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=Occupational Therapy= Occupational Therapy is a type of therapy that uses activities to help a physically, or developmentally disabled person. The activities were also known as occupation.

Early History
Back in the 1700s, those who were mentally ill were treated badly in the hospitals they were staying in. People thought that the mentally ill were either possessed by the devil or were crazy. Doctors tried to cure them by draining their blood, making them vomit, or waiting for the craziness to go away. If the town was small, the lunatic (crazy person) would be allowed to walk around the town as long as they did not hurt any townsfolk or the lunatic’s family would keep them safe at home. Sometimes the town was very big and the people did not know how to deal with these crazy people. So, the townsfolk stuck the lunatics in a hospital.

Later though, more people were becoming to be seen as insane (crazy). As the towns grew bigger, people began to lock up the lunatics in jail. This started to become a regular habit. Of the town was really big, special buildings called institutions were built and crazy people were housed there. In these institutions the mentally ill were seen as animals. People would pay money to the hospitals and jails to see the mentally ill. Just like at a zoo, where you would pay to see the animals. In order to “cure” the mentally ill, doctors continued to drain blood, starve, beat, and chain their “prisoners.” They would tie the prisoner to a chair and leave them in a room for hours. People started to notice how these mentally ill patients were being treated. In 1786, French doctor Philippe Pinel saw how the mentally ill were being treated like animals. He believed that the mentally ill should be treated as humans. Dr. Pinel said that the mentally ill could be cured through moral treatment. Moral treatment means treating the patient in an decent manner. If the patients were treated with kindness, exercised, worked, and had daily routines, they can be cured to a certain point. In the early 1800s, Samuel Tuke and his father William, established an asylum (a place especially for people who are mentally ill, crazy, or insane) in England. This asylum also believed in moral treatment.

Back in America, Doctor Benjamin Rush supported the mentally ill to be treated like humans. He suggested that using kindness was the best way to help a patient. If the patient did not react well to kindness, then the patents were punished. They were punished by draining blood, starving, dunking the patient in water, or kept them by themselves. Even though this sounds like Dr. Rush did not help the mentally ill, he did. He improved the understanding of why people were mentally ill and he improved the cleanliness of the asylums. In the 1840s, a woman named Dorothea Dix was trying and succeeding to get states to open more asylums for anyone who needs help. Also in the 1840s, a Swiss-American psychiatrist named Adolf Meyer made a discovery: using time wisely while doing an activity helps heal patients. Dr. Meyer’s wife who worked in an institution introduced activities to patients, the patient’s family, and the patient’s doctor. Dr. Meyer also said that the treatment of the mentally ill “…was a mix of work and pleasure that included both [fun] and [everyday] activity”. This became the whole idea of occupational therapy.

Susan Tracy
In 1905, Susan Tracy became the first unofficial occupational therapist. While she was studying to be a nurse, Tracy noticed that giving a patient something to do, like a puzzle, make the patient less nervous and the patients did not mind staying in bed. In 1906 when Tracy became the head nurse trainer, she “…developed a training course in occupation to prepare instructors for teaching patient activities”. These occupations/activities were usually wood working, or working with metals, painting, and other activities we see as hobbies today. Before, it was only people who worked with wood or metal could teach patients to work with wood or metal. But because some people were really sick, only doctors and nurses could see the patient. So, doctors and nurses learned how to teach a patient how to carve wood and could tell if that patient was getting too tired. Tracy also felt that kindergarten teachers could also teach patients activities but they needed to become a nurse first. There needed to be a lot of different kinds of activities though, because every patient was different—some patients were missing a finger, some patients missing their whole arm, and other patients were mentally ill. In 1910, she published a book which explained how these activities helped patients.

Eleanor Clarke Slagle
Around 1908 Jane Addams and Julia Lanthrop developed courses to teach hospital attendants (these are NOT nurses) games, arts and crafts, and hobbies that could help patients. A social worker named Eleanor Clarke Slagle took this course and finished it in 1911. She then went to teach a similar course at the psychiatric clinic in the Johns Hopkins hospital, where Slagle became head of the occupational therapy department for two years. In 1915, Slagle created the first school where people could learn occupational therapy. There were special courses about patients being mentally ill and about people who were disabled, or hurt. She wanted patients to learn a treatment called “habit training.” Habit training is balancing work, play, rest, sleep, and taking care of oneself for 24 hours in order to get rid of bad habits. This treatment was used for mentally ill patients in occupational therapy until the 1950s.

William Rush Dunton Jr.
William Rush Dunton Jr. is considered the “Father of Occupational Therapy.” Dunton was involved with occupational therapy since 1895. When Dunton was a psychiatrist in Baltimore, Maryland, a metalwork shop was created for the asylum he worked in. The metalwork shop was created to help patients. Other types of crafts were added and in 1908 a teacher of arts and crafts came to instruct patients. Dunton noticed how important it was for someone to tell his patients what to do and saw how important it was to place a patient with the right activity for them. After reading Susan Tracy’s book, he started to teach the nurses at the asylum about activities and play. In 1915, he published the first textbook about occupational therapy. In the textbook, he tells the rules about occupational therapy. The book also tells a lot about the simple activities that the nurse could use for treatments.

George Edward Barton
There were a lot of different names being used for occupational therapy. In 1915, George Edward Barton decided that occupational therapy will be called occupational therapy. Mr. Barton was sick with tuberculosis and a nurse helped treat him using occupational therapy. After he left the hospital, he created an institution where by using occupational therapy, people who were sick or injured could re-learn or get regulated to everyday life again.

American Occupational Therapy Association (AOTA)
Occupational therapy became a national society in March 1917, right before the United States entered World War I. Its members were made up of medical doctors, social workers, teachers, nurses and artists. They all agreed that occupational therapy was the best way to treat the sick, injured, and mentally ill. At the first official meeting in September, Dunton suggested that the sick, injured, or mentally ill person still in the hospital be taught occupations that they can use in the hospital. While in the hospital, patients should also learn occupations for when they get better and go home. In 1923, the name of the society was changed to American Occupational Therapy Association (AOTA).

World War I
After entering WWI, many injured soldiers were coming back to America and they needed therapy. Eleanor Slagle went to the army and explained to them that therapy can help the soldiers who were hurt. The army said agreed. In 1917, the army sent young women to Paris, France to help. There were two types of training programs. One program was for physiotherapy—therapy for the body. These girls were going to help the soldiers exercise and massage the part of the body that hurts. The second program was for occupational therapy. These girls were trained to create ways of occupation for soldiers who were permanently injured and to give patients therapeutic activities. A lot of schools to train these young girls opened. Eleanor Slagle taught a lot of the classes to the girls who wanted to help the soldiers. During the war, occupational therapy also began treating physical injuries. Special tools were invented to help occupational therapists measure someone’s strength and their limits of motion. After reading the data, activities were chosen based on someone’s strength and how far they can move the injured body part. More special tools were invented to help the injured soldier get stronger and to move the body part farther.

After World War I
After WWI, many of the emergency training schools closed. But a few official occupational therapy schools opened. Specific rules in order to graduate were set up. There were many news articles that said that occupational therapy was not a scientific job. This did not stop public and military hospitals from having occupational therapists. A lot of doctors saw how important occupational therapy was after the war. In 1923, the government made a law that said every hospital must have an occupational therapist. In 1927, the AOTA said in order to graduate and get your degree in occupational therapy, one must take a test first. In 1931, AOTA made a rule that said every occupational therapist must have a registration number. They also asked the American Medical Association to check every school to make sure every school is following the rules.

World War II
When WWII broke out, there weren’t enough occupational therapists. Emergency occupational therapy schools were set up. Students completed the course in one year and had to pass the exam. At the end of WWII, more than a thousand occupational therapists were helping in the American army hospitals and the American allies’ hospitals. Occupational therapists had to be prepared to help soldiers with psychological problems and physical problems. Many new techniques were invented to help rehabilitate the soldiers.

After World War II
After WWII, there was new medical knowledge, new medicine, and improved medical care. This increased and changed the type of patients that needed treatment. Therapists had to create new treatments. Other special types of therapy were developed. Occupational therapy came to be seen as a special type of therapy for people with peripheral nerve damage (damage to the nerves in the body), amputations, and other disabilities. “Occupational therapists had to be skilled in using constructive activities for treatment and also were required to utilize as treatment activities of daily living, work simplification, rehabilitation techniques for the handicapped homemaker, and training in the use of upper extremity prosthesis”. All of these new techniques and knowledge of physical dysfunction required a change in the classes taught at the occupational therapy schools. The first occupational textbook written by occupational therapists was written in 1947. Helen S. Willard and Clare S. Spackman edited the textbook. Spackman have important information on how to evaluate and treat patients with physical dysfunction. In 1947 there was talk about an occupational therapist assistant. Also in in 1947, the first master’s degree in occupational therapy was established.

World Federation of Occupational Therapists
Also after WWII, medical services in many countries all over the world improved. Countries wanted to exchange information about new treatment and foreign therapists wanted to take the registration exam of AOTA. The International Society for the Rehabilitation of the Disabled encouraged the formation of the World Federation of Occupational Therapists and it was formed in 1951. The World Federation of Occupational Therapists established international standards for education and practice of occupational therapy all over the world.

The 1950s
In the 1950s, there was an increase in rehabilitation techniques in physical dysfunction. This made occupational therapy measuring techniques of physical function more precise and it started a movement to make occupational therapy an “exact” science. New advances in medical science caused occupational therapy to shift to also pay attention to chronic conditions like arthritis, heart disease, stroke, traumatic injuries and birth defects. Treatment was emphasized to reduce defects “related to the patient’s pathological condition and to allow the patient to function at the highest level of which he was capable”. Occupational therapists were also looking at treatment of the psychiatric (mentally ill) patient. Treatment of a psychiatric patient stressed the social adaptation of the patient and the patient’s ability to function in the community and in his family. The type of treatment that was used was a psychotherapeutic technique called “therapeutic use of self.” This type of technique used social interactions as a tool for helping patients deal with their emotions in various settings.

Gail S. Fidler
In 1954, the first psychiatric occupational therapy book was written by Gail S. Fidler. Fidler believed that occupational therapy was a relationship with psychiatry. In the occupational therapy part of the relationship, the patient could practice handling their emotions and develop everyday living skills through productive activity. In her second book published in 1963, Fidler wrote that the activities occupational therapists use are seen as a way of the patient talking to the therapist. Even though the patient isn’t talking out loud, the patient’s actions tell the occupational therapist what the patient is thinking and feeling. Fidler made a guideline which helps the occupational therapist measure and understand what the patient is trying to say. She also measured the types of activities the patients do. “Activities should be selected [by the therapist] that [go] with the specific needs of the [patient] and then the performance of these activities should be controlled and guided in order to increase their therapeutic value”.

The 1960s
Even though there was an increase in occupational therapy schools, there weren’t that many qualified occupational therapists. Other people trained in different areas came to fill in jobs and other types of therapy like art therapy and music therapy evolved. The similar therapies made occupational therapists question if occupational therapy had a theory behind it. In the 1960s, psychiatric occupational therapists began to wonder if their treatment was helping patients. The AOTA set up workshops and psychiatric occupational therapists found that they need to examine neurobehavioral focus to treatment. Now therapists had to look at a person’s social relationships, their emotions and the behavior of the person’s nervous system in order to treat a patient.

A. Jean Ayres
A. Jean Ayres began the research which laid the foundation for a neurobehavioral focus to occupational therapy in the 1960s. Most of her research was about the senses, the nervous system, and movement. She states that the best treatment of motor function (movement) was “…sequential maturation, the influence of sensory stimuli, different types of muscle work, the of role of [voluntary movement], and the importance of repetition…”.

Mary Reilly
In the 1960s, an occupational therapist named Mary Reilly wrote a paper about the research being done on occupational therapy. She said the research should focus on “…achievement, creativity, and patterns of [skills], interests, and abilities relating to activities as a whole, rather than dealing with a specific modality, such as arts and crafts”. In 1962 at an AOTA lecture, Reilly pointed out that human beings have a need to master and improve their surroundings through various skills they have learned. If a person becomes sick or injured, the need to be the best is blocked and the human being suffers dysfunction and dissatisfaction. Occupational therapy “[t]reatment techniques should address the dysfunction and difficulties people experience in coping with play, work, and school situations”.

Wilma West
In 1966, an occupational therapist named Wilma West said that the shift from medical to health concerns had consequences for occupational therapy. She believed that in the future health and medical care will place importance on programs designed to encourage better adaptation on human development rather than technological programs offering specific solutions to specific problems. Occupational therapists would have new roles as evaluator, consultant, supervisor, and researcher in these programs. To help prevent disease, West said that occupational therapists should move into and work in the community.

Anne Mosey
In 1970, Anne Mosey said that psychiatric occupational therapy was still functioning without a theory. So she formed a “theoretical frame of reference as the basis for the treatment of psychosocial dysfunction”. Mosey said dysfunction was when parts of skills that are necessary to everyday life are not learned because the person is not old enough or the person is physically abnormal, there is a lot of stress in their surroundings, or there is no one or nothing in their surroundings to help a person develop the parts of the skill. There are three categories of reference; analytical, acquisitional, and developmental. The analytical frame is concerned with the ideas of “need fulfillment,” expression of basic instincts, and control of instinctive urges. The acquisitional frame deals with “…various skills and abilities that [a person] needs for adequate and satisfying interaction with [their surroundings]”. These skills are separate from each other, measurable, and are learned over time. The developmental frame deals with skills that depend on each other, on the quality of the skill, and are learned at specific times in life. In 1974, Mosey developed the biopsychosocial model. This model shows how a person’s mind, body, and surroundings interact with each other. This model was supposed to replace the medical and health model. Even though it was meant as a replacement, the biopsychosocial model was just a different way of what occupational therapists were saying all along.

AOTA in the 1960s and 70s
In the 1960s, AOTA began performing new functions like providing administration guidelines, suggesting treatments, and rates. These activities made the professional organization into a philanthropic one. In 1965, AOTA officially became a philanthropic organization.

In the 1970s various rules were updated including a new definition and statement of function of occupational therapy. In 1976, AOTA passed a law that said that occupational therapy assistants had to pass an examination in order to be an occupational therapy assistant. Also in 1976, new rules were adopted by AOTA. These rules changed the structure and organization of the association. These changes made AOTA able to listen to its members’ needs and concerns. In 1978 a big meeting was held because of the changes in society and in the association. At the end of the meeting, AOTA adopted a statement about the philosophy of occupational therapy and declared occupation as the common foundation of occupational therapy. This gave the occupational therapists guidelines in order to grow.

AOTA in the 1980s
In the early 1980s, a specific committee was created in order to do research in occupational therapy.

In April of 1983, occupational therapy assistants were able to study at an associate degree level in order to receive their occupational assistant degree. In 1986, it became mandatory for those studying occupational therapy to go observe an occupational therapist.

Graduate education occupational therapy leading to master’s degree was approved. Thus, entry-level graduate school programs were developed.

In 1974, New York University developed the first doctorate program for occupational therapy. The first doctorate degree was given in 1984.

There were no set roles/functions between occupational therapy assistants and occupational therapists, traditional areas of occupational therapy practice were disappearing, and occupational therapists across the country were not using the same terms. In 1980, a document stated what the roles of an occupational therapist was and a different document gave standardized terms that every occupational must use. In order to keep areas of occupational therapy from disappearing, the AOTA decided to write reports about the specific areas that are disappearing in order to help the areas. In order to help new areas of occupational therapy, the AOTA had people write standards and guidelines for the new areas.