An historical perspective

AN HISTORICAL PERSPECTIVE NANDGAONKAR HEMANT ASSISTANT PROFESSOR

ANCIENT ORIGINS OF OCCUPATION FOR TREATMENT Exercise (Physical Training)  Recreation (Play)  Work 

Nandgaonkar Hemant

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ď‚— An outline of some historical ideas, which led to the

formation of Occupational Therapy, and the milestones in the development of the British profession

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Nandgaonkar Hemant

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2600 BC

The Chinese thought that disease resulted from organic inactivity, so used physical training as therapy

2000BC

The Egyptians dedicated temples for the treatment of melancholics. Here patients’ time was spent in pleasurable activity such as games & recreation

1000 BC

The Persians used physical therapy to train their youth

600 BC

Asclepius, the Greek classical god of healing, soothed delirium with songs, farces & music

600 BCAD 200

Pythagorus,Thales & Orpheus used music to sooth troubled minds. Hippocrates emphasized the link between mind & body & recommended wrestling, riding, labour & vigourous exercise. Cornelius Celcus, who studied anatomy & medicine, recommended sailing, hunting, handling of arms, ball games, running & walking for their therapeutic benefits

1250 -1700

Leonardo da Vinci, Decartes & Francis Bacon studied anatomy, movement, rhythm, posture & energy expenditure. Ramazzini, Professor of Practical Medicine, stressed the imporatnce of the prevention of illness. He observed his patients – workers in his workshop, & placed high value on weaving, cobbling, tailoring & pottery as exercise.

This was early movement analysis.

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1780

Tissot used occupational exercise for the treatment of mentally ill. He advocated sewing, playing the violin, sweeping , sawing, bell ringing, hammering, chopping wood, riding and swimming

1786

Philippe Pinel used work as therapy in Paris. His name is associated with the concept of Moral Treatment

1786

William Cowper, in a letter to Lady Hesketh, dated 16 January 1786, described the malady which had seized him & how he improved his own state by use of carpentry, gardening, writing & poetry. This may be the first recorded account of a patient’s own experience in English literature

1792

The Quaker William Tuke opened The Retreat in York. Tuke’s name is very much associated with Moral Treatment

1850

The Crimean War enabled many women to take up careers. The nursing profession began to develop under Florence Nightingale

1914-1918

The First World War – physiotherapy began to develop

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DIFFERENT TITLES     

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December 1914, Layman George Edward Barton, Architect Suffered from TB Communicated with Dunton Barton, first President of NSPOT

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Moral treatment Work treatment Work therapy Occupational treatment Occupational recreation Ergo therapy WORK CURE OCCUPATIONAL THERAPY

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THERAPY & MEDICINE IN 18TH & 19TH CENTURIES 

Humane treatment Nandgaonkar Hemant

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MORAL TREATMENT

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ARTS & CRAFTS MOVEMENT

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MORAL TREATMENT 

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Evolved as a Reaction to prevailing approach to mental treatment Having lost all reasons and therefore became animal like, was considered sinner or criminal, and possessed by demons or supernatural spirits Person was dangerous, could not be trusted in society, needed to be removed from it Mental hospitals whipped patients, chained them, put them on exhibit for the curiosity of sightseers Cure was worst than disease Locking people --- guaranteed deterioration of the mental processes 9

MORAL TREATMENT Shift  Pessimism to optimism  Somatic to psychological  Western Europe and US --humanitarianism  Astronomy, Physics, technology, political changes  Main features 

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Respect for human individuality  Acceptance of the unity of mind & body  Belief in the ability of mentally ill patients to function & adapt to their environment as a result of participating in the activities 

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ARTS AND CRAFT MOVEMENT  

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Return to the land (farming) Live in small villages Make useful, functional products based on good designs Become skilled craftsperson –promote self reliance Role of craft work in promoting improved physical and mental health

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Concerned with general health Workers health deteriorating in many large factories which were located in large cities Public Health knowledge was meager Physical exercise & clean air importance Communicable diseases – sanitation, toxic agents, poor ventilation Proponents of art and craft movement

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GENESIS OF OT PROFESSION IN THE US Forerunner of the profession – Adolf Meyers‟s Philosophy  Psychiatrist  December, 1892 presented a paper 

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The proper use of time in some helpful & gratifying activity appeared to be a fundamental issue in treatment of neuropsychiatric patients.

Mental illness as “a problem of living” and not merely as a disease of structure & function or of toxic nature Habit deterioration

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1895, Mary Potter Booke Meyer, Social Worker 

Systematic type of activity into wards

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MEYER‟S FIVE FUNDAMENTAL ASSUMPTIONS REGARDING THE OCCUPATIONAL NATURE FOR HUMANS

A fundamental link exists between health & occupation  Healthy occupation maintains a balance between existing, thinking & acting  A unity exists between mind and body  When participation in occupation is interrupted mind & body deteriorate  As occupation maintains mind & body it is suited to the restoration of functional ability 

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FOUNDERS OF THE PROFESSION Susan E. Tracy  Herbert J. Hall  Eleanor Clarke Slagle  William Rush Dunton, Jr – Father of the Profession  George Edward Barton 

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SUSAN TRACY  

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Jamiaca Plain, Massachusetts, 1906 Nurse Master clinician Evaluation techniques for assessing patient‟s level of functional performance Wrote a Book : Studies in Invalid Occupations Setting up of OT department at Presbyterian Hospital in Chicago Because of her busy schedule in setting up OT department she declined invitation to be founding member for organization for OT According to her nurses were the only persons who could learn to use occupations correctly with patients

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SUSAN TRACY Disagreed with other founder members on the qualification of therapists  Participated actively in the NSPOT as chair of Committee on Teaching Methods  Died in 1928 

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DR. HERBERT JAMES HALL 1904, Marblehead  Seeking alternative treatment for neurashtenia  „REST CURE‟ 

Neurasthenia – affected women, severe weakness when performing any work activity. Seen as a result of overwork

Started using OCCUPATIONS  Needlework, bed-----chair  Patients graduated, boarding facility ---- Barn  Hired craftpersons  Commercially saleable products  Follow schedule of work, rest & relaxation 

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DR. HERBERT JAMES HALL President of NSPOT  Prolific writer – expanded thoughts on arts & crafts as well as OT 

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ELEANOR CLARKE SLAGLE Social worker student with Jane Addams at Hull House  Became interested in using arts and crafts at the suggestion of Addams and Julia Lantrop  Lanthrop – instrumental in setting up course on occupations and amusements at the Chicago school of Civics and Philanthropy (1907)  Slagle enrolled for the course  After completion she began helping teach  Met Adolf Meyer --- Dunton --- American Medico Psychological Association (1914) 

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WILLIAM RUSH DUNTON, JR – FATHER OF THE PROFESSION 1915, first complete textbook on OT  Occupational Therapy –A Manual for Nurses  Basic tenets or cardinal rules in applying occupation therapy  Simple activities for nurses  OCCUPATION‟s primary purpose 

“to divert the patient’s attention from unpleasant subjects, to keep the patient’s train of thought in more healthy channels, to control attention, to secure rest, to train mental processes by educating hands, eyes, muscles, etc., to serve as a safety valve, to provide a new vocation”

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FOUNDING OF THE NATIONAL SOCIETY FOR THE PROMOTION OF OT NSPOT  March 15 to 17, 1917 in Clifton Springs, New York  Founding members – Barton, Dunton, Eleanor Clarke Slagele, Susan Johnson, Thomas Bissel Kidner and Isabel G.Newton (Barton‟s Secretary and later his wife) 

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EXPANSION DURING WORLD WAR I 

March 18, call for women reconstruction aides in occupational therapy Nandgaonkar Hemant

Class 1 physiotherapy- to give massage & exercise & other remedial treatment to the returned soldiers  Class 2 Occupational Therapy – to furnish forms of occupation to convalescents in long illnesses & to give to patients therapeutic benefit of activity. 

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Purpose …to hasten the recovery of the patients…promote contentment & make the atmosphere of there hospitals such that the time spent in convalescence will pass most pleasantly because the minds & hands of the patients are properly occupied in profitable pursuits(Hospital Designated for Reconstruction,1918)

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Diagnosis treated – amputations, blindness, head & nerve injuries, osteomyelitis, tuberculosis, neurashthenia, hypochondriasis, hysteria, anxiety neurosis, anticipation neurosis, effort syndrom, exhaustion, timorousness & gas, concussion syndrome

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RIGID CRITERIA FOR APPLICATION 

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At least high school education with experience in some profession as social work or library science At least 25 years old Citizen of US or one of its allies Have theoretical knowledge & practical experince in various crafts DURATION – 6 to 12 weeks Lectures on psychology of the handicapped, fatigue, & the work cure, personal hygiene, anatomy, kinesiology, ethics & hospital administration Crafts – woodwork, weaving, cord work, beadwork, basketry, and ceramics Field work and practice – local hospitals

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EXPANSION DURING WORLD WAR I 

Positive gains for OT    

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First reconstruction aides employed in February,1918   

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Bird T.Baldwiin, Psychologist – Director of Education…April 1918 Developed department of OT & the curative workshops Measurement of ROM and MP Wrote in Army Manual on Occupational Therapy Occupational Therapy Applied to Restoration of Function of Disabled Joints (1919)

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Schools of OT established Therapists were educated Public awareness was achieved Policies and procedure were developed Definition & description of OT services

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EXPANSION DURING WORLD WAR I 

Negative outcome Decision to define OT by placing the discipline under medical authorities  Failure to gain military status  Left service after war ended  Majorly working in mental health & psychiatry  Other areas – orthopedics, general hospitals, TB hospitals, other institutions  1930s – Depression, National Economy Act- deep cut in OT budget and personnel, many clinics closed, staffing reduced, schools closed 

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POST WORLD WAR I TO WORLD WAR II Treatment techniques developed during WWI to treat physical dysfunction were not sufficiently documented in OT literature & were lost  1923 – NSPOT to AOTA  DEPRESSION YEARS 

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Budgets were cut Staff layoffs Alliance with AMA…to implement minimum standards for training Medical ancillary Holistic to reductionistic Reductionism – scientific process of understanding function by analyzing small, discrete parts

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DURING WORLD WAR II & IMMEDIATELY FOLLOWING 

Field of OT was ill prepared for the advent of WWII in 1941

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Only 12 people were working as OT No military status for OTst

War Emergency Training courses – 899 Development of department of Physical Medicine 1947, OTst achieved military status 2134 – Year1941 3224 – Year1945 Practice in mental health decreased Recognition as valuable health care service.

Comprehensive planning for the personnel development COTA,OTR

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COURSE DURATION 6 to 12 weeks  12 month course (8 month theory & three month practice) – 1923  1932 – 1 years of didactic preparation plus 9 months of hospital practice (CERTIFICATE COURSE)  1938 – 25 calendar months plus an additional 9 months of hospital practice training  1939 – First formal subjective registration examination 

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CLARE S. SPACKMAN – RESTORATION OF PHYSICAL FUNCTION 

Represented US when WFOT was founded in 1954  Elected as Assistant Secretary-Treasurer at first meeting  President – 1957 to 1962  Secretary Treasurer – 1964 to 1972 

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First textbook in US on OT written primarily by OTst, edited by Helen S.Willard & Clare S. Spackman, 1947 – Principles of Occupational Therapy  Detail information on evaluation & treatment of patients with physical dysfunction

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FORMATION OF THE WORLD FEDERATION OF OCCUPATIONAL THERAPISTS April 1952  Six countries met in Liverpool, England 

Minimum Educational Standards for Occupational Therapists (1952) – Revised in 1963  First Congress 1954..Edinburg, Scotland  1959 – joined WHO  1960 “Ethics for Otst” & “Functions of OT” Revised in 1962

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Canada, Denmark, Great Briton (England & Scotland), South Africa, Sweden & US  Australia, New Zealand, Israel, India were represented by written opinion 

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MOVING TOWARD AN “EXACT”SCIENCE Gail S. Fidler – Psychiatric OT  New levels in OT Education 

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CHANGES IN FOCUS – 1960S & 1970S A. Jean Ayres – Neurobehavioural Orientation  Mary Rielly – Occupational Behavior Orientation  Wilma West – Prevention & Community OT  Anne Cronin Mosey – FOR for Psychiatric OT 

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CHANGES WITHIN THE ASSOCIATION 1960s and 1970s  Into the 1980s  Research  Education  Certification  Practice 

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PUBLICATION  

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Maryland Psychiatric Quarterly (1912) Archives of Occupational Therapy (1921) Occupational Therapy and Rehabilitation (1922) Archives of Occupational Therapy (1923) American Journal of Occupational Therapy (1947) Occupational Therapy and Rehabilitation Occupational Therapy Newsletter (1939) Occupational Therapy Newspaper (1973) OT week (1987) O.T.News (1990) Occupational Therapy Forum (1986) Advance for Occupational Therapy (1985)

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RESEARCH 

American Occupational Therapy Foundation (1965) Nandgaonkar Hemant

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OCCUPATIONAL THERAPY Nandgaonkar Hemant Assistant Professor

DEFINITION 

“Occupation” in Occupational Therapy does not simply refer to jobs or job training;

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Occupational therapy is the art and science of helping people to do the day to day activities that are important to them despite impairment, disability, or handicap.

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In OT Terminology, these activities are called Occupational Performance areas.

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Occupation in OT refers to all of the activities that occupy people‟s time & give meaning to their lives

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These Occupational Performance areas can be divided into Nandgaonkar Hemant

Activities of Daily Living,  Work and Productive Activities, and  Play and Leisure activities 

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ACTIVITIES OF DAILY LIVING health maintenance,  socialization,  functional communication,  functional mobility,  community mobility,  emergency response and  sexual expression 

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Grooming,  oral hygiene,  bathing or showering,  toilet hygiene,  personal device care,  dressing,  feeding and eating,  medication routine, 

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WORK AND PRODUCTIVE ACTIVITIES 

Vocational activities (vocational exploration, job acquisition, work and job performance, retirement planning, volunteer participation)

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Home management (clothing care, cleaning, meal preparation or clean up, shopping, money management, household maintenance, safety procedures)  Care of others,  Educational activities, 

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PLAY AND LEISURE ACTIVITIES 

Play or leisure exploration and play or leisure performance Nandgaonkar Hemant

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Clinical role

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Management role

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Consultant role

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Educator role

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Researcher role

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CLINICAL ROLE 

Who 

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What   

Evaluation and treatment Professional communication Professional credentials

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Clients Families and other support networks Other professionals

Meetings  documentation 

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Resources: Professional organizations 50

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Where 

Facility based settings

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General hospitals  Outpatient clinics  Rehabilitation hospitals  Sub acute or long term rehabilitation centers  Nursing homes 

Community based settings school systems  Day treatment programs  Group homes  Client‟s own home 

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When

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PHILOSOPHICAL BASE OF OT(WILLARD,9TH ED) Humans are active beings whose development is influenced by use of purposeful activity  Human beings are able to influence their health & environment though purposeful activity  Human life is a process of continuous adaptation  Adaptation is change in function that promotes survival and self actualization  Biological, psychological and environmental factors may interrupt the adaptation process at any time throughout the life cycle, causing dysfunction 

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A PHILOSOPHY FOR OT(ANNIE TURNER,5TH ED) People are individual & inherently different from one another  Occupation is fundamental to health & wellbeing  Where occupational performance has been interrupted a person can: 

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Use occupation &/or activity to develop the adaptive skills required to acquire, maintain or restore occupational performance Modify their occupations and/or activities to facilitate occupational performance

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Purposeful activity facilitates adaptive process  Purposeful activity (occupation) may be used to prevent and mediate dysfunction and elicit maximal adaptation  Activity as used by the therapist includes both an intrinsic and therapeutic purpose 

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An outline of some historical ideas, which led to the formation of Occupational Therapy, and the milestones in the development of the British profession

Nandgaonkar Hemant



60

The Chinese thought that disease resulted from organic inactivity, so used physical training as therapy

2000BC

The Egyptians dedicated temples for the treatment of melancholics. Here patientsâ€&#x; time was spent in pleasurable activity such as games & recreation

1000 BC

The Persians used physical therapy to train their youth

600 BC

Asclepius, the Greek classical god of healing, soothed delirium with songs, farces & music

600 BCAD 200

Pythagorus, Thales & Orpheus used music to sooth troubled minds. Hippocrates emphasized the link between mind & body & recommended wrestling, riding, labour & vigourous exercise.

Cornelius Celcus, who studied anatomy & medicine, recommended sailing, hunting, handling of arms, ball games, running & walking for their therapeutic benefits

1250 1700

Leonardo da Vinci, Decartes & Francis Bacon studied anatomy, movement, rhythm, posture & energy expenditure. Ramazzini, Professor of Practical Medicine, stressed the imporatnce of the prevention of illness. He observed his patients – workers in his workshop, & placed high value on weaving, cobbling, tailoring &61 pottery as exercise. This was early movement analysis.

Nandgaonkar Hemant

2600 BC

Tissot used occupational exercise for the treatment of mentally ill. He advocated sewing, playing the violin, sweeping , sawing, bell ringing, hammering, chopping wood, riding and swimming

1786

Philippe Pinel used work as therapy in Paris. His name is associated with the concept of Moral Treatment

1786

William Cowper, in a letter to Lady Hesketh, dated 16 January 1786, described the malady which had seized him & how he improved his own state by use of carpentry, gardening, writing & poetry. This may be the first recorded account of a patient‟s own experience in English literature

1792

The Quaker William Tuke opened The Retreat in York.

Tuke‟s name is very much associated with Moral Treatment

1850

The Crimean War enabled many women to take up careers.

The nursing profession began to develop under Florence 62 Nightingale

19141918

The First World War – physiotherapy began to develop

Nandgaonkar Hemant

1780

THE DEVELOPMENT OF OCCUPATIONAL THERAPY AS PROFESSION An increasing awareness of the value of occupation as a treatment. The term “occupational therapy� began to evolve. The emphsis was stil very much on the use of occupation within the psychitric field

1924

Dr Elizabeth Casson introduced occupational therapy into her nursing home in Clifton, Bristol, after attending a conference by Professor Sir David Henderson & visiting a newly established occupational therapy school in Philadelphia, USA

1925

Margaret Fulton, the first qualified Occupational Therapist to work in the UK (after training in Philadelphia) established as occupational therapy department at the Royal Comhill Hospital, Aberdeen.

Dr.Elizabeth Casson sent Constance Tebbit to train in the USA. She returned to work in the Dorset House Psychiatric Nursing Home in Bristol 63

1930

Dr. Casson established the first British OT training school at Dorset House, with Constance Tebbit as principal

Nandgaonkar Hemant

End of 19th century

In Scotland the first professional association was formed.

It had 30 members

1936

The Astley Ainslie school was established in Edinburgh. The Association of Occupational Therapists (AOT) was formed in England

1938

The first public examination were held

1939-1945

The AOT set up short courses for OT auxiliaries. This could be upgraded to full professional status with further study The War Emergency Diploma allowed professionals with previous qualifications, e.g. teachers & nurses, to qualify as occupational therapists

1941

St Andrews School of OT in Northampton was established as the second English school

1943

AOT included England, Wales & Northern Ireland

1947

The National Health Service Act. OT schools were privately funded at this time

1950s

A Joint Council was formed to look at matters common to the AOT & Scottish AOT First National Congress run by the AOT

1952

64 World Federation of Occupational Therapists was inaugurated, with Margaret Fulton as president & Constance Glyn-Owens (nee Tebbit) as secretary

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1932

First World Congress, held in Edinburg

1960/1

The establishment of the Council for the Professions Supplementary to Medicine leads to State Registration

1974

The British Association of Occupational Therapists was formed from a merger between AOT & SAOT

1977

First European Congress

1978

The Association divided into: The College of Occupational Therapists(which deals with professional & educational matters) and British Association of Occupational Therapists (the trade union)

1990s

Training to first degree level is established on all preregistration courses

Nandgaonkar Hemant

1954

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OCCUPATIONAL THERAPY DEFINITIONS NANDGAONKAR HEMANT P.

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Occupational Therapy is any activity, mental or physical, medically prescribed and professionally guided to aid a patient in recovery from disease or injury

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1972, DELEGATE ASSEMBLY FOR AOTA OT is the art and science of directing man‟s participation in selected tasks to restore, reinforce and enhance performance, facilitate learning of those skills and functions essential for adaptation and productivity, diminish or correct pathology, and to promote and maintain health.  Its fundamental concern is the capacity, throughout the lifespan, to perform with satisfaction to self and others those tasks and roles essential to productive living and the mastery of self and the environment 

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1986,REPRESENTATIVE ASSEMBLY DICTIONARY DEFINITION Occupational Therapy:  Therapeutic use of self-care, work and play activities to increase independent function, enhance development, and prevent disability.  May include adaptation of task or environment to achieve maximum independence and enhance quality of life 

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