The Importance Of Occupation In Therapy

Occupations are a part of everyday life and may even form a part of a person’s existence. The occupation discussed is not necessarily one’s career choice but according to Kielhofner’s it is “the doing of work, play or activities of daily living within a temporal, physical and socio-cultural context that characterises much of human life” (1). Kielhofner emphasises the importance of occupation, however one cannot fully understand the importance of occupations until they have seen the impact it has on people. Occupations are also more personal and refer to long term goals. In this essay I will be reflecting on two events where the importance of occupation to occupational therapy is clearly evident. I will also be integrating theories from other subjects taken during the year.

The first event was in the beginning of the year when we first started learning about occupations, occupational performance and activities healthy. Occupational performance refers to the ability to do certain tasks or activities; it can also refer to how well a person can do a task (2). According to the World Health Organisation, health can be affected by not being able to perform activities, hence being unable to perform occupations (2). This was an immediate light bulb moment for me as I thought of my grandfather, who had a terrible stroke where a large portion of his body was paralysed resulting in him being bed-ridden and not being able to the activities that he used to do. Being unable to do anything lead to him becoming depressed and his health quickly deteriorated.

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We also learnt that health is not only affected by being able to do occupations but also by the balance between the areas of occupation. Areas of occupation refer to life activities such as activities of daily living, survivals skills, rest and sleep, education, work and play. Every single person takes part in most of these occupations and they cannot function without most of these areas. If there is a balance between these areas then a person can be considered activities healthy and that they have a balanced lifestyle. However, if there is a lack of balance in these areas it can also cause problems which I have personally experienced due to being ignorant at the time.

During my first year of Biomedical health science in 2009, I was what occupational therapists would call “activities unhealthy” as I had a lack of balance in my life where I spent too much time on my studies and neglected the other areas of my life such as sleep and leisure. My weekdays consisted of varsity during the day and studying at night until the early hours of the morning. This lack of sleep prevented my body and mind from rejuvenating (2). This sleep deprivation lead to me being irritable and having a lowered attention span which in turn affected my studies (3). My weekends were spent studying and doing projects which meant that my leisure activities were neglected and I had no form of relaxation or de-stressing. My stress levels increased and my immune-system was lowered resulting in bronchitis for three weeks. At the time, I did not associate my poor health with the unhealthy lifestyle and stress but now I have an understanding of activities healthy from an occupational therapy point of view as well as an understanding of stress and how it is related to health from a psychology point of view (4). With this understanding I have realised the errors of my ways and no longer take sleep or leisure for granted which both aid in reducing high stress levels. For one to fully understand how stress can affect health it is best to review what is learnt in both psychology as well as understand the biological processes of the body.

According to the British Medical Association, stress is “any interference that disturbs a person’s mental and physical well-being” (3). Stress can be harmful if it is prolonged and can contribute to poor health and decreased productivity (5). Stress can be categorised into short term and long term stress. Short term stress refers to an immediate threat or challenge. This normally results in a bodily reaction where the production of hormones, such as adrenaline and cortisol, are increased therefore leading to changes in heart rate, blood pressure and metabolism (3). This response is referred to as the fight or flight response and occurs regardless of what the threat is furthermore it is vital for one to be able to immediately address the situation (5) . Short term stress in not harmful but if it persists it can be transformed into long term stress that could be detrimental. Long term stress can be best explained by Seyle’s General Adaption Syndrome (GAS) which consists of three stages (4).

The first stage is the alarm stage which similar to the fight or flight response and occurs when one feels under threat. During this stage the body releases the hormones adrenaline, which speeds up some body processes and slows down others, and cortisol which suppresses the immune system in order for one to cope with the stress (6). If the stress continues then the person will move to the second stage, the resistance phase. During this stage the body continues to produce hormones causing the body to have a high level of fight or flight hormones which can damage internal organs and make one vulnerable to diseases (5). According to Coon and Mitter, during this phase the body also stabilises and most of the alarm symptoms fade away, however it also leads to the person being unable to cope with any additional stressors (4). If the stress persists even further then one will enter the final stage, exhaustion. During this phase all the body’s resources are depleted and in my case I was mentally and physically exhausted which in the end affected my ability to achieve my desired marks which lead to me reducing my sleep and leisure time as well as me being sick for three weeks (5).

During the course of the year, I have also learnt that activities healthy is different for each person and varies according to age, gender and context. For example, a student like me is supposed to have a large portion of my day spent on studies but for a child a large portion of their day is meant to involve playing (7). Play is an area of occupation for a child and very important for their development.

The play section of this year was a very enlightening section for me as I work with children of various ages and have younger siblings. Understanding the importance of play was demonstrated by both occupational therapy and psychology. From an occupational therapy point of view play is an essential part of the therapeutic process and is the best way to rehabilitate children as well as improve any lacking skills. While doing field work, I observed my fourth year executing a facilitated play session with paint. The child sat on a form of a tube pipe which forced the child to keep their own body upright which helps strengthen the abdominal muscles. The child had a tub of paint on each side of their body, each one a different colour, and had to reach with the opposite side hand to use the paint. For instance, the blue paint was on his right hand side and he had to use his left hand to reach for the paint and use the fingers on his left had to paint with. This develops bilateral movement as well as strengthens the child’s core. Watching this play session made me realise how play allows the therapist to achieve their goals of improving the skills that the child lacks with the cooperation and enjoyment of the child. Psychology also emphasises the importance of play stating that activities involved in play such as running, throwing and jumping can improve gross motor skills faster and plays a part in fine motor development (8).

Personal observation of my siblings gives a clear understanding of play as there was a definite adverse effect to having a lack of play. My brother who is now seven years of age has poor muscle tone and poor hand eye-coordination as he is unable to hold a bat up for long periods of time and is unable to hit a ball that is thrown towards him. This lack of physical development is due to a lack of active play and watching way too much television. Now if you had to compare my brother with my cousin, aged six, who is a lot more active and plays outside a lot more, as he is not allowed to watch TV during the day. My cousin has very good gross motor skills, normal muscle tone and good hand-eye coordination. This clearly depicts the impact that play has on a child’s physical development.

Play does not only develop motor skills but also develops a child’s social and cognitive skills; this is however is dependent on the type of play. Social skills can be developed by playing in groups or doing role play where a child learns about roles and cultural norms (9). For example, when I was babysitting a four year old girl, we decided to play with plastic vegetables and other foods. She immediately decided that she was going to be the mother and I was the child. She proceeded to dish up a plate of vegetables and instructed that I had to eat them all or I will not be allowed to eat any dessert. This form of play allowed her to explore the role of a mother and explore what it is like to exercise authority. Cognitive skills can be developed through symbolic play, such as mental games, as well as constructive play like arts and crafts (9).

As an occupational therapist it is vital for us to know a person’s occupation as well as the associated activities. It is also important to understand the significance of a person’s occupation, for example knowing that play is vital for a child’s development, as well as the significance of being able to do the associated activities, as demonstrated in the case of my grandfather. Understanding the concept of balance between various occupational performance areas is important because without balance it could affect a person’s health and well-being. Hence having knowledge and understanding is so imperative to occupational therapy and without it we cannot provide effective therapy.

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