Occupational Therapy, What is it?

Most common questions asked by the people about Occupation Therapy include:

Do you help people find jobs? No, we do not help people find jobs. ‘Occupation’ refers to the activities that you complete in your everyday life. Anything that “occupies” your time is an occupation. We help people who are experiencing barriers to activity completion; these barriers vary drastically (disability, illness, role transition, etc.). Wow! This means the therapy we provide can vary dramatically from person to person!

What do you do as an occupational therapist? We help individuals that have difficulty doing the daily task or have had an injury/disability that prevents the person from doing their daily activities. Occupational therapists provide therapeutic exercises and safety methods for daily living activities.

What does Occupational therapy practice consist of? Occupation therapy is therapy and support for ‘occupation’ or ‘daily activities. Anything that ‘occupies’ a person’s time during their day (this can include getting dressed, going to work, walking, bathing, eating, care taking and tasks that allow a person to engage in their environments).

So what is Occupational Therapy?

Occupational Therapy is known as the 'art and science' of enabling engagement in everyday living through occupation (Townsend & Polatajko, 2007).

Occupational Therapists work from a top down approach, we believe that well-being and health is not just the absence of disease but also the ability to perform all occupations that we need to and want to in our day to day lives. All aspects (physical, emotional, psychological, social, occupational, environmental and spiritual) of a human are examined and where these aspects connect - well-being and health exists. These aspects create a whole being, and thus our work is considered to be 'holistic' and client centered. The body and mind need to be considered together. It is an integrative outlook to understand the client and the therapist looks at every factor that may affect the client’s well-being. Occupation therapist listens to the client’s story, the concerns/issues, develop treatment goals based on the client’s story and concerns, and develop proper interventions specific to each goal.

Occupational Therapy around the world: Evidence based practice was a huge focus of occupational therapy beginning in 1967. It became a regulated program, and now is a Master’s only program.

In the US by 2027 entry level requirements for occupational therapy will be a doctorate degree.

Occupational therapy is evolving and occupational therapists are reengineering “their objectives and goals to include new skills to enhance therapeutic application and theoretical principles and to learn administrative skills, business skills and business ethics.” (Ellenberg, 1996).

A health promotion frame of reference is increasingly emphasized to address the health of populations rather than simply at the individual level (Lamb, 2017; Scaffa, Reitz, & Pizzi, 2010).

Occupational Therapists: The expert in empowering occupation: The main job/goal of an “expert in empowering occupation” is to use the information that is collected based on the client’s day to day activities, to ensure that carryover of skill occurs (CAOT, 2012). The goal of the “expert in enabling occupation is to follow six guidelines that can be reviewed on the CAOT website.

Maternal Care and Occupational Therapy:

Maslow’s Hierarchy of Needs outlines a five level pyramid in which health, food, and sleep are at the foundation and self-fulfillment is at the top. Without achieving basic needs (food, rest, health, sense of safety, and support), it is difficult to achieve higher needs that contribute to a sense of self. In the postpartum period, all levels of this pyramid undergo drastic change (Center for Integral Pregnancy, 2020). Occupational therapists have profession-specific skills and knowledge to address challenges that occur at each level of need.

Image gathered from: https://www.simplypsychology.org/maslow.html

Examples demonstrating the role of OT include (Slootjes, McKinstry & Kenny 2016):

• Addressing postpartum issues and impact of pregnancy symptoms on occupational performance (the ability to choose, organize and satisfactorily perform meaningful occupations). • Addressing psychosocial, physical, and emotional needs • Addressing co-occupations (including breastfeeding difficulties) during perinatal care by promoting mother-infant bonding • Promoting positive self-efficacy, self-confidence, and self-acceptance • Facilitating successful transitions to reduce maternal role strain • Improving muscle strength, postural alignment, body image, and regulation of blood pressure • Proper ergonomics in caring for children to reduce musculoskeletal symptoms • Improving emotional wellbeing through a holistic health outcome through client-centered occupational participation • Stress/ anxiety management, relaxation techniques • Returning home to resume family-centered routines • Referral source for other services

The domains and areas of function for an occupational therapist: The domains and areas of function listed below are not all inclusive, but an example of how an occupational therapist contributes to maternal health. These examples have been gathered and are listed based on the Occupational Therapy Practice Framework: Domain and Process, 3rd edition (AOTA, 2014) and are compiled from Beuning, et al. (2020).

Occupations: Daily life activities in which people engage

• Activities of daily living (ADLs): Activities that are oriented towards taking care of your own body (bathing, dressing, toileting, eating).

• Self-care: Providing support in developing a self-care schedule, providing education regarding care routines for body after vaginal or cesarean delivery. Navigating emotional components and emphasizing the value of self-care.

• Sexual activities: Returning to sexual activities and sense of sexual self by educating and providing relaxation and sensory strategies. Strategies should support increased sexual satisfaction and/or meet relational needs.

Instrumental activities of daily living (IADLS): Activities that support daily life & are oriented towards interacting with your environment.

• Health management and maintenance: Organizing overwhelming amounts of materials from providers into a checklist format

• Home management/meal preparation and cleanup: Identifying supports and contacts to maintain household during the first weeks of the postpartum period.

• Care of others: Supporting transition into the role of motherhood and co-occupations involved in caring for a newborn baby.

• Rest and sleep

• An occupational therapist can help create awareness, practice, and implementation of individualized sleep hygiene routines that consider developmental sleep milestones of infants.

• Work

• Offering guidance in returning to work after maternity leave including navigating ideas of compromise, finding balance between home and work life, work related ergonomics, support changing roles and demands.

• Play/Leisure

• Support can be provided in building new routines and habits to support life balance and engagement in leisure activities as a new mother. In addition, discovering and exploring new interests may promote identity formation and self-esteem.

• Social Participation

• Occupational therapists can help new mothers navigate communication with family members and friends. This might include identifying opportunities for social support to offset postpartum isolation.

Client Factors Specific capacities, characteristics, or beliefs that reside within the person and influence performance in occupations

• Values, beliefs, and spirituality

• Identifying and emphasizing the impact of values, believes, and spirituality guide choice of client-centered interventions to support transition to motherhood.

• Body functions

• Occupational therapy practitioners can provide tools to support awareness of thought patterns and distress connected to physical symptoms in postpartum recovery.

Performance Skills Goal-directed actions that is observable and necessary for engagement.

• Motor Skills

• Occupational therapists can provide ergonomic support for childcare and breast feeding. This would include actively practicing techniques with baby and finding positions that protect the musculoskeletal system and enhance performance

• Process Skills

• Pacing, adapting, and managing expectations of activity performance to support the development of realistic expectations.

• Selecting and sequencing prioritized activities related to self-care and childcare may also support energy conservation and decision making.

• Social Interaction Skills

• Intervention focused on social interactions skills might include finding ways to communicate social needs with partner. Disclosing emotions in supportive environments to foster sense of social connection with other new mothers.

• Focusing on maternal attachment by facilitating enjoyable interactions with baby and peers that lead to an improvement in wellbeing.

Performance Patterns Habits, routines, rituals, and roles that influence participation in activities

• Habits and Routines

• Daily routines and habits can be interrupted by a number of social, emotional, cognitive, and physical complexities in the postpartum period. Occupational therapists can promote balanced and meaningful routines that provide a structure for ADLs and IADLs. This promotes an improved sense of self-efficacy and self-management as a new mother. The transition to motherhood is often overwhelming, causing women to abandon other life routines. This might also include addressing new co-occupations such as bedtime, bathing, and sleeping routines.

• Roles

• Redefining roles and role expectations shift quickly after the birth of a new baby. Occupational therapy practitioners can help women organize and redefine their role as a mother, individual, and/ or partner. This might include education regarding burn out, stress management, and thoughts regarding competence in the role of mother. Seeking social or community support to ease role attainment may also be beneficial in promoting self-efficacy and feelings of accomplishment and control.

• Context and Environments The context and environment refer to the conditions that surround an individual. Contexts include cultural, personal, temporal, and virtual and the environment refers to the commonly thought of social and physical conditions in which occupations occur.

• Occupational therapists can offer recommendations regarding modification to environments to support engagement. This might include addressing ergonomics by introducing pillows and cushions to support breastfeeding positioning. Recognizing the picture society paints of motherhood, and modifying the home environment to support birth related precautions.

• The sensory environment is also critical to address as many mother’s experience sensory sensitivity after birth. This might include introducing new means of coping and organizing routines such as breastfeeding where a mother feels “touched out”.

As women transition into the role of motherhood, they undergo a process of attaining a new maternal identity by adapting to role changes and a new family environment. Feelings of competency in mothering occupations (feeding, playing, rocking, holding, swaddling), joy, and attachment contribute to role attainment (Froehlich et al., 2015). Defining a new motherhood identity may present unexpected challenges due to a changed sense of control, support, and self-perception (Froehlich et al., 2015). Because there is currently little support to promote role and identity attainment, mothers often feel a loss of control or experience grief during this transition period (Cheng et. al, 2006*).

And so here we are, Family Foundations Therapy:

Why Family Foundations Therapy? Our vision is to help mothers who are struggling to adjust to motherhood, learn specific tools and strategies to overcome stress, anxiety and feelings of being overwhelmed so that they can embrace their new identity as a mother with ease and comfort, while being present for their child and family.

By putting a language to the ‘new momma struggle’ we are able to embrace the inner shift that occurs, create better attachments to our babies, have better connections with our partners, family, friends and most importantly OURSELVES, which in turn we can live in calm, in happiness and be present for our world around us. We have a Holistic Approach that’s focuses on empowerment, health education and self-advocacy. Our supports focus on maternal health, infant health and pediatric health.

An Intervention implementation example can include: A Breast feeding intervention could include focus on: mother’s problem solving and generalization of techniques to holding baby, reactions and interpretation of pain, infants oral motor abilities, problem solving breastfeeding difficulties, examining the infants ‘whole body’ to determine if there are other factors impacting feeding (i.e. tight hips, torticollis, etc.), connected or disconnectedness with baby, general posture, feeling “touched out” from feeding, communicating routine disruption caused by the need to feed/care for baby, regulating frustration and stress, managing breastfeeding with work schedule, social norms and expectations of breastfeeding, implications breastfeeding cessation, how social interactions are impacted by breast feeding (Beuning, et al. 2020).

Interprofessional collaboration provides opportunities for new mothers to receive psychosocial care that directly compliments existing services. As health care professionals, we have an overdue responsibility to proactively address the interconnected physical and psychosocial experiences in the postpartum period. When practitioners across disciplines embrace each other’s strengths, they can become a powerful team, helping to transform the vulnerable time of new parenthood into the joyful and fulfilling experience it is intended to be (WHO, 2010).

The postpartum period is a complex time of physical, emotional, psychological, occupational, and environmental change that demands interdisciplinary collaboration.

Janelle Daku MSc.O.T.R. Reg. Sk. Maternal Health, Family Health, & Infant/Pediatric Occupational Therapist & Asiane Séïde OTA/PTA student

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