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What are the theoretical models of occupational therapy?
After illness or injury leads to dysfunction, the patient's working ability is also impaired. How do occupational therapists know how to treat these patients? First of all, therapists should grasp the influence of clinically diagnosed diseases on patients' physical structure and function and the possible limitations on their ability to complete work activities, and understand the current research achievement of treating this disorder-Evidence-based Practice (EBP). Secondly, therapists must be able to evaluate and treat these patients professionally. Finally, they should know the theoretical basis of treatment-practice.

The composition or process of occupational therapy is found in the practice of different theoretical models. The practical mode of occupational therapy theorizes the interpersonal relationship, living environment, professional activities and quality of life of patients, thus guiding evaluation and intervention. How to define professional activities and purposeful professional activities, explain the reasons why professional activities are important to people's lives, and how to define purposeful professional activities. What is the role of therapeutic occupational activities? These will undoubtedly play a very important role in understanding homework activities.

Early occupational therapy emphasized technology rather than theoretical basis. With the development of society and the demand of health, people have gradually realized that it is necessary to summarize the practical experience of occupational therapy in clinical treatment and promote the development of occupational therapy theory and research. Only in this way can we provide different and feasible treatment schemes for clinic, guide clinic with theory and solve practical problems. But at present, the theoretical system of occupational therapy is still in a relatively perfect and unified exploration and analysis stage.

The following introduces several occupational therapy modes popular in the world, which are considered as the theoretical basis of occupational therapy and need to be further improved and developed in the future occupational therapy practice.

(1) Development mode This mode was first put forward by Dr. LelaA. Lorerns in 1970, which he summed up through his years of practical experience:

1. The development of neurophysiology, neuropsychology, social language, daily life, action and social and cultural skills of human beings in a specific era is synchronous.

2. Human development follows the principles of sequence, gradual progress, accumulation and predictability.

3. People should have good interpersonal relationships in all aspects of development (horizontal and vertical).

These abilities are usually acquired naturally in the process of development.

The influence of family, society and public organizations is also helpful to people's growth process.

Occupational therapists work for people with developmental retardation or obstacles. Patients need to change their living conditions, and occupational therapists provide conditions for change.

(2) Mode of Work Activity This mode was advocated and put forward by MaryReilly in the 1970s and 1980s. It includes three main aspects, namely, analysis, development and learning, which are based on the early theories of work therapy, psychoanalysis and development. Work activities can interfere with cognitive and perceptual dysfunction after craniocerebral injury and other diseases in many ways, and can also be used as the basis for choosing various work activities.

1. People integrate into society by learning the psychological and social needs of roles.

Some skills may be lost after illness, but they can be regained through re-learning.

3. The adaptation of skills is gradual, and it is carried out at the same time as the adaptation of other skills, which affects each other; Adaptation is continuous, starting with conscious learning and action, and then gradually forming habits.

4. Most of the adaptation comes from the actual communication with the growing environment, so as to develop the skills needed in reality.

(3) Manual working mode This mode was published by GaryKielhofner in 1997. In his thesis report, he divided the human operating system into three levels: will and habitual behavior. According to GST method, will is the highest level and behavior is the lowest level. The will level consists of three parts: personal belonging and interest value. Habit level classifies the ways and functions of actions. The behavior level consists of the basic ability-skill of behavior, and is dominated by the other two system levels. Its theoretical basis is

1. For human beings, there is no health without meaningful homework. For human beings, most behaviors are the result of environmental rewards and reinforcement in the process of interaction between human beings and the environment.

2. Human beings can influence their health by using hands empowered by spirit and will, that is, homework can constitute human health and can also be used as a means of health.

The above two points emphasize that homework is an indispensable basic activity for human health, but the process of healing and treatment is actually to set the goals and objectives of learning and the methods to achieve these goals.

3. In order to make occupational therapy a means to achieve the goal, the characteristics of the goal itself must be concrete.

(IV) Since 1942 set foot in the field of occupational therapy, GailFidler, a psychodynamic model, has always adhered to the belief that "designing or planning a purposeful activity is the core of the treatment process of occupational therapy". This model studies the causes of the formation of personality and motivation. In order to help individuals gain self-knowledge and maturity, it holds that the behavioral motivation of such patients is ignorance or because of poor experience, morbid personality, lack of experience and skills, mental illness and incorrect understanding of reality, so that patients can not correctly understand and express their needs and wishes and form certain connections with others.

The activities advocated by her mental dynamic model focus on individual body neuroethology, cognitive psychology, social culture, etc., and at the same time combine purposeful activities with human beings who focus on meeting individual needs to make them more extensive.

This therapy is based on psychoanalytic theory. Therapists should pay attention to the combination of activities and the relationship between patients, and adapt to the needs and values of the social and cultural environment in which patients live.

(V) Sensory integration model In the 1960s, Dr. A.JeanAyres put forward this model on the basis of the "hypothesis of the development order of perceptual movement" summarized through long-term research. She believes that human development includes four different levels, starting from the integration of the inherent perception of touch and vision, which is the foundation of the second level of movement, while the third level of visual space perception and movement ability evolved through the planning ability of movement, and the fourth level of learning ability.

Ayers believes that the period that affects the normal development of sensory system can be roughly divided into four stages, which are basically equivalent to preschool and school age in infancy.

The characteristics of this model are: instead of directly diagnosing and treating every disability such as specific daily movements, it is a process of relearning according to the causes of disability; Evaluate the causes of integration obstacles from the integration process of various sensory systems; An examination tool based on sensory integration examination was developed in Southern California, which closely linked diagnosis and treatment. This treatment mode has a wide range of applications.

The main target of sensory integration model is children with learning disabilities, and its treatment sequence is roughly divided into the following steps:

1. Adjust sensory input; 2. Promote posture response; 3. Promote sports planning; 4. Bilateral integration; 5. Perception of hearing in the form of visual space-improvement of speech ability

(VI) Motion control mode This control mode is a therapeutic concept applied to patients with central nervous system injury. There are four training methods (Rood;; Bobath; Bu Runstrom; Cabat), various sensory motor and nerve recovery means are included in this model.

The basic idea of this model is that there is a development process in human sensory perception, cognition, thought, emotional behavior and social culture, and its occurrence, development and maturity are influenced by biological and environmental factors, and there is a qualitative and quantitative change process. In this model, the abnormal muscle tension and posture reflex are suppressed by applying neurophysiological mechanism, and the normal motor response is induced.

(VII) Rehabilitation model The basic idea of this model is that the problem arises because the patient has lost some functions due to illness or injury. When it is impossible to recover by other methods, it can be made up by guiding the patient to re-learn and master skills, and even through environmental transformation or the help of others, the patient can achieve maximum independence. Patients become the core of the rehabilitation team, and therapists can adjust patients' surrounding environment and social conditions by providing appropriate training methods and equipment to help them return to society.

Rehabilitation models include:

1. Learn and train to use self-help tools; 2. Dressing skills; 3. Renovation of home environment; 4. Use mobile tools; 5. Family education; 6. Leisure and entertainment activities; 7. Self-care education and training; 8. Wheelchair skills training; 9. Energy saving technology

Rehabilitation mode usually combines biomechanical mode and motor control mode to improve and strengthen the recovery of sensory motor and cognitive function.

(VIII) Biomechanical model This model holds that dysfunction is an obstacle to the endurance of muscle strength within the range of motion, and provides patients with the mechanical principle of kinematics from the perspective of kinematics dynamics and medicine. Based on the mechanical principles of kinematics and dynamics, the model applies direct motion methods such as lever moment to improve the motor dysfunction of patients.

Biomechanical model evaluation projects mainly involve joint range of motion, muscle strength measurement, endurance test and sensory test.

(IX) Work function mode The work function mode (OFM) guides the evaluation and treatment of patients with physical dysfunction so that they can complete their work activities. OFM originated from the original viewpoint of clinical practice, that is, those who can play a role in life will feel self-efficacy, self-esteem and life satisfaction. Part of the research is about support ability and satisfaction (Robinson-) Allen, 2000). For example, among the elderly, it is found that the actual performance can enhance the curative effect (Resnik, 1998), and the ability to work activities gives full play to the characteristics of patients (Cristinansen,1999; Toyar-Sullivan co. Henderson, 2004) The therapeutic goal of occupational function model is to get satisfaction by restoring self-expression or guiding others.

One assumption of OFM refers to the ability to obtain information according to existing functions and capabilities (such as power perception).

The ability to complete self-roles and daily activities constitutes low-level functions and abilities. For example, strength and endurance are related to the high-level completion of daily activities and tasks, which has been supported by research (Dijkers, 1997,1999; Gierse Natal. , 1998; Svay Netal. , 1999)Dijkers pointed out that the relationship between low-level functions and abilities and high-level tasks and roles is not direct. Only a special ability, such as strength, does not guarantee that the specified activities or tasks can be completed. Similarly, being able to complete a simple activity does not mean that role-playing can be completed.

Ability is a combination of multiple functions, and successful completion of an activity requires multiple abilities. When a certain function or ability is damaged, the operational dysfunction may not be manifested, but may be adaptively compensated by other functions and abilities to complete the activity.

It is necessary to study the complex relationship between low-level functions and abilities and high-level activities, tasks and roles (Trombly, 1993, 1995).

Another assumption of OFM is that satisfactory work function will only happen when the individual is in a specific environment and background, and the real work function will not happen out of thin air or in a controlled situation, such as a clinic; Work function is the successful communication between patients and objects, places and environments. In order to regain the lost ability, although the specific activities and working environment will be controlled at first, the treatment will not stop until the patient finds his own unique environment.

In the functional mode of homework, homework has two meanings: homework is both a career as an end and a career as a means (Trombly, 1995). Homework is a function that OFM patients can accomplish through any skills, abilities and habits. Homework is another therapeutic method and skill used to treat disabled patients.

The structure of job function mode is shown in the figure.

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1. Self-efficacy and self-esteem Occupational therapy aims to improve patients' ability to participate in activities and complete tasks, and make them feel self-realization and self-esteem.

2.satisfactionwithliferoles。

Being able to master one's own life is to get satisfaction from one's role in life. Acting role is an important part of contributing to independent life (Hallett, 1994)Reilly( 1962) emphasizes that the classification of professional roles should be divided into four categories according to gender and age. In other words, the occupational therapy practice framework (OTPF) for preschool children, students, housewives or temporary retirees uses "work fields" instead of work roles. These areas are divided into activities of daily life (ADL), activities of tools of daily life (IADL), education, work, games and leisure activities, and social participation. In 1993, Trombly divides the role in the operational function model into three aspects: self-maintenance, self-development and self-progress.

3. Complete tasks in life roles

The 1) role consists of many tasks. For example, the role of a housewife includes preparing food service, cleaning the room, washing clothes and decorating the room. These tasks of the same role will vary from person to person. The value of these tasks will also vary according to the characteristics of different people in the same situation, and may vary according to what the therapist thinks is the most important aspect for patients, because everyone has different values. In a particular role, everyone is based on.

Therapists cannot subjectively assume that these specific tasks are important or unimportant to patients' role-playing.

2) The task is composed of many related activities, and it is also an improvement of using homework (activities) as a treatment. That is to say, a task refers to an activity that can be completed with or without the help of assistive technology with few hints or under specific environmental conditions.

4. Activities and habits

In the work function model, activities refer to small behavior units with goal orientation that make up tasks.

Activities relate abilities and skills under functional conditions. For example, one task of gardening enthusiasts is to eliminate pests, and the activities that constitute this task include spreading granular pesticides with bait, shaking and spraying liquids evenly to remove pests on plants. However, each of these activities consists of many small action units, such as opening packages and pouring granular pesticides into sowing containers. For example, removing pests from plants requires concentration, and other activities that do not require concentration are called habits. Habit refers to a series of action sequences that people can complete without high concentration in general situations and familiar environments. Jonson pointed out that physical obstacles disturb habits, so it is necessary to focus on the simplest actions in daily life. Many patients who have experienced this kind of experience have realized that it increases the habit of occupational therapy for fatigue, helps patients to keep or re-learn, abandons those unaccustomed habits, and explores a new practical framework of habitual occupational therapy (OTPF) according to patients' ability and talent to change. A term similar to habit is performance mode.

Activities and habits are acquired through homework, which is called "specific task training". In the training of specific tasks, functional and meaningful activities will be repeatedly trained. When necessary, the activities can be completed by using assistive technology adaptation methods or environmental transformation.

5. Ability and skills

Activities depend on many basic abilities. If a person has many very detailed development abilities, he will be very skilled in various activities. Ability refers to a universal characteristic that individuals have when accepting new tasks. For example, the functional model of muscle strength or memory operation divides abilities and skills into six categories: movement, feeling, cognition, perception, social spirit and cardiopulmonary function. For example, memory, problem solving and concentration are some cognitive abilities needed to successfully complete activities. Some movements, such as stretching, bending, grasping, grasping, manipulating, pulling and pushing, are all athletic abilities needed for many activities. In the practical framework of occupational therapy, these "performance skills" are divided into three parts: exercise process and communication/interaction.

In the work function model, ability is regarded as the combination of innate ability and acquired skills, which means using a certain degree of perseverance and effective methods to achieve goals in various situations (Hinggins, 199 1). To complete the above-mentioned action of feeding bait in gardening, patients need to have some abilities such as coordination, flexibility and reading guidance. At the same time, it is also necessary to have the ability to transform innate talents into required technical movements. Further detailed job analysis can be used to improve the defects in ability and skills. In different environments, patients can repeatedly complete work activities that require abilities and skills that patients do not have, and patients can acquire higher levels of abilities and skills. Therapists can encourage patients to study better by changing the environment.

6. Functional advantages (development ability)

The dominant function reflects the more mature and independent ability to integrate and apply basic functions. For example, in order to improve flexibility, people need to use their fingers to gradually relax their grip, and these leading functions are derived from basic functions such as reflective grip and natural relaxation. This integration can be obtained naturally in the treatment with the normal growth of people. Professional means are used to improve these abilities. By repeating some selective tasks, some more mature and diversified treatment needs gradually emerged. Although these seem to include the dominant function and basic function and anatomical structure of OFM, their similar terms in OTPF are customer factors.

7. Basic functions (primary capacity)

Basic function refers to the functional basis of sports cognition, perception and spiritual life based on anatomy. In sports, the basic functions are primitive visual perception and reflex reaction of the motor system, including reflex grasping reflex stretching, primitive stretching kicking and going up stairs. This is the "subroutine" put forward by Bruner, which can make useful non-reflective reactions from a specific sensory environment, that is, the cognition and perception of infants' infatuation with faces, that is, the basic function of social spirit.

8. Anatomical basis (organic matrix)

Anatomical basis refers to the structural and physiological basis of motor cognition, visual perception and spirit, including the most primitive central nervous system (CNS) tissues of newborns, as well as all tissues such as skeletal muscle sensory and motor nerves, heart, lungs and skin that are reactivated and repaired after injury or disease. Without anatomical basis, treatment will be meaningless. If all anatomical foundations are available, then we can call it a basic function realized through technology, which is called "enhanced maturity".

Although the basic theory of occupational therapy is still being explored, it should be noted that there is no theory that can be applied to all aspects of patients. Therefore, therapists must fully understand the adaptability, advantages and disadvantages of this theory, choose the most suitable treatment mode for patients, and apply this theory to clinical treatment effectively and flexibly.