The occupational therapy (from ancient Greek ἔργον Ergon , German , work ' ,' work ', and " therapy " of θεραπεία therapeia , German , Service' , 'treatment') is a form of therapy that deals with the execution of specific activities and their effects concerns people and their environment. Impairments are treated through the targeted use of individually meaningful work . The personal and socio-cultural significance of the activity, its effects on health and its interactions with the environment are of great importance.
The German Association of Occupational Therapists (DVE) defines occupational therapy as follows:
“Occupational therapy supports and accompanies people of all ages who are restricted in their ability to act or are threatened with restriction. The aim is to strengthen them in carrying out activities that are meaningful to them in the areas of self-sufficiency, productivity and leisure in their personal environment. Specific activities, environmental adaptation and advice serve to enable people to act in everyday life, to participate in society and to improve their quality of life. "
The occupation of the occupational therapist originated in the USA at the beginning of the 20th century and was developed independently by different professional groups such as doctors, social workers, nurses, artists, craft teachers and architects.
In Germany, the professional occupational therapist developed from the merging of (common at the beginning of the 19th century in psychiatry) occupational therapy and occupational therapy . Even before the Second World War, Hermann Simon developed a theory of occupational therapy for the treatment of mentally ill people in 1924. After the Second World War, British nurses and German soldiers and civilians who had been injured in body and mind were first used in Germany to employ occupational and work-therapeutic procedures and methods. In Germany, the first teaching facility for occupational therapy was founded in Hanover in 1953 in Annastift . In 1999, the previously legally protected job titles employment and occupational therapist were changed. The current legally protected job title is occupational therapist.
Occupational therapy is based on (occupational) medical , social science and action-oriented principles. Subject-specific fundamentals are in Germany by research in occupational therapy and occupational physiology and abroad in the operating Sciences ( occupational science ) developed.
In occupational therapy, a distinction is made between self-sufficiency (e.g. getting dressed, preparing food), leisure time (e.g. meeting friends, handicrafts) and productivity (demands of professional life; e.g. writing texts, cleaning windows).
The mechanistic view of humans (humans are the sum of their body structures and functions, disorders in the fields of activity are therefore attributed to disorders of these structures and functions) has been used in occupational therapy since the mid-1970s in the USA and Canada and since the mid-1990s Years in Germany increasingly replaced by a holistic (holistic) view: The human being is seen as an open system in which complex relationships exist between the individual, his environment, his activities and his participation. It follows that when there are actuation problems, all factors must be taken into account in order to find a satisfactory solution.
Occupational therapists, who take a holistic view, assume the following basic assumptions and values:
- Basic assumptions
- Humans are by nature acting beings.
- Activity and participation have an important influence on a person's health.
- People can experience disturbances and restrictions in action.
- Action can be used as a starting point for change.
- The environment can be used as a starting point for change.
- Everyone has the right to participate in personally meaningful activities.
- Limitations do not diminish the value of the individual.
- Restrictions are not necessarily an obstacle to a good quality of life .
- Every individual has the right to determine their own life.
The aim of occupational therapy is the same in all areas of application: a satisfactory execution of everyday actions and the associated self-determined participation in socio-cultural life.
This is achieved by improving, restoring or compensating for the impaired skills and functions. In addition to suitable exercises, the use of aids should also contribute to the fact that the environment is adapted to the remaining abilities and thus optimum rehabilitation is achieved.
Areas of application
Occupational therapists advise, treat and support patients of all ages who are impaired in their independence and ability to act or are threatened by limitations due to a physical or mental illness, a disability or a developmental disorder . You will develop individual treatment plans, carry out therapies and preventive measures and take on managerial functions in the administration and management of health facilities.
Occupational therapists mainly find jobs in practices for occupational therapy, in preventive, rehabilitation and specialist clinics or in health centers. They are also employed in nursing homes , outpatient social services or in dormitories for people with disabilities, as well as in special schools and early intervention centers. In addition, they work at vocational schools for occupational therapy and universities.
Occupational therapy is a recognized remedy in Germany and is prescribed by the doctor as a motor- functional, psychological-functional, sensorimotor - perceptual treatment and as brain performance training. Occupational therapists work in practices or, for example, within social institutions. Areas of application are mainly paediatrics , psychiatry , geriatrics , neurology , orthopedics and facilities for mentally and / or physically impaired people.
The treatment of children ( pediatrics ) is an essential branch of occupational therapy (percentage of all prescriptions for occupational therapy treatments) and thus borrows fundamental knowledge from developmental psychology (cf. Affolter , Ayres, Frostig, etc.). Accordingly, occupational therapy overlaps in several areas and increasingly with child and adolescent psychiatry and child psychology and child psychological treatment.
Occupational therapy can therefore (within the framework of interdisciplinary cooperation) be indicated for all children and adolescents whose development into independent, competent adults is restricted or disabled, e.g. B. by:
- Disorders of the movement sequence as a result of organic brain damage (spastic paralysis , seizure disorders , hydrocephalus , spina bifida , muscular dystrophies, etc.) (overlap with physiotherapy )
- Disorders of sensorimotor development and the associated impairment of cognitive processes
- Disorders of perception and processing (sensory integration disorders )
- Failure symptoms or delays in social development , relationship building and communication skills
- mental illnesses only in cooperation with child and adolescent psychiatrists or psychologists, e.g. B. Behavioral Disorders , ADHD , Early Childhood Autism , Eating Disorders
- Sensory disabilities, e.g. B. Deafness, blindness
The actual stage of development of the child / young person is the basis of all measures. In order to avoid treatment errors, it is therefore urgently recommended to have a comprehensive developmental / neuro / psychological assessment of the child beforehand, taking into account the psychosocial context. The treatment methods to be applied are based on neurological - anatomical , anatomical-functional, psychosocial, developmental psychological and learning theory- oriented principles and knowledge. When applying neurophysiological, neuropsychological, psychosocial and motor-functional procedures, the focus is always on the basic sensorimotor functions. These form the basis for further cognitive development based on this (see developmental psychology ).
Depending on the disorder, level of development and social environment, the treatment is based on treatment concepts or approaches such as the Bobath concept , sensory integration therapy by Anna Jean Ayres , swallowing and oral motor skills by Castillo-Morales and approaches by Félicie Affolter , Marianne Frostig or Maria Montessori .
Treatment goals include:
- Improvement of the movement sequences, tone regulation and coordination
- Improvement of sensory perception and perception processing
- Improve concentration and endurance and cognitive performance
- Strengthening motivation and curiosity
- Integration in the family and the environment, including intensive engagement with the environment and compensation for remaining deficits
- the greatest possible independence in everyday life, in school and in the wider environment
Treatment can take place in special schools, special kindergartens, early intervention centers, children's clinics and special rehabilitation centers of all disciplines, children's homes, social pediatric centers or mainly in occupational therapy practices.
The inclusion of the child's social environment in an interdisciplinary collaboration, i.e. the educators, teachers, child psychologists, child and youth psychiatrists and other therapists, but above all the parents, is of eminent importance.
Mainly diseases of the central nervous system, for example the condition after a stroke , traumatic brain injuries , paraplegia , multiple sclerosis , Parkinson's syndrome or amyotrophic lateral sclerosis are treated here.
Occupational therapy treatment in this specialist area includes, for example:
- Therapy of the disorder and restoration of the condition known before the disease
- Inhibition and reduction of pathological posture and movement patterns and learning and practicing normal movements
- Improvement of the processing of sensory stimuli in the sense of a normalization of the stimulus perception, a filtering and evaluation of the perceived stimuli, a normalization of the speed of stimulus processing and the normalization of the stimulus processing up to a suitable motor response
- sensory integration
- Treatment of gross and fine motor disorders
- Improvement of feelings of equilibrium and equilibrium reactions
- Improvement of neuropsychological deficits and limitations of mental abilities such as attention, concentration, retentiveness, memory or reading-sense comprehension, the recognition of objects or the understanding of spaces, time and people
- Weaning from the ventilator
- Trying to get comatose or awake patients out of the coma
- Improving or relearning how to swallow
- Learning of substitute functions
- Development and improvement of skills, among other things, in the areas of feeling control, affects or communication
- Training in everyday activities with a view to personal, domestic and professional independence
- Advice on suitable aids and changes in the home and professional environment, possibly adapting aids
In order to achieve the goals described above, occupational therapy uses various treatment approaches, such as according to Anna Jean Ayres , Bobath / physiotherapeutic method , Affolter , Johnstone, PNF / physiotherapeutic method , Perfetti, Castillo Morales , basal stimulation, FOTT
Orthopedics, traumatology and rheumatology
The following are treated in occupational therapy:
- People with musculoskeletal disorders, e.g. B. at or after:
- traumatic and degenerative disorders of the upper and lower extremities and the spine e.g. B. fractures, operations
- Tendon cuts
- Carpal tunnel syndrome
- De Quervain's tendovaginitis
- Soft tissue rheumatism
- Back pain
- Contracture prophylaxis in geriatric and coma patients
- Scar treatment of burn injuries and a splint fitting
The work is mainly done through motor-functional training. Furthermore, aids are adapted and their handling practiced and the living space of the person affected is adapted if necessary. A special focus is the restoration of motor skills in order to achieve the greatest possible independence when eating, drinking, washing and dressing (= activities of daily life ).
The goals of occupational therapy in this area are:
- Improvement of mobility, strength and load building
- achieving the greatest possible independence in everyday professional, school and domestic life
- Extension of the total range of motion of all joints
- Manufacture and testing of adaptations, aids and splints, e.g. B. Storage splints and Quengel splints, Kleinert splints after severing tendons, Murphy rings
- Practicing low-pain and compensatory movement sequences
- Retraining the working hand
- Living space adaptation
The contents of occupational therapy are:
- sensorimotor-perceptual treatments
- motor-functional exercises
- psychological-functional treatments
- Brain performance training / neuropsychological treatment
- home visits
- Sensory integration therapy
- ADD / ADHD treatment
- ATL training: dressing - eating - household - personal hygiene etc.
- Stump hardening and prosthesis training
- Rail production and its adaptation
- Aid advice, if necessary, production or adaptation of aids
- Advice and training on joint protection
- Scar treatment
- Living space and workplace design / adaptation
- Stress tests in occupational therapy and rehabilitation clinics
- Address issues related to sexuality
Elderly people with acute and chronic illnesses in the fields of neurology, internal medicine, orthopedics, surgery and psychiatry who live in retirement and nursing homes due to the above-mentioned disorders and multiple illnesses ( multimorbidity ) are treated as occupational therapy .
The goals of occupational therapy in this area are:
- Promotion and stabilization of existing and lost mental, social and physical abilities
- Avoidance / reduction of dependency and isolation
- Independence in everyday life
- Expansion and maintenance of the range of motion of all joints (actually more of a focus of physiotherapy, but here the fields overlap)
- Improvement of action and movement planning and execution
- Promotion of perception in all sensory areas
- Use of existing skills
- Promotion and stabilization of memory, attention, concentration and orientation
- Improvement and maintenance of individually determined quality of life
- Fall prevention
The contents of occupational therapy are:
- Training of motor and sensory skills
- Training of independence in everyday life
- Provision of aids
- Training of social and communication skills
Occupational therapy in psychiatry offers people of all ages - who suffer from addictions , psychotic experiences , neurotic or psychosomatic disorders , for example - the opportunity to (re) discover their own creative potential and to regain abilities that have been lost due to the illness. The clinical pictures with which occupational therapists in psychiatry deal with include mental disorders in childhood and adolescence, anxiety disorders , personality and behavior disorders , depression , schizophrenia , eating disorders , mood disorders , dementia syndromes , alcohol, drug and disorders Drug addiction or the organic brain psychosyndrome .
The basic goals of occupational therapy in psychiatry are the development, improvement and maintenance of
- psychological basic performance functions such as drive, motivation, resilience, endurance, flexibility and independence in day structuring
- Body awareness and perception processing
- situation-appropriate behavior, socio-emotional competencies and ability to interact
- Reality-relatedness of self-perception and perception of others
- mental stability and self-confidence
- independent lifestyle and basic ability to work
Essentially, four therapy methods are important in occupational therapy:
- Restoring, increasing or maintaining the motor functions e.g. B. by means of manual therapy, soft tissue techniques, PNF, fascia techniques (also device-supported)
- Sonic and ultrasonic treatment
- EMS training, electromyostimulation
- Exercises for joint mobilization and muscle building / strengthening
- Movement exercises of all kinds with or without weight / resistance
- Scar treatment after injury or surgery
- Therapy means: various sports equipment, various weights / resistances, devices and systems to remove resistances
- Acquisition and training of meaningful tasks from the everyday life of clients
- Exercises from the practical and leisure area
- Acquiring lost or non-existent skills
- Use of selected craft techniques
- Use of therapeutic means in creative and creative form as means of expression, means of representation, means of communication
- Subjects that are free and emotional allow people to be close
- Therapeutic means: music, materials
- Group dynamic process (discussion in the group, togetherness in the group)
- The participants can occupy different positions within the group
However, it is difficult to rigorously separate these four forms of treatment from one another, so that a combination of different approaches often flows into the treatment. The above-mentioned methods with their corresponding media then lead to the following group work in the inpatient area.
The creative therapy is a group in which the expression-centered method is implemented; the patient should put a given topic on paper according to his imagination and his feelings. The picture of each patient in the group is then presented and viewed by the therapist with the patient and interpreted by the patient himself. The therapist should abstain from any interpretation and at most provide further food for thought by asking questions.
Employee advice and business coaching
In occupational therapy, professional integration and the permanent promotion of professional skills through prevention and rehabilitation are becoming increasingly important . These aspects were in the outdated job title work and occupational therapy expressly mentioned already as targets of occupational therapy and vocational development have been partly occupied by other professionals during the course. In addition to vocational training in the ability to work (keyword - "First train then place"), this includes support for the employee in the workplace through Employee Assistance Programs (EAP) (keyword - "First place then train"). As part of the support, among other things, competence-centered methods through media such as working on the PC, guiding texts for word processing and internet use are used.
The aim is to maintain professional rehabilitation as well as the productivity and satisfaction of the employee in the workplace on a permanent and preventive basis. The external employee counseling (EAP) is a preventive treatment offer for all employees of a company. In the context of preventive health care, problems of workplace stress, stress, burnout syndrome , family challenges such as bringing up children or caring for older family members are addressed and dealt with in a solution-oriented manner before they lead to significant psychological stress and the resulting inability to work . The focus of this treatment approach is a personal conversation with a qualified occupational therapist, or business coaching tailored accordingly .
Sensory integration therapy
Sensory integration therapy is an important therapeutic approach in occupational therapy. It was developed around 1976 by the psychologist and occupational therapist Anna Jean Ayres and is used to improve sensory integration, i.e. to better process sensory stimuli in the central nervous system. An essential means in sensory integration therapy is the targeted setting of stimuli by the therapist.
Sensory integration therapy is used primarily for children with developmental delays and attention disorders, and disorders of gross and fine motor skills, psychosomatic problems and disabilities are treated with sensory integration therapy. In the field of geriatrics, the occupational therapist Gudrun Schaade has increasingly dealt with the possibilities and limits of sensory integration therapy in people with dementia .
In occupational therapy, a distinction is made between process models and conceptual models.
The process models include:
- Occupational Therapy Intervention Process Model (OTIPM)
- Canadian Practice Process Framework (CPPF)
The conceptual models include:
- Model of Human Occupation (MOHO)
- Canadian Model of Occupational Performance and Engagement (CMOP-E)
- Biel model
- KAWA model
- Person-Environment-Occupation-Model (PEO)
Occupational Therapy Intervention Process Model (OTIPM)
The OTIPM is an occupational therapy process model with a focus on the top-down approach , client centering and activity-based. It was developed by the American occupational therapist Anne Fisher in 2009. Client centricity means that the client is picked up "where he is". The top-down approach means that the occupational therapist gets a comprehensive picture of the client's needs, wishes and everyday tasks. The activity-based intervention includes “performing actions, doing something and being involved in doing something”.
Criteria that an activity should meet are:
- relevant everyday reference
- natural environmental connection
- Expediency for client
- Importance to Client
The OTIPM process is divided into three phases: evaluation and goal setting phase, intervention phase and re-evaluation phase.
In this way, the client is comprehensively recorded in an initial discussion and the strengths and problems mentioned are identified. On this basis, a performance analysis, an observation of a task that the client has described as difficult, is made in order to assess motor, process-related and interactional skills. Based on the observation, goals are formulated together with the client and activity-based interventions are determined. The interventions are divided into four models: compensatory, acquisitive, restitutive and educational. The goals and interventions are regularly checked and re-evaluated in order to adapt the therapy adequately, ensure the quality and document the course of the therapy.
- The compensatory model includes interventions for the application of tools and techniques, adapted methods of execution, as well as modifications of the physical and social environment.
- The acquisition model is used to restore, develop or maintain the quality of the execution of an operation. The intervention is carried out directly in the actuation.
- In the restitutive model, personal factors and body functions are restored, redeveloped, or preserved through the therapeutic use of activities
- The educational model deals with the information and training of groups about daily life and the associated activities, whereby possible strategies are discussed in the group without their concrete implementation and practice.
In occupational therapy practice, one or more models can be selected for an intervention. However, for each model that is used, there should be enough evidence to lead to improved actuation performance.
Training as a state-approved occupational therapist takes place in Germany at one of over 200 state-approved schools for occupational therapy, usually lasts three years and ends with an exam . The exam to become a state-certified occupational therapist (within the EU protected professional title ) includes both theoretical and practical parts as well as a final interview with an examination committee. The examination is only considered passed if the overall final grade “sufficient” has been achieved.
Theoretical and practical lessons
- Professional, legal and political studies
- Technical language, introduction to scientific work
- Basics of occupational therapy
- Language and literature
- Motor-functional, neurophysiological, neuropsychological and psychosocial treatment methods
- work-therapeutic procedures
- Adaptive procedures in occupational therapy
- Prevention and rehabilitation
- Basics of health and hygiene
- Biology, descriptive and functional anatomy , physiology
- General disease theory
- Special pathology including diagnostic , therapeutic, preventive and rehabilitative measures as well as psychosocial aspects
- Pharmacy , basics of occupational medicine, first aid
- Psychology and education , curative education
- Medical sociology and gerontology
- Handcraft and design techniques with different materials
- Games, tools, rails and technical media
- Movement education
Practical training in
- psychosocial (psychiatric / psychosomatic)
- neurophysiological or neuropsychological and im
- occupational therapy
The basis for the training content in Germany is the training and examination ordinance for occupational therapists of August 2, 1999.
Perspectives after the training
Further qualifications can be obtained after the training. So it is possible to become a specialist in health and social services. Through a WFOT-certified training (World Federation of Occupational Therapists) there is also the possibility of practicing in non-European countries.
In 1999, the European University of Applied Sciences Fresenius in Idstein was the first German university to introduce the state-recognized degree in Occupational Therapist (FH). Against the background of this experience, she initiated the accreditation of a Bachelor's degree in 2007 . During the course, by passing the state examination, which is integrated into the course of studies, you acquire a professional qualification in occupational therapy and, after acquiring 240 ECTS points, the academic degree of a Bachelor of Science.
In Austria , in the course of the Bologna Process, there is a change from a diploma at an academy to an education at a university with an academic degree. In the winter semester 2006, the first classes started at the FH Joanneum and in the winter semester 2007 at the FH Wiener Neustadt , the FH Gesundheit Tirol , the FH Campus Wien and the FH Salzburg , which finished with the bachelor's degree in the summer of 2009/2010 . An overview of the courses currently offered in Germany can be found on the website of the German Association of Occupational Therapists.
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- Link catalog on occupational therapy at curlie.org (formerly DMOZ )
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- HJ Polatajko, J. Craik, J. Davis, EA Townsend: Canadian Practice Process Framework. In: EA Townsend, HJ Polatajko: Enabling occupation II: Advancing an occupational therapy vision for Health, well-being, & justice through occupation. CAOT Publications ACE, Ottawa (ON) 2007, p. 233.
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- Vienna University of Applied Sciences - occupational therapy course - Vienna University of Applied Sciences, Fachhochschulen.at
- Archive link ( Memento of the original from March 2, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.