Occupational therapy

“ One man emphasized the static machine, another man built up his institution upon the basis of Hydrotherapy, another upon the physical exercise, but it remains for the work in the Army Hospitals to coordinate these agencies and present a solid front for Physiotherapy. One of the things that remains yet to be accomplished is a proper coordination between Physiotherapy and Occupational Therapy. ”

“ Now I will not go into the subject of psycho-therapy. We pay special attention to mental questions but we do not neglect the physical by any means. Every physical disorder which is found is corrected, if correction is possible. We have complete physio-therapy and occupational therapy and all other facilities for treating nervous cases. We are careful never to stress too much on the physical treatment we give these patients, because by so doing we suggest to them conditions they really do not have and by that means prolong their functional disorders. ”

“ Its graduates, moreover, are trained not only in psychiatric and general nursing, as well as the care of neurological cases, but in hydrotherapy, occupational therapy, reeducational, industrial and social work. The nurse of the future who has had no psychiatric training and experience is one whose education is not complete. Every effort should be made to encourage the training schools of general hospitals to send their senior nurses to a hospital for mental diseases for a service of at least three months. ”

“ The special work is directed by the Educational Director, who should be considered as one of the staff of the hospital. The greatest criticism that has been partially sustained in regard to Occupational Therapy has been that men who are physically able to do more purposeful things have been kept making trivial things, First, because it was relatively easy to amuse them, Second, Because of some of the articles the patient has derived considerable revenue from the sale thereof. ”

“ With reference to reconstruction aides, every week our reconstruction officer gives them a talk on some phase either of occupational therapy or physio-therapy or of mental disorders. We cover any subject in which the neuro-psychiatrist should be interested. ”

“ It is expressly understood that all the work in Occupational Therapy should be upon prescription of the Medical Officer in Charge of the Hospital or his designated agent, and a proper cooperation between the Medical staff and the staff of the Reconstruction Section will insure most satisfactory results, and that this cooperation of the work will be very necessary in order to secure proper efficiency. ”

“ In the first place he is there getting occupational therapy—something that will keep the mind active, something to drive away the tedium of idleness and keep him from thinking about himself, something that gets him again interested in life. Occupational work of a very simple nature is sometimes carried on at the bedsides or in the wards and serves the double purpose of interesting him and being of per- manent value. ”

“ The general outline of the policy is that to serve the men in Occupational Therapy and pro-vocational training it will require one teacher for every 20 men at work, or for every 40 men in a hospital, exclusive of the administrative force, as it is estimated that only 50 per cent will be available for this work. ”

“ Nurse-teachers were prepared for this work by courses of intensive training, lasting from two to four months. By the time the tide of injured men returning to this country was at its height this reconstruction work was in progress in nearly fifty hospitals, some 700 officers and men of the army had been detailed to serve as instructors and assisting them were 1,200 nurse-teacher aids trained in occupational therapy. ”

“ In the new hospitals, however, numbering over 200 patients, where pre-vocational training is desired, a reasonable equipment would have to be furnished.
(c) As to expendable materials for Occupational Therapy the past experience has shown that it will amount to $2.00 per month per man actually at work, and possibly 25 per cent of the entire hospital population will be doing some work of this character. ”

“ Inasmuch as the strain of piano playing is very slight, the first lesson may last thirty minutes if the physician so decides. The patient should be encouraged to practice freely at other times during the day as long as his interest can be sustained. Chief attention must be placed on the use of the fingers requiring exercise. As is true in all forms of functional occupational therapy, the impatient patient will try to speed his work by using unaffected joints or by improper use of muscles. ”

“ As the men were discharged from Army Hospitals the burden of the Public Health Hospitals became greater, and many of the individuals who had been active in the Army work became associated with the Public Health and established as a part of their hospital program the Section of Physical Reconstruction, to include Occupational Therapy and Physiotherapy. ”

“ The subjects of Occupational Therapy and Physiotherapy constitute what has been designated as the Section of Physical Reconstruction in hospitals. Early after the United States entered the War the Surgeon General of the Army realized that it was necessary to utilize all the agencies that would aid in the recovery of men disabled in the War. ”

“ Licensed or certified occupational therapy assistants who meet the qualifications for occupational therapy assistants specified in such section 484.4, or any successor regulation, to furnish services under the supervision of an occupational therapist. (b) Supervision.— The Secretary of Defense shall establish in regulations requirements for the supervision of physical therapist assistants and occupational therapy assistants, respectively, by physical therapists and occupational therapists, respectively. ”

“ The others, however, have not been overlooked and occupational therapists, who devote their entire time to stimulating the interest of the patients who cannot leave the wards, on account of their mental or physical condition, in some absorbing and diverting occupation, are an important part of the personnel of every institution. No other form of treatment employed in hospitals for mental diseases has been so productive of results. ”

“ How do you suppose it affects students of an Osteopathic college to read in a representative journal that the secretary of their school, and the greatest of all its boosters, calls medical men into his own family when there is sickness in it?
There are many men and women practicing to-day who try to be honest and conscientious, and by using all the good in Osteopathy, massage, Swedish movements, hydrotherapy, and all the rest of the adjuncts of physio-therapy, do a great deal of good. ”

“ Then there is the industrial type of work therapy in which the patient is carried still further along the line of personal initiative and given an opportunity to do creative work which is at the same time useful and which helps him to keep in form pending the time of his ultimate discharge from the hospital. And finally, there is the vocational education work, which undertakes definitely and systematically to give a man training in some specific direction which he can 136utilize, after he leaves the institution, and which will have a definite economic value. ”

“ She became invested, involved, and excited about herself becoming more. We, myself and each of her patients, become for her more whom we essentially were. Most important to her and to me, this graduate student grew in her recognition and acceptance {60} of herself and her ability as an adult nurse therapist. The thanks and meaningful praise she received from both her patients on termination of therapy made this apparent. ”

“ It is not until we realize that we have not a cure already, that we do hustle around to get it. It is not until we realize that we are now very helpless in medicine that we shall labor in a way to become less so. At present the best that we can do for most patients is to explain what the trouble is, let them know what is going to happen, to preach some hygiene, and above all to make them realize that we care and suffer with them. That is the essence of medical work and of the social assistant's work in the dispensary and in the home. ”

“ Our friends, the osteopaths, have only a pitying smile for our arduous labors. They ask: "Why fool with cold water and drive patients away, when pleasant manipulations bring the business?" If we query in return: "Do your pleasant manipulations cure obstinate chronic ailments?" They answer: "We do not expect to cure them. The effort involves too much labor and spoils the reputation of our work. Not one in a hundred chronics has the patience and perseverance to be cured. Besides, if a patient comes too long to the office for treatment he drives others away." ”

“ Nonetheless, one of the few areas of agreement among behavioral specialists is that an uncooperative patient cannot benefit from therapy and that the first step in effective treatment is acknowledgment by the patient that he is suffering from an abnormal condition. ”

“ The employer shall provide the workers with pre-service training in occupational health and regular in-service training in this field, in order to popularize knowledge about occupational health, urge on them the need to abide by the laws, rules and regulations on prevention and control of occupational diseases and the rules of operation, as well as to show them the correct way of using the facilities for prevention of occupational diseases and such articles for personal use. ”

“ On medical grounds because in very many cases before treatment is quite complete the addition of carefully graduated and supervised work is an important part of the treatment. On social grounds because it is necessary to fight in every possible way against the common tendency of the patient to fall into habits of laziness and intemperance.
This is now understood, and almost everywhere to-day the wounded soldier can resume work in workshops attached to the centres of physiotherapy, and thus begin his re-education while continuing his treatment. ”

“ The best possible factor in therapy is secured if patients can be brought to the state of mind of these distinguished physicians who calmly faced the future, refusing to disturb themselves or their work, because they feared that the worry that would come down upon them in inactivity would aggravate their disease. Where men are occupied with some not too exacting occupation, that takes most of their attention and at which they have been for years, it is best to leave them at it, though the harder demands of it must be modified. ”

“ If these essentials are entirely eliminated from the life of an invalid, the patient's greatest needs are probably left unsatisfied, even though the physical care he receives may be perfect in every detail. All that was said in regard to occupations for invalids applies with particular force to occupations for chronic patients, since however valuable manual occupations may be as a means to bring about recovery, they are still more valuable in furnishing interest and purpose in a life whose only prospect is a succession of weary, useless years. ”

“ As I have already said, it is impossible for the dispensary doctor to become acquainted with the details of the patient's malady, or to find out by investigation and experiment how the patient's mind may be made to aid his recovery rather than to impede it. This is the proper task for a social worker, partly because she has more time, partly because she is a woman, and is for that reason more fitted to get into close touch with the patient's mind and to use skill and tact in managing him. ”

“ One of the most important things Americans have to learn is how to relax. Anything that will teach them to do this should prove a boon.
Therefore I feel certain that, before many years, the principles and practices of zone therapy will be as familiar and universally applied as are now the principles of domestic hygiene or the practice of sterilizing baby bottles. And then zone therapy will add to the depth and breadth, as well as to the length of human life. ”

“ This therapeutic measure, in addition to aiding greatly in shortening the convalescent period, retains or arouses mental activities, prevents the state of mind acquired by chronic hospital patients, and enables the patient to be returned to service or to civil life with the fullest realization that he can work in his handicapped state and with habits of industry much encouraged, if not newly formed. ”

“ So in the type of home visiting which now particularly concerns us, it is essential to make it clear from the outset that the social worker is a part of the medical organization. She is one of the means for diagnosis and treatment. All that she does from the moment when she first scrapes acquaintance with the patient is to be connected with the condition of the patient's health. She is not to pursue [Pg 4] independent sociological or statistical inquiries. She is not to be the agent of any other non-medical society. ”

“ It should be suited to the individual, and, as a rule, should not be that to which the man has been accustomed. Particularly is this true of the man who is used to mental labor only,—the clerk, the physician, the pharmacist, the merchant, etc. For them out-of-door work on the farm, lawn, or in the garden, is the very best, and next comes indoor shop-work. We must provide something that engages time and attention, that provides some new outlook upon life, and enlarges some field of endeavor in which the patient has labored before coming to the Hospital. ”

“ The influence of the occupation upon health will be governed not only by the character of the work, but also by the environment in which the work is performed. Whether it is indoor or outdoor work, whether it is an active or sedentary occupation, and whether there are extremes in the temperature, humidity, air pressure or light, or whether the work is on the surface or below it as in mines, are all factors. The position of the worker, the length of the working hours, the physical, mental and nervous strain all have a bearing on health. ”