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THE ISSUE Is

Occupational Science is Multidimensional

The development of a science ofoccupation is one of the goals ofthe profession of occupationaltherapy. Disagreement exists, however, asro the definition of occupational scienceand therefore as to what is considered legitimate cx:cupational therapy research.An overly restrictive interpretation of theterm occupational science wiU affect thefunding and publication of research studies, resulting in porenrially valuableknowledge being lost ro the profession.

We believe that occupational science comprises nor only the study ofoccupation (self-care, work, leisure) butalso the componems of funcrion relatedto occupational performance (e.g.,movement, cognition, emotion). Furthermore, we propose that research inoccupational science should nor be restricted [ treatmems involving purposeful aerivity. To address fully the domain of occupation, we must studyfacilit:uOlY agents that are nor traditionally called purposeful aCliuity.Definition o PurposefulCLivityWe believe that the use of purposeful ac-tivity, including occupation, is the core ofoccupational therapy, that is the therapeutic kernel of whar makes change inpatients. We have three provisos, however: First, that the definitions of purposeful activity must be multidimensional; second, that purposefulness andmeaningfulness are anribmes of personsand nor of acrivities; and third, thar it berecognized that legitimate occupationaltherapy services include techniques mherthan purposeful activity.The ultidimensional Nature ofPurposeful ActivityThe debate over the idenrification ofpurposeful activity as the core of occu-

Anne Henderson,Sharon Cermak,Wendy Coster,Elizabeth Murray,Catherine Trombly,Linda Tickle-Degnenpational therapy (American Occupational Therapy Association [AOTAJ, 1979)arose in pan from misinterpretation ofthe term purposeful actiuit) and in panfrom differing occupational therapy philosophies. For example, some pracritioners saw purposeful activity as synon)!mous with crafts (West, 1984).

Hinojosa, Sabari, and RosenteJd's(1983) position paper began the process of clarifying the meaning of theterm purposeful activity. but strugglesfor a bener definition cominue(Breines, 1984, 1989; Nelson, 1988;Steinbeck, 1986). We believe that wideacceptance of purposeful activity as thecore of OCCupational therapy is contingem on definitions that recognize themultilevel nature of aeriviries used inthe field. The multidimensional narureof occupational therapy is well recognized (Allen, 1987; Breines, 1989; Kielhofner, 1983, 1988; Llorens, 1981). Ac-tivity used in therapy ranges fromconcern with life tasks of work and leisure (i.e., high level) to Single-actionskills such as reaching for or rouchingsomething (i.e., Jow level). The level ofactivit)! chosen, from simple to complex,is determined by the presenting clinicalproblem as well as by the therapisr'sframe of reference. Thus, adaptive livingskills, which are high-level acrivities, areused in chronic disability, panicularlywithin the occupational behavior frameof reference. Practice in acute physicaldisabilities, however, also emphasizeslow-level acrivjties (AJlen, 1987). In any

area of practice, whenever activity is usedro remediate motor, cognitive, perceptual or socioemotional disability, that iswhen therapy is directed toward enhancing components of performance, simpleactivities or parts of activities, includingexercise, may be the most appropriate.The eaning of ActivityLow-level aCtiVity such as single-aCtionmovements or exercise, are often decriedas nm meaningful and therefore areviewed as inappropriate tools of cx:cupationa I therapy. We believe a aCtiVities arepotentially meaningful. The meaning ofan activity changes, however, with theperson, the treatment context, and thetiming of its use. The meaningfulnessmay be in the enjoyment of the activityprocess, for example, in a game or play;it may be in the production of a produCt,as in crafts; it may be in the gratificationof succeeding in a task such as dressing;or it may be in the satisfaction of increasing strength or mmor skiU. The meaningor lack of meaning does not lie with theactivity but with the person for whom itis chosen and with the context in whichit is done.FaC/htatolY AgentsThere are many non-occupational techniques that are legitimate and necessaryadjuncts to occupational therapy service, including interpersonal interaction,orthmics, physical agents, family counseling, biofeedback, and the shaping ofbehavior. Such techniques would nOt bedefined as occupation, but they preparefoe or are facilitatory to occupationKielhofner, 1983); they are not the

core but are important [ good occupational therapy practice in many areas.The meaningfulness of these techniquesto the patient lies in their power to enhance the effecriveness of an activity orto facilitate performance.

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SummaryWe believe that the conceptualization ofpurposeful activity should be congruentwith the uses of activity in occupationaltherapy practice. Definitions of purposeful activity should then encompassthe breadth of activities from single actions or movements to adaptive livingskills and should encompass historicand traditional as well as contemporaryuses of activity in the profession. Fromthe profession's beginnings, the occupational therapy process has included theuse of activity focused on the increasingof competence in daily occupations ofwork, self-care, and leisure and on theuse of activity to reduce pathology andrestore function. We believe the boundaries of the use of activity should continue to be flUid. Definitions of aCtivityshould be used for orientation, not forlimitation, and should captLIre the richness of our profession.

o cupattonal cienceWe believe that the definition of what isproper occupational therapy researchshould reflect contemporalY practicesthat are widespread in occupationaltherapy. Just as the definitions of purposeful activity should be congruell[with definitions of occupational therapy,so should definitions of what is rroperoccupational therapy research be congruent with definitions of purposeful activity and of occupational therapy

Reilly (1960) said that our mostfundamental area of research is and always will be the nature and meaning ofactivity. We see the natLIre of activity asnot only including the characteristics ofan activity that make it meaningful to aperson but also the complex of humansubskills that are needed to engage inan activity. The stLIdy of purposeful activity must include not only the occupational natLIre of man in his environmentbut also the effect of disease and injuryon specific activities and the effect of activity on dysfunction.

The research of the AOTNAmerican Occupational Therapy FoundationNeurobehavioral Rehabilitation Research Center of the Occupational Therapy Department, Boston University, Sargent College, is directed [Oward anunderstanding of the relationship between purposeful activity and health.One focus is on the subskills of activity,

The Amel-ican Journal of Occupational Therapy

that is, the components of performanceas well as facilitatory procedures used intherapy. We seek to better define andmeasure the deficits in various clinicalpopulations in order to clarify the goalsof treatment. Much of our knowledge ofdisabilities and components of activitiesis gleaned from [he research of otherdisciplines. Researchers in other disciplines, however, conduct their stLIdieswith different aims. The basic researchquestions of concern to occupationaltherapy are not asked by these researchers. We are concerned with thequestions that will otherwise go unanswered. Some of our questions are basicand directed toward a better understanding of the effect of disease and injury on occupational performance, suchas (a) What are the componell[s of occupational performance? b) How dothe performance componell[s changewith disease or injury and how do the)'change as funCtion is restored? and (c)What aspects of disability provide barriers to life experiences?

The applied science questions begin with the assumption that occupational therapy facilitates the mechanismof change from dysfunCtiOn towardfuncrion and that there is a need to investigate the assumptions about howthis OCClH S. What are the critical therapeutic aspects? What are the assumptions of treatment and are they valid?What aspects of the therapeutic processbeyond aCtivity affeCt goal anainment?How does the context of treatmell[, including therapeutic ill[eracrion, affecttherapeutic change?

A research focus on componell[s ofperformance or aspects of disability hasbeen labeled reductionist and thereforehad and not occupational therapy. A

focus on the understanding of components of behavior, howevel', does notimply that we have reduced occupationand activity to nothing more than theircomponents. We believe, rather, that ahetter understanding of the components of function will help to constructbetter models of occupational scienceand to analyze how the componentscontribute to occupation and purposeful activity.

\'(Ie believe that life skills and cornponell[ skills, activity and enablingagents, remediation and adaptation, areall a pan of the fabric of occupationaltherapy and thus proper subjects for occupational therapy resealch....

Ackmm ledgmen tsThis paper was supponed in part by theNeurobehavioral Rehabilitation ResearchCenter, Boston University, Boston, Massachusetts, a center for scholarship and researchin occupational therapy funded by the American Occupational Therapy Association andthe American Occupational TherapyFoundation.

ren esAllen, C. K. 1987). Activity: Occupational therapy's treatment method- 1987 Eleanor Clarke Slagle LeCture. American journalof Occupational Therapl', 41 563-575.American Occupational Therapy Association. 1979). The Philosophical Base of Occupational Therapy (Resolution 531-79) [Internal documentJ (Available from theAmerican Occupational Therapy Association,PO Box 1725, Rockville, MD 20849-1725)13reines E 1984). The Issue Is An attempt to define purposeful auiviw Ameri

call journal of Occupational TherapJl, 38543-544Breines, E. 13 1989). The Issue Is -Making a difference: A premise of occupation~ n c l health. American journal of Occupational Tberapy, 43. 51-52.Hinojosa,]., Sabari J. & Rosenfeld M. S1983). Guidelines and Position P ~ p e r s P u rposeful activities. American jounwl of Oc-cupalional Therapv. 37, 805-806.Kit:lhofner. G. ]983). A paradigm forpractice: The hierarchical organization of occupational therapy knowledge. In G. Kielhofner (Ed.), Heald, rbruugh occupalion(pp. 55-91). Philadelphia: F. A. Davis.Kielhofner, G 1988). O c c l l p ~ t i o n a l therapy-Base in occupation. In H L. Hopkins & t-I. D. Smith (Eds.), Willard andSpackman s occupalionallherap) (7th ed.,pp. 84-92). P h i l a d l p h i ~ Lippincott.Llorens, L. 1981). On the meaning ofaClivil)' in occupational t h e r ~ p y journal ofthe New L.ealand Associales of OccupmionalTberapists. 32. 5-6.Nelson. D. L. 1988). Occupation: Formand performance. American journal ofOc-cupCllional Therapy, 42, 633-641Reilly, M. 1960) Research potentialit\'of occupational therap\'. American journalof Occupational TberapJ', t4 206.Steinbeck, T. 'vI. 19H6). Purposeful activitv and performance. Americanjownal ojOccupational Therapy, 40. 529-554West W. L. 1984).1\ reaffirmed philosophy and prauice of occupational therapyfor the ]9805. American jounwl ofOccujJationaI Therapy. 38. 15-23

Anne Henderson, phi). OTR/L is ProfessorEmerilus of Occupational TherapySargenr College, Boston University,635 Commonwealth Avenue, Boston,iVlassachusetts 02215, and ResearchFaculty Member, Neurobehavioral Re-habilitation Research Center, BostonUniversity.

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Sharon Cermak. f:.dD. OTR/L. is AssocialeProfessor of Occupational Therapy,Sargent ColleRe, Basion University, Boston, /\lJassachuselts, and Director,Neumbehavioral Rehabililalion Research Cenler, Boston UniversiZyWendy Coster, t bD. OTRII., is AssislantProfessor o Occupalional Therapy,Sargent College, Boslon UniversiZy, Boston, Massachusells, and Research Faculty Member, Neurobehavioral Rehabilitation Research Cenler, BostonUniversiZyElizabeth Murray, SeD OTR/I. is AssistantProfessor of Occupalional Therapy,Sargenl College, Basion University, Bos-

Advanced TherapyBTE ,Department of Veterans Affairs

Fred SammonsG E. MillerHygenic orporationOlympic Medical

ton, Massachusells; Research Facultyi\ /emher, Neurobehavioral Rehabilitation Research Center. Boslon University; and Assistant Director of Occupalion l Therapy Eunice KennedvShriver Cenler, Wallham, MassachusettsCathe rine Trombly,HA. orR/t is Professor of Occupational Therapy, SargentCollege, Basion Uniuersity, Basion, Massachusetls, and Acting Director, Neu1'0behavioral Rehahilitation ResearchCenter, Basion Universily.Linda Tickle-Degnen, Pbl). OTR/I. is Assistant Professor of Occupational Therapy, Sargenl College, Basion University,Basion, Massachuselts, and Research

ndex to dverti ersage

Facultv Mem.ber. Neurobehavioral Rehahilitation Research Center, BostonUniversilyThis article was accepted for publication OcLober 15 1990

Tilt.' ISSUt. IS provides a urumfur debateand discussion of occupationaltberapy issues and related topics. Tbe Contribu/inKtdi ur uf tbis sec/ion, Julia Van Deusen,s/rives 0 baw bo/b sides of an issue addressed. Readers are encouraged to submimanuscrtpts discussing opposite palms oflJiew ur new topics. All manuscrip s are subject tu peer relJiew. Submit tbree copies tot'l aine Viseltear, EditorPuhlisbed articles refleci tbe opinion0/ tbe autbors and are selected on tbe basisul'interest to tbe prol'ession and quality oftbe discussiun.

age,.. , 299 Psychological orporation 289

Cover 3 S S Arts Crafts 330377

Cover 4Cover 2

Smith Nephew Rolyan

Southpaw Enterprises

290

339

380-381 Tandy Leather ompany 330

339 Vocational Research Inst itute _ 323

Physical Medicine Research Foundation 338 WFR Aquaplast 294

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