Discuss the relationship between occupation and health, and recognise factors which facilitate occupational performance.
In the context of this essay “occupation” is taken to encompass care of self, leisure and employment (American Occupational Therapy Association: Uniform Terminology, 1994) whereby the person interacts with the environment. These areas are not mutually exclusive. It is the “ordinary and familiar things that people do every day” (American Occupational Therapy Association Commission on Practice Home Health Task Force: Guidelines, 1995). Performance components include the necessary skills for the task and the temporal and environmental performance context. Occupational performance is important; people identify who they are by what they do.
Relation between occupation and health
Occupation is important in maintaining health but certain occupations may actually cause ill health. Ill health may lower occupational performance. The relationship is further complicated by poor performance contributing to ill health which further lowers performance. An example would be someone performing poorly in paid employment and becoming depressed as an indirect result (perhaps because of redeployment) and performing even more poorly as a result of the depression. A goal of occupational therapy is to use appropriate occupation therapeutically to counteract the effects of disability and to promote well being.
The effect of some disease processes on performance will now be explored. Certain pathological conditions will have a typical effect on performance for instance a cerebrovascular accident, a not uncommon cause of occupational dysfunction, will affect sensation and motor skills in a fairly predictable way. The degree of impairment is variable depending on the aetiology, severity and location of the cerebral injury. The effects may be profound. Laterality is important since one side of the brain has a major impact on language and the other motor skills. Which side of the brain is dominant for various functions depends on whether or not the individual is right handed. Occupational performance is affected by sensorimotor deficit and subsequent musculosketal affects for instance significant sensorimotor deficit commonly affects the shoulder joint with its innate dependence on good muscular tone of the rotator cuff from which the joint largely derives its stability. Disruption of cognitive function and emotional liability are factors commonly involved in severe cerebrovascular accidents to the further detriment of performance.
Of the musculoskeletal group of disorders Rheumatoid arthritis is important since it is so common. In addition to affecting movement by joint deformity, sensorineural and neuromuscular effects the individual may suffer psychological effects such as depression further limiting performance (Deyo 1982). Temporal effects are important in this condition, typically the symptoms and performance being significantly worse in the morning and improving as the day progresses.
Schizophrenia is an example of a psychiatric illness which can become chronic and disabling. The effects on occupational performance can get really complex here. Not only are there varying manifestations of the illness with exacerbations sometimes accompanied by ultimate deterioration over time but there is often effects of the medication, substance abuse and disordered living arrangements.
Chronic pain may affect occupational performance by limitation of physical components of the activity in question. Some conditions appear resistant to clear diagnosis. For instance following accidents such as whiplash or back pain following lifting during paid employment there may be long drawn out background litigation and this coupled with difficulties returning to work may have significant effects on occupational performance. Because affected individuals may be young, in paid employment and with families to look after despite the fact that the physical disability may be relatively minor there may be major effects on the activities of daily living, leisure and employment.
Factors facilitating performance
Occupational performance can be split into a number of components: sensorimotor, cognitive integration, cognitive, psychosocial and psychological. In addition the performance cannot be taken out of context.
The individual’s personal characteristics will affect quality of performance. There must be a good fit between the individual’s knowledge, skills and attitudes, the task must be appropriate, contributing to well-being and the environment must be conducive with regard to physical, cultural and social aspects; (Hagedorn, 2001). Context is important (Dunn 1994) for instance it is easy to speak with friends but public speaking is another matter entirely performance nearly always suffering substantially and yet the basics of the task are the same.
The following factors are associated with occupational dysfunction (Hogedorn, 2001) thus their avoidance may enhance performance:
- Deprivation of occupation
- Occupation alienation (the task seeming pointless)
- Occupational imbalance focussing on one aspect to the exclusion of others
- Difficulties with relationships and participation
- Lack of resources
- Negative self-image; expectation or fear of failure
- Poor ability to adapt to different roles
The performance itself may be adequate in its component parts but be poor overall since it takes too long to complete.
Ottenbacher describes in Crepeau, 2003 to optimise performance requires an appreciation of the dicstinctions between body systems, impairment, activity and participation defined by the WHO 2001.
To facilitate performance various compensation mechanisms can be utilised. Training in compensatory movements can occur alongside provision of adaptative equipment and environmental adaptation.
An enhancing factor is the purpose and meaning of the task for the participant. This is to the extent that intervention will be more effective in achieving the desired improvement or other goal if the individual is active in setting the goal at the onset. Goal directed action and pure exercise showed the advantage of the former for retaraining movement following stroke (Trombly, 1999).
Full utilisation can be made of the inherent adaptatbility of human beharioural (both physical and psychological) mechanisms. The ability to learn and improve occupational performance is improved by practice, repitition and feedback at an appropriate rate.
In providing occupational therapy care it is important to appreciate the state at which the individual is at; acute and not stabilised, inpatient, outpatient, extended (Crepeau, 2003). It is important to look at the overall task and its purpose before concentration on the components of the activity. Evidence base is accumulating and should guide the interventional approach chosen.
Occupational health promotes well-being from engaging individuals in relevant occupation. Improving the underlying capacities of sensorimotor skills, memory and mental outlook is only part of the whole process of facilitation of occupational performance.
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Hansen RA Atchison 2000 Conditions in Occupational Therapy Effect on occupational performance 2nd edition Lippincott Williams & Wilkins Baltimore
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American Occupational Therapy Association: Position Paper: occupation, Am J Occup Ther 49:1015-1018, 1995
Deyo RA et al 1982 Physical and psychosocial function in rheumatoid arthritis. Arch intern Med 142:879-82.
Dunn W Brown C McGuigan A 1994 Ecology of human performance: A framework for considering the effect of context. Am J Occup Ther 48(7):95-607
Trombly CA & Wu C (1999) Effect of rehabilitation tasks on organisation of movement after stroke. American Journal of Occupational Therapy 53 333-4.
World health Organization (2001) International classification of functioning, disability and health (ICF) Geneva.