This article, the first of a two-part series, focuses on occupational therapy for adults, in which the emphasis is on entry into or return to work, and social and self-care activities. Part 2 will discuss occupational and related therapies for children, in which the emphasis is on school, play and promoting physical and psychological development.

A wrist support (splint), customized by the OT Department at Rancho Los Amigos National Medical Center in Downey, Calif., helps Rosalba Rios to paint.

Rosalba Rios, 22, has a lot in common with other college students. As a senior art major at Biola University in La Mirada, Calif., Rios has to get to her classes, get to her part-time job in the disabilities office, prepare for art shows, do homework and research papers, and maintain relationships with friends and family.

Rios does it all, despite obstacles most students don't face: She has Dejerine-Sottas disease, a disorder of the nervous system that keeps signals for movement and sensation from traveling along her nerves as quickly as they should. As a result, she's had to use a wheelchair since she was 7 (she now has a power chair), had surgery to stabilize spinal curvature at age 10 and has nearly lost the use of both hands.

As a child, she received various kinds of therapies through the public schools in California, and eventually found her way to Rancho Los Amigos National Medical Center, a major rehabilitation center in Downey, where Rios also attends the MDA clinic.

Over the years, working with occupational therapist Lori Rowley and others, Rios has received instruction and devices that have helped her manage her life. Her most recent acquisition is a wrist support (often called a splint) that helps her with painting and other hand activities. She can still use her right hand to "squeeze a little," which makes the splint particularly useful.

She's also received reaching devices ("reachers"), handles and a special knife. "If your hands aren't working properly, equipment -- even something as simple as a new cutting knife -- can help," Rios says. "There are special types of utensils you can use."

Driving is another part of Rancho's OT program, but, unfortunately, despite her efforts, Rios' disability didn't allow her to achieve this skill. She now rides as a passenger in her family's adapted van.

WHAT IS OCCUPATIONAL THERAPY?

Occupational therapy has roots that reach back to the 19th century and brings to mind images that differ depending on a person's age and experience.

Rios uses a computer (with a velcro cuff for the pencil on the other hand) while occupational therapist Lori Rowley at Rancho stands by.

Basket weaving and other crafts -- now called diversional activities by therapists -- are less common today than they once were in OT settings, having drifted into the domains of psychotherapists and recreation specialists. And specific vocational training activities, which in earlier times played a larger role in the profession's scope of practice, have likewise nearly disappeared and entered the realm of state vocational rehabilitation departments.

So where does that leave occupational therapy?

Some experts define the field as promoting virtually any purposeful or meaningful activity.

If that sounds a little broad to be useful, the American Occupational Therapy Association defines occupational therapy as "the therapeutic use of self-care, work/productive activities, and play/leisure activities to increase independent function, enhance development, and prevent disability."

AOTA goes on to say that OT "includes adapting tasks and the environment to maximize independence and quality of life. The term 'occupation' refers to activities that are meaningful to the individual within the environments in which the person lives and functions."

AOTA's motto sums up OT neatly as "skills for the job of living."

'FUNCTION' IS KEY

Glen Gillen is a senior occupational therapist and clinical instructor in occupational therapy at Columbia-Presbyterian Medical Center in New York who sees adult clients with neuromuscular disorders. The philosophy of OT stays the same in different settings and age groups, he says, but the interventions and specific goals are different. In all cases, improving function is the goal, with "function" being the key word.

He puts occupational therapy in a framework devised by the World Health Organization. In 1980, WHO published a model in which "impairment" is defined as a dysfunction at the level of an organ, such as a limb; a "disability" is a functional limitation at the level of the person, caused by an impairment; and "handicap" is a disadvantage in role performance at the level of interaction with society.

Levels of Dysfunction
Impairment disturbance at level of organ or limb	Disability disturbance in function at level of person	Handicap disturbance in the relationship between person and society as result of disability
The above is adapted from the World Health Organization's International Classification of Impairments, Disabilities and Handicaps, first published by WHO in 1980. Occupational therapy is primarily concerned with the middle level of dysfunction, the disability level, although it can move into the related areas of impairment and handicap.

Gillen's practice centers mostly on the "disability" part of the model, with other professionals taking the territories that surround it -- physical therapy at the impairment level and social work and psychotherapy at the handicap level.

When asked about the differences between physical and occupational therapy, he answers this way: "If I think about physical therapy, I'm thinking more in terms of mobility, flexibility, strength. And when I'm thinking about occupational therapy, I think of return to functional activity performance."

Rowley answers the same question by saying: "I always qualify that with regard to the facility that I work at. Depending upon the facility, OTs and PTs may have different roles. At our facility, physical therapy works primarily with mobility, with how is somebody going to move around." At Rancho, "physical therapy works a lot with the legs." Occupational therapy is "to help you to be as independent as you can be with things that you want to do every day."

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