사고와 질병으로 인하여 사람들은 '환자'라는 타이틀을 가지게 된다 그것은 기존에 행하던 일, 놀이를 포함한 다양한 사회의 흐름 아래에 있는 모든 활동(작업, Occupation)을 잃게됨을 말한다 환자들이 호소하는 고통과 어려움은 신체적 증상에 국한된 것이 아니며 잃어버린 작업(Occupation)을 되찾아가는 과정이 필요하다 걷기 힘든 신체적, 사회적 조건을 가지게 된 사람은 걷고 싶어 한다 당연하다 왜? 걸어서 마트에 가서 맛있는 아이스크림을 사올 수 없고 카페에 걸어가서 테이블에 앉아 커피를 마시기 어려운 조건을 가지기 때문이다 그로 인해 직업, 놀이 등 활동에 제약이 생기고 그에 따라서 사회적 활동 참여에 대한 제한이 생기기 때문이다 우리는 이러한 어려움을 장애(Disability, 무능력)라고 이야기한다 느리지만 꾸준히 잃어버린 작업을 되찾아가는 클라이언트들을 보면서 교감하고 또 소통하고 서툴고 어렵지만 우리 함께 옮기는 작은 발걸음들이 나는 너무 좋다 "나는 작업치료사다"


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저는 사과를 굉장히 좋아하고 또 즐겨먹어요. 제가 만났던 클라이언트는 과일은 그다지 좋아하지 않았지만 손님을 많이 만나고 대접을 해야하는 경우가 많았기 때문에 과일을 평소에 많이 손질을 했었다라고 합니다. 하지만 뇌졸중 이후 어눌한 손의 움직임 때문에 어려움이 많았고 과일과 거리를 두고 있으셨습니다. 클라이언트와의 인터뷰를 통해서 위와 같은 사실들을 이해할 수 있었고 그에 적절한 의미 있고 목적 있는 작업에 기반하는 중재를 선택할 수 있었습니다. 작업치료란 무엇일까요? 우리들은 작업치료를 공부하고 실제적인 적용을 하고 있는 전문가라고 할 수 있습니다. 우리들의 전문성을 살리기 위해서 어떠한 노력을 기울이고 있는지 고민해봅시다.


 
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[출처] SOAP노트 & 장기, 단기 목표잡기|작성자 정준식

Long- and Short-Term Goals

A goal is a measurable, narrowly defined end result of therapy to be achieved in a specified time.

(Bryant, 1995)

 

Long-term goals reflect what will be achieved by the time the patient is discharged from treatment or discharged to the next level of care on the continuum(Moorhead & Kannenberg, 1997).

 

In occupational therapy, long-term goals always relate to expectations of the patient's functional skills and/or resumption of roles.

 

Short-term goals are the small steps that cumulatively result in long-term goal achievement.Short-term goals are based either on expected improvements specific to client factors(AOTA, 2002) or impairments that ultimately contribute to improved function or on the patient's improved ability to perform portions of the functional task(McGuire, 1997). A patient's occupational therapy goals are always linked to a predicted outcome and typically complement the work of other rehabilitation disciplines.

 

Example of establishing Short-term goals

Long-Term Goal : Independence in Lower Extremity Dressing

Examples of Short-term goals

Based on Impairments

Examples of Short-term goals

Based on Task Analysis

ㆍTrunk flexion and both upper extremities forward reach adequate for LE dressing

ㆍCognitive-perceptual skills adequate for positioning clothing during LE dressing

ㆍEndurance adequate for safety and independence during LE dressing

ㆍDemonstrate compensatory methods and

appropriate use of adaptive equipment for safe, independent LE dressing

ㆍClient will be able to properly place trousers over feet for donning.

ㆍClient will be able to spontaneously dress Left LE before Right LE.

ㆍClient will be able to pull up trousers from a standing position.

ㆍClient will be able to demonstrate proper and long handled shoe horn and complete LE use of sock donner dressing in 5 minutes without shortness of breath.

 

√ Procedures for practice

- Liking long- and short-Term Goals to anticipated rehabilitation outcomes

P.B. is a 20-year-old man with C8 tetraplegia beginning multidisciplinary inpatient rehabilitation. The following examples of outcome and long- and short-term goals are not meant to be exhaustive lists of intervention plans but rather to illustrate the linkage between global outcome projections and therapy plans.

ㆍProjected outcome of rehabilitation stay : In 8 weeks, P.B. will resume self-maintenance roles, requiring no more than occasional physical assistance from family members to manage in the home environment.

ㆍExamples of long-term occupational therapy goals(to be achieved in 8 weeks):

1) P.B will perform upper body dressing independently and require no more than moderate assistance for lower body dressing.

2) P.B. will use adaptive equipment to feed himself independently.

ㆍExamples of short-term occupational therapy goals(to be achieved in 2 weeks) :

1) P.B. will don a pullover shirt with no more than general verbal cues.

2) P.B. will participate in the evaluation of various types of adaptive equipment for self-feeding and use selected aids to feed himself independently after set up by therapist.

 

Collaborating with Clients to Set Goals

Patients who had functional goals had higher discharge scores on the FIM for grooming, upper and lower extremity dressing, and toilet and tub transfers. Despite the potential benefits, collaborative goal setting is challenging for newly disabled patients.

 

Suggestions for collaborating with clients to set meaningful occupational therapy Goals

ㆍIncorporate life history information into the assessment process so that you are able to get a glimpse of what the patients has found meaningful and important during the course of his or her life events(Spencer, Davidson, & White, 1997). Awareness of the patient's personal context enables the clinician to discuss, frame, or propose possible therapy outcomes and goals in ways that the patient will understand.

ㆍAppreciate that the patients' ability to identify and advance their goals for therapy will be influenced by where they are in recovery and adaptation process. Individuals who are acutely ill or whose hospitalization has insulated them from the real-world impact of newly acquired disabilities will often be unable to anticipate the challenges that await them in the community. Outpatients or home-based clients are typically more able to articulate needs and hopes for therapy because of their experiences with performance gaps.

ㆍConsider the broad continuum of care(inpatient to home health to outpatient to work reentry) as you aim to match the "right" goals with the "right" time frame by asking, "what does the person both value and need from occupational therapy at this point in his or her recovery?"

ㆍAppreciate that most patients are unfamiliar with occupational therapy services and what we have to offer them and, therefore, are unable to independently generate goals for therapy. The therapist sometimes facilitate collaborative goal setting by proposing a menu of possible goals to address in therapy and modifying that list with the patient.

ㆍAcknowledge the influence of cognitive function on a person's capacity to set meaningful goals. For a person to establish a meaningful goal, he or she must first accurately appraise his or her current status and compare it to past or premorbid performance. The individual must be able to imagine what is both possible and likely(given present condition and status) and how much time and effort is required to attain what is envisioned. Solicit input from family if the patient seems to unable to independently determine or communicate his or her goals for therapy.

ㆍIf you are unable to arrive at consensus of broad therapy outcomes, try to agree on short-term goals. For example, a patient who is 3 months post brain injury wants only to work toward resuming his career as an air-traffic controller, a broad outcome the clinician views as unrealistic. Instead of haggling over what the future may or may not hold for this individual(which dampens energy, hope, and motivation), the patient and therapist agree that, to return to work, he needs to be able to independently get ready each morning, and begin their work there.

 

Levels of Assistance

Level

Description

Independent

Client is completely independent.

No physical or verbal assistance is required to complete the task.

Task is completed safely.

Supervised

Client required supervision to safely complete task.

May require a verbal cue for safety.

Contact guard/standby assistance

Hands-on, contact guard assistance is necessary for the client to safely complete the task or care-giver must be within arm's length for safety.

Minimal

assistance

Client required 25% physical or verbal assistance of one person to safely complete the task.

Moderate assistance

Client required 50% physical or verbal assistance of one person to safely complete the task.

Maximal assistance

Client required 75% physical or verbal assistance of one person to safely complete the task.

Dependent

Client required 100% assistance to complete the task.

 

Intervention Plan

Information obtained from the occupational profile and the various assessments is analyzed and a problem list is generated. The therapist must use theoretical knowledge and clinical reasoning skills to develop long- and short-term goals, intervention approaches, and the types of interventions to be used to achieve the goals. The intervention plan also includes recommendations or referrals to other professionals or agencies. The intervention plan is based on selected theories, frames of reference, and evidence-based practice. It is directed by the client's goals, values, and beliefs.

Goals must be measurable and directly related to the client's ability to engage in desired occupations. The overarching goal of occupational therapy intervention is "engagement in occupation to support participation." This must be kept in mind at all times when developing the long- and short-term goals. OTPF further identifies the outcome of occupational therapy intervention to be improvement in the following areas : occupational performance, client satisfaction, role competence, adaptation, health and wellness, prevention, and quality of life. Documentation that incorporates this terminology will support the unique focus that occupational therapy contributes to the client care plan.

Short-term goals or objectives are written for specific time periods(e.g., one or two weeks) within the overall course of the client's therapy program. They are periodically updated as the client progresses or in accordance with the guidelines of the practice setting. Short-term goal achievement leads to attainment of the established long-term goal, which usually encompasses the entire therapy stay. Short-term goals are the steps that lead to the accomplishment of the long-term goal, which is also called the discharge goal in some setting. The long-term goal is generally considered to be the overall functional goal of the intervention plan and is broader in nature than the short-term goal. For example, the client's long-term goal may be to become independent with dressing. One short-term goal to accomplish this might be that the client is to be able to dress in a simple pullover shirt without fasteners. When this short-term goal is achieved, a subsequent goal might be for the client to be able to dress independently in a shirt with buttons. Eventually lower extremity dressing would be added as an objective, then outerwear, until the long-term goal of independent dressing is achieved.

Client-centered goals are written to reflect what the client will accomplish or do, not what the therapist will do, and are written in collaboration with the client. Goals must be objective, measurable, and include a time frame. The expected behavior is clearly stated(the client will don pants), a measurable expectation of performance is identified(independently), with conditions or circumstances that support the outcome listed(using a dressing stick). An indication of the time frame in which the outcome will be achieved(within one week) may also be included, although this may be written in a separate section of the evaluation form. Well-written goals contain all of the components listed below.

 

Examples of Short- and Long-Term Goals

Area

Short-Term Goal

(to be completed in 2 weeks)

Long-Term Goal

(to be completed in 4 weeks)

Cooking

Client will prepare a cup of tea with minimal verbal assistance for safety and technique.

Client will independently adhere to safety precautions during simple cooking tasks 100% of the time.

Hygiene

Client will brush teeth with moderate physical and verbal assistance while seated at the sink.

Client will complete morning hygiene and grooming independently after task set up while seated at the sink.

Dressing

Client will don socks with minimal assistance using a sock aid while seated in a wheelchair.

Client will independently complete lower body dressing with assistive devices while seated at the edge of the bed.

 

SOAP note

 

Subjective

information reported by the client, family, or care-givers.

Any information that the client tells the therapist about his or her current condition, functional performance, limitations, general health status, social habits, medical history, or client goals can be appropriate to include in this section. A client's subjective response to treatment is recorded in this section. Family, care-givers, and others involved in the client's care can also provide valuable information. For example, nursing may report that the client was unable to feed him or herself at breakfast or a family member may supply information on the client's normal routine prior to hospitalization. If the client is nonverbal, gestures, facial expressions, and other types of nonverbal responses are appropriate to include. This information can be used to demonstrate improvement, support the benefit of chosen interventions, document the client's response, and show client compliance. should only include relevant information that will support the therapist's decision on which assessments to use and which goals are appropriate for this client.

 

Objective

the results of assessments performed and objective observations. data - measurable or observable. Only factual information may be included. Results of standardized and nonstandardized tests are documented in this part of the note. Measurable performance of functional tasks(BADLs, IADLs, ROM measurements, and tone assessments) are examples of appropriate information for this section of the SOAP note. It is important that the therapist not interpret or analyze data in the objective sections. Rather, statements should only include objective recordings of the client's performance. Simply listing the activities that the client engaged in is not sufficient. The emphasis is on the results of the interventions, not on the interventions themselves.

 

Assessment

the therapist draws from the subjective and objective finding and interpret the data in order to establish the most appropriate therapy program. impairments and functional deficits are analyzed and prioritized to determine what impact they have on the client's occupational performance. Clinical reasoning is required to analyze the information and develop the intervention plan. The therapist demonstrates his or her ability to summarize relevant assessment findings, synthesize the information, analyze its impact on occupational performance, and use it to formulate the intervention plan.

 

Plan

As the client achieves the short-term goals, the plan is revised and new short-term goals are established. Documentation reflects the client's updated goals as well as any modifications to the frequency of therapy. Suggestions for additional interventions are included.

 

SOAP note 예

Subjective : Client states that "it takes too much energy to dress each day and my hands are too stiff to manage buttons and ties anyways." Client's family reports that client no longer seems interested in self-care activities.

Objective : Client became SOB with seated self-care task(dressing) after 5 minutes of activity. Client required minimal assistance for upper body dressing, moderate assistance to don pants and maximal assistance to don shoes(last week she required maximal assistance with all tasks), client had moderate difficulty with buttons(last week she was unable to button blouse). Client was unable to tie shoes. BUE shoulder strength is 3+/5 (was 3/5).

Assessment : Client is improving in her ability to complete her self-care tasks. COPD still interferes with ADL independence. She may benefit from adaptive equipment for lower body dressing.

Plan : Continue ADL training : assess for independence with adaptive equipment(dressing stick, long-handled shoe horn, and elastic shoe laces). Instruct client in energy-conservation techniques during ADL task completion. Instruct client in AROM exercises before beginning morning ADL tasks.

 

※ Reference

패드리티

 

There are four commonly used components of SOAP:

S = Subjective (what the client Said - e.g. their reported feelings)

O = Objective

(what you Observed - e.g. what you did. NB: not your subjective interpretation)

A = Assessment (the Analysis of Subjective & Objective)

P = Plan

 

Subjective

Presents the problems from the patients viewpoint — how he/she may feel Information from other individuals also go here. Relevant info also include:

■ The reason for the patients visit — often in the patients own words

■ History of presenting condition/function in chronological age

■ Symptoms data including severity, location, duration & frequency of symptoms the patient is experiencing

■ Past medical/social history

■ Medications being currently taken as well as appetite, diet and allergies

 

Objective

Records the physical symptoms and includes specific objective statements. Can be gathered from Observation of the patient, Physical Examination, Lab results and X-Rays for example. More than often it consists of what you observe. Note that it is this part that is often scrutinized for accuracy - don't make observations unless they wouldn't be observed the same way as someone else - e.g. X was crying and not X was sad.

 

Assessment/Analysis

Interpretation of the subjective/objective elements.

 

Plan

Describes plan for treatment/further sessions and management of the noted issues. Could include referral, phone call or plan to collect more information. Note that some people often use this as objective style plan - a client-centered, specific and measurable plan of intervention by a set time (SMART).

Note that some people will put Objective before Subjective statements - arguing that its easier to write - it doesn't matter just as long as its all in there! Its also often wise to put a little line before the SOAP just stating what the note entry is for (e.g. visit, phone call, discharge etc..)

So on with the examples. Now I'm in no way suggesting these are perfect - just examples of soap format. Remember that everybody writes notes slightly differently! Feel free to comment on them below. See the "OTA's guide to writing SOAP notes" book for far more comprehensive examples (see references below)

 

Example 1 - Acute Accident & Emergency

OT (Bob Smith) initial interview, mobility assessment (bed to rollator frame, walk 10m).

S. Patient reported difficulties in home care, in particular cleaning and shopping. Expressed concern of putting strain on son as a primary carer. Keen to get back to previous roles within home (mother, housewife) and visit friends.

O. Patient was polite and joking throughout. Jane required touch cues for sit -> stand and moderate physical assistance to grasp rollator frame. Stood un-aided at rollator-frame for 20 seconds. Reduced mobility and endurance seen - needing assistance after 2m.

A. Jane is at risk of further falls. Would benefit from home visit to investigate risks in home environment.

P. Refer to physiotherapy for full mobility assessment, Plan home visit with Jane this PM, Discuss with social work current/future Package of Care.

 

Example 2 - Paediatrics

OT (Bob Smith) visited Jenny at School to observe play and socialization skills

S. Jenny was non-verbal throughout session. Jenny's teacher discussed with OT how Jenny had previously been listening to a story with no concerns.

O. Mary observed to stand and play in sand tray for 15 minutes. Bilateral use of upper limbs and independent in manipulating objects. Worked on her own with moving sand in a truck from one area to another. Did not interact with others when asked by another child to join their game or when OT asked Jenny if she would like to join them. Continued playing in sand when asked to stop.

A. Jenny would benefit from further observation within other classroom activities.

P. Organize visit to school during group-work time

 

Example 3 - Mental Health

Group cookery session

S. Jane stated that she enjoyed baking cakes at home.

O. Client was admitted 1 week ago and second cooking session attended. Participated in activity focussing well on tasks throughout and helped other less-proficient members. Unable to recognize other group members social cues to have no assistance and carried on assisting. Jane needed 2x verbal prompting to initiate termination/restoration of activity.

A. Jane is having difficulty recognizing social cues from others. Would benefit from greater group involvement with emphasis on time management skills. Jane shows a level of motivation that indicates good rehab potential with medication.

P. Ask Jane to attend future baking groups. Jane to work on time management and social skills by planning and organizing a meal with others.

 

References :

■ College of Occupational Therapists (2003) Professional Standards for Occupational Therapy Practice London: COT [Download here (need to be a COT member)]

■ Weed L.L. (1971) Medical records, medical education and patient care. The press of Western reserve University, 5th ed.[amazon]

■ Borcherding S, Kappel C. (2002) The OTA's Guide to writing SOAP notes, SLACK [amazon]

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작업치료가 생기기까지는 오래되진 않았지만 치료로서 활동을 시작한 것은 기원전부터 시작이 되었다. 중국의 외과의사 화타가 만든 쿵푸는 통증과 증상들을 완화시키려 처방되었지만, 영혼불멸을 목적으로 하기위해서 만든 것이다. 그리고 페르시아인들은 청소년들이 강한 군사가 될 수 있도록 운동치료를 사용해 군사훈련을 하였다.

고대 그리스와 로마 시기엔 기원전 600년경 에스쿨라피우스는 음악, 노래, 연극을 통해 섬망을 줄일 수 있다고 주장하였고 히포크라테스는 레슬링, 승마 노동을 통해 목적을 제공했다. 그리고 에스클리피아데스는 음악과 운동, 그리고 작업을 사용해 정신질환을 치료하였다. 그 외 세네카, 리비 등 여러 사람들이 정신과 환자들을 위한 활동을 중요시 했다.

유럽의 르네상스 시기엔 즐거움을 추구해 치료로서의 작업이 거의 이루어지지 않았다. 그리고 1780년 Tissot이 작업운동을 능동적, 수동적, 혼합적 운동으로 분류해 바느질, 바이올린 연주, 톱질 등과 같은 활동을 추천하였다. 프랑스 외과의사 Phillipe Pinel은 우리 속에 감금 되 죄인과 같은 취급을 받았던 정신과 환자들에게 일을 제공해줌으로서 치료를 하였다. 그럼으로써 이렇게 시작한 도덕적 치료가 작업치료의 시작이 되었다. 19세기 초에는 치료에 대해 긍정적인 생각으로 변화시킨 인본주의가 등장하였다. 영국 퀘이거 교도인 william Tuke는 정신질환을 정신적 작업을 통해 치료했고 Pinel과 함께 도덕적 치료의 실용화를 선도하였다. 19세기 중반, Strory Kirkbride 박사는 정신질환 치료를 위해 도덕적 치료와 작업을 사용해야 한다고 주장했다. 그는 매일 도덕적 치료를 하면 체계적이고 능동적으로 활동을 할 수 있다고 했다. 그래서 그는 매일 환자들의 성별에 따라 남성은 농사, 페인트칠 같은 일을, 여자는 가사일과 수공예 같은 일을 하도록 했다. 19세기 말에는 산업혁명의 영향으로 사회적 질환인 산업재해 때문에 치료를 필요로 하는 장애인들이 늘어나 새로운 치료방법이 필요하게 되었다. 이에 Benjamin Rush는 작업의 개념을 설명하고 승마, 자수 놓기, 볼링 등의 활동을 할 것을 주장하였다.

1914년 뉴욕에 환자와 장애인을 위한 병원을 개설 하고 Occupational therapy란 용어를 처음으로 쓴 건축가 Barton은 정신과 의사 Dunton과 함께 작업에 관심을 갖는 사람들의 모임을 만들게 되고 1917년 3월, Clifton Springs에서 NSFPOT(National Society for the Promotion of Occupational Therapy)의 첫 국제 모임이 개최되었다. Barton과 Donton 외의 사회사업가 Slagle, 건축가 Kindner, 수공예교사 Johnson, 간호사 Tracey 등이 있었고 Barton이 초대회장을 맡게 되었다.

1914년 제1차 세계대전이 발생하고 부상병들을 위해 많은 재활병원이 생겼다. 1918년엔 전쟁응급과정이 보스턴, 필라델피아, 세인트루이스, 볼티모어, 뉴욕에 단기과정으로 개설되고 이 과정을 마친 여성들은 재건도우미(Reconstruction aid)로 불렸다. 이들은 신체장애인의 작업치료 발전에 공헌하였고 상이군인의 재활프로그램을 개발하기도 하였다. 제1차 세계대전은 신체질환을 위한 작업치료가 급성장하였고 의학계에서도 인정받아 학교까지 설립되었다. 1918년엔 심리학자 Baldwin에 의해 워싱턴에서 작업치료실이 생겼다. 그러나 전쟁 후엔 작업치료가 인력부족으로 인해 일반병원으로 확대되지 못하고 대부분 일을 그만두게 되었다. 그 결과 정신과 분야의 작업치료는 계속되었지만 신체장애의 작업치료는 축소되었다. 1932년엔 NSFPOT가 아름을 미국작업치료협회(AOTA)로 변경했고 현재까지도 이 이름으로 활동하고 있다.

1930년대엔 대공황으로 의학계 전체에 큰 타격을 주었다. 작업치료 영역도 예외는 아니었다. 이로 인해 인원축소로 작업치료 클리닉과 학교가 폐쇄되었다. 작업치료는 축소주의에 편입해 직장으로 빨리 복귀하기 위한 기능회복과 근력증진에 초점을 맞추었다.

제2차 세계대전이 일어나면서 작업치료의 필요성이 증가하였다. 국군병원에는 재활의학과가 개설되고 작업치료사는 말초신경손상 환자와 절단환자를 치료하는 역할을 맡았다. 그리고 일상생활 훈련, 작업단순화, 기능적 수행, 운동 치료, 의수족 훈련 등을 실시했다. 작업치료사들은 육군과 협의해 작업치료를 전문영역으로 인정받게 했다. 1947년엔 Spackman과 Willard가 '작업치료원리(Principles of occupational therapy)' 라는 최초의 작업치료 교과서를 출판하였다.

1940년대까지 작업치료는 총체주의와 축소주의가 공존하였으나 임상기술이 증가하면서 전인적 철학은 점차 침식되었다. 결국 과거의 인본주의를 붕괴하고 기술의 획득에 중심을 두는 결과를 가져왔다. Shanon은 이런 움직임을 ‘작업치료의 탈선’이라 했다. 그는 새로운 테크닉 기술 중심의 철학이 인간을 치료를 통해 조작되고 조정되는 민감한 기계적 존재로 본다고 비판했다. 그리고 이런 움직임을 재활운동이라고 하였다.

1960년대엔 시민인권운동과 빈곤과의 전쟁 같은 사회적 운동이 일어나면서 다시 인본주의가 수용되었다. 그러나 아직 작업치료사들은 목적 있는 활동 보다는 다른 영역의 방법을 인정하고 있었다. 1960년대 이후 새로운 감각운동과 신경생리학적 치료법이 성행해 목적 있는 활동은 점차 감소하였다. 그 결과, 작업치료사들은 목적 있는 활동을 인정하지 않게 되었다. 1980년대엔 많은 학자들이 목적있는 활동이 작업치료의 기본중심이 되기 위해 목적 있는 활동을 정의 하려고 하였다. 1983년 4월 AOTA는 목적 있는 활동이라는 용어의 사용을 명백히 하기위한 의견서를 채택하였다. 그리고 20세기 말엔 인본주의적 접근과 과학적 접근과의 통합의 중요성을 강조했다.

우리나라에서 작업치료가 시작된 것은 6.25 한국전쟁이 일어난 1950년 이후이다. 그리고 전쟁터에서 다친 군인들의 치료를 위해 미군의 보호 아래 작업치료사 양성교육 기관을 설치하였다. 본격적인 작업치료가 시작된 것은 전쟁 이후 1952년에 부산 동래에 상이군인을 위한 ‘정양원’이 설립되었다. 정양원은 1953년 ‘국립재활원’으로 변경되었다.

그 때 국립재활원의 의무과장 오정희와 한국인 최초로 미국 작업치료사 면허를 취득했던 박 에스더는 함께 작업치료사 양성교육을 시작해 한국에서의 작업치료가 본격화 되었다. 그리고 1969년 이들의 교육을 통해 한국최초의 작업치료사가 배출되었다. 1975년도엔 각 병원에서 본격적인 작업치료사 수습 제도가 시행되었고 1979년엔 대학에서 작업치료사들의 정규교육 과정이 시작되었다.

1989년, 작업치료사 협회가 결성되었고, 1993년도엔 대한 작업치료사 협회를 발족하였다. 1995년도엔 아시아 태평양 작업치료사 협회 회원국으로 가입하였고, 1998년 세계 작업치료사 연맹(WFOF)에 49번째 정식 회원국으로 가입해 대한 작업치료사 협회(KAOT)란 명칭으로 활동하고 있다.

출처 : 
http://blog.naver.com/eunmin1273/140114104486 

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1910s - "Reconstructive Aides" 

First practitioners in OT profession, called reconstructive aides, worked during World War I to rehabilitate disabled soldiers and civilian patients. They addressed the need of these soldiers for care beyond wound repair. The need to have something useful to do, and thus recapture purpose in their lives.

 

1920s - OT expands into mental illness

Occupational therapy expanded beyond serving people with physical impairments to include those with mental illness.

 

1930s - OT becomes more scientific

Occupational therapy became more closely aligned and identified with organized medicine, which led to the beginning of a more scientific approach.



1942 - 1960 - the "Rehabilitation Movement"

Often referred to as the "rehabilitation movement," and occupational therapists were called to organize and run rehabilitation programs for injured veterans. In addition, other medical advances were extending and saving the lives of people who had previously died - including those with spinal cord injury, traumatic brain injury and cerebral palsy.

 

1960s - 1970s - Move to specialization

The entire medical profession moved towards specialization, and occupational therapy followed suit. Services for individuals with developmental disabilities and pediatric disorders expanded greatly during this time.

 

1980s - 1990s - Expanding the focus on health and well-being

Occupational therapy became more involved in education, prevention, screening programs and health maintenance efforts. "Quality of life" was becoming increasingly accepted as a goal of occupational therapy intervention.

 

2000s - Return to the roots of occupation
In May 2002, the American Occupational Therapy Association adopted a revised framework of practice for the profession. This was done to provide occupational therapists with richer language and constructs to more accurately and fully explain what they do that is unique from other health disciplines. The new practice framework, Occupational Therapy Practice Framework: Domain and Process, returns to the roots of participation in occupation as the focus of the profession. The field of occupational therapy is an ever-evolving and dynamic profession.

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