are called upon in conjunction with workmen’s compensation claims.

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