Occupational therapy and complementary and alternative medicine

Transcription

1 OCCUPATIONAL THERAPY INTERNATIONAL Published online in Wiley InterScience ( Editorial Occupational therapy and complementary and alternative medicine EMILY HALTIWANGER AND FRANKLIN STEIN Traditional roles What are the traditional roles of the occupational therapist in treatment? Occupational therapists traditionally have three primary roles that include healer, teacher and ergonomist. As a healer, the occupational therapist applies purposeful and meaningful activities or occupations in treating clients. For example, the occupational therapist may use creative art as an activity to reduce the symptoms of depression. The range of motion dance could be used with clients with osteoarthritis to reduce pain. In this role, the occupational therapist uses a meaningful and purposeful activity to reduce the symptoms of a disease or as a restorative tonic, meaning that the activity has a generalized benefit to the individual in building up one s health or preventing illness. As a healer, the occupational therapist is applying an alternative to traditional medication or in some cases, surgery. If a client chooses to engage in an exercise, such as tai chi, that is facilitated by an occupational therapist, instead of medication, then this treatment truly becomes an alternative medicine to medication. The second role of the occupational therapist is to serve as a teacher or facilitator to the client. In this role, the occupational therapist teaches the client, for example, health and wellness strategies, steps in independent living and biomechanical principles, such as when the occupational therapist teaches energy conservation methods to a client with multiple sclerosis or teaches proper biomechanics in lifting objects off the floor to a client who has chronic low back pain. This approach is referred to as psycho-educational practice. The occupational therapist as an effective teacher breaks down the activities through a task analysis and structures the activities to be learned so that the client is able to incorporate the newly learned activity or occupation into

2 2 Emily Haltiwanger and Franklin Stein one s everyday life schedule. The occupational therapist can be a teacher and healer when the occupational therapist applies stress management and biofeedback with an individual with a diagnosis of depression; the occupational therapist is using a conservative treatment modality that may reduce the need for medication. In the third role, the occupational therapist applies ergonomic principles in preventing injuries and facilitating function in individuals who are disabled, by adapting and accommodating the home or work environment. For example, the occupational therapist may use assistive technology to help clients achieve functional independence such as splinting and office ergonomics with a worker diagnosed with carpal tunnel syndrome. Alternative medicine can fit into the occupational therapist s role as a healer, teacher or ergonomist. In each instance, the occupational therapist can apply an intervention that is either complementary to conventional medicine or alternative medicine in itself. One shared commonality among all occupational therapists worldwide is the mindset of trial and error problem solving by looking for alternative solutions and new approaches to interventions. This shared creativity is what has led some practitioners to take alternative paths. It appears that once an occupational therapist has followed this alternative pathway for some time, it is difficult, if not impossible, for him/her to turn back to traditional ways and methods. Those occupational therapists that espouse a more holistic approach to healing and clearly understand its beneficial effects rely on it as a primary form of intervention for their family and friends. The complementary practitioners who were contacted in regard to submission of papers for this journal agreed that allopathic physicians are essential for a diagnosis, may offer medication to reduce symptoms, but may not eliminate disease (E. Haltiwanger, personal conversations with 15 occupational therapists in the United States, January 2008). Historical trends This special issue on occupational therapy and complementary and alternative medicine reflects the core of what occupational therapy is as a healing profession. Occupational therapy began in the early part of the 20th century as a healthcare profession to rehabilitate people with physical and mental disorders. During World War I, occupational therapists were recruited to help soldiers disabled by the war to reintegrate into their communities. As the fi rst occupational therapists, the reconstruction workers in 1917 used arts and crafts in the army hospitals to reduce stress and anxiety as well as to increase physical function. The modalities were conservative but effective alternative methods to heal the wounded soldier and to enable him to return to his community motivated to work and to engage in everyday activities.

3 Editorial 3 Cutting-edge science Complementary and alternative medicine is on the cutting edge of science. What alternative medicine is today may become conventional medicine in the future. For example, acupuncture is considered alternative medicine among Western medicine practitioners, but it is rapidly being used in many of the most prestigious medical centres to reduce pain. Certainly, it has been used as mainstream medicine in Eastern countries for thousands of years. Definitions Complementary and alternative medicine (CAM), as defi ned by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine (NCCAM, 2007, p. 1). While much scientific evidence exists regarding CAM therapies, there remains a need to validate practice through well-designed scientific studies and to determine whether the CAM practices are safe and effective for the medical conditions for which they are intended. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional healthcare and as new independent approaches to healthcare emerge. Alternative medicine is a term that refers to the treatments or interventions that are used in place of conventional medicine. Alternative medicine is defi ned as those treatments and healthcare practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies (London, 2001, p. 1). Alternative and complementary medicine exists worldwide. Bodeker et al. (2005) published for the World Health Organization (WHO) a two-volume atlas covering the use of traditional, alternative and complementary medicine in 23 countries. This defi nitive guide covers legislations, public fi nancing and practitioners who provide services. A second publication of WHO (2001) available on the Internet shows the legal status of traditional, alternative and complementary medicine in 123 countries grouped into global regions of Africa, South America, Eastern Mediterranean, Europe, South East Asia and the Western Pacific. This document was organized to promote the safety and authenticity of good practice in all areas of medicine. Eisenberg et al. (1993) compared the prevalence of visits to providers of complementary care with visits to primary care physicians in He found there were 425 million visits to providers of complementary care. This surpassed the number of visits to primary care physicians (388 million that year). Individuals in the survey spent approximately $13.7 billion, paying $10.3 billion or 75% of expenses out of pocket. This amount was

4 4 Emily Haltiwanger and Franklin Stein comparable with the $12.8 billion out of pocket expenses associated annually for all hospitalizations in the United States. A later study revealed increases in CAM usage with a rise in CAM visits to 42%, at 629 million visits and expenditures of $27 billion just 8 years later (Eisenberg et al., 1998). In 1992, the National Institutes of Health (NIH) created the Office of Alternative Medicine to evaluate evidence-based practice in the United States. This effort was associated with the dramatic use of CAM therapy beginning in the 1970s, in response to the congressional mandate. This resulted in a classification of CAM therapies that include the following: alternative healthcare systems have evolved separately from the conventional medical approach used in Western cultures, such as homeopathy, naturopathy, traditional Chinese medicine and Ayurveda (Mackenzie and Rakel, 2006). Biologically based therapies include natural substances found in nature such as herbs, vitamins, minerals, oils, teas and dietbased therapies. Manipulative and body-based methods include all of the various forms of massage, therapeutic touch and chiropractic. Mind body interventions encompass methods that enhance the mind s capacity to impact bodily functions and reduce symptoms, such as the many forms of meditation, support groups, spiritual prayer, biofeedback, tai chi, yoga and music therapy. Approaches might also be based on folk knowledge, spiritual beliefs or new ideas for healing (NIH, 2008). Complementary medicine and integrative medicine are sometimes used synonymously with alternative medicine. Although the techniques and treatment methods imply that all three methods are the same, the differences are in how the interventions are applied. For example, complementary medicine includes those treatment techniques and interventions that complement conventional medicine sometimes referred to as allopathic medicine or medicine that applies surgery and medications to treat diseases. Complementary medicine includes other acceptable practices that physicians prescribe that are used alongside traditional practices. Some consumers of healthcare are not satisfied with allopathic medicine today because such medicine may not treat the cause of the medical problem to restore health. They ask important questions. Can nutritional therapies prevent and reverse some diseases? Do sound waves, light waves and magnetic waves have healing effects on bone, nerves and muscles, and promote positive neurological changes? Can non-contact therapeutic touch alleviate pain? Which musical tones are effective with children who are diagnosed with autism? Are shamans or curanderismo effective in healing individuals with disease? These are some of the research questions that, when answered, can perhaps, in the future, lead to dramatic changes in how clients are treated. The manuscripts included in this issue reflect the interest of occupational therapists in complementary medicine with specific evidence as to how the methods have been incorporated into occupational therapy practice by creative practitioners. One should approach this journal with an open mind. The public is asking for change and initiating the movement. Occupational therapists must

5 Editorial 5 be open to that change and use their exploratory natures to investigate what is becoming a reality. As practitioners, we must explore the empowering, holistic and client-centredness of the CAM approach to restoration of health, well-being and quality of life to our clients. In this special issue, we have included original research where occupational therapists used a sound-based intervention with a child diagnosed with a pervasive developmental disorder, non-contact therapeutic touch with elderly clients experiencing pain in an acute care setting, and aromatherapy in conjunction with electro-acupuncture to a client diagnosed with Bell s palsy. A survey of Canadian occupational therapists using complementary and alternative is described, and there is a comprehensive literature review of CAMs used by clients diagnosed with multiple sclerosis. Lastly, we have included a scholarly review of the cultural beliefs and practices of curanderismo (Mexican and Mexican American spiritual healers). These papers can be viewed as a mosaic sample of how CAM is being applied by occupational therapists in a number of diverse settings. It represents the creativity and commitment of occupational therapists internationally to quality care and evidence-based practice. It is our wish that these papers will generate discussion and further research. References Bodeker G, Ong CK, Grundy C, Burford G, Shein K (2005). WHO Global Atlas of Traditional Complementary and Alternative Medicine: Text Volume. Kobe: World Health Organization Centre for Health Development. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL (1993). Unconventional medicine in the United States: prevalence, costs, and patterns of use. New England Journal of Medicine 328: Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler, RC (1998). Trends in alternative medicine use in the United States, : Results of a follow-up national survey. Journal of the American Medical Association 280: London WM (2001). Statement to the White House Commission on Complementary and Alternative Medicine Policy. (Available at (Accessed 20 November 2008). Mackenzie ER, Rakel B, eds. (2006). Complementary and Alternative Medicine for Older Adults: A Guide to Holistic Approaches to Healthy Aging. New York, NY: Springer Publishing Company. National Center for Complementary and Alternative Medicine (2007). What is CAM? (Available at: (Accessed 28 November 2008). National Institutes of Health National Center for Complementary and Alternative Medicine (2008). The use of complementary and alternative medicine in the United States: CAM therapies used the most. (Available at: (Accessed 28 November 2008). World Health Organization (2001). Legal status of traditional medicine and complementary/ alternative medicine: a worldwide review. (Available at WHO_EDM_TRM_ pdf) (Accessed 20 November 2008). Correspondence to: Emily Haltiwanger, University of Texas at El Paso/College of health Sciences, 1101 N. Campbell Street, El Paso, Texas, 79902