OCTH 611 (Theory & Philosophy) Flashcards

Question

Asceticism:

Answer 1

“The religious doctrine that one can reach a higher spiritual state by rigorous self-discipline and self-denial.”

Answer 2

* Renouncing worldly pleasures, typically in order to pursue a spiritual goal, but may apply to other goals * Restraint is a virtue * Max Weber was a proponent, as were Buddha and Gandhi

Answer 3

“Through understanding the philosophical foundation of occupational therapy, one is likely TO BE BETTER ABLE TO UNDERSTAND the profession and its relationship to clients, to colleagues in other areas of specialization or other professions, and to society to which is it responsible.”

Answer 4

Included the view that idleness contributes to mental illness Slagle, Tracy, and Johnson championed involving individuals in healthy daily routines Tasks were graded and environments structured for healthy engagement in occupation

Answer 5

Based on an appreciation of skilled craftsmen versus industrialization Preserving tools and traditions Hull House in Chicago and the Guildhall in London Barton, Tracy, and Slagle emphasized crafts in OT

Answer 6

1. “Occupation is as necessary to human life as food and drink.” 2. “Every human being should have both physical and mental occupation.” 3. “Sick minds, sick bodies, and sick souls may be healed through occupations.”

Answer 7

Dunton’s foundational notion of occupation as paramount to health and well-being

Answer 8

◦ Calling for scientific evidence to support the emerging medical model ◦ OT adopts a biomedical worldview at the expense of holism (e.g., man is a machine, just fix the parts) ◦ OT fragmented by specializations; managed care complicates reimbursement

Answer 9

◦ Return to foundational focus on meaningful occupations as central to well-being and health ◦ Occupation-based models emerge

Answer 10

Rapid growth in hospitals More OTs in the field Slagle and Meyer develop habit training Reconstruction offered to WWI veterans and to factory workers with industrial accidents Emergence of rehabilitation focus and the biomechanical model, with activity analysis applied to ADLs and re-entrance to the workforce

Answer 11

Scientific influence plus arts and crafts ◦ Use of adapted tasks in handcrafts OTs able to work in institutions ◦ Respected centers of the latest care Scientists studying human behavior ◦ Pavlov, Watson, and Skinner ◦ Positive and negative reinforcements Declining interest in psychoanalysis

Answer 12

Vocational rehab needed again after WWII Social Security (New Deal provision of income for the disabled) GI Bill (funding for vocational retraining) ◦ For people with physical and mental needs ◦ Sheltered workshops emerge Physical Dysfunction Models ◦ Kinetic Model (Licht, 1947) ◦ Rehabilitation Model (Spackman, 1947)

Answer 13

Psychopharmacological advances ◦ Thorazine and Librium ◦ Increased patients’ ability to participate in OT Re-emergence of interest in psychoanalytic application of tasks Freudian-influenced Object Relations Theory advocated the “therapeutic use of self” Neurological advances ◦ Rood, Ayers, and Bobath's methods for facilitating motor development

Answer 14

Questioning of authority and demonstrations Deinstitutionalization ◦ Goffman’s 1961 exposé of asylums ◦ Medications to prevent, cure, and manage chronic conditions ◦ Resocialization (IADL training and opportunity for OT groups) discussed in publications by Fidler and Mosey Therapeutic milieu ◦ Community Approach ◦ Collaborative effort between therapist and client Community Mental Health Act of 1963 Sensory Integration (Ayers, 1968)

Answer 15

Specialties made it hard to find an OT frame of reference ◦ Psychosocial ◦ Physical disabilities ◦ Hand therapy ◦ Pediatrics ◦ Geriatrics AOTA established the Representative Assembly who published the “Uniform Terminology” document in 1979

Answer 16

Mosey (1970) – 3 Frames of Reference for Mental Health ◦ Acquisitional: behavior/learning theory ◦ Psychoanalytic: object relations ◦ Developmental: recapitulation of ontogenesis Llorens (1970) – Facilitating Growth and Development ◦ Based on a review of contemporary theories of human development

Answer 17

1. Ruth Weimer (1972) – Prevention Model 2. Mosey (1973) – Activity Therapy 3. Fidlers (1978) – Doing and Becoming 4. Kielhofner (1977) – Temporal Adaptation 5. Lorna Jean King (1978) – Individual Adaptation 6. Model (use of sensory integration with adults)

Answer 18

Accountability ◦ Pressure to show evidence for interventions before receiving reimbursement ◦ Exacerbated by lack of standardized assessments Manpower shortage ◦ Education of All Handicapped Children Act of 1975 Lack of unified theoretical base Lack of research to validate practice

Answer 19

AOTF offers grants for research Movement towards state licensure Proliferation of models, theories, and frames of reference continued Academic programs had a difficult time keeping up with the changes being made in the profession

Answer 20

Gilfoyle & Grady (1981) - Spatiotemporal Adaptation (pediatrics) Ross & Burdick (1981) - Sensory Integration Groups for Adults Howe & Briggs (1982) - Ecological Systems Model Townsend (1988) - Client-Centered Task Force in Canada Allen (1982) - Cognitive Disabilities

Answer 21

Reilly (1958) - Occupational Behavior Kielhofner & Burke (1980) - Model of Human Occupation ◦ 1st occupation-based model ◦ Reilly was their mentor Mattingly & Fleming (1994) - Emergence of Clinical Reasoning

Answer 22

Occupational Behavior

Answer 23

◦ Gave the 1961 Eleanor Clark Slagle Lecture, OT Can Be One of the Great Ideas of the 20th Century Medicine ◦ Believed strongly that OT needed a unifying theory base ◦ Kielhofner, her mentee, credited her with the shift in focus back to the occupation

Answer 24

OT had been reducing practice to “fixing the problem” with modalities and techniques Reilly urged OT to recall the purpose of OT as defined by Meyer and Slagle - to “prevent and reduce the incapacities resulting from illness” Focus on the disruption in function rather than the medical diagnosis Kielhofner and Burke, two of her students, incorporated her ideas of occupational behavior into a model of practice that they called the Model of Human Occupation Reilly stressed the importance of childhood play had on the normal, adaptive development of productive activity in adulthood

Answer 25

Introduced in 1969 Focused on the prevention and reduction of dysfunction that results from injury and illness Emphasized a balance of self-care, work, and play/leisure

Answer 26

Man has a need to master, alter, and improve his environment. Occupation is intrinsically motivating, and people engage in occupation for its own sake to experience learning, control, and mastery that occurs during performance. Humans have a psychological need for occupation, and when they lack occupation, they suffer. Society and culture highly influence the specific occupations chosen by a person. Health is realized in the rhythm of activity and rest and includes the need for balance and habits. OB includes both physical and visible forms as well as a subjective and affective experience for the person

Answer 27

Model was criticized by OTs for difficulty in clinical application and lack of research Several case studies have been published (Line, 1969; Reilly, 1969) Served as the “conceptual inspiration” for other occupation-based models such as…

Answer 28

Kielhofner and Burke reviewed the conceptual history of OT and proposed the MOHO in the 1980s Called for reclaiming of the original concepts of the founders Sought to understand and explain human occupation

Answer 29

Initially a concept introduced by Rogers in her 1983 Slagle lecture “The thinking process that expert OTs use during treatment and interactions with clients” (p. 17) Rerouting mechanistic OT back to its holistic roots Mattingly & Fleming’s qualitative research (1994) identified three types of reasoning ◦ Procedural reasoning: specific interventions ◦ Interactive reasoning: collaborative communication ◦ Conditional reasoning: connecting culturally

Answer 30

* Founded in 1989 by Yerxa and colleagues at USC * Defined as “the study of the form, function, and meaning of human occupation” * A controversial topic that has been agreed upon to be used to inform current practice * Considered a separate academic discipline from OT with separate research methods

Answer 31

1. Christiansen & Baum (1991) – Person Environment Occupation Performance Model 2. Schkade & Schultz (1992) – Occupational Adaptation Model 3. Dunn, Brown, & McGuigan (1994) – Ecology of Human Performance Model 4. Law et al. (1996) – Person Environment Occupation Model 5. CAOT (1997) – Canadian Model of Occupational Performance ◦ Revised by Polatajko, Townsend, & Craik (2007) as Canadian Model of Occupational Performance and Engagement

Answer 32

ADA of 1990 Change in requirement for MS degree Many master's and doctoral OT students doing research Well Elderly Study (Clark et al., 1997) ◦ Randomized control trial of OT’s influence on independent living in older adults ◦ Published in JAMA

Answer 33

1. Moving away from the medical model 2. Moving toward a holistic approach 3. Expanding the definition of occupation 4. Understanding cognition, sensation, and neuroscience 5. Embracing occupational science 6. Building an evidence-based practice 7. Human adaptation in the context of culture and community 8. Putting the client first

Answer 34

* Medical director of a hospital in Paris * Credited with “removing the chains” * Champions “activities as a means of securing good morale and discipline” in his 1801 book advocating occupational treatment – rather than restraint – for those with mental health illnesses * Influenced others in Europe

Answer 35

forbids the use of chains and shackles removed patients from dungeons and provided them with sunny rooms and allowed them to exercise on grounds

Answer 36

* Grandson of Quaker William Tuke, who established The York Retreat in England in 1796 * “Retreat” versus “asylum” * Activities and occupations used to promote self-control and habit training * No chains or physical punishment * The Retreat York

Answer 37

* American physician and Physician General of the Military Hospital, signer of the Declaration of Independence, and politically influential * Known as a “Father of Psychiatry” in America and known for making a change in the approach to treating the mentally ill with activities and incentives * Established first humane hospital and The Brattleboro Retreat in USA

Answer 38

* Difficult childhood led her to education, jail, and social reforms at an early age * Inspired by Rush and Pinel; met with Tuke * Began a crusade to reform mental health care, which led to Europe and an audience with the Queen and the Pope * Had a “nervous breakdown” herself in 1836 and was hospitalized in the York Retreat in England * Was so impressed with their philosophy that she brought those methods to the USA * Meeting with Moses Sheppard in 1851

Answer 39

* Yale graduate and a financier * Experienced bipolar disorder, suicide attempt and hospitalization * Wrote about his experience in “A Mind That Found Itself,” exposing the deplorable conditions in asylums * Devoted himself to improving the mental health system and sparked the founding of the modern mental hygiene movement * Founded Mental Health America

Answer 40

Dr. Herbert James Hall Susan Tracy Eleanor Clarke Slagle George Edward Barton Dr. William Rush Dunton Jr. Dr. Adolph Meyer

Answer 41

* Harvard grant in 1905 to study occupation’s therapeutic use * Set up arts and craft workshops (called them “sanatoriums”) * Demonstrated that “physical, mental, and moral health could be restored and maintained through occupation” (Quiroga, as cited in Kielhofner, 2009, p. 16) * Pioneer of sorting, adapting, and grading tasks by activity analysis * Engagement in manual occupation addressed issues of failure, boredom, cognition, and thought diversion * President of AOTA* in 1921

Answer 42

* Observed that those who were active had better outcomes which led to her to the use of “occupation” as a private nurse * As nursing school administrator, she integrated occupation courses into nursing curriculum * Considered one of the first Ots * Eventually shifted her emphasis to instruction in “occupational therapy” * Authored Studies in Invalid Occupation * Was invited to the 1917 founder’s meeting but was unable to attend and sign * Listed as a founder and elected to the Board of Management

Answer 43

* Physician working at Sheppard Asylum (SA) * Influenced by Tuke’s integration of occupation and moral treatment * 1896 – collaboration with Meyer at Hopkins’ psychiatric clinic * 1912 – director of occupation at SA * 1915 – published Occupational Therapy: A Manual for Nurses * Was a founder and became president of the NSPOT * Was the editor of the first professional journal, Occupational Therapy and Rehabilitation (1939)

Answer 44

* 1911 – took a course in “Amusements and Occupation” at Hull House in Chicago School of Civics and Philanthropy (influenced by Adolph Meyer) * 1912 - director of OT at Phipps Clinic; then returned to teaching in Chicago to become primary early educator of OT * Studied music in private school in NY * Was a caregiver for family members (father with Civil War gunshot wound, brother with TB, nephew with polio) * Implemented “habit and moral training”

Answer 45

* Structure of self-care, occupations, walks, meals, recreation, and exercise for those with chronic and severe mental illness * Based on ideas of Meyer, who felt that disorganized habits were linked with mental illness

Answer 46

* WWI – asked by Red Cross to direct a six-week training program for reconstruction aide volunteers working with returning soldiers * Appointed by US Surgeon General as a consultant to the US Army for training these aides (up to 4000 therapists) * Was a founder and elected the first VP of the NSPOT, then elected president; later served as Executive Secretary for AOTA * First Eleanor Clarke Slagle Lecture given in her honor at the 1955 annual AOTA conference

Answer 47

* Trained as an architect, but after some medical issues he became inspired to use his interests in manual arts for his own recovery to help others * Established Consolation House in Clifton Springs, NY in 1914 as a workshop for recovering patients * Became interested in getting like- minded people to establish an organization * First to use the term "occupational therapy"

Answer 48

* Received his MD in Switzerland with a focus on neurology * Emigrated to Chicago in 1892 and worked in a state hospital as a pathologist * Influenced by his mother’s mental illness, he became interested in psychiatry * Became director of Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital * Contact with Dunton at SP and later collaborated with Slagle to develop OT

Answer 49

* In care of the mentally ill, it is important to * “…support development of a regime of work, rest, play and socialization” (Meyer, 1931, p. 170) * “…do work that is meaningful to them” (Winters, 1952, as cited in Kielhofner, p. 33)

Answer 50

* William Dunton * Isabel Newton * Thomas Kidner * Susan Johnson * George Barton * Eleanor Clarke Slagle

Answer 51

cultural humility

Answer 52

 Ongoing process of examining ones own cultural identity and beliefs  Adopted by therapist to increase quality of patient interactions  Different parts of the world are becoming increasingly diverse  We must approach environmental and cultural contexts that contribute to health disparities

Answer 53

 Cultural competency  Building an understanding and knowledge of other cultures  The clinician becomes an expert on culture  Cultural humility  The patient is the expert on their culture  Builds client-centered care

Answer 54

 Philosophical assumptions  “Each individual is able to be understood only within the context of his or her environment of family, community, and cultural group.” (Mosey, as cited in Ludwig, 1993, p. 52)  “Choice and control extend to decisions about Intervention, thus identifying occupational therapy as a collaborative process between the therapist and the recipient of care. In this collaboration, patient's values are respected.” (Christiansen & Baum, 1997, p. 36)  How did our OT roots and founders account for or attend to culture?

Answer 55

 Refugees  Socioeconomic status  Minority groups  Stigma  Language  Age  Disability  Health literacy

Answer 56

 “Are we equipped (theoretical frameworks, interventions tools and guidelines) to provide a culturally appropriate response to disability management, return-to-work or work rehabilitation in regard to the diversity of workforce?”  Is it part of our academic training?  Is it encouraged in the workplace between staff members?  Is it maintained with all patient populations? If not, how could it be incorporated?

Answer 57

“The whole is more than the sum of its parts.” -Aristotle

Answer 58

 René Descartes (1659-1650) - French philosopher; proposed separation of body and spirit (observable would be studied by science, the ephemeral by the church); This philosophy was widely embraced and persists today

Answer 59

 Late 20th century paradigm shift out of mechanistic and reductionist ways of thinking.  Kielhofner introduced it as counter approach to reductionist specializations in OT.  Valued holistic approach to assessment and intervention.  OTPF, MOHO, EHP, OA, and PEOP (and others) all use concepts from systems theories.

Answer 60

 Ludwig von Bertalanff y (1901-1972)  Hungarian biologist who introduced the idea of Systems Theory in 1948  “A whole that functions as a whole by virtue of the interaction of its parts”  “An entity that is greater than the sum of its parts because it consist:  1) parts  2) the way they work together  3) the qualities that emerge from these relationships”

Answer 61

 AJOT article titled “General systems theory: Implications for theory and action in occupational therapy” (1978)  Identifi ed ST as “the emerging paradigm that will transform… reductionism”  The MOHO was published two years later with Burke and used ST as its foundational framework  OTPF embraced and embedded ST constructs

Answer 62

 Scientifically, it takes the conversation away from the level of waves and particles to the level of relationships  “Looking for patterns behind patterns and for processes beneath structures.”

Answer 63

“…to see the universe not as a collection of physical objects, but rather as a complicated web of relations between the various parts of a unified whole.” -Fritjof Capra

Answer 64

* Systems are self-organizing * Even chaos has underlying, inherent order * “Some systems are so complex that prediction is not possible due to multiple potential interactions between multiple variables * Exact weather prediction (e.g., Lorenz’s “butterfly effect”

Answer 65

 Father was a pioneer of genetics  Degree in Anthropology from Cambridge  Traveled to New Guinea to study  Met his wife, anthropologist Margaret Mead  Studied zoology, psychology, anthropology, and ethology

Answer 66

 Central message is the shift from objects to relationships  “What pattern connects the crab to the lobster and the orchid to the primrose and all four of them to me? And me to you?”  Metaphor versus logic as a means of understanding nature

Answer 67

 Things are comprised of relationships, not parts  Stories are a means of describing things in terms of relationships, rather than simply a description of the elements of the story  The more complex the relationships, the “prettier”

Answer 68

 Mead was born in Philadelphia  Progressive and controversial anthropologist who became very well know as someone who translates other cultures for Americans  Bateson was her 3rd husband  Named “Mother of the World” by Time Magazine in 1969

Answer 69

“Never doubt that a small group of thoughtful people could change the world. Indeed, it is the only thing that ever has.” “Always remember that you are absolutely unique, just like everybody else.”

Answer 70

 Only child of Mead and Bateson  Anthropologist  Authored the first chapter in Zemke and Clark’s “Occupational Science: The Evolving Discipline” textbook  Participant in a USC Occupational Science Annual Symposium

Answer 71

 World Health Organization recognizes life as an ecological system in which health falls along a spectrum  OT models incorporate its assumptions  OTPF 1. Describes contexts as “a variety of interrelated conditions within and surrounding the client that influence performance” (AOTA, 2002, p. 623) 2. Physical, Social, Cultural, Spiritual, Personal, Temporal, and Virtual

Answer 72

* Tend to be more focused than a theory * A template rather than a protocol used to structure interventions * Customizable * Applicable * Foster clinical reasoning * Meant to be used in conjunction with other frames of reference “The purpose…is to…link theory to intervention strategies and to apply clinical reasoning to the chosen intervention methods”

Answer 73

* Kinematics and kinesiology * Assessment of the physics (e.g., torque, force, leverage) of movement * Interventions include (but are not limited to) exercise and splinting * Lower motor neuron and orthopedic diagnoses * Interventions to improve strength, range of motion, and endurance * Focus on physiological factors (e.g., activity analysis) as the means to achieve a functional outcome * Motivated by a goal in which “the outcome must reflect engagement in occupation” (Schultz-Krohn & Pendleton, 2001, p. 39) * Trombly and Scott published Occupational Therapy for Physical Dysfunction in 1977 (Schultz-Krohn & Pendleton, 2001; Breines, 2001)

Answer 74

* Cellular theories * Free radicals disrupt cellular balance at a rate affected by internal (e.g., biological processes) and external (e.g., radiation exposure) factors as well as a “decreased expression of…mixed function oxidases” (p. 32) * Genetic theories * Stochastic theory: delayed outcome of decreased replication ability of non-repeating DNA sequences * Control theories * Natural decrease in the “function of specific physiologic systems known to be vital for the maintenance of homeostatic equilibrium”

Answer 75

* Initiated in response to the heightened need for medical care for wounded WWII soldiers and veterans * Physical medicine and rehabilitation programs created within Veterans Administration hospital systems * Government programs and funding * Addressed needs of chronically ill populations * Hill-Burton Act of 1946 “provided federal aid for the construction of rehabilitation centers” (p. 19) * In 1965, Medicare and Medicaid were initiated to ensure access to rehabilitative services for the chronically ill, the community, and the institutionalized

Answer 76

* Goal of “return[ing] to the fullest physical, mental, social, vocational, and economic functioning as possible” (p. 39) * Interventions increase a client’s abilities by: * Facilitating participation in tasks with assistive devices and technologies * Education on compensation (e.g., sock aid for lower body dressing, coping strategies to counter obsessive-compulsive disorder symptoms) * Remaining focused on meaningful occupational outcomes “engagement in occupation through alternative means” (p. 39)

Answer 77

The biomechanical FOR focuses on the physical state of a person and their sometimes immutable biological processes. The rehabilitative FOR takes biological aspects into account, but focuses more on adapting and restoring function than addressing physical processes. However, because both are closely related - in that they both account for biological processes and have goals of addressing functional outcomes - they are often used in conjunction in research.

Answer 78

Pros… * Easier to gather quantitative data * Support from medical community * More research on physical rehabilitation * Reimbursement favors measurable results …and Cons * Tend to focus less holistically * More medical model, less focus on function * Addresses symptoms rather than whole the person or situation

Answer 79

* Is effectiveness increased when these FORs are coupled with other models? * Would there be increased support for OT in the medical community because of easier-to-present data? * Is this the only concrete means of justifying reimbursement?