PRACTICE AREAS

I wrote this reflection of what OT is to me prior to the beginning of my foundational coursework during the summer of 2020. I felt as though I had a relatively good insight into the opportunities this profession has to offer as well as the extensive scope of practice that I've witnessed firsthand during my internship at an outpatient rehabilitation center during the summer of 2019.

OCCUPATIONAL THERAPY IS...

...a holistic approach to the acquisition of health and well-being through the therapeutic use of everyday activities known as occupations. The foundation of this profession lies in evidence-based research that has found that by meaningfully participating in these activities of our everyday lives, individuals feel empowered, stronger, and more resilient, offering a unique protection to specific physiological and psychological maladaptations associated with illness or disability.

An occupational therapist plays a variety of roles including caregiver, cheerleader, therapist, problem-solver, and advocator when treating his or her patient. Oftentimes the occupational therapist is part of an interdisciplinary team that works to treat patients and help them regain or assume a sense of independence and confidence in their ability to participate in the occupations that are most meaningful to them. While other skilled professions are equipped to do just that, occupational therapists may take a unique approach to assessing a patient’s personal goals to fully understand the biopsychosocial context in which that person operates throughout his or her everyday life.

The occupational therapist must develop a unique protocol that addresses these goals and helps the patient return to a lifestyle with as much meaning and independence as possible.

Shawn Roll spoke about the area of industrial rehabilitation as it relates to occupational therapy. Having interned at an outpatient rehab center, I saw many cases where people had injured themselves on the job. To be quite honest, I wasn’t totally sure I knew what was involved in this type of area, but after listening to the interview, I realized I simply didn’t know what to call the type of skills and knowledge that I had already observed as components of industrial rehab. Occupational therapists, as Shawn Roll put it, are in their element because these OTs will assess and treat patients who have lost the ability to fully participate in what is commonly thought of as one’s occupation--their work job. Much like other areas, the OT is one of several members of an interdisciplinary team. Rolls, however, states the OT is the one professional that ties the rest of the team together because the profession is so unique in its holistic approach to treatment interventions. The physiological aspects of the work are no more important than the psychosocial aspects and how they play into the person’s everyday role as an employee of the company. Having done several studies and presentations on worksite ergonomics throughout undergrad, I had a relatively good understanding of the techniques and knowledge base required for this type of specialization. And it was interesting to hear from Roll the importance of resilience in the face of push-back from the employees and employers you serve and treat. When you offer new ideas to change how a worksite operates, that can be very disruptive to the overall productivity, and people can get frustrated or upset because of this kind of change. Rolls makes an excellent point when listing the ideal personality traits of the profession. It’s important to be firm yet show empathy toward your patients. I really appreciated Roll’s advice at the end when he said to “make a name for yourself.” Our profession is so broad, so it’s important to keep an open mind. It’s also important that we take control of our education and how we want to utilize our skills so we feel a sense of fulfillment and pride in our work.

Hector Huerta didn’t know what he wanted to do for the longest time, but eventually he found OT, and now he works at an inpatient rehab center in Miami, Florida. I thought he offered a lot of great insight into just how much vulnerability and sensitivity revolves around the practice of occupational therapy and the relationships that are developed with patients. I shadowed OTs who specialized in cognition and visual perception/stroke rehabilitation, and the approach was so fascinating because there’s so much vulnerability, and both the therapist and patient can get so frustrated during a lackluster session. Hector’s love for neuro really resonated with me. He offered great advice when it came to professional identity development. He said it is important to know your weaknesses and strengths and to push yourself to do things that make you uncomfortable. With such little time to interact and really establish a connection with a patient, he emphasized the importance of making every minute count because he may only get an hour and a half with a stroke patient every day for roughly two weeks. His response to “how do you introduce OT to a patient” was so great, too! He said he gives them the power by asking how they’d prefer to be addressed either by first name, last name, etc. He said he “puts the ball in their court.” And while many say they’ve never heard of OT, Hector simply says he’s there to help them be as independent as possible in doing the things they want or need to do. Inpatient rehab involves a lot of self-care activities, and Hector touches on the insight that many patients gain as to just how limited they are. Basic tasks become very difficult, and the fear and anguish that sets in leaves that person extremely vulnerable. He said a therapist must be very patient and empathetic. He also said it is hard to fight the impulse to help the patient, which I can totally relate to as well. When I assisted the OTs during stroke rehab, it was hard to resist the urge to pick something up for someone or make the task easier so they felt more accomplished even though the cues or assists would not be applicable in a real-world context. Hector understood the humanity that goes into being an OT and the many roles we must play whether that be a cheerleader or someone who is able to be firm and set boundaries. His advice was to “be a chameleon.” Additionally, Hector said we must open ourselves up to the domain of OT and that we do not choose the specialty; the specialty chooses us. As someone who does not necessarily know where they see themselves working quite yet, I’m really taking this to heart and allowing myself to try everything and see everything I can, and hopefully I’ll find something that feels right to me.

Someone once told me to consider COTA vs. OT because of my initial goals/vision for myself as an OT. COTAs are oftentimes the ones implementing treatment and the OT will supervise, having limited hands-on interaction with the patients assigned to their caseload. While this certainly doesn’t have to be the case, it definitely made me consider what I want to be and how I should go about reaching that vision/goal. I always envision myself being the one that had the independence to evaluate, treat, and assess my own patients--having that autonomy. Joan has a 2-year degree in occupational therapy and works with mentally-disabled individuals as a member of the Franklin County Board of Developmental Disabilities. This sounds like such a rewarding area of work, utilizing meaningful work to help teach skills to those with disabilities. Joan uses ergonomics and creativity to help individuals be as productive as possible in whatever work they choose. In terms of her work relationship with Lynn, her supervisor, Joan says that while they work in separate locations, they maintain frequent and transparent communication. Being able to work with someone else like that requires a lot of openness and trust. Joan is such an incredible COTA who uses her knowledge to help teach her patients and give them the skills to live healthy, independent lives. Thanks to her, they are able to engage in meaningful occupations. Additionally, I really appreciate her holistic approach to her work. While it’s not outwardly stated, Joan uses exercise to build a foundation for her clients to be able to function within and manipulate their environment. This physical foundation allows for improved productivity and stamina. It also makes their work more enjoyable. She talks about improved ROM and flexibility to improve certain comorbidities such as spasticity in individuals with cerebral palsy. I also really appreciate the insight she provides at the end when she’s talking about specialization. She says many times the same theories are applied in different ways depending on your specialty or area of interest. Understanding the foundations of OT is going to be really important in becoming an exceptional general practitioner who can apply their skills and techniques to a variety of settings and circumstances.

Karen works for Columbus Speech and Hearing and is a PhD candidate. Her specialization and research interests lie in sensory integration practice. Sensory integration is a fascinating concept because so much is unknown about it. Oftentimes she works with children who suffer from language delays, cerebral palsy, autism, or apraxia. These are children who have difficulties with self-regulation and may feel overwhelmed by certain stimuli whether auditory, tactile, visual, proprioceptive, vestibular, etc. The idea is that, by addressing these stimuli and adapting appropriately, children’s ability to function and participate in school and play is improved. Addressing sensory issues is definitely a part of occupational therapy and the need to participate in occupations. For children, those occupations are participating in school and play. Her professional identity is developed through her knowledge of the theories that support what she does while using multiple resources and techniques that she learns about through her research. She makes a point to highlight the research she does and its implications in a clinical setting. She said it’s important to continue learning to legitimize what you do as an OT. When I shadowed pediatrics, the OT said she used sensory techniques but understood that there was still so much more research needed to further justify sensory integration and its effectiveness in helping children learn self-regulation. Another OT said it was important to understand that achieving self-regulation through SI can be difficult in certain circumstances or settings. For example, a child who self-regulates with vestibular stimulation may find it hard to concentrate at school but may not be able to access a swing at that moment. How does the child go about self-regulation without the apparatus or specific cues utilized in a therapeutic setting? Essentially, how does what happens in the sensory room translate into normal settings? These are important questions to ask, and I think they shed light on just how limited we are in terms of knowledge about sensory integration as a tool in our occupational therapy toolbox.

Nationally-recognized occupational therapist Theresa Berner speaks on the specialization of mobility and seating as it relates to occupational performance and environmental manipulation. Her interests lie in the ability to maximize a person’s independence and ability to engage and interact with his or her environment by using adaptive equipment such as a wheelchair, walker, handlebars, etc. She was especially interested in how the equipment connected with one’s independence and sense of empowerment. She works at Dodd Hall in the seating clinic and assistive living center where she sees adult patients with injuries or illnesses such as stroke, spinal cord injury, TBI, MS, dystrophy, ALS, or Parkinson’s. A typical evaluation with this type of focus will be on examination of the environment in which the person lives and functions, the person’s current mobility and interaction with those environments, and access to things such as a computer monitor, keyboard, table tops, etc. Oftentimes technology like this plays a huge role in people’s occupations as they can be for social means or more practical means like instrumental ADLs. Her professional identity is rooted in her love for equipment and its connection with the individual and a sense of independence. She said occupational therapists have the unique insight to view individuals’ conditions holistically and help them make good decisions and maximize their performance. She pays particular attention to how she uses meaningful occupation in her work, oftentimes consulting outside parties and networking with others to figure out how to best simulate an activity or occupation that may not be replicated as well in a clinical setting. She always makes an effort to simulate the environment so it accurately reflects how the actual setting will look for the person learning to interact with it. She said aspiring OTs who like gadgets and thinking outside the box may find this work especially rewarding. She said they must be comfortable thinking abstractly as well. Her words of wisdom were similar in that students should think outside the box. Additionally, she said to trust the fundamentals and apply them to any situation. She said having the big picture of these theories and fundamentals is what will help us adapt to any type of work or situation we may find ourselves in, even if it’s not our specialty or just a new experience.

Joe Otto is a graduate of OSU who chose occupational therapy because he loved the broad spectrum of areas and opportunities for work and specialized focus not always found in PT. He also enjoyed establishing long-term connections with individuals he treated. He spent three years in the Army and was later deployed. He served in the Air Force reserves, the Federal Reserves, and eventually the United States Public Health Service. A lot of his work is focused around TBI and the many implications they can have on one’s short-term or long-term memory, attention, cognitive processing, performance, vision, photosensitivity, fine motor deficits, physiological responses to exertion, sleep, etc. He said these issues can bleed into other aspects of their lives, affecting things like money management, social interaction (or lack of), and recurring PTSD. In his field of work, the OTs will work with individuals on instrumental ADLs, cognitive processing, motor control, vision, and a return-to-duty program to track and assess someone’s ability to return to their work. During initial assessments, he will oftentimes take note of the person’s effort to regain independence, taking into account their motivation, what motivates them, and if there is any secondary gain that plays into their participation and perceived likelihood for success. One especially interesting topic he brought up was the BTE Primus, a functional re-trainer that can simulate a variety of work-related tasks while offering quantitative data on the biomechanics and work output from the individual performing the task. I actually had the opportunity to see and use one of these during my internship at an outpatient clinic where PT and OT used it to simulate a variety of tasks oftentimes associated with some sort of skilled labor work. The machine is absolutely incredible, and I definitely geeked out over it every single time! It truly is an extraordinary piece of equipment! Otto said his identity was formed from his experiences in a variety of settings. He’s continually redefined what being an OT means to him personally. He said his OTD helped him to gain clinical skills to make him a better provider of care for patients. He said he had a better understanding of theory, environmental context, psychosocial aspects, the importance of research, and seeking new knowledge. He said the best thing we can do as students is to read everything to learn more about diseases, protocols. By building our knowledge, we’re going to be able to find gaps or new inspiration to better assist individuals and stay current in our field. He also said volunteering everywhere is going to be very helpful and necessary so we can be the most informed about where we see ourselves in the future.

Camille is the director faculty practice at the University of Southern California. Her career as an occupational therapist began when she decided to leave behind her career as a dancer/yoga teacher. She taught yoga classes to people with illnesses such as cancer and MS, and she one day met an OT who ran a sensory integration room. The conversation she had with this OT fascinated her, and she decided to start volunteering and learning more about the career of OT. Lifestyle Redesign is a process by which individuals with chronic illnesses learn to adapt and change their daily habits and routines to promote health and wellness. The concept was derived from a research study that focused on the development of a preventative model and protocol to see if OT would help to keep elderly individuals active and independent longer without the need to transfer to a nursing home or assisted living facility. The model itself has been applied to a variety of conditions including academic/student roles, smoking cessation, oncology, diabetes, and movement disorders such as MS and Parkinson’s. The protocol is meant to be conversational and the goal-setting and follow-through are unique and dynamic processes. The OT helps to refine those goals and make short-term goals more long-term if they are beneficial to the patient. The main difference between lifestyle redesign and counseling is psychotherapy. The main focus is practical problem-solving as it relates to occupation in the present and for the future. To avoid stepping on toes of other health professionals, it is important for OTs to rely on their skill base and capitalize on their specific goals and approach to healthy human development and wellbeing. The Weight Management program lasts 16 weeks; the pain management program lasts for varying amounts of time. The weight management program was especially fascinating and it’s something I was already very familiar with because I helped promote and design a program at an outpatient rehab center last year. It’s so exciting to know more about OT’s role in weight management and the holistic approach that is used. OT plays such an integral role in wellness and prevention, and that’s so exciting because it means we have the ability to not only make people better but keep people healthy and truly educate them to make smart choices. Occupational self-analyses are used to break down how individuals utilize the time in their day. By observing this breakdown, the individual and OT can adjust how time is spent and what time and energy can be dedicated to working toward their goals no matter what those are!

Dan Eisner is an OT and Life Coach who works in psychiatry at the University of Maryland. He started his OT career in rehab and worked with stroke patients (which is something I’m very interested in myself), describing the work as very challenging but also very rewarding. About a year and a half later, Dan decided to work with children in an early intervention special needs daycare center where he remained for several years. At one point in his life, Dan realized a drive and passion for life coaching after going through his own experience with personal growth. He ended up getting his certification through a “virtual” program where he spent six months completing classes and getting experience coaching individuals. His passion for life coaching is very apparent in this interview, and his drive to help others find that sense of self and live life unapologetically is what makes him exceptional at what he does. Personal growth and development is nonlinear; it is dynamic. It is ever evolving and takes on many different forms. OT allows us to use our basic knowledge and theory to tap into one’s internalized sense of self and provide the tools and guidance necessary to help individual’s live their lives in the most meaningful and optimal way, which is exactly what OT is all about!

I have not been involved in the political process at the local, state, or national levels. I was in student senate during undergrad, which was my first taste of what politics was like in terms of running a campaign, holding an office, and representing individuals. I have always hated the idea of politics because I always saw instances where peers would run for an office and make promises to work hard and serve the people they represented and then never deliver. Personally, that was the most abhorrent instance of hypocrisy and disservice. I never wanted to get involved because I didn’t truly believe in the impact it had on our society. But I decided to get involved and I loved every second of it! I began to dive into politics a lot more through Senate and serving as editor of the school newspaper for a couple years. I became more aware of the politics that affected school policies and decisions made by the administration. I saw the impact this had on my peers and the school’s culture. This interest translated into my awareness of our own nation’s political landscape. I had the opportunity to attend political debates and see advocacy first-hand. I won an award for my leadership in undergrad, and my dean, who nominated me, saw me as an advocate for my peers through my leadership positions. I realized right then and there that my work in OT had to involve some sort of advocacy dimension. I don’t think advocacy for a singular profession is necessarily different from advocacy in general. Advocacy is standing up for what you believe in, and I believe in the power and impact OT can have on people’s lives. I also believe in its influence in healthcare in general and how we approach health and wellness both physically and mentally. I definitely see myself becoming an occupational therapy advocate. Dr. Robinson is motivated by her trust in her work and profession, and I am, too. She’s dedicated and enjoys teaching people about the benefits of our work, and she believes in the importance of building relationships with people who can help influence and bring about change. It’s never one person’s job to advocate. We all have to! I really want to take advantage of every opportunity I can to become an advocate for OT and help change our healthcare system so it is accessible for all Americans. I believe OT has an integral role in this goal, and I hope to be a part of the movement!

Sharon found her love for occupational therapy when a community member who had suffered from the effects of a brain tumor and stroke inspired her to become of service to others who struggled to do things they would normally do without illness or disease. She was taught how to do many occupations single-handedly. While she didnt love exercise programs, she did love the general knowledge she was taught how to do basic splinting. She started out at a general hospital in Cleveland where she started as a generalist. She’d see various types of patients (burn, stroke, parkinson’s). She had a lot of difficulty balancing focus on these different types of cases. She was the first OT at the Cleveland Clinic in a period for 15 years. She became quite acquainted with the medical model and learned more skills alongside residents, completing dissections and going to surgeries. She even taught others about splinting techniques. She realized through her work that not all patients responded to exercise and splinting to enhance their abilities. She saw a lot of trauma/fracture patients and started to move into physician’s offices, continuing to learn more about hand patients, trauma, reimplants. Her experiences brought to light the lack of effectiveness in the protocols that were being used to treat these kinds of patients and help them get back to work. She knew something needed to change. She opened her own industrial rehab clinic soon after. Sharon realized that impairment doesn’t predict one’s functional outcome. This is important because she put a lot of thought into what went into her new clinic. Things like volleyball nets, ceramics, a school bus, etc. were introduced to the space. The development of this environment was a cornerstone of her approach to occupational science and health. This careful consideration and extra creativity is what separated her work and approach to those of physical therapists. She found occupation was working. Worker’s compensation changed the team’s approach, and she knew they had to move out into the community more. Sharon absolutely loved that. Her focus moved from hand therapy to industrial rehab to community work. Ultimately, she pursued her PhD in clinical research to figure out how other OTs can make their work just as effective. Her work now focuses on the barriers to successful programming as it relates to using occupations as a therapeutic means. She also wants to change the reimbursement model, shifting the focus from a standard approach based on a specific time frame to reimbursements based on patient's conditions and what type of care they need. Sharon is a charter member of the American Society of Hand Therapists. The org was focused on best practice and developing a certification procedure to improve the effectiveness of hand therapy as a practice. She helped develop the curriculum and examinations and the science behind standard procedures. Her professional identity, unlike others, was not found through her love for OT. She said she was embarrassed about the profession because she didn’t feel OTs offered anything unique. She stuck to what she knew--splinting--but eventually she found the reason why OT was necessary and so effective. She found inspiration in patients finding their spark again through the use of meaningful occupation as therapy. Her clinic utilized the Flinn performance screening tool to help identify the most important occupations for a specific client. This helped to quantify and measure occupation and how to best develop a protocol that fit the individual needs/desires of clients. A hand therapist, according to Sharon, needs to be confident when working with an interdisciplinary team of other physicians or therapists and employers. She said being an educator for clients is also an important role to help describe the physiological dispositions that clients face. Manual skills were also another asset of a good hand therapist when talking about splinting or fine-motor control. Continuing education (workshops, seminars, etc.) and further studying is also important to stay on top of the literature and best practices.

Our mental health coursework and level 1 fieldwork taught me how occupational therapy can have a profound effect on people’s mental well-being through engagement in meaningful occupation. AOTA’s Vision 2025 states the following: “Occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living." While initially I felt this statement seemed so intuitive, I realized I lacked understanding of the actions behind those words and how practitioners become entrepreneurs to advocate for mental health services. For me, the ACE course was my first glimpse into the vastness of OT’s role in mental health. I learned to recognize the inequity and social injustice many children face and how OTs can support children as they grow and develop. Occupational therapy’s holistic approach to healing means practitioners are able to look past physical injury and address the psychosocial impact of trauma. I learned trauma contributes to mental health and a person’s ability to engage in healthy occupation. The role of the practitioner is to facilitate engagement in occupations that promote safety and mitigate the psychopathologies related to trauma. The youth mental health first aid course helped me further grasp the concept of trauma-informed care and how to react in a crisis situation. Occupational therapists may encounter clients (children and adults) with a referral for one diagnosis and present with signs of mental illness.

While our focus of care is dependent upon the client’s concerns and goals, practitioners can support their mental health by incorporating specific approaches and models into their intervention plans while promoting the client’s engagement in occupations to improve mental well-being. Our simulation course with Simone and Vera offered great insight into the structure and purpose of intervention sessions in a mental health setting. Skilled therapists utilize the principle of positive psychology and the skills to address psychosocial development and group dynamics in addition to the general skills of activity analysis, environmental analysis, and occupational performance. The role of the occupational therapist in mental health is to support successful occupational engagement. Rather than push the client to achieve a specific level of mental health, practitioners should meet them wherever they are and work toward optimizing mental health through occupation and skilled intervention.

This semester, I was also asked with developing a resource portfolio to organize all the course materials from our MHCF class.

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Reflection

This reflection was written following the conclusion of the foundations course I took during my first semester of OT school. When I started the program, I felt as though I already understand the main concepts of occupational therapy and how to provide a comprehensive explanation of our roles and identity. However, the course helped me find the vocabulary and understand the theory behind what we do as OTs to convey our role and duties in a more concise manner. I realized there are two ways to describe occupational therapy. One way is to break down the larger concepts to explain those to someone who inquires about my career in a generic setting such as a grocery store. The other way is to highlight the theoretical framework—the philosophy behind the therapeutic use of occupations and the extensive history that dignifies the work we do as clinicians and separates us from other healthcare professions. I attempted to make every word count and ensure that each one accurately described occupational therapy. The word "client-centered" appeared only five times in my cohort's initial discussion board in which everyone shared their initial explanation of OT. I was not one of those individuals, so I wanted my second attempt to include this phrase because it is indubitably essential to our identity and mission. I kept the words "holistic" and "evidence-based," recognizing the importance of the mind-body connection and the extensive research that has enhanced the value of our work. The word "humanistic" refers to the diversity of the individuals we treat as well as a reminder that OT requires an artistic and creative approach to the treatment of autonomous and diverse beings. The term "biopsychosocial" is a nod to the terminology used in models related to occupational science: people, environment, occupation, and performance outcomes. What was omitted is now implicit in this definition of OT. The responsibility of a therapist to be a supporter and advocator for themselves, their clients, and their profession is necessary. The collaboration among healthcare professionals is equally important. I believe these points are implied in the new definition I've provided now, specifically in the words "holistic" and "client-centered."

OCCUPATIONAL THERAPY IS...

...a holistic, client-centered, and humanistic approach to the acquisition of health and well-being through the therapeutic use of occupations. The foundation of this profession is theoretical and evidence-based in nature, relying on a variety of models, theories, and frames of reference that promote effective treatment interventions with consideration for biopsychosocial factors as they relate to an individual's unique roles and occupations.