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Hand Therapy and the Practice Framework

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The 2002 AOTA Representative Assembly adopted a document, "Occupational therapy Practice Framework: Domain and Process", that will lead the practice of OT into the 21st century. It replaces Uniform Terminology (UT III), which educators and practitioners were using to illustrate and explain the practice and domain of OT. Although it will not immediately impact day-to-day operations within the field, the Framework does have long-term implications for practice and will eventually change the way that OTs view themselves and their clients.

UT III explained practice, evaluation and treatment of dysfunction in a list of terms used in the profession that were categorized into areas of performance, components and context. But the document, whose initial purpose was as a glossary, did not explain how treatment should be created, conducted or concluded.

The new Practice Framework does exactly that. We now have a working description of practice that explains how components must be viewed as small parts of the overall function of the client. It demonstrates that "occupations" as a means and an end are the focus of our profession, and are in actuality the only things that set us apart from other disciplines.

Evaluation within the new Framework must include a look into the patient's occupational profile that includes such specifics as the client's interests, values, patterns of daily living and needs. Within the evaluation, one must consider "the client's problems and concerns about performing occupations and daily life activities." Additionally, "the client's priorities are determined."

The second part of the evaluation process addresses the analysis of occupational performance wherein performance skills, patterns, context, activity demands and client factors are reviewed. It is through an integrated analysis of all of these areas, in keeping with the desires of the client, that "targeted outcomes are identified."

Intervention is three-fold and consists of the plan, the intervention and the review. All three sections of this process continually refer back to treatment of the targeted outcomes. In other words, treatment must be created upon and actually include specific attention to those outcomes that have been determined by and include the occupational performance of the client.

The outcome of service, according to the Framework, is now universally described as "engagement in occupation to support participation." In other words, the primary focus of OT is to ensure that our clients can participate fully in life.

The authors of the document did create a passage to protect those who currently practice a "heal now, function later" methodology. The passage states "the profession recognizes that in some areas of practice (acute rehabilitation, hand therapy) occupational therapy intervention may focus primarily on performance skills or on client factors (i.e., body functions, body structures) that will enable engagement in occupations later in the continuum of care."

But a change in hand therapy may perhaps be on the horizon. Educators will be creating a new generation of OT practitioners who will embrace these philosophies because they will see and learn about the power of occupation. Hand therapists of the future may very well choose an occupation-based approach to hand-injured clients because they will view the clients as functional beings who must be immediately assisted in returning to their desired occupations, sometimes before the tissues of the body have healed.

The therapeutic use of self, the integration of body, mind and spirit, and the use of occupations as a means and an end are what set us apart and what will make hand therapy practice and the practice of occupational therapy of the future better than ever.

Deborah Amini, MEd, OTR/L, CHT, is director of the occupational therapy assistant program at Cape Fear Community College in Wilmington, NC. A 1983 graduate of Quinnipiac University, Hamden, CT, she has been a clinical hand therapist for 15 years. Readers may reach her at 910-362-7096 or by e-mail at damini@capefear.cc.nc.us or through ADVANCE at otedit@merion.com.


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