In a 1989 article in the Psychiatric Bulletin, consultant psychiatrist Denise Coia and senior occupational therapist Anne Joice from the Florence Street Hospital, Glasgow, UK, asked, "Is occupational therapy the forgotten specialty within the mental health community?" In their article, Coia and Joice lamented that despite high-quality evidence for occupational therapy's positive contribution to mental health, psychiatrists rarely recommended it.
Is this benign neglect observable today? Is it restricted to the mental health field? Unfortunately, the situation has improved only slightly. According to 2009-12 Medicaid data from all fifty states, only 3.7 to 6.3 percent of eligible adults with autism spectrum or other intellectual disabilities received occupational therapy. However, 20.5 to 24.2 percent of eligible children received occupational therapy. These data show the underuse of occupational therapy for this patient group even though there is ample evidence that it significantly benefits them.
Individuals on the autism spectrum or with intellectual challenges are not the only patient groups benefiting from occupational therapy. Ample evidence also exists that:
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Sensory, motor, and oral interventions provided by occupational therapists reduce the length of hospital stays during infancy.
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Occupational therapy-inspired early intervention programs for preterm infants improve cognitive outcomes through preschool.
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Pediatric play-based activities involving modeling and prompting, prescribed and carried out by occupational therapists, improve social behavior in early childhood.
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Occupational therapists who provide sensory integration interventions can address maladaptive behaviors in older children with sensory processing issues.
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Occupational therapy reduces disease severity in patients with multiple sclerosis.
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Cognitive skills training, a key occupational therapy intervention, improves job retention among adults with serious mental illness.
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Working with an occupational therapist helps older adults stay cognitively healthy and occupationally functional longer.
Is occupational therapy one of modern healthcare's "best-kept secrets?" Why is an obviously important and highly beneficial medical specialty still neglected?
When Grey House Publishing approached me to edit this volume on occupational and physical therapy, I recalled the cadre of brilliant students I have had the privilege of teaching who were accepted into physical therapy and occupational therapy programs and are working as physical and occupational therapists. Some of these remarkable young men and women often had to spend hours explaining to their family, friends, and colleagues (and, sometimes, their professors) what occupational therapy was and what occupational therapists do. Also, many bright, emotionally intelligent high school and college students have the skill set for occupational therapy but have no idea what it is or what it entails. What if we could give them a volume that succinctly and informatively explains it?
This present volume strives to make occupational therapy the no-longer-forgotten medical specialty. Occupational therapy is a science-based profession. Therefore, occupational therapists must have a solid foundation in human anatomy, physiology, functional anatomy, movement dynamics, neurology, psychology, and pathology. Second, therapists must understand physical and mental rehabilitation. Additionally, therapists must have a creative edge to visualize what tools, home modifications, and therapeutic steps might help their patients live longer, better, and independently. Occupational therapists help individuals of all ages improve their ability to perform everyday activities or occupations. The goal of occupational therapy is to enable people to participate in activities that are important and meaningful to them, despite any physical, cognitive, or emotional challenges they may face.
A healthcare field that closely collaborates with occupational therapy is physical therapy. Physical therapy treats movement disorders that result from surgery, injury, disease, genetic conditions, and aging. Functional movement is a hallmark of good health. The "meat and potatoes" of physical therapists (also known as physiotherapists) are exercises that improve patient mobility, coordination, and strength. Some exercises are assigned by the physical therapist and done by the patient at home. Other special exercises are done in the clinic to improve movement and everyday life activities. Physical therapists also use physical manipulation, mechanical devices (such as traction, braces, restraints, slings, corsets, elastic bands, and several others), and electrophysical agents (including heat, cold, electricity, ultrasound, radiation, assistive devices, or those, and other interventions) to increase range of motion, relieve pain, increase local blood flow and break up scar tissue.
Physical therapists can also help prevent or delay mobility loss by promoting fitness and developing wellness and health programs for patients that promote active lifestyles. Because occupational and physical therapy share many treatment goals, techniques, and outcomes, physical therapy is included in this volume.
Our volume has articles on human anatomy and physiology, musculoskeletal and neurological conditions, and rehabilitation strategies to illustrate the foundational knowledge of occupational and physical therapists. Occupational and physical therapists work with individuals with various conditions or disabilities, such as developmental delays, physical injuries, neurological disorders, mental health conditions, or aging-related issues, and a representative selection of these conditions and injuries is clearly explained.
Since occupational therapists, and some physical therapists, often work with children, this volume has a range of articles explaining various pediatric conditions and the types of interventions an occupational therapist might recommend.
Although neither occupational nor physical therapists prescribe medications (in other countries, physical therapists can prescribe some medications), much of their work overlaps with patients on prescribed pain relievers and psychopharmaceuticals. Therefore, we included a section on some of the more commonly used medicines observed in occupational and physical therapy practice.
One of the "superpowers" of occupational therapists is their skill in assessing and treating patients with difficulties performing activities of daily living. Occupational and physical therapists use activity analyses to treat patients who live in a community but require rehabilitation. They assess their client's abilities and limitations and develop personalized treatment plans to address their needs. This volume has an article on patient examination and diagnosis; treatment tips are scattered throughout.
An article on assistive devices and technologies educates readers about the various assistive devices and technologies, home modifications, and adaptive equipment that occupational therapists recommend enhancing their client's independence and safety.
Finally, a cardinal role of occupational therapists is collaboration and patient advocacy since they collaborate with other healthcare professionals, such as physicians, physical therapists, speech therapists, and psychologists, to provide holistic care. They also advocate for their client's rights and promote inclusive environments that support their participation in society. Therefore, this work includes articles on Medicare, and the many medical specialties occupational therapists collaborate with.
Occupational therapy is guided by a philosophy that goes beyond symptom treatment. As a medical specialty, occupational therapists encourage patients through activities to work towards an improved quality of life regardless of their disabilities. Because of its hybrid nature, occupational therapy is the only medical profession employed by the Health and Social Services Departments. This volume hopes to present occupational therapy in this light—an indispensable medical specialty that deserves to come out of the shadows and take its rightful place in modern healthcare.
Further Reading
Coia, Denise, and Anne Joice. "Occupational Therapy— The Forgotten Specialty Within the Community Mental Health Team?" Psychiatric Bulletin, vol. 13, 1989, pp. 420-21.
Watling, Renee, and Sarah Hauer. "Effectiveness of Ayres Sensory Integration® and Sensory-Based Interventions for People with Autism Spectrum Disorder: A Systematic Review." American Journal of Occupational Therapy, vol. 69, no. 5, 2015, pp. 1-12, doi:10.5014/ ajot.2015.018051.
Benevides, T. W., et al. "Occupational Therapy Service Delivery Among Medicaid-Enrolled Children and Adults on the Autism Spectrum and with Other Intellectual Disabilities." American Journal of Occupational Therapy, vol. 76, no. 1, 2022, doi:10.5014/ ajot.2022.049202.