Clinically Oriented Theory for Occupational Therapy

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Clinically Oriented Theory
for Occupational Therapy
Clinically Oriented Theory
for Occupational Therapy

Christopher J. Alterio, DrOT, OTR

Assistant Professor of Occupational Therapy
Keuka College
Keuka Park, New York

&. Wolters Kluwer

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Library of Congress Cataloging-in-Publication Data

Names: Alterio, C. J. (Christopher John), author.

Title: Clinically-oriented theory for occupational therapy /Christopher J.
Alterio.
Description: Philadelphia: Wolters Kluwer Health, [2019] |Includes
bibliographical references and index.
Identifiers: LCCN 2018027353 |ISBN 9781496389534 (paperback)
Subjects: |MESH: Occupational Therapy |Models, Theoretical |Clinical
Medicine
Classification: LCC RM735.3 |NLM WB 555 |DDC 615.8/515—dc23 LC record available at
https://Icen.loc.gov/2018027353

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Foreword

have known Dr. Chris Alterio for many years, primarily through our work together
on a variety of projects associated with the National Bond for Certification in
Occupational Therapy. I know him to be a clear thinker, a master clinician, and an
exemplary educator. With this text, he has written one of the best and most informative
textbooks on occupational therapy theory available today. This book is a must-read for
students learning the basics of their chosen profession and for clinicians struggling to un-
derstand the myriad theoretical models on which they can base their practice. Educators
will applaud this effort, which provides clear descriptions of past and current conceptual
models for practice.
Dr. Alterio has undertaken the task of identifying prominent theoretical models and
organizing them on the basis of paradigms and paradigm shifts throughout the history of
the profession. He traces the historical roots, influences, and rationale for paradigm con-
sensus and crisis, from the initial paradigm of occupation to medical model reductionism
to paradigm crisis resolution.
He clearly advocates occupation-based approaches to practice, along with Reilly's
NOBA principle, which acknowledges the importance of not only biomedical levels
of concern but also biosocial levels of concern. The biomedical level provides valuable
treatment methods associated with improving disabling conditions. The biosocial level
provides occupation focus with treatment methods targeted at improving play, work, skill
development, productive participation, and social engagement.
I applaud Dr. Alterio for a clear presentation of Dr. Reilly’s contributions to the
biosocial core of occupational therapy knowledge. I was one of Dr. Reilly’s graduate
students at the University of Southern California and, along with my colleagues in the
program, contributed to the knowledge base in the evolving occupational behavior frame
of reference (as Reilly termed it at the time). We studied literature predominantly drawn
from the behavioral sciences on the broad areas of play, work, intrinsic motivation, rules,
interests, time, occupational choice, and occupational role behavior through the life cycle.
Clinically, we did occupational and play histories to identify skills and achievements in
good order and deficit areas needing intervention. We constructed play and productive
work environments in our practice settings as we strove to develop skills of the individuals
we treated. Dr. Reilly would say: “Skills are to OTs what pills are to MDs.”
Dr. Alterio presents thorough descriptions of prominent practice models and de-
scribes how they can be integrated into an occupation-based model. The chapters overall
are informative, clear, easy-to-follow, and well referenced. Of particular interest are his
vii
viii Foreword

fascinating accounts of the key events, individuals, and cultural forces that influenced
the formation and growth of occupational therapy practice and education. This text also
includes thoughtful discussions of contemporary issues related to public health, occupa-
tional science, ethics, and the globalization of the occupational therapy profession.
The individuals with whom we work cover the entire age span and have significant
insults to their minds and bodies because of illness, injury, deviations in development,
and/or poor living conditions. They share the commonality that engagement in meaningful
and purposeful daily occupations is significantly impaired. Individuals in our caseload,
whether in hospitals, rehabilitation centers, schools, or community facilities, present many
challenges. It is critical and very practical to adopt a sound conceptual model to guide the
complexities of occupational therapy practice.
Dr. Alterio offers students, instructors, and practitioners a lively discussion of relevant
topics enhanced by his unique perspective based on 30 years of practice and 15 years as
an educator. This excellent text deserves wide readership encompassing both educational
and professional circles.

Linda Florey, PhD, OTR/L, FAOTA

Former Chief, Rehabilitation Services
Resnick Neuropsychiatric Hospital at UCLA
Los Angeles, California
Preface

n occupational therapy, theory is important because it tells us what to expect. The-

ory is a framework for practitioners because it provides a structure for perceiving
and solving problems. Theory is a framework for educators who conduct research
to validate practice approaches and pass on knowledge to students who will be future
practitioners. Theory is a framework for the public feos it represents the profession’s
social contract and establishes guidelines for what people can expect from its practitioners.
Our profession sometimes lacks agreement about how and when various practice
theories are applied. That may be partially due to the wide range of practice areas in which
occupational therapists work. The demands of a pediatric intensive care nursery are very
different from a clubhouse for adolescents with substance abuse problems or a home
environment where someone is trying to arrange care fora parent with dementia. Occu-
pational therapists work in all these settings and many others, but without theory, practice
devolves into pragmatic and context- medic methods that can lack central coherence.
I wrote this book with the aim of addressing this concern. In more than 30 years of
practice, I have worked in many different settings and have seen many approaches to
providing occupational therapy services. Over the course of my career, there have been
numerous changes to health care systems, and occupational therapy became a worldwide
profession. I’ve witnessed the profession’s struggle to emerge into a Third Paradigm and to
integrate its scientific advances while maintaining a focus on the core value of occupation.
When I was a student, my mentor, Kent Tigges, told me that every person who
needed my help would be a test for the profession’s central premise as articulated in
occupational behavior theory. I was gifted with that educational heritage, and in many
settings and in providing intervention to thousands of people, I learned repeatedly that
when we understand the complexity of people’s needs and the impact of broad systems
on occupations, our services can be coherently directed, effective for problem solving,
and, most importantly, meaningful to those we serve.
This text builds on that simple formula: that we should be not only concerned with
our basic science, but also constantly mindful of how that science impacts the person,
family, community, and society related to occupation. This integration constitutes the
science and art of occupational therapy practice.
The book is primarily intended to be used as a college-level textbook, particularly for
courses dedicated to theory and the development of the occupational therapy profession.
It is also designed to be helpful for practicing clinicians who are interested in reviewing
theory to support an integration of practice approaches.
ix
Preface

This text is divided into three parts. Section 1 provides important historical information
about the profession’s philosophy and core values. This material serves as a foundation for
understanding paradigm changes that occurred over time and how the field has evolved
into its current state as a care-providing profession. Section 2 includes discussion of im-
portant approaches and models and how they can be integrated in clinical practice. Section
3 includes an exploration of emerging practice and new practice models, including a call
to critically reflect on how these ideas apply in everyday practice settings.
Each chapter includes learning objectives, key terms, and review questions to help the
reader organize study and reinforce understanding of the material. Individual, small-group,
and full-class learning activities are provided to encourage research and critical-thinking
skills. Selected chapters include case studies and case study questions to facilitate mak-
ing the connection between theory and practice. All chapters include references listing
relevant supporting literature.
Occupational therapists frequently find themselves in a position of needing to explain
the nature and scope of their services. My hope is that this book can also contribute to
clarifying our role by providing a concise overview of what practitioners, educators, and
the public can expect from occupational therapy.

Christopher J. Alterio
Acknowledgments

riting a book is a team-oriented occupation, and I am grateful to so many peo-

ple who made this project possible. Thank you to Michael Nobel, for seeing
merit in my original idea and for introducing me to the wonderful team of
professionals at W olters eines Thank you also to Kerry McShane and Amy Millholen,
whose encouragement and support helped keep this project on target.
I want to express extra special thanks to Tanya Martin, my development editor, whose
guidance and feedback was instrumental in shaping this text. You never know how much
you need a development editor until you work with someone like Tanya. I can’t thank
her enough.
Tam very grateful for all the content reviewers who provided excellent feedback and
suggestions for improving the book. I appreciate the efforts of so many people who helped
with photographs: my dear friend Dee Berline, Nicole Schmidt from ABC Therapeutics,
who helped hold the fort and provide assistance with photos, and Clare Bye from Imprint
Hope for her photos and inspiration. Thanks also to all my other family members, friends,
and patients, who made important photographic contributions. Thank you so much!
I am very grateful for the contributions of my Keuka College occupational therapy
graduate students. Emily Good led the team with obtaining permissions for photographs
and illustrations, and I need to credit Brittany Mendel ea Ashlee Lytle for helping to
unearth historical documents and photos long forgotten in library ar chives. These students
and many others provided important support for researching the history chapters.
I want to thank the occupational therapy faculty at Keuka who thought it would be
interesting to add the extra challenge of Division Chair during an pc taen year to
my responsibilities as I was writing—but their unending support and friendship made
it all possible. I am privileged to work with this faculty, and they provided a lot of feed-
back, encouragement, and laughs along the way. Of course, the keystone of my Keuka
family support is Sandy Teague, whose everyday administrative wizardry allowed me to
multitask and actually have an appearance of competence. I could not have written this
book without all this support.
There are so many intangible acknowledgments that I want to make. | am thankful to
my first occupational therapy theory instructor, Phillip Shannon, who carried the intellectual
heritage of Mary Reilly into his own classroom and passed it along to his students. Iam
forever grateful to my mentor and friend, Kent Tigges, who showed me how to take the
concepts of occupational behavior and put them directly into practice. Another mentor

xi
xii Acknowledgments

and friend, Peter Talty, provided me with many professional opportunities that supported
my ability to take on this project.
Tam thankful to all my friends and colleagues at the National Board for Certification
in Occupational Therapy (NBCOT). Over many years of volunteer work, I have been men-
tored and supported by so many knowledgeable colleagues and leaders—too numerous to
count—but their cumulative impact on my professional development is beyond measure.
In particular, I am very thankful to Linda Florey, another of Mary Reilly’s students, who
was so gracious with her willingness to write a Foreword. I met Linda during my work
with NBCOT. She has been a professional and leadership inspiration, mentor, and a good
friend. It is an honor to have her contribute to this effort and represent the intellectual
heritage that serves as the foundation of this book.
I also want to thank the many occupational therapy colleagues who have been so
willing to engage in conversation and debate in person and online and who have helped
me with my critical thinking and professional growth. All these experiences are written
between the lines of this book.
Finally, I want to thank my family and, in particular, my wife Caroline. Her unending
love and willingness to endure the obsession required to produce a textbook made this
possible. She is my foundation, and everything she does makes it possible for me to do
everything that I do.
Reviewers

Alma R. Abdel-Moty, Dr.OT, MS, OTR/L Cassady Hoff, MS

Clinical Associate Professor Occupational Therapy Assistant Program
Academic Fieldwork Coordinator Director
Nicole Wertheim College of Nursing and School of Health Science
Health Sciences Casper College
Florida International University Casper, Wyoming
Miami, Florida
Veronica T. Rowe, CBIST, MS(R), PhD,
Karen Brady, D.Ed, OTR/L OTR/L, FNAP
Assistant Professor Assistant Professor
Department of Occupational Therapy Department of Occupational Therapy
The University of Scranton University of Central Arkansas
Scranton, Pennsylvania Conway, Arkansas

Elizabeth Cara, PhD, OTR/L, MFCC Linda S. Russ, PhD, OTR

Professor Emerita Assistant Clinical Professor
Department of Occupational Therapy Occupational Therapy Department
College of Applied Sciences and Arts D’Youville College
San Jose State University Buffalo, New York
San Jose, California
Aricka Schweitzer, MSOT, OTRL, C/NDT
Paula Carey, OTD Assistant Professor of Occupational Therapy
Associate Professor of Occupational Therapy Saginaw Valley State University
Utica College University Center, Michigan
Utica, New York

Gregory Chown, OTD, OTR/L, BHSc(OT),

BA, CPAM, CKTP
Associate Professor
Occupational Therapy Program
Alvernia University
Reading, Pennsylvania

xiii
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Contents

Foreword
Preface
Acknowledgments
Reviewers

Section 1 Development and Growth of the Occupational Therapy Profession 1

1. Key Concepts and Core Values

2. The Historical Context of Occupational Therapy
3. Twentieth-Century Paradigm Shifts

Section 2 Theory-Driven Approaches to Practice 53

4. Modern Occupation-Based Approaches

5. Occupation-Based Models: From Theory to Practice
6. The Biomechanical Model
7. The Sensory Integration Model
8. Cognitive Behavioral Models
9. Motor Control and Motor Learning Models

Section 3 The Future of Occupational Therapy 165

10. A Public Health Perspective

11. Occupational Science and Occupational Therapy
12. The Globalization of Occupational Therapy
13. Ethics and a Changing Vision

Glossary
Index

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