Embrace the Science of Occupation
Representative Assembly Motion 1 asserts that entry-level OT students are not learning the necessary skills to compete in the market of physical disabilities and upper-extremity rehabilitation. In posts to AOTA's Physical Disabilities SIS listserv, one of the motion's authors contends that ACOTE standards are too vague and that the move toward a more occupation-based curriculum detracts from the core sciences of anatomy, kinesiology, neuropathology, etc.
I contend that preparation for work in UE rehabilitation should not be the goal of entry-level education. UE rehabilitation is a specialty area of practice, much like lymphedema or wound care. Expertise develops over years of experience and after specific training. Entry-level OT students should be prepared to adequately treat all areas of the body and should not focus knowledge and skills on the upper body. If evidence suggests that entry-level students are ill prepared for practice in physical disabilities, this situation warrants immediate attention. However, Motion 1 primarily addresses UE science courses. For decades, OTs in adult phys dys have focused treatment on the UE. I believe this situation exists because it provides an easy way to delineate OT from PT and it's easier for treatment facilities to meet productivity guidelines and mandated therapy levels. But this artificial division hinders our profession and, more importantly, our patients. Often, because of this limited focus on UEs, OTs perform age-inappropriate games and use contrived activity to simulate occupation. Such activity bears little resemblance to patients' real-world needs.
"The part of convalescence that I found most profoundly humiliating and depressing was occupational therapy... I was reduced to playing with brightly colored plastic letters of the alphabet, like a three-year- old, and passing absurdly simple recognition tests. Sitting in my wheelchair with my day-glo letter-blocks, I could not escape reflecting on the irony of the situation." (McCrum, 1998, p. 139, as cited in Kielhofner, A Model of Human Occupation, 2002, p. 297)Unfortunately, the above experience is common for patients of OTs who only treat patients' UEs.
As a profession, OT needs to move away from body-specific training and embrace our Framework. AOTA's Practice Framework states: "[OTs'] expertise lies in their knowledge of occupation and how engaging in occupations can be used to affect human performance and the effects of disease and disability." In essence, our Framework articulates that as a whole the profession practices occupation, yet in the field of adult physical disability, nothing is further from the truth. Years ago when occupational science formed, I saw a wonderful opportunity for OT to advance itself. Unfortunately, it appears that many OTs are still resistant to such science. While basic sciences are important to our profession, the "science" of occupation is truly our unique contribution to health care. If we specialize in UE rehab, how is OT significantly different than PT? We need to advance toward the Centennial Vision. Focusing on UE rehab hinders this advancement.
Note: This article originally appears in:
Carson, R. (2008). "Embrace the Science of Occupation". Advance for OT Practitioners, 24(7), p. 5.