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A Voice in the OT Wilderness

The F-word: Function(al)

Published April 6, 2009 12:35 PM by OTCM
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"If the relationship functions, then there's nothing to talk about. If the relationship doesn't function, then there's nothing to talk about, either." - Gunborg Palme 'On The Psychologist's Couch'        

Do you make any distinctions between function and occupation? Do your service plans and documentation articulate the distinctions?

I believe that we OTs will continue to lack recognition for our unique skills until we are consistently careful to articulate the differences between "function" and "occupation". I believe that "function" used in the health and human services context implies a requirement for "health" and "absence of illness or disability", regardless of what people are actually able to do. Therefore, I consider "function" to be a subset of "occupation" and as such, of limited descriptive value.

I have many "functional" deficits, but I am occupationally intact. I have plenty of things "wrong" with me, but I've adjusted my occupational choices, and adapted many components of those occupations, as a result of changes in my functional abilities. Granted, for a variety of "functional" reasons, I prefer sedentary activities (an understatement: I could win a medal in a "couch potato" Olympics); but as my recent trek up Mount Kilimanjaro indicates, there are activities for which I'm willing to go beyond my "functional limits".

Rehab. and medical professionals use the terms "within normal limits" and "within functional limits" as questionable descriptions of recovery and abilities. But I've seen plenty of "WFLs" and "WNLs" that haven't automatically translated into meaningful occupations after discharge from rehab.

As a Case Manager who's always thinking in occupational terms, I can do a lot to bridge the gaps in understanding between "function" and "occupation" even while people are still in the treatment and rehab. phases of their recoveries. Keeping occupation in mind also serves the long-term, "post-clinical" phases of my clients' journeys. My efforts have often made the difference in the things Case Management is intended to maximize: the efficacy of diagnostic and treatment decisions; types and appropriateness of referrals; duration of services; reimbursement decisions; and most certainly outcomes.

By the same token, OTs can think in Case Management terms - and provide vital information for Case Managers - if we consistently focus on and emphasize the "occupational whole", instead of the "functional subsets".

posted by OTCM

5 comments
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Tim & Ed, thanks for your comments.  I'm not suggesting we OTs abandon the use of "function/al"; only that we use it more as a starting point for elaborating on how far beyond "function" OTs understand and use the concept compared to other disciplines.  As for the assumption that OT is only for people w/ problems related to working, it seems to me we can turn that stereotyping into "teachable moments", using, for example, AOTA's slogan "OT: skills for the job of living".  We're each equipped in different ways to articulate what OT is (and isn't); my perspective on the term "function/al" is just that: my way of approaching the challenge.  :)
Allie Hafez May 1, 2009 1:14 PM
Prior Lake MN

Hi Allie;

I also agree there is some value in this line of thinking, Function and Occupation do have subtle differences. However; as far as the general public goes I'm far more in line with Tim.

I think we'd do better trying to enhance the definition of "function" than trying to keep redefining "occupation".

The general public will have a very hard time understanding what we do as long as we are using this term. It was surprising to me to learn that Occupational Therapy had its origins long before Physical Therapy. Despite this, Physical Therapy is by far the numerically dominant and influencial counterpart of OT. Even in places where arugably OT philiosophy should dominate we have a problem getting any OTs.

I am a member of the American League of Functional Therapists. We are working to enhance the certification of an OTR/L or COTA/L by controlling access for them to become a "Registered Functional Therapists RFT"(TM) or "Registered Functional Therapy Assistant RFTA"(TM). Check out the website at www.functionaltherapist.org.

I think the value of Occupational Therapy as a field is still incredible. Over 200 years after the original thought and it is still revolutionary in many ways. Other fields are trying to become more "functional" but we still hold the most "functional skill base in healthcare."

Ed Kaine

www.functionaltherapist.org    
Ed Kaine, Acute Care - OTR/L, RFT, www.functionaltherapist.org April 30, 2009 10:59 AM
Bridgeport CT

Hi Allie,

I don't disagree with your premise, however, the public at large will always be confused with our profession simply due to the name.

As therapists, we know the distinction and what kind of goals to help the client achieve based on their life's tasks and current limitations. We can articulate the goals of OT to the client and family and this will help to spread the word of the unique benefits of OT. However, if you google 'occupational' you will inevitably get a lot of work related results.

So, we are stuck with the fact that occupational means work to the public at large, and the discussion of function is only relevant to each client based on their level of deficits which we are treating them for.

Tim
tim, geriatrics - OT April 23, 2009 1:09 PM

You've stumped me, Ron: what's the "a-word" you're referring to? Why is it on your "do not use list" also?
Allie Hafez April 11, 2009 10:09 AM
Prior Lake MN

I was recently pointed to your blog. I haven't read all the information but I wanted to make a quick comment. Several years back, I taught a class on human occupation.  In that class, students were instructed to not to use the 'f' word  and the 'a' word.

Look forward to reading more.

Thanks,

Ron Carson MHS, OT

www.OTnow.com
Ron Carson April 7, 2009 7:28 AM

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