Occupational Therapy

1. Occupational Therapy 1940 - 1969

2. The 1940s • World War II- increased demand for OTs • Changes in Occupational Therapy Education • The Structure and Focus of Occupational Therapy • Medical Advancements • Important Individuals: Clare Spackman, Helen Willard, Wilma West

3. World War II • Large numbers of injured soldiers • Women working

4. Growth in OT schools • Accreditation • Expansion- 1947: USC introduces first Master’s Degree program • Revision of Essentials for accreditation • More flexibility in specialties

5. Occupational Therapy • Move away from Arts & Crafts Movement • Positive attitude towards work • Patients are motivated through personal interests & material goods • Goals: • 1. Meet person’s interests and abilities • 2. Use activity with physical/mental objective

6. Medical Model • Disability is deficiency or abnormality • Disability is negative • Disability is in the individual body • Remedy for disability-related problems: cure or normalization • Change strategy: surgery, medication, medical technology and intervention • Agent of remedy: the professional • Independence seen as individual physical, cognitive, and mental ability to perform and capacity to make decisions • (Willard & Spackman, p. 871)

7. OT Practical Design • Medical model & influence on field of occupational therapy • Self-repair activity discounted in favor of conceptions in psychology, physiology and anatomy • Redefinition of mission & emergence of a new paradigm

8. 1940s Advances in Medicine • Antibiotics- penicillin and streptomyocin • Vaccinations- eradication of many childhood diseases • Improvement in quality of healthcare • Federal government funds research and passes laws regarding delivery of healthcare • Life expectancy increases

9. Wilma West • Head of orthopedics occupational therapy at the Walter Reed General Hospital 1943-4

10. Helen Willard & Clare Spackman

11. Publication of the first OT textbook in 1947

12. IT’S QUIZ TIME!

13. The 1950s • Post-war Effects • Social Context: Women’s Roles, Civil Rights Movement • Polio Epidemic • The Structure and Focus of Occupational Therapy • Treatment of Mental Health • WFOT • Important Individuals: Sister Elizabeth Kenny

14. Post-war Effects • Baby boom • Economic prosperity

15. Women’s Roles • Housewife- ideal of femininity • Discouraged from working • Continued to work, mostly in low paying jobs (“pink-collared work”)

16. Civil Rights Movementearly 1950s • Korean War- desegregation of armed forces • 1954: Brown v. Board of Education- Supreme Court rules segregation unconstitutional, desegregation of schools • Non-violent protests • Civil disobedience • 1955-56: Rosa Parks and Montgomery Bus boycotts

17. Poliomyelitis • Known as Infantile Paralysis • Most cases of polio are symptom-free • When the virus enters the blood stream, it attacks the CNS • causes muscle weakness & paralysis of the legs • Bulbar polio affects nerves responsible for breathing, swallowing and speech

18. Polio in the Media

19. “Plague Season” • In 1952, there were 57,000 cases of polio in the US • Targeted children from 5-9 years old • 21,000 permanent paralysis • 3,000 deaths • 1955: the Salk Vaccine is distributed in mass quantities • Children of the 1950’s are today’s baby boomers

20. OT Practical Design • The Mechanistic Paradigm emerges • More Freudian-based psychological treatment of patients • Disability viewed as abnormal expression of repression within • Incorporation of neurological knowledge into practice

21. OT Methodology Change • Practice of splinting and prescribing adaptive devices flourished • Discrete analysis of requirement needed for activity • Emphasis on the patient returning to healthy functioning • Respect for objective measurement and scientific precision gained • Functional knowledge related to internal processes and body structure applied

22. Working with Mental Patients • Do not work on causative factors of behaviors—correct symptoms • Do not stress activity over relationship with patient • Use graduation & persuasion to overcome distasteful habits • Select tasks within ability level to assure success • Give patient choice of activity • Develop patient’s sense of responsibility • Hold “community sing”

23. Video • Mental Health Rehabilitation in 1950s

24. World Federation of Occupational Therapists • Founded in 1952 • 1959: WFOT entered into relations with WHO Mission: • To promote occupational therapy as an art and science • To develop and use occupational therapy worldwide • International cooperation

25. WFOT Focus Program Areas: Education & research Standards & quality International Cooperation Executive programs Promotion & development

26. WFOT 1952 USA • United Kingdom • Canada • South Africa • Sweden • New Zealand • Australia • Israel • India • Denmark

27. WFOT 1969 USA • United Kingdom • Canada • South Africa • Sweden • New Zealand • Australia • Israel • India • Denmark • Belgium • France • Germany • Netherlands • Norway • Philippines • Portugal • Switzerland • Venezuela

28. 1950s OT changes • 1956: Certified Occupational Therapy Assistant (COTA) position created • 1958: Pi Epsilon Theta founded at UNH

29. IT’S QUIZ TIME!

30. The 1960s • Social Context: Civil Rights Movement Continues, Women’s Empowerment • The Structure and Focus of Occupational Therapy • Medicare/Medicaid • Important Individuals: Gail Fidler, Mary Reilly, Wilma West, Elizabeth Yerxa, A. Jean Ayres

31. Civil Rights Movement • Presidents Kennedy and Johnson set tone by making civil rights a priority of their administration • Nonviolent protests continue • 1960: sit-in protests • 1964: Civil Rights Act passed- outlaws discrimination based on race

32. Women’s Liberation Movement • 1964: Civil Rights Act- outlaws sex discrimination • Empowerment of women • More educated • More economically secure • More willing speak up about their ideas

33. OT Practical Design • Occupational therapy clarified in accordance with the medical model • Pathological conditions better understood • Use of technology to intercede with dysfunction increased

34. OT Practical Conflict • Field in conflict • Occupational therapy had turned from holistic foundation toward concrete scientific rationale • Interventions mechanized, losing meaning in favor of achieving purpose

35. Call for a new Paradigm? • Occupational therapy valued with respect to conformity with the medical model • Many therapists had difficulty adjusting to the approach of the medical model • Practitioners not united • A realization that the profession needed to ameliorate its differences was recognized

36. Wilma West • President of AOTA from 1961 to 1964 • Wanted to address changing needs of society and adapt OT accordingly • Wanted OT to have a new role of “health agent” in order to focus on prevention in the health care system

37. Mary Reilly • Active in the 1960s • Re-evaluation of mechanistic model • Advocated a more interdisciplinary approach

38. 1960s Changes • More work with pediatrics and developmental delays • Beginning of de-institutionalization • Working to integrate formerly institutionalized clients into society as independent and productive members

39. Medicare/Medicaid • Established in 1965- Inpatient occupational therapy services covered

40. Elizabeth Yerxa • “the scientific attitude is not incompatible with concern for the client as a human being but may be one of the best foundations for acting upon that concern” • Advocate of client choices

41. Gail Fidler • Wanted to recognize the professional commitment to learning, critical thinking, and creativity • Advocated teaching more than just technical skills

42. A. Jean Ayres • Developed sensory integration approach • Influenced by Piaget

43. Influences from the 40s-60s that we see today • Occupation-based therapy • Client has choices • De-institutionalization

44. IT’S QUIZ TIME!

45. Questions?