Occupational therapists treat people who are mentally, physically, developmentally, or emotionally disabled. They employ a variety of techniques designed to help individuals develop or maintain daily living skills, and to cope with the physical and emotional effects of disability. With support and direction from the therapist, patients learn (or relearn) many of the "ordinary" tasks that are performed every day at home, at work, at school, and in the community. The aim is to help them establish a lifestyle that is as independent, productive, and satisfying as possible.
Like other health professionals, occupational therapists often work as a member of a multidisciplinary team whose members may include a physician, nurse, physical therapist, psychologist, rehabilitation counselor, and social worker. Team members evaluate the patient in terms of their individual specialties and work together to develop goals that meet the patient's needs. During the course of treatment, team meetings are held to evaluate progress and modify the treatment plan, if necessary.
Activities of all kinds can be used for treatment purposes. When working with children, for example, occupational therapists often use toys. For adults, therapy may include anything from activities that strengthen muscles to using a computer. While some treatments may give the appearance of recreation, all have a serious purpose. Working in the kitchen may produce a cake, but the skills practiced include memory. sequencing, coordination, and safety precautions, which are important for independent living at home. Woodworking or leatherworking may help increase strength, endurance, and dexterity. "Word find" games can help improve visual acuity and the ability to discern patterns. Computer programs have been designed to help patients improve cognitive skills, including decisionmaking, abstract reasoning, and problem solving, and perceptual skills such as peripheral vision and the discrimination of letters, colors, and shapes. All of these treatments are designed to foster independence at home and at work.
During each therapy session, patients are assessed by the therapist to determine the treatment's effectiveness as well as the progress made toward meeting the treatment's goals. These assessments are then used as a basis for modifying goals and therapeutic procedures. A patient suffering short-term memory loss, for instance, might be encouraged to make lists to aid recall. One with coordination problems might be given tasks to improve eye-hand coordination.
In addition to helping patients strengthen basic motor functions and reasoning abilities, occupational therapists help patients master daily living skills. Helping severely disabled individuals learn to cope with seemingly ordinarily tasks such as getting dressed, using a bathroom, or driving a car requires sensitivity as well as skill. Patients may be newly disabled, as in the case of an accident victim who has suffered spinal cord injury, or they may have been disabled since infancy by a condition such as cerebral palsy or muscular dystrophy. Therapists provide individuals with adaptive equipment such as wheelchairs, splints, and aids for eating and dressing. They may design and make special equipment for disabled individuals and recommend changes in the home or work environment to facilitate functioning.
Computer-aided adaptive equipment offers the prospect of independence to some severely disabled persons. Occupational therapists often work with rehabilitation engineers to develop such special equipment. Examples are microprocessing devices that permit paraplegic and quadriplegic patients to communicate while confined to a wheelchair or bed, help paraplegics walk, and enable quadriplegics to operate telephones and television sets. As such devices move out of the research and development stage, occupational therapists are involved in helping patients learn to use them.
Occupational therapists tend to work with a particular disability or age group. Approximately 3 out of 5 therapists work principally with persons who have physical disabilities; the rest work with patients who have psychological, emotional, or developmental problems. A growing number of therapists are working in the wellness and health promotion areas. Often, the practice setting determines the age level and treatment needs of a therapist's patients. In home health care, for instance, a growing number of referrals involve elderly patients with conditions such as arthritis, cardiac problems, and hip and other fractures.
The goal of occupational therapists working in public schools differs from those of therapists in other settings. Instead of emphasizing treatment and rehabilitation, as is the case in medically oriented settings, the emphasis in schools is on providing handicapped children with an education. Therapists accordingly render services designed to facilitate handicapped children's participation in public school programs and activities. This may involve an initial evaluation of a child's ability and the implications for learning; recommending special therapeutic activities; consulting with parents and teachers; modifying classroom equipment or school facilities; and developing the functional, motor, and perceptual skills necessary for learning. Like teachers, these occupational therapists work regular school hours and participate in teachers' meetings and other activities.
Occupational therapists in mental health settings treat individuals who are mentally ill, mentally retarded, or emotionally disturbed. Among the emotional disorders that occupational therapists encounter are alcoholism, drug abuse, depression, eating disorders, and stress-related disorders. Therapists provide individual and group activities which simulate real-life experiences to help people learn to cope with the daily stresses of life and to manage their work and leisure more effectively. These activities may include crafts that require planning and time management skills, budgeting, shopping, meal preparation and homemaking, self-care, and using community resources such as public transportation and service agencies.
Therapists may also take steps intended to improve a patient's attitude and self- esteem. As is generally the case in the rehabilitation professions, occupational therapists also work to support a patient's quest for independence. Concrete assistance might take the form of helping an accident victim regain a revoked driver's license, for example, or encouraging a socially isolated person to relate to people in a more appropriate manner.
Besides working with patients, occupational therapists may supervise student therapists, occupational therapy assistants, volunteers, and auxiliary nursing workers. The chief occupational therapist in a hospital may teach medical and nursing students the principles of occupational therapy. Many therapists supervise occupational therapy departments, coordinate patient activities, or are consultants to public health departments and mental health agencies. Some teach or conduct research in colleges and universities.
Keeping notes is an important part of an occupational therapists job. Some of the records for which an occupational therapist may be responsible include an initial evaluation, progress notes, reports to the physician, special internal staff notes, Medicare records, and discharge notes. Careful and complete documentation is required for reimbursement by insurance companies and Medicare. Working Conditions
Although occupational therapists generally work a standard 40-hour week, they may occasionally have to work evenings or weekends. Their work environment varies according to the setting and available facilities. In a large rehabilitation center, for example, the therapist may work in a spacious room equipped with machines, handtools, and other devices that often generate noise. In a nursing home, the therapist may work in a kitchen when using food preparation as therapy. In a mental hospital, therapists may work directly with patients in the ward. Wherever they work and whatever equipment they use, they generally have adequate lighting and ventilation. The job can be physically tiring because therapists are on their feet much of the time. Therapists must also face minor hazards. For example, occupational therapists may develop backaches as a result of having to lift and move patients and equipment.
Occupational therapists held more than 35,000 jobs in 1990. The largest number of jobs were in hospitals, including a substantial number in rehabilitation and psychiatric hospitals. Employment of occupational therapists in school systems rose sharply in response to requirements established by the Education for All Handicapped Children Act of 1975. Today, school systems and schools for handicapped children are the second largest employer of occupational therapists. Other major employers include nursing homes, community mental health centers, adult day care programs, out-patient clinics, and residential care facilities.
A small but rapidly growing number of occupational therapists are in private practice. Some are solo practitioners, while others are in multispecialty group practices or consulting firms. They typically see patients referred to them by physicians or other health professionals.
Private practitioners also provide occupational therapy services on a contract or consulting basis. Largely because of incentives in the health care financing system, much of the occupational therapy furnished in nursing homes, adult day care programs, and home health agencies is provided by contract rather than by staff therapists.
Training, Other Qualifications, and Advancement
Preparation for this field requires a bachelor's degree in occupational therapy. Twenty-five States, Puerto Rico, and the District of Columbia regulate the practice of occupational therapy through licensure or trademark laws. Applicants for a license must have a degree or certificate from an accredited educational program and pass a national certification examination.
Certification is available by examination through the American Occupational Therapy Certification Board, which awards the title of registered occupational therapist (OTR) to qualified applicants.
Coursework in occupational therapy programs includes physical, biological, and behavioral sciences and the application of occupational therapy and skills. These programs also require students to complete successfully at least 6-month supervised clinical internship following the classroom component of their training.
Entry to educational programs is competitive, and applicants are screened carefully. Persons considering this profession should have above-average academic performance in biology, anatomy, psychology, and other high school science courses. In addition to the physical sciences, high school students interested in a career as an occupational therapist are advised to take course in health, art, and the social sciences. At least one occupational therapy program requires applicants to observe occupational therapists at work before being accepted as students. The exposure is designed to prevent any misconceptions a prospective student might have about the occupation, and is believed to help reduce the dropout rate. In choosing among applicants, many educational programs weigh heavily any previous job and volunteer experience in a health care setting. College students who consider transferring from another academic discipline to an occupational therapy program in their sophomore or junior year need superior grades because competition for entrance to programs is more intense after the freshman year.
Persons considering this career must be able to work with people of all ages, temperaments, and personalities. To gain patients' confidence, it is necessary to have a warm, friendly personality that inspires both trust and respect. It is also necessary to have ingenuity and imagination in adapting activities to individual needs. The potential therapist also needs to be skilled, patient, and resourceful in teaching, since patients often have difficult learning problems. Individuals working in the growing field of home health care must be willing and able to travel and adapt to the variety of work settings one experiences when providing services in the home.
Newly graduated occupational therapists generally begin as staff therapists. Advancement is chiefly to supervisory or administrative positions; some therapists pursue advanced education to teach or conduct research. Job Outlook
Employment in this occupation is expected to increase much faster than the average for all occupational through the year 2000 due to anticipated demand in the areas of rehabilitation and long-term care.
The number of people who need rehabilitative services will rise as advances in medical technology continue to save lives that only a few years ago would have been lost-- children with birth defects, for example, and accident victims, a disproportionate number of whom are teenagers and young adults. Further, as the baby-boom generation begins to move into middle age, a period of high risk of heart disease and stroke, demand for cardiac rehabilitation programs is expected to increase markedly. Finally, substantial growth is projected for the population 85 years of age and above, an age group that suffers a very high incidence of disabling conditions.
Demand for occupational therapists will be affected in the years ahead by changes in the way health care is delivered and paid for. Perhaps the foremost consequence of current and anticipated changes in the payment system is a redefinition of the role of the hospital. In the future, more health services will be delivered on an outpatient basis. This will affect occupational therapy as well as other health professions.
Occupational therapists in general hospitals will treat patients more intensively, providing more therapy sessions over a shorter period of time than in the past. In addition, therapists will be less likely to see a hospital patient through an entire course of treatment. Instead, they will evaluate and prepare patients for post-hospital care by therapists in outpatient therapy clinics, rehabilitation facilities, nursing homes, or home health agencies.
As hospitals strengthen their rehabilitation programs, set up new "sub-acute" units, and expand their outpatient clinics and home health programs, hospital-based occupational therapists will find themselves working in a much broader range of settings than in the past, when they dealt almost exclusively with inpatients. The greatly increased emphasis on outpatient and ambulatory care is expected to sustain strong demand for occupational therapists is hospitals.
Some of the new hospital jobs will be part-time or contract positions. Use of part- time workers can provide more flexibility in scheduling, enabling hospitals to increase or decrease staff according to fluctuations in patient load. Use of contract employees also contributes to flexibility in staffing: Some organizations launch new programs with contract employees, not only to begin operations sooner, but to ensure maximum flexibility as the program evolves.
The number of occupational therapy positions in the public schools rose sharply in the 1970's as school districts throughout the Nation came into compliance with Federal legislation that mandates special education programs for all handicapped children. The 1975 law also requires "related services" such as diagnosis and evaluation of handicapping conditions, transportation to and from school, and support services (including physical and occupational therapy) that assist handicapped students in learning self-care and independent functioning. Employment of occupational therapists and other special education personnel in the public schools appears to have peaked; little growth in the number of these jobs is expected through the year 2000. Nonetheless, replacement needs are substantial, and these will continue to provide excellent opportunities for occupational therapists prepared to work with mentally or physically disabled children.
Restructuring of the health industry is expected to create additional jobs for occupational therapists in private practice. Private practitioners often work on a contract basis, and treat patients in a wide range of settings including hospitals, nursing homes, rehabilitation centers, adult day care programs, group homes, and in industrial settings. Recent changes in the law may accelerate the movement into private practice, since occupational therapists are now permitted to bill directly for services provided to Medicare beneficiaries. Previously, occupation therapists had to submit all Medicare billings through a Medicare-approved facility such as a hospital or home health agency.
The home is emerging as an increasingly important practice site, not only because of changes in the way treatment is provided in hospitals, but because of the prevalence of functional disabilities among older persons, and consumer and insurer preference for health care in home or community-based settings. The home health field is expected to experience spectacular growth, and should provide very good opportunities for occupational therapists.
Job prospects in occupational therapy are expected to be excellent through the year 2000. Enrollments in occupational therapy programs have leveled off in recent year, primarily because programs are operating at capacity. Significant growth in the number of occupational therapy students appears unlikely at present, and, barring such growth, the number of graduates is projected to fall short of job openings.
Employers faced with a shortage of qualified applicants might respond by raising salaries, which should increase the supply of reentrants (trained occupational therapists who are not currently engaged in practice). They might also alter staffing patterns, making greater use of occupational therapy assistants, or substituting recreational, art, music, and other expressive therapists.
According to a national survey conducted by the University of Texas Medical Branch, the median annual starting salary for occupational therapists in hospitals was about $24,900 in 1990. The middle 50 percent earned between $22,880 and $26,000. The median salary for experienced occupational therapists in hospitals was about $33,200.
Some states classify occupational therapists employed in public schools as teachers and pay accordingly.
Occupational therapists use specialized knowledge to help individuals return to their normal activities and achieve maximum independence. Other workers perform similar duties include orthotists, prosthetists, physical therapists, speech-language pathologists and audiologists, rehabilitation counselors, recreational therapists, art therapists, music therapists, and dance therapists.
Sources of Additional Information
For more information on occupational therapy as a career, a list of education programs, and requirements for certification, write to:
American Occupational Therapy Association, P.O. Box 1725, 1383 Piccard Dr., Rockville, MD 20850.