OT A to Z Challenge: O and P are for Occupational Performance

It seemed fitting to do double duty and combine "O" and "P" as occupational performance reflects that which is truly OT!

Occupational performance is the completion of an occupation or an activity that requires the interaction of the person, the context, and the activity. Many things - including things we have addressed in our OT A to Z Challenge - may support or hinder a person's occupational performance. For instance, a person's habits may improve occupational performance by enabling him or her to more proficient at an activity. Conversely, features in a specific context may hinder a person's occupational performance.

What are examples of occupational performance? Much of what a person needs or wants to do throughout the day constitutes occupational performance - a person getting up and getting ready fro the day, a young child engaged in play behaviors that are necessary to acquire developmental skills, a person participating in a leisure activity or hobby, a student participating in a classroom setting, a person socially interacting with his or her peers to maintain social relationships, a father preparing a meal fro his family, a person balancing his or her bank account in order to manage their finances, a person taking care of a pet...and the list would be nearly endless.

How does an OT address occupational performance? As part of an evaluation, an OT will assess the client’s occupational performance needs and goals, strengths, and problems areas. Occupational performance is often observed in context to identify what supports performance and what hinders performance. Then, the OT will address with the client specific performance skills (sensory, motor, cognitive, etc.), performance patterns (habits, roles, routines), context, and activity demands.

There is probably no other profession that views activities in the way OTs do - as an interdependence between the person, the activity, and the context!

OT A to Z: N is for Neuroplasticity

Neuroplasticity - while not a concept unique to OT - holds tremendous application for neurorehabilitation provided by OTs. Neuroplasticity refers to the brain's ability to adapt and change over the course of one's life - not just in the period of development. This is particularly important when considering rehabilitation following a neurological event such as a stroke.

When I was in OT school in the early 1990s, the accepted thought was that a person with a stroke would see maximum recovery within 6 months following the stroke. Consequently, if a person was seeking therapy several years post-stroke, it was thought that the person had limited rehabilitation potential and it was often difficult to receive approval to provide services. With the improved understanding of neuroplasticity that has occurred in more recent years, it is now accepted that the brain has the ability to modify itself even years after a stroke. More specifically, following a neurological event such as a stroke, it has been demonstrated that the brain has the ability to "rewire" itself.

This understanding has provided the explanation as to why interventions such as constraint induced movement therapy provides such notable results. In this approach, "forcing" the use of the affected upper extremity appears to unmask neural pathways that reorganized or sprouted following the stroke. However, the person learned not to use the affected upper extremity based on their unsuccessful attempts initially following the stroke.

OT A to Z: M is for Model

Thanks to the suggestions of of @pinkypanda, the OT "M" is for model. Models provide a conceptual tool to assist in translating our theories into practice. Models are not prescriptive with regard to intervention activities, but rather provide a set of guidelines or principles which OTs can apply in developing their approach to working with clients. Fortunately, research surrounding several OT models has been robust which has facilitated the development of associated standardized assessment measures.

Two widely known models in OT practice are The Model of Human Occupation (MOHO) and the Canadian Measure of Occupational Performance and Engagement (CMOP-E). Although each is unique in it s approach, both models seek to explain the process through which humans engage in occupations. MOHO has several assessment tools associated with it and the CMOP-E provides the foundations for the Canadian Occupational Performance Measure (COPM).
Due to the overarching principles addressed through models, they can applied to a variety of client populations and OT settings.

A newer conceptual model in OT is the Kawa Model. This interesting conceptual model uses a river as a metaphor for life and enables a person to consider the rocks or challenges they have encountered.

If you are an OT student, how has learning and understanding supported your understanding of OT?

If you are a practitioner, has your view or understanding of a specific model changed over time?

OT A to Z: L is for Leisure

"L" is the OT alphabet represents leisure. Leisure is defined as a" non-obligatory activity that is intrinsically motivated and engaged in during discretionary time, that is, time not committed to obligatory occupations such as work, self-care, or sleep” (Parham & Fazio, 1997, p. 250). Akin to interests, leisure activities are those pursuits that we engage in because we enjoy the activity. Leisure activities are those things we look forward to doing and fulfill us in a way that other things that we are required to do often do not. Since it is not something we are obligated to do, very few of us would spend the time and energy engaging in a leisure activity that we did not like.

From a perspective of occupational balance, we would agree that everyone needs to have the opportunity to engage in leisure activities for optimal health and well-being. However, most of us can readily identify barriers to pursuing leisure activities. Do OTs have a role in addressing leisure participation at the community level? If so, what could that look like?

We all probably have leisure activities that we would be interested in pursing if it weren't for time and money (sailing in the Caribbean would be high on my dream list of leisure activities!). Whereas we may not get the opportunity to pursue all leisure activities that appeal to us, is the opportunity to participate in some form of leisure activities a fundamental right? If this is the case, when populations have limited opportunities - perhaps due to socioeconomic conditions or limited accessibility - is this an issue of occupational justice? If so, what is the OT's role in addressing leisure participation for disenfranchised groups?

OT A to Z: K is for Kielhofner

What else could "K" be today but Kielhofner?

Any OT - and OT student - knows of Gary Kielhofner. Dr. Kielhofner was a passionate OT, a groundbreaking theorist, an educator and researcher, and a mentor to countless OTs in the US and abroad. He developed the Model of Human Occupation, more commonly know as MOHO, which is used internationally by OTs. The OT community was truly saddened by his passing in September 2010 at only 61 years of age. One must wonder what else he would have accomplished in years to come.

I never had the honor of meeting Dr. Kielhofner in person. I did attend several of his presentations at AOTA conferences over the years and was struck by how approachable and affable he was, despite all of his accomplishments. I am also on the MOHO listserv and similarly was always impressed at the lengthy and thoughtful responses he provided on the listserv, regardless of whether the person was a notable international colleague or an OT student grasping the concepts of MOHO for the first time. In addition to his intellect and creativity, graciousness was clearly a strong part of his character.

If you missed some of the many tributes for Dr, Kilefhofner, I have provided some links:

http://www.aota.org/News/AOTANews/Gary-Kielhofner.aspx

http://articles.chicagotribune.com/2010-09-07/features/ct-met-kielhofner-obit-0908-20100907_1_gary-kielhofner-uic-professor-occupational-therapy

http://abamblog.wordpress.com/2010/09/20/gratitude-for-the-life-and-work-of-gary-kielhofner/

OT A to Z: J is for (Occupational) Justice

Occupational justice is a concept that has arisen in the field of occupational therapy in recent years. Occupational justice refers to the humanistic principle that all members of a society have a right to equally participate in in their occupations. Conversely, occupational injustice occurs “…when participation in occupations is barred, confined, restricted, segregated, prohibited, underdeveloped, disrupted, alienated, marginalized, exploited, excluded, or otherwise restricted,” (Kronenberg & Pollard, 2005, p. 66). Typically, the people most at risk for occupational injustice are those who lack resources, are refugees, imprisoned, or ill.

Since the role of occupational therapists is to engage people so that they may participate in occupations, considering issues of occupational justice seems a natural extension of our role. Activities related to occupational justice may occur at the societal level and include such activities as assisting those experiencing injustice to advocate for their rights or address policy issues. Forerunners in the area of occupational justice have often addressed in the context of international needs. For instance, the Occupational Therapy International Outreach Network (OTION), established in 1999 by a group of Australian OTs, is an organization focused on addressing the occupational needs of those in under-served countries.

While it is is easy to imagine the occupational deprivation that may occur in developing countries, where there are often limited resources including employment, healthcare, and education, as well as the often ongoing potential for political instability, how often do we think of occupational injustices that exist in our communities? What could - or should - our role as OTs be in own communities to bring awareness to situations that consciously or unconsciously limit the participation in occupations to ALL of those in our communities?


Note: Photo retrieved from the National Council of Independent Living

References


Kronenberg, F. & Pollard, N. (2005). Overcoming occupational apartheid: A preliminary exploration of the political nature of occupational therapy. In F. Kronenberg (Ed.), Occupational Therapy without Borders: Learning from the Spirits of Survivors (pp. 58-86). London: Elsevier Churchill Livingstone.

OT A to Z: I is for Interests

Our OT "I" word is interests! As children, interests tend to convey things they are attracted to doing. One only has to spend time with an enthusiastic kid, and hear him or her talk about how they "want to" play a certain sport, or dance, or fly an airplane, or take care of animals. As adults, our interests may reflect our skills, or they may be ways we continue to develop new skills. Interests are often the things we are excited about doing, the things we look most forward to doing in our days, the things that are meaningful to us. Most of us have no shortage of interests, but the ability to pursue our interests - especially as adults - tend to be limited by our resources such as time.

As OTs, interests are something that are considered in the assessment process, as part of the occupational profile. Understanding the interests of a client can help help determine goals of a client, things that may motivate the client, or activities to use in order to achieve a therapeutic goal.

In thinking about interests...

• Have your interests remained stable over the course of your life, or have they changed?
• What barriers exist in the pursuit of your interests?
• If time (or money) weren't a consideration, is there something that interests you that you would like to pursue?

OT A to Z: H is for Habit

Today in our OT alphabet, H is for Habit!! If we all stopped to think about it for moment, we can probably identify several of our habits. Interestingly, we may tend to think of habits in reference to bad ones, or behaviors that are less desirable or supportive. But habits serve an important function in our occupational lives!

OTs consider habits as specific, automatic behaviors that may support - or hinder - occupational performance. The key to habits is that they are automatic so that we don't even really think about these behaviors when we do them. Examples may include the way we brush out teeth, the order in which we get dressed, how we groom our hair, or the way we place our keys in the same place upon arriving home (well - I have hear some people do that!).

What purpose do habits serve? In OT terms, effective habits enable us increase the efficiency of our occupational performance because the behaviors are automatic. For instance, how long would our morning self-care routine be if we actually had to stop and think about performing each step of brushing our teeth, getting dressed, or grooming our hair? It would take us HOURS to get ready - everyday!! But because our habits enable us to do large portions of our daily tasks efficiently, our occupational performance is improved.

But what happens when an injury or illness occurs and we are no longer able to utilize our existing habits? As OTs we work with clients to find new ways to do things, or adapt an activity, but do we use the term "habits" when working together?

Wallenbert and Jonsson (2005) published a fascinating study on the challenges people with stoke encountered in developing new habits to support their occupational performance. They discovered the participants in their study were often reluctant to utilize the adaptive strategies they learned through OT, or develop new habits, as this would be an acknowledgment that they would not continue to progress. It was as if they resisted developing new habits, they could remain in a "waiting" period to see if things improved. For me, reading the words of the study participants, made me think of our OT process in such a different way.

So, do you specifically address habits with your clients?

References

Wallenbert, I., & Jonsson, H. (2005). Waiting to get better: A dilemma regarding habits in daily occupations after stroke. American Journal of Occupational Therapy, 59, 218–224.

OT A to Z: G is for Grading

G proved a little tougher to select a word! Thanks to @kirstyes and @clissa89 for their suggestions of goals, goal attainment scaling, and groups. But I opted to use @clissa89's suggestions of "grading" as the word to represent the OT "G," as grading is a concept that is truly inherent in OT practice regardless of the client population or setting.

What is grading? Grading is the modification of an activity to support the client's performance. Grading of activities occurs in the therapeutic process when a client is working toward a specific goal. Therefore, activities may be modified - or graded - for the purpose of making them easier or more difficult, depending on the goal. Activities can be graded in a variety of ways. A few examples include increasing or decreasing the complexity or difficulty of a task by changing the amount of steps required to complete it, the amount of time given to complete a task may be altered, or the amount of cues or assistance given to the person may be changed. Grading of activities is done for therapeutic purposes and can only be done with consideration of the client's abilities.

However, the precursor to grading of an activity is a process termed activity analysis. Activity analysis is when an OT analyzes all of the complexity inherent in an activity in order to know how and in what ways to grade it. This would include things such as space requirements, the objects that must be used to complete the activity, the social or cultural requirements of the activity, the required actions to complete the activity, and the body structures and functions needed for the activity.

To illustrate this, let's think about the seemingly simple activity of making a peanut butter sandwich. As part of activity analysis we would consider demands or the requirements of the activity. This will include things like:

1. Formulate a plan to make the sandwich
2. Sequence the activity
3. The properties of the objects needed to make the sandwich such as the supplies (bread which is pliable, peanut butter which offers resistance, the knife which requires grasp)
4. Physically gather the supplies
5. Manipulate the objects - open the jar lid, open the bag of bread, hold the knife
6. Position the objects for performance of the task
7. Complete each step of the process including: get the bread out of the bag, open the jar, use the knife to get an appropriate amount of peanut butter out of the jar, put the peanut butter on the bread, spread the peanut butter on the bread without tearing the bread, put the bread together with appropriate pressure, place the sandwich on a plate, close the peanut butter jar, close the bread, wash the knife, clean the work area

First, I think we begin to recognize how even "simple" are actually complex, multi-step tasks which require multiple processes to be working effectively in parallel. After analyzing the requirements to make a peanut butter sandwich, it becomes easy to imagine how any challenge in cognitive skills, visual skills, perceptual skills, coordination, sensation, motor planning can make this activity difficult.

So how would an OT grade this activity? Depending on the goals being addressed, the OT may choose to have the supplies out already or may have the person retrieve everything from the cabinet. The OT may provide minimal or maximum cues for the planning and sequencing of the task. The OT may choose to add more items to the sandwich, or make a deli sandwich with vegetables and spread that will require numerous additional steps to complete.

In other examples of grading, if a person is having difficulty completing their morning self-care routine due to debilitation, the OT may select portions of the activity for the person to complete so they are able to do as much as possible. For instance, rather than having a person retrieve their dressing and grooming items in the room, the OT may "set-up" the activity so his or her available energy may be utilized in performing the dressing and grooming activity. As the person's endurance and safety improve, the OT may choose to grade the activity to make it more challenging, by having the person retrieve the needed items prior to dressing.

Another example of grading may be when a person is working on cognitive skills such as problem solving by developing a budget for a trip to the grocery store. To grade the activity, the number of items may be increased or decreased, the quantities of items may be changed to increase or decrease the complexity of calculations, coupons may be applied, etc.

The possibilities of grading an activity are multi-faceted, but it must be done with regard to the client's goals. OTs, because of their education and experience, have the expertise to assess the ability of the client as well as the requirements of the activity in order to achieve a therapeutic outcome.

OT A to Z: F is for Function!

Today...F is for Function!! Function is a word that is near and dear to the heart of OTs. My intuition would say that OTs probably use the word function even more often than they use the word occupation. But, as I learned in preparing this post, function seems to be one of those concepts that we know what it means but is a bit hard to actually articulate.



I fumbled with a few definitions on my own, then consulted some standard documents and texts. Interestingly, the word function readily appears - function, functional activity, functional performance - but an actual definition was elusive. After retrieving dictionary entries of function, this one seemed the most applicable:

The purpose for which something is designed or exists.

I think this really gets to the heart of how we think as OTs...we - as humans - are designed to do. Our ability to do - or to function in our environment - supports our health and is also affected by our health. So when we address function, we are focusing on ways to support a person's ability to do what they need or want to in the context of their daily lives.

So, how do you define function?

OT A to Z: E is for Evidence

In the A to Z Challenge for the letter E, there were several OT words and concepts that came to mind including environment, evaluation, and education. However, evidence is the "E" of the day because how OTs identify, use and convey evidence about our practice is so vital.

The prominence of using the best evidence to support our OT practice, or evidence-based practice has certainly increased in the past decade in OT. Evidence-based practice is defined as the conscientious use of best evidence to make decisions regarding care of individual clients, and is the integration of clinical expertise, systematic research, and patient goals (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000).

Gutman (2010) has stated that occupational therapy – like other health professions – has not fully answered questions regarding treatment efficacy and efficiency. Consequently, this has placed third-party payers in the decision-making role regarding many aspects of treatments including who receives services, for how long, and even what treatments are denied (Gutman, 2010). In an effort to build the evidence needed to respond to these external challenges, the publication goals of the American Journal of Occupational Therapy (AJOT) were aligned to match the research needs of the profession. The stated publication priorities of AJOT include: high-quality effectiveness studies; efficiency studies including cost and time efficiency, patient satisfaction, safety, and patient compliance; studies addressing the psychometric properties of occupational therapy assessment measures; studies demonstrating the relationship between participation in occupation and health indicators; and analyses of current professional issues (Gutman, 2010).

While research priorities of the profession have been stated, it is important to recognize that challenges exist in the utilization of research. Research on professional practice indicates that many barriers such as lack of time, resources, and training on how to locate and incorporate research into daily practice creates a gap in the utilization of research in clinical practice (Grol & Grimshaw, 2003).

But what about the instances where there is little systematic research or perhaps conflicting findings? Keep in mind that evidence-based practice also considers clinical experience and patient goals. The key is that we are aware of the evidence - or perhaps lack of evidence - related to an intervention and are prepared to discuss that with our clients and families.

Last week, @virtualOT shared an eye-opening blog post (which was brought to her attention by Bronnie Thompson and Claire Hayward) that was written by a parent of a child with autism. Please keep in mind that in no way do I intend for this to be a commentary on the intervention being discussed (of which I know almost nothing), nor do we know of the conversation that occurred between the OT and the parent regarding the OT's clinical experience in using this intervention. But what is clear is that the parent is well-informed and readily obtained information regarding the lack of published evidence related to this intervention. Furthermore, it is clear from the post that this experience has substantially reduced his view of OT.

In thinking about evidence-based OT...

• What is your reaction to the parent's post?


• What are barriers you experience in identifying and utilizing evidence in your practice?


• How do you work to incorporate best evidence into your practice - despite the challenges in doing so?

References

Grol, R. & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change in patents’ care. Lancet, 362(9391), 1225–1230.

Gutman, S. (2010). AJOT publication priorities. American Journal of Occupational Therapy, 64(5), 679–681.

Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence based medicine: How to practice and teach EBM (2nd ed.). London: Churchill Livingstone.

OT A to Z: D is for Domain of OT

An exciting part of the OT A to Z Challenge is that I have received a few messages and comments from people who are not OTs! Therefore, it seems important that early in this process, we take the opportunity to address what is it that OTs do. In other words, what is the Domain of OT?

Any OT student or practitioner has undoubtedly had the experience of trying to explain succinctly and clearly what we do. No, we are not "kind of like [insert other profession - nursing, PT, social work]", nor do we just work on the upper body or find people jobs. However our work can vary tremendously depending on the setting and the client population, so explaining our work can be a bit of a challenge. Interestingly, I once read that Eleanor Clark Slagle, one of the founder of OT in the US, did not particularly like the name "occupational therapy" for the profession as she felt it was unclear and would be confusing to others.

So what is the domain of OT? It the broadest sense, it is defined in the Occupational Therapy Framework: Domain and Practice (AOTA 2008) as "supporting health and participation in life through engagement in occupation" (p. 626). While we understand what those words mean, I am not sure it helps explain to others what it is we actually do!

To be a little more specific, our domain is further defined by the areas we uniquely address:

• Activities of daily living - basic activities such as self-care, instrumental activities such as home management and driving, but also work, play leisure, education, and social participation
• Client factors - values and beliefs of our clients, but also body structures and function
• Performance skills - motor and praxis skills, cognitive skills, sensory processing skills, communication and social skills
• Performance patterns - roles, habits, routines, and rituals
• Context (our post from yesterday!) and environment - physical, social, cultural, personal, temporal, and virtual
• Activity demands - objects used, activity requirements, sequencing, timing, body structures and functions required to complete the activity

Of course, when working with a client, these things are not addressed in a linear approach as we recognize that these functions and systems are at work simultaneously and cannot be considered independent of the others. On one hand, this is an exciting delineation as we begin to see the unique contribution of OT and how no other professions addresses these aspects of engagement in participation. However, it is still quite a litany of information to provide to someone who is learning about OT!

When explaining our domain to others, I have found that using the word occupation early in the process really makes a difference. If a client, or family, or person sitting next to me on an airplane begins to understand to what we are referring to when we say "occupation," their understanding is greatly supported. So I usually say something to this effect:

Think of all the things you need and want to do during the day - you get up, get dressed, complete your grooming, prepare your meal and feed yourself, go to work or school, interact with others, socialize with friends and family, participate in a hobby - these are all occupations. If a person has difficulty performing their daily occupations due to an injury, illness, or a developmental condition, he or she greatly benefits from occupational therapy. Occupational therapists - or OTs - address a person's ability to participate as fully as possible in their daily activities. Sometimes this is achieved through the use of activity, or sometimes the underlying cause that is limiting their participation - such as decreased strength, endurance, cognition, or sensory processing abilities - is addressed. But the goal of any OT is to support a person's occupational performance.

So how do you explain the domain of OT to those who are not familiar with our profession? What words do you consistently use in your definition?

If you are not an OT, do these explanations give you a clear picture of what it is OTs do?

OT A to Z: C is for Context

The letter "C" seemed to offer many opportunities to explore, such as the array of topics suggested by @clissa89: cognition, creativity, client-centered, children, culture, and context! Whereas other professions also address many of these areas, I think context is something uniquely considered by OTs. So, today, C is for Context!!

The concepts for environment and context are often considered together and these terms may even be used interchangeably. Context is defined in the Occupational Therapy Practice Framework (AOTA, 2008) as interrelated conditions that surround the client and are within the client. These include cultural, temporal, personal, and virtual. Context is distinguished from environment in that environment refers to the external situations that surround the client to include the physical and social environments. In general, OTs emphasize occupational performance at the intersection of the client, the context and environment, and the activity.


The cultural context is includes the customs, beliefs, activity patterns, and behavioral expectations accepted by the society of which the person is a member. The temporal context is the experience of time as shaped by occupational participation and includes aspects such as time of day, duration of activity, rhythm, tempo, and stage of life. The personal context considers aspects of the individual that are not part of the health condition and includes things such as age, gender, as well as socioeconomic and educational status. Finally, the virtual context is when communication occurs in the absence of physical contact and may be real-time or asynchronous.

The aspect of context that I have spent the most time thinking about recently is that of cultural context. I am fortunate to co-teach a service learning course in Belize for OT students and we spend a lot of time considering the cultural context of the adult and pediatric clients we serve while we there. Immersion in another culture is such a profound way to experience cultural aspects of occupational performance - everything from the value of various occupations to the manner of engaging in occupations. It is a powerful learning experience as we strive to better understand the cultural context and, perhaps most importantly, not relay on or emphasize aspects of our cultural context.


In thinking about context, do you

• tend to specifically address aspects of context in your assessment and intervention, or are they aspects you consider as part for of the whole picture when working with your clients and families?
• emphasize one of the aspects of context more frequently that others?

For you personally, what aspect of your contexts either support or hinder your occupational performance?

References

American Occupational Therapy Association. (2008).Occupational therapy framework: Domain and process(2nd ed.). American Journal of Occupational Therapy, 62,625–683.

OT A to Z: B is for Balance

After consulting my OT colleagues on Twitter (thanks, @kirstyes!), it was decided that B is for Balance...occupational balance that is!

Image by cogdogblog and used under a Creative Commons License.

The concept of balance is certainly one that garners media and public press attention. Usually this is the form of discussions surrounding work-life balance. So I think there is at least a general acceptance of the notion that it is healthy to balance the activity demands and roles in our lives. And while many people may agree with the concept, this is probably one of those areas where knowing and doing may not always coincide.

But how do OTs view balance? OTs readily state that there needs to be a balance in our occupations - often thought of in general terms or self-care, work, and leisure. OTs would also assert that occupational balance and health are interdependent. Changes in health may impact occupational balance - either in the short-term or long-term, but occupational imbalance certainly may impact health.

First, how may health impact occupational balance? Let's think of two clients - perhaps one who underwent a total hip replacement due to osteoarthritis and another who had a spinal cord injury (SCI). The person with the total hip replacement will certainly experience occupational imbalance - he or she will initially have difficulty performing activities of daily living (ADLs) such as dressing, bathing, and toileting and much effort will be focused on completing self-care tasks. However, she or she will also have difficulty performing instrumental ADLs such as driving, meal preparation, and home management and most likely is temporarily not going to participate in work or leisure activities. But with the assistance of an OT, he or she will be able to adapt (our "A" word) some activities and perform them in a different way - such as dressing his or her lower extremities using adaptive equipment. And we can also assume that in a fairly short period of time, his or her ability to perform the range of occupations - from self-care to work and leisure - will be improved with recovery from the surgery and increased strength.

However, if we think of a client with SCI, it is easy to recognize that not only may they have difficulty performing many occupations but the time required to perform them leads to an imbalance. Early in my OT career, I worked with a college student who sustained a cervical SCI. He made terrific progress in his rehabilitation and achieved his goal of returning to school in a matter of months. However, he did not stay away at school for long. In talking to him some time later, he shared with me that while at college he could do everything he needed to do himself, it took him so long to do everything that tending to much beyond his self-care and making it to classes was not realistic. So when friends called to go out, he quickly grew frustrated with the time that it took him to get ready and felt that he missed many social activities because of this. So because his self-care activities took such as large portion of his time, he had difficulty achieving occupational balance.

What are some ways that occupational balance affect health? I think one area where this is truly evident is the occupational imbalance experienced by caregivers. Hunt and Smith (2004) studied the experiences of caregivers of people with stroke and found that many reported changes in their activities, their roles, and their routines. While this is probably not a surprise, it certainly warrants increased attention as reports of studies indicate that caregivers also sustain decreased health status.

Furthermore, this is really an area where OTs have the expertise to contribute to the public discourse on health. It is an interesting prospect to consider how many public health challenges could be improved at least if more attention were focused on occupational balance.

What do you think?

• Do OTs have a role in addressing the occupational balance in a public forum? If so, how might this be accomplished?
• What about in working with clients - do you address the occupational balance of their caregivers?
• How do you strive to achieve occupational balance in your own life?

References

Hunt, D. & Smith, J. (2004) The personal experience of carers of stroke

survivors: an interpretative phenomenological analysis. Disability and Rehabilitation, 26 (16), 1000- 1011.

OT A to Z: A is for Adaptation

I just learned about the A to Z Blogging Challenge in April. For this challenge, bloggers will post everyday in April (except for Sundays) for a total of 26 posts - one for each letter of the alphabet. Thanks to Kirsty Stanley for promoting this challenge!

And since April is Occupational Therapy Month in the US, it seems fitting to focus the posts around things related to OT!! So to kick things off...A is Adaptation.

The concept of adaptation is deeply rooted in the development of occupational therapy. Adolph Meyer described psychiatric illnesses as largely "problems of adaptation" and could be improved through occupation and temporal rhythms. Adaptation is defined as "a change in response approach that the client makes when encountering an occupational challenge" (AOTA, 2008, p. 662). Schulz and Schkade (1997) also describe how adaptation can happen at the level of the individual, groups, or communities. Here are are a few questions for us to consider:

• So how do we as OTs understand and facilitate adaptation?


• Since OT is surely not the only profession to consider adaptation, how do our views of adaptation differ from those in psychology or other health professions?


• Is adaptation a process or an outcome - or both?


• How does adaptation differ among clients and in different cultures?

References

American Occupational Therapy Association. (2008).Occupational therapy framework: Domain and process(2nd ed.). American Journal of Occupational Therapy, 62,625–683.

Schultz, S., & Schkade, J. (1997). Adaptation. In C.Christiansen & M. C. Baum (Eds.), Occupationaltherapy: Enabling function and well-being. Thorofare, NJ: Slack.

Can OTs afford NOT to engage in social media?

While I know my use of tweeting, blogging, and Facebook is nascent compared to those in other fields, I am always struck by how the representation of the OT community is still relatively small in the world of social media. There are certainly individual OTs who are effectively using blog sites, Twitter, and other sites to convey information about their work and experience in OT. Even our professional association such as AOTA and BAOTCOT are increasingly on Facebook and Twitter. But I would still expect that OTs use of social media as a profession lags behind many others. I have often wondered why this is, because for a profession that often cites "lack of public awareness" as one of its challenges, the electronic world of social media seems full of potential. When I read Kevin Levin's post http://cwmemory.com/2010/09/19/can-you-afford-not-to-use-social-media/ urging teachers to consider the use of social media, it really resonated with me in thinking about OT and social media. He said if nothing else, social media enables educators to build an audience. That is EXACTLY what OT needs - a way to build an audience!!!! OTs have so much to contribute to the public sphere - a truly unique perspective about participation in meaningful occupations, fostering typical development in children, life transitions for patients and families, aging in place, caregiver issues, community participation, accessibility of community events...just to name a few! Understandably, OTs may be concerned about issues related to anonymity in using social media. But as we all build more robust digital lives, I think the issues of anonymity is less of a concern. However, it is important to be mindful of mixing completely personal information with professional information on the same site. Just as in all face to face interactions, it is critical to maintain anonymity of patients and be cautious when referring to any specific case or person. And certainly as health care professionals, there is a definite responsibility to only write or comment about things that are in the scope of practice for OT and generally applicable to the public. Kevin Pho, a leading physician in the arena of social media, posted theses strategies on his blog site for health care professionals interested in social media. http://www.kevinmd.com/blog/2011/01/simple-social-media-plan-health-care-professional.html Given the possbilities afforded with effective use of social media and OTs ongoing need to build public awareness all that OT has to offer, the question that is becoming increasingly vital is...can OTs afford NOT to engage in social media? What do you think?

Publishing Purgatory - R&R

I recognized the name of the sender of the email. Anticipation built as I prepared to open the message....was the editor of the journal to which I had submitted one of my first articles going to tell me that it was the best submission they had received this year or that it was the worst one they had ever received?!?!?! For a moment, it almost felt as if my potential to succeed in an academic career hinged on this one message.

Click........................

Dr. Piernik-Yoder:

We sincerely appreciate your recent submission to our esteemed journal. Yada Yada Yada.....Three reviewers have taken time to review your work and have rendered an opinion on your work. Yada Yada Yada............We would like to infrom you that........................[Here it comes!!!! I can hardly bear it!!!!!] your submission will require further revision.

____ Best submission (ever!!!). You should be offered tenure by your instituion on the spot!!!

_X__ Revise and resubmit. You have earned a ticket to the purgutory of publishing!!

____ Worst submission (ever!!!). Are you sure you spent years in graduate school?

-------------------------------------------------------

Ok.....now what I am supposed to do?!?! I was done with this article. It was off of my "To DO" list. I was moving on to other things. Now I have to work on it...again!?!? I will admit that this process feels a bit like graduate school all over again: work really hard on something and hold your breath until you are told what change should be made.

Not that I was REALLY expecting it to get accepted without any changes, but what do I do with the reviewers comments? One said add more in this section, the other two said that section was good. So can I take the two out three vote and leave it alone? Probably not...

I feel as if this is the start of an ongoing process....a world of academic limbo....Revise and Resubmit...could it be Publishing Purgatory???