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This assignment is aimed at establishing occupation as the link between occupational science (academic discipline) and occupational therapy (a profession) (Cohn 2003). Both occupational science and occupational therapy has a passion to solve performance problem or occupational dysfunction by applying occupation as a tool. Hence the complexity of occupation requires activities analysis as a process for finding and adjusting an occupation to achieve some therapeutic benefit or allow a person to engaged in a former or new occupational role. (Duncan, 2009. p.91)
Occupational science (OS) was first mooted by the National Society for the promotion of occupational Therapy in 1917 in the USA (Wilcock 2001,2003, Larson et al 2003). The primary objectives of that organisation, which later became the America Occupational Therapy Association, anticipated that it should focus on the ‘development of occupation as a therapeutic measure, the study of the effects of occupation upon human being, and the propagation of scientific knowledge of this subject’ (Dunton et al 1917 as cited in Wilocock 2003,p.164). As the profession grew, only the therapeutic use of occupation attracted much attention (Wilcock, 2001). Occupational science was formally founded in 1989 when the university of south California’s (USC) doctoral program was launched (Zemke, 1996). This was champion by Yerxa et al (1989,p.6) and she described Occupational science as ‘the study of the human as an occupational being, with the need for, and competence to engage in and coordinate daily occupations in the environment over the lifespan. Yerxa et al (1989), Occupations are defined in the science as chunks of daily activity that can be named in the glossary of the culture (Clark, 1991)
Occupational science and occupational therapy are intimately related, and that in fact the former emerged from the latter. (Duncan 2009,p.300) Occupational science was seen as a basic science, that is, one which dealt with ‘widespread issues about occupation without concern for their instant application’ (Yerxa et al 1989, p.4) occupational therapy on the other hand, was seen as being worried with the application of knowledge about occupation for therapeutic ends (Clark et al, 1991)
Occupation is equally the fundamental focus of occupational therapy practice and the unit of analysis considered in occupational science (Cohn, 2003). Occupational science generates knowledge about the rich variety of human occupation and the socio-cultural, political, economic, environmental, biological and other conditions to sustain healthy, fulfilling, meaningful occupation for person and communities in different world contexts. There are some reservations whether or not the basic science of occupation is essential at all given that an abundance of knowledge about occupation exists in other discipline (kielhofner, 2002). What is obvious, though, is that whilst other fields may tackle issues, which might usefully inform an understanding of occupation, these fields do not use the idea of occupation as the center of inquiry (Clark et al 1993, Polatajko 2004). This guarantee that any knowledge generated not only tackles the concern of therapists but also has clear direction on how that knowledge can be used in practice (kielhofner 1997,2002 Taylor et al 2002).
Occupational science impact on therapist to reflect on their practice and resolve its congruence with the philosophy and mounting facts base of an occupational perception. (Duncan 2009)
There are concerns that occupational science overlaps with other disciplines and is therefore not adequately unique to validate its institution as a scholarly discipline. Nevertheless, it is examination that occupational science, because of its sole subject matter and emphasis, ”constitutes a conceptually distinct field of inquiry”(Clark et al. 1991,p.304). Traditionally, the social sciences established their uniqueness not by their formal description but by their emphases and traditions. The unique traditional base of occupational science ‘lies in the practice of occupation therapy, with its concern with the adaptation, by way of engagement in occupation, of person with disabilities’. (Clark et al. 1991.p30)
It has been recommended that one of this new field will force occupation on occupational therapists to re-engage with there philosophy and revisit occupation as the core of occupational therapy (Molineux, 2000), since the centre of Occupational science is human as occupational being (Yerxa et al., 1989; wilcock, 1993)
However, another school of taught define occupational science as an academic discipline, the reason of which is to generate knowledge about form, the function and the meaning of human occupation. (Zemke, 1996). Occupational Science focuses on:
Form, which is the directly observable aspect of occupation. The objective set of physical and socio-cultural situation, external to the individual at a particular time. Though, occupational form guides, structures, or suggests what is to be done by the individual. In completing the form imitate on what happens ‘behind the scenes’ and recognize the association between doing & being. (Hersch et al, 2005 p36). In a study of preschoolers receiving occupational therapy, Case -Smith (2000) found that the occupation of play fostered the development of visual and fine -motor skills suggesting occupation-based interventions distorted component skills. In contrast, a Meta -analysis study of occupational form found out that, in contrast to less enriched forms, enriched occupational forms moderately enhanced performance outcomes, especially in the area of movement kinematics (Cohn, 2003).
The function of occupation refers to the way occupation influences health, adaptation, development and quality of life, the purpose or intended outcome when participating in occupation
(Larson et al, 2003). Occupational scientists could study how being fed versus being helped to feed oneself to the maximum extent possible affects the physical health and life satisfaction of residents of health care institutions. (Cohn, 2003).
Meaning in occupational science refers to the
refers reentire interpretive knowledge engaged in by an person encountering an occupational form. The subjective experience of engagement in occupations
(Larson et al 2003). People instil occupations with personal meaning or value. Further more, occupations are metaphorically constituted in a culture and interpreted in context of person’s life stories. For example, a dining event with a new friend may be seen as essential in influential one’s future, resulting in a romance or even marriage.
The attempt to occupational diagnosis begins with the identification of activity limitations or participation restrictions. (Molineux, 2009). Whether physical or mental in nature, the behaviours necessary for completion of tasks in daily occupations can be analysed according to specific components related to moving, perceiving, thinking & feeling (Hersch et al 2005). Hence, it is consonant with the top-down approach to the occupational therapy process (Trombly, 1993). Impairments, negatively influencing performance, are then identified through Task analysis. Task analysis examining an activity to identify the sequence of steps or tasks that constitute the activity. Each task may be analysed into a further series of sub-tasks. (Creek, 2003) Subsequently, they are evaluated in detail through additional targeted observations or specific impairment tests, such as goniometry for range of movement and screening test for depress. Then, attention is directed to potential environmental factors restricting performance. Through it the process, clients collaborate (client centeredness) with the parishioners to develop an understanding of problems in relation to clients’ situation and to prioritise the relative importance of problems. . (Molineux, 2009).
The top-down approach differs from the approach in putting the initial emphasis on occupation. In the bottom-up approach, the practitioner begins the evaluation of occupational performance by exploring impairments. For example, knowing that a client has rheumatoid arthritis, the evaluation may begin with measures of pinch strength, 1.5 pounds of pinch on the right (dominant) and 5 pounds on the left, the practitioner might infer that the client is unable to proper meals due to the in adequate pinch strength. This is a weak diagnostic statement because it is based on prediction or inference about prefromance supported by impairment testing but not activity analysis. (Molineux, 2009).
The technical skills of the therapist involve competence in the administering diagnostic procedures and tests client data are gathered through the sense (vision hearing touch smell taste and kinaesthesia) aided by structured and unstructured interviews, observations, and tests. A completed activity analysis results in a change of some kind, either something has been added to or subtracted from the environment, or altered within it, or something has changed in the subjective experience of the participant. (Hagedorn 2000 p27). Occupational science acknowledges that occupation is contingent upon the environmental context. The study of human occupation must consider the dynamic relationship between the choices people make for action and the various environment al forces that facilitate or impinge upon those choices, the capacity of human to transform their environments to meet their needs though and for engagement in occupation is central to this science (Jackson, 1998)
Occupational therapists believe in ‘occupation for health’ ‘We are concerned with individuals’ quality of life in terms of how they engage in satisfactory and meaningful occupations’. We have a deep appreciation of the occupational nature of humans, of the relationship between health and occupation, and how occupations can influence health (Wilcock, 1999 cited in Finlay, 2004.p.3). Occupation therapist focuses on occupational performance. The active doing of the person in the context of the occupational form, after the person interprets the occupational form and wants to do something about it, the person’s voluntary doing is the occupational performance, (Nelson and Jepson-Thomas 2003 p.111) performance is the outward expression of skills (Creek 2002, p276). We are centrally concerned with how individual function in their work, leisure, domestic life and personal self-care, a healthily person is one who is able to perform his or her daily occupations to a satisfying (for that person) and effective level. A person’s occupational performance may well be disrupted or impaired when he or she becomes ill or disabled in some way. ‘we have unique ability to assess occupational performance and to use occupations to improve or maintain that performance’ . (Finlay, 2004.p.4 ,,,)
Underlying body functions and structures â€¦ have potential to influence occupational performance (Crepeau et al 2003) help shape a person’s identity effect individual’s choice and subjective experience of occupations and persistence in sustaining occupational behaviour.
Occupational therapist view service user holistically as unique individuals (the person) who have particular life experiences, interests, needs, skills, problems and motivations arising out of their particular social and cultural background? Occupational therapy concerned with the individual as a skilled and competent performer of a range of roles and occupations appropriate to his age, environment and culture. Each process contributes in some way to the attainment and retention of skilled performance (Haledon 2000). We aimed to view and treat individual as complex whole being rather than seeing their problems in isolation. We try to attend to emotional, cognitive, physical and social dimensions, in the context of the person’s life style. (Finlay, 2004)
Occupational therapists value the therapeutic potential and purposeful meaning- full activities to promote health and well being. Thus, occupational therapist is premised on the idea that purposeful activity can be therapeutic and can be used to improve individual functioning when used in a way that is meaningful top that person. One of the core skills is being able to apply activity in the treatment process. This process values the inherent properties of activities, the experience of ‘doing’ and the end product. We employ two main types of therapeutic activities: activities of daily living (such as cooking and therapy activities) such as group work). Treatment often involves grading and adapting these actives in their inherent properties (Findlay, 2004)
Study from out side occupational therapy and occupational science is demonstrating the occupational nature of humans and the impact of occupation on health. For example, the Health walks Research and development Unit (2000) at Oxford Brookes University has been investigating the health benefits of led walks in the countryside. The original walk project was investigated by a general practitioner zand seen then has been developed and scrutinized. Researcher in the unit have found that in addition to the obvious impact on physical fitness, participants also reap benefits due to the social aspect of the walks, and this is consistent with the multidimensional nature of occupation. (Yerxa et al., 1989).
Recent research, particularly in the field of occupational science, has demonstrated the link between occupation and health/well being. For instance, in a review of literature on occupation and mental health in care homes for older people, Mozley (2001) provides evidence that opportunities for occupation and pleasure in homes contribute not only to mood state but also to actual survival rates.
Wilcock’s (1998) influential ‘work on occupation for health’ stresses the importance of being in turn with our occupational nature in terms of the dynamic balance of ‘doing, being and becoming’. She shows how ‘being’ arises from ‘doing’ and becoming is dependent on doing and being. She argue how we are more susceptible to illness as a result of continuing occupational injustice, deprivation, alienation or balance’ (wilcock, 1999,p.195.)
Wilcock (2001) identified 3 occupational problems that can compromise health
Occupational Imbalance, Occupational deprivation, Occupational alienation
Occupational Imbalance: has been proposed in the literature to refer to the loss of a balance of engagement in occupation which leads to ell-being, and might include balance between physical mental and social occupations between chosen and obligatory occupations; or between doing and being (wilcock, 1998).
Occupational deprivation has been defined as ‘the deprivation of occupational choice and diversity due to circumstances beyond the control of the individual’ (wilcock, 1998, p.257). These could be as a result of poverty, lack of employment opportunities, illness health/disability, discrimination, abuse, being a prisoner or war refugee, and so on. (Whiteford, 2000).
Occupation alienation refers to the subjective experiences of ‘isolation powerlessness, frustration, loss of control, estrangement from the society or self which results from engagement in occupations which fails to satisfy the inner needs of the available to patients.
Specially, occupational scientist should consider placing occupation at the centre of their analysis would need to recognised the importance of an individual ‘occupations and the symbolic meaning attributed to those occupations. This ensure that any knowledge generated not only addresses the concern of the petitioners but also has clear guidance on how that knowledge can be used in practice (kielhofner 1997,2002). This approach can be contrasted with occupational science, which informs proactive but may not necessarily provide specific tools or methods to be utilised by occupational therapists (molineux 2001),
In doing so, philosophical explanation to support treatment was developed along with the concomitant principles and practices that would guide that treatment as well as outline the knowledge and skills that would be needed by those who provided it to patients. (Kramer 2003)
The lack of a science unique to occupation or theories of practice, or research that proved the efficacy of practice, deeply hampered therapists’ efforts to establish credibility in all areas of practices. The richness and complexity of occupation is not evident if one cannot articulate the underling rationale and its basis in a recognisable science (Kramer 2003)
The basic philosophical tenets of occupational therapy continue to have an enduring presence in today’s world of human health and illness. Occupation and related concepts such as interests and individual preferences, the importance of the environment in stimulating and supporting activity, and the fit of the activity to the person- continue to be applicable to people who have problems related to disability, disease, or other chronic debilitating conditions. As a field devoted to the study of occupation, occupational therapists and occupational scientist have remained committed to the founding principle. These principles are embedded in recognition of the potency of occupation as a catalyst for health.
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