What is Occupational Therapy ?
Occupational Therapy (OT) is concerned with rehabilitation and the prevention of certain conditions after illness, trauma or mental handicap. The following is the definition given by the 15th Council Meeting of the World Federation of Occupational Therapists (WFOT) in Amsterdam, June 1982:
"Occupational Therapy is assessment and treatment through the specific use of selected activity. This is designed by the Occupational Therapist and undertaken by those who are temporarily or permanently disabled by physical or mental illness, by social or developmental problems. The purpose is to prevent disability, improve health and to fulfil the person's needs by achieving optimum function and independence in work, social and domestic environment."

There are five areas of Occupational Therapy:

the clinical role involves the assessment and treatment of clients, the promotion of health and prevention of dis-ease in the public and private sectors;
the educational role involves extending the profession, updating knowledge and skills, development of services and promotion of research.
the administrative role involves co-ordination of one or more services. This role includes taking charge of accommodation, equipment, tools and materials, stock control and inventories, recruitment, selection and appointment of staff, general and clinical records and correspondence.
the research role is concerned with the survival of the profession, through evaluation of treatment and effectiveness. This role also involves continually refining and analysing current theories, improving on them and forming new ones.
the consultancy role is relatively unfamiliar. This is usually undertaken by a mature, experienced and knowledgeable individual. He/she does not play an active part in development of services or therapy, but assesses a situation or environment in terms of weaknesses and strengths and presents this to those who will be involved. Consultancy is used in adult education programmes, retirement schemes, community centres and schools.

What are the origins of OT ?
Occupational Therapy can be said to stretch as far back as the advent of medicine. Remedial exercises were used to promote health since the beginning of civilisation, in communities all over the world such as China (2600 BC), Egypt (2000 BC) and Greece (1000 - 200 BC).

After the Dark Ages (200 - 1250 AD) in which classical civilisation all but disintegrated, and the Light Ages (1250 - 1700 AD), a time of regeneration of medical subjects such as psychology, anatomy and physiology, there evolved a particular interest in psychological medicine. These ideas formed the basis of OT as it is known today. It was probably during the First World War that therapies such as OT really evolved out of a need for such rehabilitation. During this time, two centres for OT were opened - one in Chicago, USA in 1914 and another in Toronto, Canada in 1918. Similarly, during the Second World War the therapy proved its worth, with developments taking off in Canada, Europe, Scandinavia, South Africa, South America, Australia, New Zealand and the Far East, with 31 countries belonging to the World Federation of Occupational Therapists in 1986.

How does OT work ?
The most important principle of Occupational Therapy is that of purposeful activity. It is through purposeful activity that OT is distinguished from other health care professions, and also the means of treatment used by an occupational therapist, the activity being physical or psychological. Hand-in-hand with purposeful activity is active participation. The therapist selects certain activities which will be beneficial to the client's condition, and reduce functional problems - this is known as the remedial purpose. In addition, activities in which the client shows an interest and feels comfortable performing, are selected, being the second purpose. There are many advantages of this type of treatment: firstly, the client is involved in the process of doing something, and is therefore playing an active part in his/her therapy; the activities often involve repetition which is so crucial in neurophysiological integration; occupational therapy involves learning through doing which encourages and motivates the client, hence facilitating the healing process.

Purposeful activity increases and maintains sensory-motor skills, sensory-integrative behaviour, cognitive skills, psychological function & integrity, and social & work competence, at the same time assisting the development of tactile, kinaesthetic, auditory and visual perception, especially in the growing child.

What happens during a session ?
There are seven steps or procedures to be followed which form the framework of therapy, which every therapist will employ regardless of the type of client.

Referral: referrals come from a wide range of sources. Clients may be seen without a referral from a health team member.

Assessment: in order to familiarise him/herself with the client's condition, the therapist may do some background work before meeting the client. This can be in the form of discussing the client with the referral agent, exchanging views with colleagues, reading case notes etc. The therapist will then need to perform a formal assessment. This involves meeting and interviewing the client. Assessments often include the administration of specific Standardized testing tools. Non standardized testing tools are also used, these data as well as clinical/functional testing results are essential in the formulation of an appropriate treatment plan for the individual client.

Planning: The therapist will then work out a structure of treatment according to the client's particular needs and dysfunctions. The short and long term positive treatment aims are also noted at this point.

Implementation: This begins with the first treatment session. The client's response is observed at all times and adjustments made, if necessary. Throughout the therapy itself, the therapist will constantly be observing, re-evaluating and assessing the client's progress, until the therapy comes to an end. The treatment approach is often an eclectic one. Therapists often use a combination of various techniques in the treatment of clients. Treatment is holistic and comprehensive, focusing on each aspect of the individual (cognitive; conative; affective; functional; physical; perceptual).

Various techniques are used in the treatment of clients - the range is comprehensive, including the application of

neurodevelopmental therapy
sensory integration
play therapy
evocative techniques like projective art
ergonomics
pain management
assertiveness and social skills training
group handling, neurophysiological, perceptual motor, projective, reality orientation, relaxation, educative and counselling techniques
assistive devices (e.g. application of pressure garments to reduce keloid formation and hypertrophic scarring in burn victims).

Conclusion: once the therapist is satisfied that the client has achieved optimum functionality, therapy can be concluded. There are two other situations where therapy will be concluded: with the therapist referring the client elsewhere or only temporarily discharging the client (i.e. with the prospect of future therapy).

Follow-up: this is not performed with every client and may take different forms, such as a questionnaire, letter or consultation with another therapist, or directly through a personal visit from the therapist to the client's home, school or place of work. Progress is duly recorded.

Evaluation: This is an overall account and summary of the treatment, including the effectiveness and final outcome.

Who can benefit from OT ?
OT is indicated for anyone suffering from disturbances in the central nervous system, emotions and sensory mechanisms; difficulties in intrapersonal and interpersonal interactions; residual impairments of a static or deteriorating nature and developmental deficits. OT is specifically useful with children who have learning and concentration difficulties and has shown to be most successful in addressing these problems.