OCCUPATIONAL THERAPY

INTRODUCTION

Occupational therapy is the application of goal-oriented, purposeful activity in the assessment

and treatment of individuals with psychological, physical or developmental disabilities.
Occupational therapy is a treatment that focuses on helping people achieve independence in
all areas of their lives-can offer client with various needs positive, fun activities to improve
their cognitive, physical, and motor skills and enhance their self-esteem and sense of
accomplishment.

DEFINITION
Occupation therapy defined as a profession concerned with promoting health and well being
through occupation.
Occupational therapy is the application of goal oriented purposeful activity in the assessment
of individual with psychological, physical or developmental disabilities.
-Susan B Fine
Occupational therapy is defined as "an active method of treatment with a profound
psychological justification. - Clark(1963).

GOAL
 Increasing functioning and independence.
 Maintaining or increasing skills
 Adapting environment to meet the unique needs of an individuals
 To provide intervention.

Indications

 Traumatic injuries (brain or spiral cord)

 Learning problem.

 Autism

 Pervasive developmental disorder

 Mental health or behavioral problems

 Developmental delays.
Therapeutic activities

These are purposeful activities including arts, crafts, recreation, sports, leisure, self-care,
home management and work activities which help to
 Develop or maintain strength, endurance and range of motion.
 Provide the use of voluntary, automatic movements in goal direction tasks.
 Exercise effected parts of the body.
 Identify vocation potential and work training
 Improve sensation, perception and cognition
 Develop social skills

Types of occupational therapy

Any vocation which earns ones livelihood can be used.Therapies commonly used in hospital
as a rehabilitation therapy are pottery therapy, carpentry, candle making, basketting, mat
weaving, tailoring, craft etc.

Process of intervention

It consists of following stages.

1. Initial evaluation of what patient can do and cannot do
2. Development of immediate and long term goals by patient and therapist together
3. Develop therapy plan with planned intervention
4. Implement the plan
5. Call for review meetings with patient and all the staff involved in treatment.
6. When immediate goals have been achieved set further goals and alter the treatment
programme.
7. Highlight the monitoring when the patient is ready to discontinue treatment.

SETTINGS
Occupational therapy is provided in psychiatric units, psychosocial and physical
rehabilitation centers, sheltered work-shops or clinics, special schools for physically and
mentally handicapped, integrated schools, community group homes, community mental
health centers, day care centres, Industrial health unit, halfway homes adeaddiction centres.
Points to be kept in mind
 The client should be involved as much as possible in selecting the activity.
 Select an activity that interests or has the potential to interest him.
 The activity should utilize the client's strengths a abilities.
 The activity should be of short duration to foster, feeling of accomplishment.
 If possible, the selected alenty should provide son, new experience for the client.
Process of intervention
It consist of six stages:
1. Initial evaluation of what patient can do and cannot don a variety of situation over a period
of time.
2. Development of immediate and long term goals by be patient and therapist together. Goals
should be concrete and measurable so that is easy to see when they has been attained.
3. Development of therapy plan with planned intervention
4. Implantation of the plan and monitoring the progress.The plan is followed until the first
evaluation. satisfactory it is continued, or altered if not.
5. Review meetings with patient and all the staff involves in treatment.
6. Setting further goals when immediate goals have been achieved, modifying the treatment
program as relevant.
TYPES OF ACTIVITIES
Diversional activities:
These activities are used to divert ones thoughts from stresses or to fill time.
For example: organized games.
Therapeutic activities:
These activities are used to attain a specific care plan or goal.
For example: basket making, carpentry.
SUGGESTED OCCUPATIONAL ACTIVITIES FOR PSYCHIATRIC DISORDERS:
Anxiety disorder
Simple concrete tasks with no more than 3 or 4 steps that can be learn quickly.
For example, kitchen task, washing, sweeping
Depressive disorder:
Simple concrete tasks which are achievable, it is important for the client to experience
success. Provide positive reinforcement after each achievement.

Example crafts, mowing lawn, weeding gardens.

Manic disorder

Non competitive activities that allow the use of energy and expression of feeling. Activities
should be limited and changed frequently. Children need to work in an area away from
distractions. For example raking grass, sweeping
Schizophrenia (paranoid)

Non competitive, solitary meaningful tasks that require some degree of concentration so that
less time is available to focus on delusion.

For example: puzzles, scrabble.

Schizophrenia (catatonic)

A simple concrete task in which client is actively involved. client needs continuous
supervision and at first works best on a one to one basis.

For example metal work, moulding clay

Antisocial personality:

Activities that enhance self esteem and are expressive and creative. But not to complicated.
Client needs supervision to make sure each task is completed.

Dementia:

Group activities to increase feeling of belonging and self worth. Provide those activities
which promote familiar individual hobbies. Activities need to be structured, requiring little
time for completion and not much concentration.

Substance abuse

Group activities in which client uses his talents. For example involving client in planning
social activities, encouraging interaction with others

CHILDHOOD AND ADOLESCENT DISORDERS:

Children:

Playing, story telling, painting, poetry

Adolescence: creative activities such as leather work, drawing, painting

Mental retardation:

Repetitive work assignments are ideal; provide positive reinforcement after each
achievement.

For example cover making, candle making, packing goods

Services of Occupational therapy:

 Independent living skills, self care / self maintenance.
E.g. bathing, washing, combing, dressing.
 Task oriented treatment - Crafts, play, socialization, leisure time.
 Work adjustment programme:

Home making: child care / parenting.

 Sensory motor treatment (Neuromuscular)
 Design, fabrication and application of arthotic devices.
 Therapeutic exercise.
 Discharge planning and community re-entry.
 Patient or family education and counseling.
Advantages
1 Diverts the patients attention from himself on to other things.
2 His interests and energies are directed to work.
3 Maintain normal habits of work.
4 Provides an incentive and a goal.
5 Stimulates interest and attention.
6 May teach the patient a new skill / hobby.
7 Feeling of doing something useful.
8 Offers opportunities to explore and re-evaluate self concepts and objects concepts.
9 Helps to make the patient more accessible and more co-operative with other therapy.
10 Enable the patient to have a feeling of achievement whel he completes the task.

ROLE OF A NURSE IN OCCUPATIONAL THERAPY

 Coordinates with other therapeutic team members in diagnosing the abilities, strengths,
talents, interests IQ levels of the client and in selecting the activity for a specific client.
 Provides a series of graded experiences to the client, e.g. observing the demonstration of
any activity to more direct and active experiences.
 Educates the client to develop specific new skills.
 Encourages socialization of client and exhibits positive interest.
 Guides the client in formulation of new hobbies by strengthening the abilities of the
client.
 Supports, supervises and cooperates the client in implementation of work related
activities.
 Appreciates, if the client performs any approved activity.
 Offers tokens for each accomplishment of the work
 Helps the client to develop independent living skills.
 Approaches community agencies for Job placement of the clients, after discharge.
 Needed guidance will be provided to family members.
 Friendly in nature, counsel the client in approved social activities.
 Assists in developing good social interaction and relationship.
 Never criticizes the client, when he is performing any activity.
 Provides continuous, constant encouragement and support.
 Assists in psychosocial productiveness of the client.
CONCLUSION

Occupational therapy has proven to be useful and effective and contributes significantly in
managing symptoms of a variety of disorders and enhancing or maintaining functional
performance for person with disabilities and health related problems.It is well clear that
occupational therapy plays an important role for treating and rehabilitating mentally ill
clients.
 RECREATIONAL THERAPY

DEFINITION

It is a form of activity therapy, where an individual enjoys pleasurably the leisure time
through recreating and renewing the body and mind by relieving emotional tensions or
internal conflicts and thereby releases monotonous life of mentally sick or ill persons.

It is a planned therapeutic activity that enables people with limitations to engage in

recreational experiences.

INDICATIONS

 Clients who have difficulty in relating to others e.g. withdrawn

 Schizophrenia
 Excitement
 Depression
 Anxiety disorder
 Organic brain syndrome
 Obsessive compulsive disorder
 Substance abuse

PURPOSES

 To relieve from stress, anxiety, boredom, tension, emotional internal conflicts, loneliness
 To assist the client for self expression of their thoughts, feelings freely and openly
 Identifies own creative ability
 Provides socially acceptable outlet for fantasy and wish fulfillment
 Increases self esteem
 To develop and enhance social skills
 To promote the clients to engage in healthy and competitive interaction
 To use leisure time in a constructive manner
 To divert the mind from stressful situations.
 To change moods
 To encourage social interaction
 To decrease withdrawal tendencies
 To increase physical confidence and a feeling of self worth.

POINTS TO BE KEPT IN MIND

 Provide a non threatening and non-demanding environment.

 Provide activities that are relaxing and without rigid guidelines and time frames

 Provide activities that are enjoyable and self-satisfying.

TYPES OF RECREATIONAL ACTIVITIES

1. Indoor activities

• Ludo, craft, Chinese checker, puppet shows, carom board, singing, dancing, painting etc.

2. Outdoor activities

• Picnic trips, visits to interested places

e.g. zoo, garden etc, shopping, swimming.

3. Activities for intellectual expression

•Reading books, magazine, painting, drawing, celebrating the days of Global importance,
writing stories, poems etc

4. Activities for psychosocial expression

• Singing, dancing, painting, drawing etc

5. Activities for expression of love and tenderness

• Taking care of kids with play material, pets, gardening etc

6. Activities for expression of muscular strength

•Sports and games

7. Activities increasing sensory power

- Visual e.g. watching pictures, movies
- Auditory e.g. listening to music, radio
o Kinesthetic e.g. painting, art, drawing.

SUGGESTED RECREATIONAL ACTIVITIES FOR PSYCHIATRIC DISORDERS

 For clients with anxiety:

o Indoor activities - listening to music, painting, watching movies etc
o Outdoor activities - visiting interested and significant places, walking, attending like-
minded gatherings etc.
 For Schizophrenic patients:
Schizophrenia (catatonic)-social activities to to give contact with reality.eg
dancing ,athletics
Schizophrenia (paranoid)- concentrative activities like chess, puzzles etc.
 Depressive disorder:

Non competitive sports which provide outlet for anger like jogging, walking, running
etc.
 Manic disorder

One to one basis individual games like badminton, ball

 Dementia
 Concrete, repetitious crafts and projects that breed familiarization and comfort

 Childhood and adolescent disorders

For child activities like playing , story telling and painting which is provided on one to
one basis and give child feeling of importance.

For adolescent, gross motor activties like sports and games to use up excess energy.

 Mental retardation

Activities should be according to the client's level a functioning such as walking, dancing,
ball playing .

BENEFITS OF RECREATIONAL THERAPY WITH PSYCHIATRIC DISABILITIES

SYMPTOM REDUCTION

SYMPTOM REDUCTION:
o Reduction in depression.
o Reduction in anxiety.
o Reduction in tension.
o Reductions in sleep disturbances
o Reduction in negative thinking.
o Reduction in hallucinatory speech and behavior.
o Reduction in inappropriate laughter.

SOCIAL SKILL BENEFITS:

o Decreased social anxiety.
o Improved social skill competence and retention of skills.
o Increased socialization.
o Improved cooperation.
o Improved communication skills.

COMMUNITY SKILL BENEFITS:

o Increased tolerance for change.
o Increased trust and cooperation.
o Reduction of problem or delinquent behavior.
o Increased parenting skills.
 o Improved family relations.
o Increased activity skill competency.

SELF MANAGEMENT SKILL BENEFITS

 Improved coping skills for anxiety.
 Increased sense of personal responsibility.
 Increased self mastery.
 Increased self concept and self confidence.
 Increased quality of discretionary time use.

BENEFITS OF RECREATIONAL THERAPY FOR PERSONS WITH ADDICTIONS

 Improving social functioning.

 Developing effective problem-solving skills.
 Improving use of free time and leisure planning.
 Improving self-esteem, self-actualization.
 Developing exercise and relaxation skills.
 Increasing ability to have fun while sober.
 Decreasing loneliness.
 Increasing ability to choose non chemical alternative for achieving goals.
 Increasing involvement in active vs. passive activities.
 Increasing ability to cope with stress without chemical use.
 Reducing boredom.
 Increasing skills for socializing drug-free.

ROLE OF NURSE IN RECREATIONAL THERAPY

 Encourage the patient to communicate and express his feelings.

 She must provide a non threatening and non demanding environment.
 Teaches the necessary skills for each activity
 Nurse must help the patient to develop skills, talents abilities.
 Provide activities that are enjoyable and self satisfying
 Frequently observe the clients behaviour throughout the abilities.
 Nurses have to appreciate the effective performance of clients.

CONCLUSION:

Recreation therapists work with clients to develop a tailored approach to help them increase
their mental, physical and emotional well-being through interventions that may include
physical activity.
Recreation therapy is one of the essential treatment areas within the health care team.

PLAY THERAPY

INTRODUCTION:
Play therapy is an emerging therapeutic discipline, based on play as a child’s natural medium
of self -expression. Play is a natural mode of growth and development in children. Through
play a child learns to express his emotions and serves as a tool in the development of the
child.

DEFINITION:

Play therapy is a dynamic relationship between a child (or person of any age) and a therapist
who provides selected play materials and facilitates the development of a safe relationship for
the child to fully express and explore self(feelings, thoughts, experiences and behaviours)
through play, the child’s natural medium of communication , for optimal growth and
development.

INDICATIONS:

 Childhood emotional problems

 Children who have been adopted or in foster care

 Children dealing with parental conflict, separation or divorce.

 ADD/ADH

GOALS OF PLAY THERAPY:

 Helping the child better understand feelings and how feelings relate to behavior.
 Helping the child find more appropriate ways of expressing feelings.
 Helping the child find ways to solve personal problems.

FUNCTIONS OF PLAY THERAPY

CURATIVE FUNCTIONS:

 It releases tension and pent up emotions.

 It allows compensation for loss and failures.
 It improves emotional growth through his relationship with other children
 It provides an opportunity to the child to act out his fantasies and conflicts to get rid of
aggression and to learn positive qualities from other children.
DIAGNOSTIC FUNCTION:

 It gives the therapist a chance to explore family relationship of the child and discover
what difficulties are contributing to the child's problems.
 Play therapy allows to study hidden aspects of the child's personality.
 It is possible to obtain a good idea of the intelligence level of the child.
 Through play inert sibling relationship can be adequately studies.
TYPES OF PLAY THERAPY:

1. Individual vs. group play therapy:

 In this individual therapy the child is allowed to play by himself and therapist attention is
focused on this one child alone.
 In group therapy other children are involved.

2. Free play vs. controlled play therapy:

 In free play, the child is given freedom in deciding with what toys he wants to play.
 In controlled play therapy the child is introduced into a scene where the situation or
setting is already established.

3. Structured vs. unstructured play therapy:

 Structured play therapy involves organizing the situation in such a way so as to obtain
more information.
 In unstructured play therapy no situation is set and no plans are followed.

4. Directive vs. non directive play therapy:

 In directive play therapy, the therapist totally sets the directions where as in non directive
play therapy the child receives no directions.
 Play therapy is generally conducted in a playroom. The playroom should be suitably
stocked with adequate play material, depending upon the problems of the child.

ADVANTAGES OF PLAY THERAPY:

 Offers the child an opportunity to experience growth under the most favorable
conditions.
 Child uses the therapy time to play out his accumulated feelings of fear, tension,
confusion, frustration and aggression.
 Allows the child's feelings to surface and learns to control, accept or abandon them
 Helps the child to realize that he is an individual in his own right and is capable of
thinking and making decisions for himself.

DISADVANTAGES OF PLAY THERAPY:

 Requires long -term commitment

 Children might not like it
 Children with disorders respond in an aggressive way
 Can cause stress and anxiety.

CONCLUSION:

Play therapy can be a beneficial approach for children, adolescents, and families. It allows
children to enjoy counselling in a way they can understand, free from stress and the pressure
to understand adult conversation. Counsellors who choose to use this form of therapy must be
properly trained in play therapy.
Counsellors who are not trained in this form of therapy should make referrals to best benefit
the child and the family.