PARADIGM SHIFTS IN OT PARADIGM SHIFTS IN OT PRACTICEPRACTICE

A review of how history has A review of how history has shaped the profession of OT in shaped the profession of OT in today’s practicetoday’s practice

ParadigmParadigmGeneral DefinitionGeneral Definition

Greek originGreek origin Pattern or modelPattern or model Conceptual frameworkConceptual framework Allows explanation & investigation of Allows explanation & investigation of

phenomenaphenomena Becomes understood thru Becomes understood thru

professional training & changed via professional training & changed via environmental demandsenvironmental demands

THOMAS KUHNTHOMAS KUHN(1970)(1970)

Paradigm is a universally recognized Paradigm is a universally recognized scientific achievement that temporarily scientific achievement that temporarily models problems and solutions to models problems and solutions to practitionerspractitionersSufficiently unprecedented scientific Sufficiently unprecedented scientific

achievement among competing achievement among competing sourcessources

Adequately open to allow exploration Adequately open to allow exploration of solutions for a variety of problemsof solutions for a variety of problems

BARKERBARKER(1992)(1992)

PARADIGM PARADIGM Filters perception – contrary info is Filters perception – contrary info is

often left outoften left out““What is defined as ‘impossible’ today What is defined as ‘impossible’ today

is impossible only in the context of is impossible only in the context of present paradigms.”present paradigms.”

““Every paradigm will uncover problems Every paradigm will uncover problems it cannot solve & these become a it cannot solve & these become a catalyst for a paradigm shift.”catalyst for a paradigm shift.”

Gary Kielhofner (1997)Gary Kielhofner (1997)

Paradigm is the cultural core of the Paradigm is the cultural core of the discipline & provides professional discipline & provides professional identityidentityhow professionals view practicehow professionals view practiceguides questions, solutions, goals of guides questions, solutions, goals of

practicepractice

KUHN’S PARADIGM SHIFTKUHN’S PARADIGM SHIFT

Definition – when a discipline Definition – when a discipline abandons one view of the world for abandons one view of the world for another; a revolution; a drastic another; a revolution; a drastic conceptual restructuringconceptual restructuring

4 STAGES WITHIN THE 4 STAGES WITHIN THE DEVELOPMENT OF A PARADIGMDEVELOPMENT OF A PARADIGM

1.1. Pre-paradigm phase – various thinking Pre-paradigm phase – various thinking approaches emerge to solve the same approaches emerge to solve the same problemproblem

2.2. Paradigm – “winner”; use of one school of Paradigm – “winner”; use of one school of thoughtthought

3.3. Crisis – not all problems can be solved this Crisis – not all problems can be solved this wayway

4.4. Resolution – reorganization of the old Resolution – reorganization of the old PLUS new thinkingPLUS new thinking

Kielhofner & Burke’s Kielhofner & Burke’s Historical ReviewHistorical Review

Paradigm of Occupation (1900-1940s)Paradigm of Occupation (1900-1940s)

Mechanistic Paradigm (1950s-1970s)Mechanistic Paradigm (1950s-1970s)

New Emerging Paradigm (1980s-New Emerging Paradigm (1980s-2000)2000)

Paradigm of OccupationParadigm of Occupation(1900-1940s)(1900-1940s)

Defined by…Defined by…Moral treatment (advocating for persons Moral treatment (advocating for persons

with mental illness by participating in with mental illness by participating in occupations that “normalized” behavioroccupations that “normalized” behavior

Origins: Origins: Consolation House Consolation House (1914, NY) (1914, NY) a convalescent home founded by a convalescent home founded by George Barton & Eleanor Clark Slagle; George Barton & Eleanor Clark Slagle; Hull House Hull House (1915, Chicago) a work (1915, Chicago) a work program for persons with physical & program for persons with physical & mental disabilities mental disabilities

History and development of OT

Paradigm of occupation

(1900-1940s)

Paradigm of occupation

(1900-1940s)

Mechanistic ParadigmMechanistic Paradigm

(1950s-1970s)(1950s-1970s)

Mechanistic ParadigmMechanistic Paradigm

(1950s-1970s)(1950s-1970s)

New Emerging New Emerging Paradigm Paradigm

(1980s-2000)(1980s-2000)

New Emerging New Emerging Paradigm Paradigm

(1980s-2000)(1980s-2000)

• Moral treatment • Consolation

house

• Moral treatment • Consolation

house

• Medical model • Specialization

• Lost commitment to occupational performance

• Medical model • Specialization

• Lost commitment to occupational performance

• Holistic view • Balance of art

and science

• Holistic view • Balance of art

and science

WWIIPressure to

Provide scientific evidence

WWIIPressure to

Provide scientific evidence

Away from core beliefs of OT

Unable to treat chronically ill

patients

Away from core beliefs of OT

Unable to treat chronically ill

patients

Paradigm of OccupationParadigm of Occupation(1900-1940s), cont.(1900-1940s), cont.

““Occupation” was the central Occupation” was the central phenomenon of interest referring to phenomenon of interest referring to balance of work, play, self-care, & balance of work, play, self-care, & rest; holistic viewrest; holistic view

The Paradigm Shift (1940s-The Paradigm Shift (1940s-1950s)1950s)

Crisis Era Crisis Era

The profession comes under pressure The profession comes under pressure from medicine to provide scientific from medicine to provide scientific

evidence for its practice evidence for its practice

Mechanistic Paradigm Mechanistic Paradigm (1950s-1970s)(1950s-1970s)

Medical model (reductionistic) replaces Medical model (reductionistic) replaces “occupations” of moral tx “occupations” of moral tx

OTs seek to gain professional respect as a OTs seek to gain professional respect as a scientific discipline by focusing on diseasescientific discipline by focusing on disease

Specialization is a popular trendSpecialization is a popular trend

Loss – commitment to occupational Loss – commitment to occupational performanceperformance

Gain – new assistive devices, technology, Gain – new assistive devices, technology, techniques; SI; NDTtechniques; SI; NDT

Paradigm Shift of the 1970sParadigm Shift of the 1970s

Crisis EraCrisis Era

Reductionism was inadequate for Reductionism was inadequate for treating chronically disabledtreating chronically disabled

OTs express dissatisfaction over a loss OTs express dissatisfaction over a loss of professional identity & unityof professional identity & unity

NEW EMERGING PARADIGMNEW EMERGING PARADIGM(1980s)(1980s)

Recommitment to holistic view and Recommitment to holistic view and the occupational nature of humans the occupational nature of humans

Client centered practice including Client centered practice including active engagement & empowermentactive engagement & empowerment

Systems theoretical view Systems theoretical view Balance of the art & science of Balance of the art & science of

practicepractice