Introduction

According to the World Federation of Occupational Therapy, occupational therapy is a profession which is concerned with the promotion of well-being and health of individuals through engaging them in occupation. It is a holistic healthcare profession with an aim to promote health in individuals by enabling them to perform purposeful and meaningful activities across their lifespan. Occupational therapist by using different treatments help their patients with a mental, physical or developmental conditions to recover, develop or maintain daily work and life skills in themselves. OT is client-centered and see client as an integral part in the process of Occupational therapy. Therapist gives individualized attention and evaluation to his/her client or clients (individual and families) in learning the current state of affairs and the desired state of affairs in client’s life. occupational therapist learn about the goals his/her client is trying to achieve (desired state of affairs) uses his experience and judgment to alter the goals if necessary and align them with the abilities and resources clients hold to achieve them or help clients achieve the necessary skills and knowledge required to achieve his goals.

Occupational therapy services may include comprehensive evaluations of the client’s home and other environments (e.g. workplace, school), recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team (Borell, pp.311-316).

The definition of identity and a reason to maintain their existence in life presents certain occupational demands (a good student, an obedient daughter/son, a good pianist etc.) to a person which upon fulfillment help an him/her to find oneself and integrate his/her meaningful role in the larger community.

If people perform their given roles with competence, their self-esteem gets high which help them to feel content with the different roles they are playing in their life. If they don’t perform them with competence, their self-esteem gets low and they do not feel content with their roles, which in turn affects their relationship with others and causes behavioral, psychological and health problems in them.

That’s where occupational therapy comes in. Occupational therapists help an individual to define himself as successful individual by developing a stable, positive and competent occupational identity, establish and maintaining his/her relationships with the people around him/her, and do community participation. Occupational therapy develops in a person the ability to desire, perceive, recall, plan and carry out routines, roles tasks for the purpose of productivity, self-maintenance, leisure and rest in response to demands of the internal and external environment (Carpenter, pp.310-313).

This essay will explore and critique the therapeutic occupation of playing the piano, for John an elderly gentleman who suffers an auto immune disease – Rheumatoid Arthritis; an incurable inflammatory disease mainly affecting the joints. The rationale for choosing this occupation is based upon current evidence that suggests it has fundamental links which provide an array of therapeutic benefits to promote wellbeing. Therapeutic occupation unpins the philosophy of the OT profession. Therapeutic occupations otherwise known as meaningful activities can be categorized into three performance areas referred to as self-care, productivity and leisure. Playing the piano is a meaningful leisure time activity for John so it is important he continues to do this to promote social inclusion, physical exercise, boost his self esteem and to make that spiritual connection.

Key factors which may impact on the John’s occupational performance

This inflammatory incurable disease Rheumatoid Arthritis came as a surprise to John as he had never experienced such an ‘excruciating pain’ in his joints. Pain initially started in his left hand and the next day he suffered from the same excruciating pain in his right hand. This really disturbed him as he had no idea what to do with it. The pain was absolutely excruciating that he decided to see a doctor and seek medical advice. His doctor was also confused and just recommended him some Analgesic or Paracetamol tablets to mitigate the pain. This indicates that John has led a healthy life in his past and has good medical record, since he was experiencing this kind of disease for the first time in his life; his doctor was unable to learn about his condition in the first place (Charmaz, pp.976-993).

John went home and took some tablets which relieved him at that particular time. Since the disease is incurable and chronic, the excruciating pain in his joints surfaced again, this time with more intensity as it almost locked him up solid by stiffening up his joints. This time pain also stayed for more time and partially paralyzed him for about 3 days as he was unable to perform his routine functions like his washing and dressing etc. during these three days, john also experienced profuse sweating and severe sickness.

Though pain went away after 3 days, residual aches remained and caused john to begin to live in a constant fear that pain will come back again pretty soon and will never leave his body. Pain returned with renewed intensity after 2 days of relief and cemented his belief that the pain is going to stay in his life forever. This saddened him more (Dahlin, pp.3-9).

The pain came again locked john up again and again for a period of five weeks. During this period, John had to rely on the support services of his wife for his cleaning, dressing and all other functions, acts and facilities. After that, John started to see himself as a lifeless lump as this on-off paralysis for a period of 5 weeks caused him to lose interest in his daily life activities which lowered his self-esteem and damaged his self-image which his pass achievements had driven (He was an accomplished chartered mechanical engineer, married to a supportive and faithful wife who has also given him a child of their own).

The disease “well shattered” john as he was bothered by the fact that the disease he is having is incurable and going to stay forever and will keep on locking him up like this for his life. Interestingly, John had shown positive attitude towards other life calamities which attacked him in the past (like road accidents) by accepting them. In his past, he didn’t waste his time to regret those calamities as there is no turning back once things have happened. Since he was unable to put the clock back, he focused on getting well as soon as he can, and he succeeded all the time. But this time he seems to be shattered as he has started to believe that this calamity of incurable disease will never ever go away from his life unlike other life calamities he had faced in his life.

Clearly, psychological factors will contribute in his occupational performance here. He needs to be indoctrinated with the belief that life is a name of happiness not sadness. Though this disease will cause him some pain time to time, he can add more flavor in his life by doing things which will give him happiness that can help him to offset his pain (Darzins, pp.127-131).

But a good thing is that John possesses a strong will and resilience to fight off his life calamities. That’s why he always looked for ways which can relieve him. This led him to do gain more and more information about his disease to gain more understanding about it. Knowing your enemy well will help you to fight off him competently. That’s why John begun to know his enemy by collecting more information about Rheumatoid Arthritis. He believed that sometimes more information over something worries you, at least a bit of it. But he was positive that the more information he will gather the more comfortable he will get. John’s research proved to be fruitful as he was comforted by the fact he learned in his research that new ways of curing this disease are on their way. These thoughts which gave him hope that the disease might be curable in future came as a great relief to him but again the subsequent thoughts about his ‘halt’ as a person always saddened him.

John learned during his research that this disease is caused by a virus. Then he recalled that he went to a farewell party and the following week, he felt ill. He must have caught a virus from the party. This may cause him to become a depressed, lonely and anti social person. He might start to see parties and social gatherings as no-go places as he might catch some more viruses in these social events. John is an informed person and knows he is an old person with a weak immune system that’s why he should refrain from parties and other social gatherings. John thinks it’s not inherited as general pundits say. But it can be his diet which has contributed in this disease (Di Mauro, pp.141-150).

John is going to play Piano alone as well as in social gatherings to gain admiration and appreciation from his social circle. This way he will be able to live happy and well by seeing himself as blessed with beautiful and caring people around him. External approval is something everyone looks for and if gets, feel content in his life. But John’s depression and anti social behavior fueled by his belief about his never-ending disease which he caught from a social gathering is going to create a problem in his occupational performance.

Johns thinks physiotherapy has proved to be of great help to him that’s why he still performs some exercises. But he needs his hands in every exercise and activity he performs. He also plays piano but the fear that he will probably never be able to use his hands again always gets him. But John sees piano playing as a great pastime and mental relaxation which always helps to take him out of depression and get him the company.

John wants to get back to his life, that’s why he keeps doing a bit of every activity he used to perform before this disease. To get his legs going, he uses old stairs. He tries to perform his toilet things on his own though it’s very hard on him now. Just getting off the toilet seat takes 4 minutes average. John loves to talk about his disease and get recommendations about it. He has attended a 6 week course run by the fellow sufferers of the Rheumatoid Arthritis and loved it as there he got a chance to express his views about the whole disease, discussed its effects, especially psychological and physical, on him and got best recommendations from his fellows there which has proved to be of great help to him. By listening to other’s success stories and same feelings, he gets inspired to fight off this disease. This disease is fearful inertia which has put his life at halt and this six week course has made john willing to drill through the hard rock of this fearful inertia (Drummond, pp.647-656).

This program helped john to set daily tasks for him that saved him from just sitting and rotting at home and thinking about his helplessness. Once he was at home and thinking about his disease, this led him to burst out in crying. John uses different drugs to lift himself up whenever he thinks about his disease and fall into the depression. He just wanted to feel free and ready to do anything which takes his mind off this disease.

But these drugs do a trick and lift him up and feel in control again for the time being. John needs a permanent solution to his problem, and this permanent solution lies in the occupational therapy of playing piano which john loves to play. This will satisfy his sociability needs by amassing him a fan base if he play it in gatherings, will improve his self image which will lead him to reject the idea of being a lifeless lump and will keep his mind off the disease till a permanent solution arrives, which according to his own research, is on its way.

CMOP-E for John

|Person |Occupation |Environment: |
|Cognitive |Self-care |Physical |
|Affective |Productivity |Institutional |
|Physical |Leisure |Cultural |
|Social |

In CMOP-E (Canadian Model of Occupational Performance and Engagement) occupational performance of a person is conceptualizes as the dynamic interaction of person, occupation and environment. CMOP-E sees person’s interaction with its environment using his cognitive, affective, physical and spiritual dimensions, as a function of his/her occupation. Person participates in the environment through occupation. In CMOP-E, occupation is further classified into three categories, productivity, self-care and leisure. Since john is retired, OT intervention can be made in his leisure interaction with the environment which will promote his health and well-being. CMOP-E is a client-centered, and focuses on their occupational needs by taking everything as relevant that is coming from a client/person (Everard, pp.208-S212).

As per CMOP-E, John’s occupational needs and his relationship with the environment has changed over his lifespan in response to the challenges and opportunities that has changed his occupational life course. Since john is facing a great challenge to fight off the disease he thinks will stay with him for his life, his spirituality will play a great role in this battle. One of the main purposes to choosing CMOP-E model for john’s situation is its dimension of ‘spirituality’. John’s spirituality is somehow evident in the form of his inner drive to defeat this disease (His attending a 6 week course, his information gathering) which represents his sense of meaning he want to give to his life by not engaging himself in valuable activities and not becoming a lifeless lump. Changed has occurred in John as he aged over his lifespan. His needs has changed. Even though the number of occupations (He was student once and must have played some sport in his younger days) has diminished with his age and other circumstances (physical ability to play sport has reduced for example) He can expand his repertoire of occupational experiences he has gather over his lifespan by developing some meaningful occupation, like playing a piano, which will promote his health by giving him more choice and control over his life, not mere by curing his disease which different drugs john takes are already doing. Since the disease puts him in physical inertia and made john to think that his life is at halt now and will always be like this, control over the piano and the appreciation which he will receive (he already knows how to play it) will improve his self-perception and he might start to see himself as in total control of his life and the activities he performs (opposite of what he thinks right now). Playing piano will promote John’s health in two ways. When john will perform occupational activity of playing piano, he will take his mind off his disease and enjoy his life by receiving fun and appreciation (Fitzpatrick, pp.217-245).

Enjoyment will make him to look after of himself (Since he think disease cannot be cured, he may not be looking after himself the way he should be). Appreciation he will receive from his friends and family represents a social dimension which will fulfill john’s belonging needs. In the old age, people’s belonging need are all time high and they need a good company more than ever before in their life. John is blessed with a caring and supportive wife, his belonging needs are somehow fulfilled, but his social needs will be fulfilled by his friends and other family members. Leisure occupation like piano is an important determination of health, something which John needs most in his old age. He needs to perceive himself as a healthy person whose life is still meaningful.

Piano playing will contribute in developing john’s motor skills. A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. Piano playing is a particular task which will contribute towards the improvement in John’s sense of well-being. When john’s sense of well being will improve, he will get good sleep (which he might not be getting due to his worries about the disease). Sleep deprivation dramatically decreases and good sleep dramatically increases person’s motor skills.

Sharing is deeply sensory and improves person’s sensory skills. When john will play piano, he will share his skills, thoughts and experience in the form of notes with others. This will surely improves his sensory skills and help him to express and manage his identity in a more controlled way. When john will have his 4, 5 sessions of piano playing with others, his brain will built his sensory perceptions using reference to his recent previous favorable experiences of playing piano and will make his mental schemes in a way that will enhance his sensory skills.

Since there will nothing be arbitrary in john’s activity of playing piano and result in the great use of his cognition. This healthy cognition will replace his somehow current disturb cognition about himself that his life has now at halt and he is now dependent on others for the rest of his life.

John’s piano playing activity will amass him a fan base in his friends and family, will earn him words of appreciation and words are strong enough to minimize a interpersonal conflict and promote a positive and healthy interpersonal relationship between/among individuals (Fugl-Meyer, pp.239-246).

References

Borell, L., Lilja, M., Andersson Svidén, G., & Sadlo, G. (2001). Occupations and signs of reduced hope: An explorative study of older adults with functional impairments. American Journal of Occupational Therapy, 55, pp.311-316.

Carpenter, G. I. (2005). Aging in the United Kingdom and Europe: A snapshot of the future? Journal of the American Geriatrics Society, 53, pp.310-313.

Charmaz, K. (2004). Premises, principles, and practices in qualitative research: Revisiting the foundations. Qualitative Health Research, 14, pp.976-993.

Dahlin Ivanoff, S. (2002). Focus group discussions as a tool for developing a health education programme for elderly persons with visual impairment. Scandinavian Journal Occupational Therapy, 9, pp.3-9.

Darzins, P., Fone, S., & Darzins, S. (2006). The international classification of functioning, disability and health can help to structure and evaluate therapy. Australian Occupational Therapy Journal, 53, pp.127-131.

Di Mauro, S., Scalia, G., Di Mauro, A., Di Fazio, I., Giuffrida, F., Leotta, C., et al. (2001). The leisure time and the third age: The experience of a geriatric day hospital. Archives of Gerontology and Geriatrics, 33, pp.141-150.

Drummond, A. E. R., Parker, C. J., & Logan, P. A. (2001). Development and validation of the Nottingham Leisure Questionnaire (NLQ). Clinical Rehabilitation, 15, pp.647-656.

Everard, K. M., Lach, H. W., Fisher, E. B., & Baum, M. C. (2000). Relationship of activity and social support to the functional health of older adults. Journal of Gerontology: Social Sciences, 55B, pp.208-S212.

Fitzpatrick, T. R., Spiro, A., Kressin, M. R., Greene, E., & Bossé, R. (2001). Leisure activities, stress, and health among bereaved and non-bereaved elderly men: The normative aging study. Omega, 43, pp.217-245.

Fugl-Meyer, A. R., Melin, R., & Fugl-Meyer, K. (2002). Life satisfaction in 18- to 64-year-old Swedes: In relation to gender, age, partner and immigrant status. Journal of Rehabilitation Medicine, 34, pp.239-246.