Occupational Therapy (OT) is a health profession recognized by law (Law 44/2003 of 21 November on the Regulation of Health Professions); entry to occupational therapy practice requires specific university-level education. Occupational therapists, as members of transdisciplinary teams working in health and social settings,have direct contact with people with different types of disabilities, different levels of dependency or functional limitations, and/or with people who are restricted in their social participation; therefore, the implementation of OT interventions has a direct effect on the health, personal autonomy, and quality of life of people.

Occupational therapy occupies a privileged position in the rehabilitation process: when addressing activities of daily living (ADLs), it is necessary to coordinate physical, cognitive, emotional, and behavioral aspects to achieve the patient’shighest level of function⁽¹⁾.

Occupational therapy is regulated by different laws and regulations. Article 7 of the Law on the Regulation of Health Professions defines the role of occupational therapists as follows: “Occupational therapists are university graduates in occupational therapy responsible for implementing techniques and carrying out activities of an occupational nature to enhance or compensate for diminished or lost physical or cognitive functions, and to guide and increase development of such functions”⁽²⁾. If, on the other hand,we take the consensus definitions across the European environment such as those of the ENOTHE terminology group⁽³⁾, the term “occupation” is defined as such: “A group of activities that has personal and socio-cultural meaning, is named within a culture and supports participation in society. Occupation can be categorised as self-care, productivity and/or leisure.” For an activity to be understood as therapeutic, it must have a series of characteristics, including the following:

Characteristics

• Be goal-directed
• Be meaningful to the client
• Be a suitable tool for the prevention of dysfunction, maintenance or improvement of function, skill, and quality of life
• Promote client participation in activities of daily living
• Be determined by the occupational therapist professional judgment based on knowledge of the pathology, specific procedures, interpersonal relationships, and the specific value of such activity.

In view of the above aspects, occupational therapy can be defined as a set of techniques, methods and procedures to—through activities used for therapeutic purposes—prevent disability and maintain health, promote restoration of function, compensate for deficits and assess behavioral responses and their importance for achievingtheindividual’s maximum level of independencein activities of daily living, both basic and instrumental, and the possible reintegration of the individual in each of several dimensions:physical, psychological, cognitive, emotional, social, and career.

On the other hand, in 1968, the American Occupational Therapy Association (AOTA)defined occupational therapy as such ⁽⁴⁾: “The art and science of directing man’s response to selected activity to promote and maintain health, to prevent disability, to assess behavior, and to treat or train patients with physical or psychosocial dysfunctions.”

Goals and functions of occupational therapy

Thegeneric goals pursued in the practice of occupational therapy are: disability prevention, health promotion (COTEC, 2012) and the achievement of an optimallevel of functioning in those individuals whose function is reduced or impaired by injury, physicalor mental illness, dysfunctional condition, developmental or learning disabilities or adverse contextual factors.

Occupational therapy includes four major concepts ⁽⁵⁾ that define it as a profession and define the overall goals of its intervention:

• Occupational therapy is a health-related profession using selected activity to prevent and overcome many physical, emotional or social disabilities in people of all ages. The objective is to promote, maintain and/or restore functional independence in daily living skills.
• Occupational therapy is concerned with human occupation and its importance in health for persons of all ages. Occupational therapists evaluate the physical, psychosocial and environmental factors which reduce a person’s ability to participate in everyday activities of occupation.
• Therapeutic objectives are achieved through techniques or activities designed to:
  • Diminish and control pathology
  • Restore and/or reinforce functional capacity
  • Facilitate learning of skills and function essential for adaptation to the environment
  • Promote and maintain health
• Occupational therapy is a health profession which teaches,maintains, and promotes competent behaviourin the areas of daily living, learning and working to individuals experiencing illness, developmental deficits and/or physical and psychological dysfunction or who are otherwise at risk.

Promotion of health and well-bein

Occupational therapy is a profession based on the promotion of health and well-being through occupation, which is its core concept, and whose primary goal is to enable people to participate in activities of daily living. To this end, occupational therapists have a broad education in the skills, abilities and capacities of humans related to their participation in a variety of activities and contexts, as well as inthe interactions that occur between these elements in people with limitations or impaired body structures, which hindertheir participation in the occupations of everyday life.

On the basis of the above, the roles of occupational therapists in the departments of physical medicine and rehabilitation include: re-education and training in the basic and instrumental activities of daily living;development, remediation, or compensation of cognitive, perceptual, neuromuscular, sensory-motor functions and behavioral skills, among others;the design, fabrication and training in assistive technology (adaptation and training in positioning devices and wheelchairs, for example); the evaluation, consultation, and application of ergonomic principles, and adaptation to physical and sensory environments (e.g.: architectural barriers, adaptation to the workplace environment, etc.).

Disability prevention

Occupational therapists provide services in disability prevention, activity limitation, and participation restriction. The primary goal of occupational therapy is to enable peopleto participate in the activities of everyday life ⁽⁶⁾. More specifically, the goals or aims of occupational therapy are:

• Disability prevention: occupational therapists help clients avoid problems in activities of daily living, prevent occupational dysfunctions, prevent future injuries or diseases in occupational performance, and participate in projects and actions aimed at the prevention of disability at the community level.
• Evaluation of performance components of activities of daily living from a specific and global perspective: occupational therapists perform functional assessments of both joint range of motion and muscle strength, assess functional limitations, analyze everyday gestures, evaluate sensory, perceptual, cognitive and behavioral capacities related to activities of daily living,assess social skills,and evaluatehome and work environments.
• Maintenance, acquisition, improvement or restoration of the components of activities of daily living: improving mobility,strength, coordination, and dexterity;increasingpain threshold andpain tolerance; teaching compensation techniques for lost or impaired functions, range-of-motion exercises and energy conservation techniques; developing functional residual capacity; evaluating residual functional capacity; fabricating, fitting and training in the use of prosthetic and orthotic devices; improvingadherence to medical treatment;helpingclientsenvision their possibilities for improvement and achievement offunctional independence;working to maximize independence in activities of daily living;fabricating and training in assistive technology for both basic and instrumental activities of daily living, including the use of mobility devices such as wheelchairs, walkers, etc.; modifying/adapting the work environment; eliminating/adapting architectural barriers; helping clientslive with theirlimitations by providing a realistic and optimistic vision of their new situation, as well as recommending and informing them about interests and occupations.

In short, occupational therapists assist disabled clients to maximize their functional capacities, develop functional residual capacities, compensate for their functional deficits, and achieve their reintegration into the community while achieving the greatest possible degree of independence.

Bibliography

1.- Sánchez Cabeza, A. ¿Qué es un terapeuta ocupacional neurológico y en qué puede ayudarle? In: Guía de Neuroterapia Ocupacional. Ediciones SEN. Madrid. 2016.

2.- Boletín Oficial del Estado. 21340 Ley 44/2003, de 21 de noviembre, de ordenación de las profesiones sanitarias;2003.

3.- European Network Occupational Therapy in Higher Education. European Occupational Therapy Terminology Database. (citado 7 de septiembre de 2009). Available: http://pedit.hio.no/-brian/enothe/terminolgy/

4.- American Occupational Therapy Association: Summary report: 1990 member data survey, Rockville MD, AOTA, 1990.

5.- World Federation of Occupational Therapy. Definitions of occupational therapy, draft 7. August 2005.

6.- Summary of the occupational therapy profession in Europe 2012. Council of Occupational Therapists for the European Countries (COTEC). Update 06/06/2012. Available: www.baot.org.uk.