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Occupational therapy

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Edgar Moreno: A survivor, a champion bicyclist, and a man who got his life back thanks to occupational therapy.

Occupational therapy is a healthcare profession dedicated to helping people live their lives to the fullest. Occupational therapists support, encourage, teach, and treat patients with a wide range of disabilities. Their mission is to help their patients live to their optimum potential as an independent person within the general community.

While working on a cattle ranch in Latin America as a teenager, Edgar Moreno (pictured at right) stepped on a landmine. When he finally reached a hospital two days later, doctors amputated his left leg. Poor health prior to the accident and the trauma incurred by amputation brought Edgar close to suicide, ashamed of his disability. Fortunately, through faith and a rehab program (which included occupational therapy), Edgar recovered. He has since begun a new life, marrying and now a proud father, as well as a bicycling champion and a mentor for others with disabilities.[1]

Education

Up until 2007, occupational therapists were only required to earn a bachelor's degree in the field to be eligible for licensing. Now students studying to become OTs must earn at least a master's degree to qualify for the career. Because of this, many universities have developed pre-occupational therapy classes and/or a combined bachelor and master's degree program for occupational therapy, allowing students to finish their schooling in five years (separate bachelor and master's courses often take more time to complete). There are two kinds of master's programs for OTs:

  • Entry-level-- Focuses on preparing students with no prior work experience to take the national examination required to obtain a license; frequently requires fieldwork. [2] Fieldwork provides students with the opportunity to apply their classroom knowledge in a clinical setting. Students develop practical experience and the abilities necessary to be a well-rounded, competent healthcare professional. [3]
  • Post-professional-- Intended for professional OTs, typically those interested in specializing in a particular field like pediatrics or administration. Because these students are often practicing occupational therapists, internships are generally not required.
A group of First Year occupational therapy students attending a lecture as they work towards obtaining their degree.

Both of these master's programs take two to four years to finish, and online master's programs are usually only available to professional occupational therapists with clinical expertise. [2]

For graduate certificates, students need only five to fifteen courses depending upon the program. Doctoral programs are only available to practitioners with field experience. Like a master's degree, a doctorate usually focuses on a specific area, and earning a doctorate degree can take more than six years. Overall, education for occupational therapists involves courses in biology, anatomy and physiology, and sociology, as well as classes in medical terminology and intervention strategies. [2] In order to be eligible for the national exam, OT students must attend an academic program that has been accredited by the Accreditation Council for Occupational Therapy Education (ACOTE), programs which usually require a minimum of 24 weeks of supervised internship. Students that pass the national exam become registered and certified occupational therapists (OTRs). [4]

Each state regulates its own standards for occupational therapy practitioners, so the eligibility for state licenses varies. The national exam meets some states' requirements for licensing, but others have their own exams. Some states even require extra certification for those OTs that work in early intervention programs or in schools. Practicing occupational therapists are expected to continue taking educational courses throughout their career (many states require continuing education in order to renew licensure.) [4]

To be an occupational therapy assistant (OTA), a student must earn an associate degree, which includes basic educational courses (English, mathematics, etc.) plus occupational therapy classes; some internship is usually required. Students applying for acceptance into an associate degree program must hold a high school diploma. The program can be taken online, or at community or technical colleges, and take two years to complete. Upon completion, graduates obtain their OTA licenses by taking a national examination. [2]

Career Opportunities and Statistics

The need for occupational therapists is rising dramatically; in fact, from 2006 to 2016 the estimated number of therapists employed is expected to increase 23%. The growing demand for OTs is caused by several factors. The baby-boomer generation is beginning to hit retirement and ages where strokes and heart attacks are more common. An increase in people turning 75 years or older, a group vulnerable to many disabling conditions and prone to accidents, also contributes to the growing need. Advances in medical technology help critically ill patients to live longer than before, and these survivors often require therapy to regain basic living skills. Occupational therapists are also needed to treat the growing number of children diagnosed with sensory disorders. [4]

In 2006, occupational therapists held around 99,000 jobs in the U.S., and about 10% held multiple jobs. Major employers include: hospitals, educational services/schools (private and public), offices of healthcare practitioners, and nursing care facilities. Other employment opportunities include government agencies, care centers, nursing homes, outpatient clinics, and home or individual services. A small percentage of OTs even have private practices, offering consulting and contracting services to organizations. [4]

Advance, a professional occupational therapy magazine, took a survey in 2009, the statistics of which indicate that 25% of the respondents work in skilled nursing facilities/nursing homes; this was followed closely by 24% working in hospitals and 23% in schools. According to Advance, the majority of OTs and OTAs (occupational therapist assistants) are employed by a staffing agency or rehab company rather the particular facility where they work. In schools however, this statistic is reversed with most of the occupational therapists directly employed by the school or district. [5]

By salary, those working in skilled nursing facilities earn an average of $74,828 annually (or $35.59/hour). By hourly pay, personal contracting and consulting in schools, homes, or agencies, prove the most lucrative, ranging from $45.93 to $50.92/hour. OTAs earn less than occupational therapists; in hospitals they average $19.44/hour and in schools $26.29/hour. OTs with specialty certification earn up to $4,000 more annually than those without, and OTs with doctorate degrees can have salaries reaching $75,000. OTs that remain with one employer for long periods of time gradually earn more, but OTAs typically earn more by switching jobs than waiting for a salary raise. Overall, the survey concluded the mean wage of a full-time occupational therapist is $65,190 and $45,044 for a full-time occupational therapy assistant, up more than 25% since Advance's survey in 2003. [5]

Demographically, the majority of OTs are Caucasian (85%), although recent trends seem to indicate an increase among minorities in this field according to the survey. African-Americans for example, make up 4.4% of occupational therapists, but on average earn over $70,000 (mostly due to high-pay settings). Interestingly enough, of the OT respondents to Advance's survey, roughly 10% were men, yet they averagely earn $6,200 more a year than women. Among OTAs however, the gender disparity is virtually gone, with women earning $0.52 more per hour (though it must be acknowledged that these figures are derived from a very small pool of OTs and OTAs). [5]

Even amidst the economic recession (2007--), occupational therapy as a career has remained resistant to job losses. It has also been on the U.S. News & World Report's "Best Careers" list in 2008 and 2009. The advantage of occupational therapy is the wide variety of specialties, positions, and patients. Current job opportunities for OTs and OTAs are numerous, particularly those in rural settings where the shortage of OTs leads to higher pay and incentives. Government agencies and army bases are also actively recruiting OTs to treat returning troops with traumatic brain injuries. Changes in America's health care and Medicare funding however could strongly impact the job stability of occupational therapists, whose patients often rely on government funding.[6]

Practice

Pediatrics

In Evangel Hospital in Jose, Nigeria, occupational therapist Gay Lynn McCrady treats a young boy with a major fracture.

Occupational therapists help children of all ages, working with the smallest infant to the oldest teenager. For newborns and infants, OTs often participate in early intervention programs for young ones diagnosed with developmental disorders, autism, Down's syndrome, etc., working with the child's parents to minimize the potential for future developmental delays. They also teach and improve basic play, cognitive, sensory processing, motor, and communication skills in the child. Occupational therapists communicate with the parents concerning the specific needs of their child and ways to foster their natural development. [7]

Early intervention therapy focuses primarily on the family aspect of raising a child with disabilities, and incorporating the therapy methods in regular activities (further refining the skill and its practical use in the child's mind). For example, if a toddler is struggling to pick up food or grasp small objects, the OT may help the child practice using their index finger to grab things. The parents then reinforce this new-taught skill by asking the toddler to point to pictures in a book, press buttons on a remote, or pick of large pieces of food that are easy to grasp. In this way, the child's therapy becomes applicable in performing commonplace tasks. [7]

For children in general, occupational therapy aids those struggling with traumatic injuries (brain/spinal cord) or amputations, hand injuries, behavioral problems, cancer, chronic illnesses (cerebral palsy, multiple sclerosis, etc.), sensory difficulties, mental health disorders, and many other potentially disabling conditions. Occupational therapists can help children improve hand-eye coordination for taking notes in class or playing sports, as well as developing fine motor skills for good handwriting or for holding objects. For those children with disabilities, OTs can teach them how to cope with and thrive despite their limitations, improving coordination skills so they can work on a computer, feed themselves, etc. Sometimes children with developmental delays struggle with simple tasks like bathing, dressing, or brushing their teeth; an occupational therapist can teach them these basics to make them more independent. OTs help children learn anger-management skills, as wells the ability to focus and socialize properly. [8]

In addition, occupational therapists identify and evaluate the specific needs of child in regards to specialized equipment, from wheelchairs to splints and communication aids. Through occupational therapy, children with various disabilities find a greater sense of accomplishment, freedom, and self-worth through the fun and didactic activities that improve their physical and mental skills. [8]

Geriatrics

When most people hear of occupational therapy, they commonly assume the branch of geriatrics, or senior citizens. Many occupational therapists are, in fact, involved in this branch because their skills are necessary for elderly people recovering from, or struggling to cope with, disabling conditions. OTs focus on enabling these elderly patients to live as functionally as possible in their social, work, recreational, etc. areas of their lives. [9]

For seniors that have suffered some dysfunction, from conditions like a hip-replacement, stroke, arthritis, depression, etc., occupational therapists work to help them recover. Most often the therapy includes re-learning or developing different methods of the basic activities of daily living (BADLs). BADLs include personal hygiene (bathing, grooming, toileting, etc.), eating, and transferring (movement from one surface to another, like from the bed to a wheelchair). Once these basics are mastered, the OT may move on to more complex tasks such as cooking, working on a computer, balancing checkbooks/overseeing finances, taking daily medication, driving a car, etc.; these new tasks require a combination of higher-level thinking and physical demands. [9]

Occupational therapists also take an interest in their elderly patient's personal goals and favorite activities. In this manner, OTs are able to develop and teach new strategies that compensate for a disability or change in circumstances, enabling their patient to continue in their leisurely pursuits. Encouraging senior patients to be socially active reduces the risk of social isolation and its negative consequences such as depression. [9]

The overall aim of geriatric occupational therapy is to empower disabled senior citizens to continue living at home or even return to work, or at the very least, to provide them with as much independence as possible. [9]

A study published in an October 1997 issue of the Journal of the American Medical Association, conducted at the University of Southern California, confirmed that patients that received individualized occupational therapy treatments "sustained 90% of the therapeutic improvements they originally realized in health and independence;" this indicates that occupational therapy aids patients in developing new routines that help them cope with stress, as well learning and maintaining a healthy lifestyle. [10]

Occupational therapists help people like this man learn how to take public transportation despite being in a wheelchair.

Mental Health

In the mental health, or psychiatric, arena of occupational therapy, OTs work with patients diagnosed with serious emotional problems or mental illness. These mental health issues include illnesses like Alzheimer’s disease, as well as conditions like autism, attention-deficit/hyperactivity disorder, schizophrenia, and learning disabilities. Occupational therapists can also help patients suffering from substance abuse, eating disorders, stress-related disorders, or depression. [1]

Through the use of basic everyday activities such as shopping, cooking, managing a household, taking public transportation, and budgeting, OTs can teach mental health patients how to handle daily life as a normal person. Psychiatric patients also learn time management skills to aid them in coping with day to day life. [1] Occupational therapists begin treatment by first identifying the individual's abilities and limitations in regards to their disorder or illness. After this assessment, the occupational therapists develop an individualized program suited to their patient's needs in an effort to meet the patient's personal goals. These goals can be social, physical, vocational (employment-related), pre-vocational, or leisure. [11]

Occupational therapy enables mental health patients to better understand their disorder or illness and to learn methods to promote mental wellness. They can develop hobbies, interests, and skills necessary to lead more independent lives within society. These patients can also improve their self-esteem and their relationships with others. Some are even able to work again. [11]

Occupational therapists work with the patient's caretaker(s) and/or family, as well as community agencies and fellow health practitioners to provide the best care possible for the patient. OTs also get involved in the home, work, community, and hospital environments their patient functions in. [11] Occupational therapists treating mental health patients primarily teach skills in cognition (problem-solving, etc.), self-awareness, relationships, role development (parenting, etc.), self-sufficiency, health, independent living, and assertiveness; in this manner, mental health patients can maximize their potential for physical and mental health within the community. [12]

Adaptive Equipment

These finger, hand, and arm splints and bandages were used to help a woman heal after a car crash. Thanks to surgery and occupational therapy, the woman's fingers no longer claw and she has regained almost normal function.
This motorized reel was custom built for a wheelchair-bound fisherman.

After evaluating a patient and determining their individual needs, occupational therapists develop or recommend assistive devices to help their patient function better. One common assistive device is a splint, which can be used for a patient with a condition like arthritis, in which the joint tends towards deformity without proper support. A similar apparatus, an orthosis, lends support to damaged bones, ligaments, muscles, and tendons. Occupational therapists can also work with prosthetics; for example, an OT can teach a patient with an amputated hand how to use the prosthetic arm to hold a fork or pick up an object. [13]


Some devices are quite simple and seen everyday, like grab-bars in a handicap bathroom stall. Equipment used to help people with poor balance, dizziness, or weak legs includes wheelchairs, canes, walkers, and even chairs in the shower. If a patient has a weak grip with their hands and has trouble grasping smaller objects, occupational therapists can suggest things like large-handled utensils and shoehorns. Grabbers help patients with limited movement reach things on high shelves. People that struggle with standing up out of a chair due to a back injury or weak legs can use chair leg extenders (which raise the seat), raised toilet seats, or seat-lifting chairs. Advanced computer technology aids severely disabled people in movement and communication despite their impairments. [13]

This CCTV unit uses a camera to magnify objects placed under its lens, and is an assistive technology device currently in use in government facilities in Arizona to aid the visually impaired.

Occupational therapists help patients obtain these innovative assistive devices, but because of the expense, many OTs often seek cheaper alternatives. A shower seat for instance, can be as simple and as inexpensive as a plastic lawn chair (as long as the patient has someone there to assist). Other ideas include substituting a regular pair of tongs for a grabber advertised in an equipment catalogue. For patients with little vision, OTs can buy brightly colored cups for them to use, mark the edges of stairs with colored tape, and use puff paint to label the buttons on a microwave or stove. [14]

Occupational therapists have also been known to use things like non-skid shelf liner to add grip to a wheelchair brake or under objects like rugs, wheelchair cushions, and plates to keep them from slipping. An alternative for patients that can't afford a bed bar, yet struggle to sit up in bed, is to tie a rope to the bed frame to pull themselves up. Through their creative ingenuity, occupational therapists can provide low-cost, effective solutions that assist patients in everyday functions. [14]

The goal of adaptive equipment is to simplify everyday life for people encumbered by disabilities. Assistive devices can be as complicated as voice-activated computer software and as simple as magnifiers or hearing aids. They aid patients in living independently and without fear of injury (like falling down and fracturing a hip). Each individual person requires different devices to suit their own needs, and part of an occupational therapist's job is to identify those tools and teach their patient how to use them effectively.[15]

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References

  1. 1.0 1.1 1.2 Storis of Survival: Edgar Moreno- Latin America, Colombia From survivorcorps.org. © Copyright 2008 Survivor Corps.
  2. 2.0 2.1 2.2 2.3 Guide to College Majors in Occupational Therapy Published by worldwidelearn.com. Copyright © 1999 - 2009.
  3. The Purpose and Value of Occupational Therapy Fieldwork Education Prepared by Donna M. Costa and Ann Burkhardt for the 2003 Addendum to The Reference Manual of the Official Documents of the American Occupational Therapy Association, Inc.
  4. 4.0 4.1 4.2 4.3 Occupational Outlook Handbook, 2008-09 Edition By the Bureau of Labor Statistics, U.S. Department of Labor. 6/16/09.
  5. 5.0 5.1 5.2 ADVANCE's 2009 Salary Survey By Jill Glomstad. Advance magazine. Vol. 25 • Issue 8 • Page 10. April 10, 2009. © 2009 Merion Publications.
  6. Job Market Re defined . Or not By Sarah Lebo. Advance magazine. Special Student Edition • Page 8. March 6, 2009. © 2009 Merion Publications.
  7. 7.0 7.1 Occupational Therapy in Early Intervention: Helping Children Succeed By Ashley Opp. 5/13/2009. © 1999 - 2009 American Occupational Therapy Association, Inc.
  8. 8.0 8.1 Occupational Therapy Reviewed by Kimberly S. Pierson, OTR/L. October 2007. KidsHealth. © 1995-2009 The Nemours Foundation.
  9. 9.0 9.1 9.2 9.3 Occupational Therapy: Introduction-- Geriatric Essentials Editor-in-Chief Mark H. Beers, MD. The Merck Manual of Geriatrics. April 2006. Copyright © 2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A
  10. Study confirms preventive occupational therapy helps seniors remain independent From the American Occupational Therapy Association. Science Blog. January 2001.Copyright © 2004.
  11. 11.0 11.1 11.2 OT and Mental Health From the Occupational Therapy Australia.
  12. OT and Community Mental Health Developed by the Occupational Therapy Department, Springfield Hospital Center, Sykesville, Maryland. 5/16/2007. American Occupational Therapy Association. © 1999 - 2009 American Occupational Therapy Association, Inc. All rights reserved.
  13. 13.0 13.1 Occupational Therapy (OT) By Masayoshi Itoh, MD, MPH; Mathew H.M. Lee, MD. July 2007. Copyright © 2009 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.
  14. 14.0 14.1 Creative Alternatives to Self-help Devices By Phyllis Ehrlich, MS, OTR/L, CHES. Advance magazine. Vol. 25 • Issue 17 • Page 9. August 14, 2009. © 2009 Merion Publications.
  15. Assistive Devices To Make Life Simpler Found at babyboomercaretaker.com. © 2007

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