 Occupational therapy is interest-motivated activity with a therapeutic purpose, a controlled means for satisfying the physiological and psychological needs for activity. Such therapy is prescribed by the medical officer to the occupational therapist to fit the individual physical or mental need of the patient. Occupational therapy stimulates a healthy mental attitude. The body and the mind are not restored to good health by bed rest and boredom. When the mind rejects reality for fantasy and no longer reacts to the actualities of the world, illusions and delusions can become all the more firmly fixed and drab idleness. Healthful activity must be provided to fulfill the psychological and physiological needs of the individual patient. The primary consideration of physical medicine is the restoration of the patient's maximum function. The combined efforts of many trained specialists who work as a team under the direction of the prescribing medical officer are utilized. Disabilities must be individually evaluated in each patient and physical activity initiated as soon as possible. It is here that occupational therapy plays an important part. Take for instance this patient who suffered a fracture of the head of the right radius, which required surgical excision. After the period of immobilization, there was considerable loss of range of motion in the elbow joint with marked loss of muscle strength. The problem for physical medicine at this time was to increase joint range of motion and strengthen the muscles of the right arm so that the patient would have a strong elbow joint. The printing press in occupational therapy became a therapeutic aid in the patient's treatment. The repetitive process involved coupled with the resistance of the press eliminated greater muscle contraction and increased endurance. Here we see a patient whose hand was severely damaged by a power saw, necessitating surgical amputation of the third finger, excision of the second metacarpal, and the transposition of the index finger over the third metacarpal. Following bone grafts and tendon transplants, the problem was to train the patient to use his reconstructed hand to the maximum. Although the final concern of physical medicine was motion for function and to train the patient to use his reconstructed hand, the first consideration was to reduce edema and to initiate motion in the individual joints of the impaired hand. When the ability to grasp the handle of a tool has been reached, his efforts are concentrated on acquiring dexterity and skill and the patient learns to minimize his disability. This patient was evacuated from a combat area with an extensive peripheral nerve injury resulting in complete impairment of the ulnar and partial involvements of the median and radial nerves. After the infection had subsided, the extensively scarred area was excised. A pedicle graft was placed on the hand and definitive surgery on the intrinsic structures of the hand was then completed. An evaluation of the hand at this stage shows atrophy of the hand muscles, limited opposition, loss of the thumb motion with loss of ability to grasp. The aim of occupational therapy is to train the hand to its maximum useful capacity. In the case of Sergeant Matthews, a telephone line repairman, he was stricken with poliomyelitis affecting both upper and lower extremities. He has been treated by physical therapy and at present has residual impairment of function of both extremities, the left arm and hand being more involved than the right. He has insufficient strength in either lower extremity to enable him to walk without the use of braces and crutches. It is necessary during the period of retraining of muscles to support those too weak to perform their function against gravity. In the instance of the upper extremity and of the shoulder muscles, this is often done by an overhead sling. During the period of treatment of the polio patient, three factors must be considered. One, the reeducation of certain muscle groups. Two, the increase in strength of the weak muscles. And three, the restoration of function of the remaining available muscles. In addition to the principles of treatment, the ultimate goals must also be the achievement of confidence, self-care and the adaptation of the individual to a vocation commensurate with his disability. A program of occupational therapy is also included in the treatment of tuberculosis. It must be well-organized and planned for the patient on a long-range basis. Take the case of Sergeant Stevens. When he was discharged from the Army, X-rays showed that his lungs were normal. But three years later, while working as a locomotive engineer, infection was discovered. The wiry Sergeant is now a bed patient. Rest and relaxation are his first requirements. A series of these X-rays tell the doctor a story of acute exudative lesion, which he explains to the patient. The Sergeant's problems are discussed in detail with the occupational therapist, the psychiatrist, and with vocational advisors, nurses and social workers. They all know that he will not be able to go back to his work as a locomotive engineer. And so they try to stimulate new interests for the patient. And if possible, new skills are explored and will be developed. A patient is classified in accordance with the stage of his recovery. First, complete rest in bed. Second, along with other patients in the tuberculosis ward, he will have a graded program of manual activity. When there is evidence of clinical improvement, the patient is permitted short periods of activity. He may engage in some light crafts in the supine position. Activities are selected that require a minimum of shoulder motion and depend cheaply on movements of hands and wrists. As improvement progresses, his occupational therapy program may be increased in time while in a sitting position in bed. The first aim of occupational therapy is to motivate interest during his hospitalization. During the patient's long stay in the hospital, he must be provided with controlled outlets for his energy and interest. When the disease process subsides and the patient is strong enough to spend some time out of bed each day, he may explore a variety of activities that will encourage the use of basic skills. The light work prescribed in the ward occupational therapy clinic is the stepping stone to the more demanding activities that come later when the medical officer decides that he is well enough to work in the main occupational therapy clinic for a limited period daily. Here programs are planned to develop physical capacity and work tolerance by fostering interest and activities which make increasing demands upon mental and physical energy and to prepare the patient for either his old employment or vocational training. Stevens has revived an old school interest in mechanical drawing and by studying within the limits of his strength has become an accomplished draftsman. His new skill in which he hopes to earn his living in the years ahead is now applied toward designing and helping build an elaborate stage that the public puppet shows to entertain the children undergoing treatment in the hospital. After 18 months, Stevens has no further symptoms of tuberculosis and has received maximum benefits from hospital treatment. He is not cured, but his tuberculosis is arrested and he may return to his home to rest. If he is careful and adheres strictly to the directions of his medical advisers, he can look forward to light work in six months to a year. Yes, and in the meantime, to occasional angling using those trout flies which was one of his occupational therapy projects. Let's review the case of Fred Lawrence. In a well-rounded plan for treatment of psychotics, occupational therapy is prescribed to fit individual needs. The therapy evolves jointly from the centering of a patient's attention upon a reality situation and from the healthy interpersonal relationship that develops between the patient and the therapist. Well, now, what about Fred Lawrence? He's quite regressed. Frankly, you may have to spend a considerable amount of time with him before you can even expect a response. However, with sympathetic encouragement, you may be able to help him maintain what little contact with reality he still has. Well, how about starting him on something that catches his eye, something simple and quickly completed? Yes. The kind of thing that would give him satisfaction early without too much effort on his part. We'll see what we can work out. Like this, Fred. This end of the link goes through this slit. Through there and through this one. And the next one is done exactly the same way. See? There it is. That's how the whole balance is made. You do the next one. Men usually like to work with leather. We often make billows, too. You're doing it very well. You don't need to have me help you on that part. You know how to fit it together. When it's long enough, we'll fasten a buckle on the end of it. Just a little more work, and it'll be finished and you'll have a good-looking belt all ready to put on. Oh, but first, we have to know the right waist size to make it. The teaching of these skills is not to provide a trade for the patient, as the phrase occupational therapy might suggest, but to focus the attention of the patient away from his ailments to external interests. You like the ashtray Sergeant Len made? Yes. Perhaps he'll show you how he made it. You can start on one like it tomorrow. In the next case, the patient was doing good work in army-public relations until her manic symptoms made further work impossible. It's just that there are certain things we need to know to help you. Help! But you don't know us when anyone doesn't know. Is that way with science, poetry, or in the modern newspaper world today? Let's say I have a telephone call from B.G. Swenson of the Associated Press. Swenson, the famous... That's just what I mean about your prying at the Pristula Femus. You mean Professor Swenson? No, I never knew any college professor who died. There's a B.G. Swenson with the Associated Press in Washington. Washington where the Mellon Art Gallery is. Art. There's a basic relationship between art, science, poetry, religion. Yes, even the operation of the modern newspaper world today. You probably think there's no place for aesthetics in the Fourth Estate. The fundamental conflict between cultural values and material values. Maybe you're right. I don't care to discuss it. You say there's no religion in business? That's another matter. God is omnipotent. I resent your attitude, drifting with the stream. What sort of Pristula philosophy have you got? And where do you think it's going to get you? Human beings have lives to live. Ms. Plummer has a special watch and is under constant sedation because of her hyperactivity and unpredictable behavior. I want you to take her in OT under a program of heavy activity. Keep her away from other patients as much as you can. No distractions. Give her something that requires plenty of physical activity without too much thought. Whoever works with her should take a friendly, impersonal attitude. Positive direction would probably only make her belligerent. She'll have to be handled with suggestions. I can see how a place of this sort can get run down. Things like this happen. Of course they happen, but that doesn't mean nothing will be done about it because something can... Of course, Ms. Plummer. Now, you were going to help get the material ready for the rug. Just tear this cloth in strips. This wide. I see just what you mean. This is the way you do it. System. That's what it takes. System. You're getting a little wide. This width. I'm going to need a lot of this stuff. Here, I'll do that. You haven't got the system. Ms. Plummer, let's finish this last ball. I'm going to need a lot of this. Yes. It does take a good many to make a rug. Well, I should think so because... After we fill this shuttle, then we can start to weave. Ms. Plummer, suppose you finish winding the shuttle and I'll get the loom ready. All right. How to take the shuttle? Now put the foot pedal down and throw the shuttle through here. Change the foot pedals and beat it again. Now we put the shuttle back through the other way. Understand all that now if you'll just let me. All right, Ms. Plummer, you can try it. Now put the foot pedal down and beat it. Now change the foot pedals and beat it again. The shuttle goes right back the other way. Occupational therapy was prescribed not as a hobby or for industrial activity, but to redirect her hyperactive energies into more worthwhile channels. An interesting activity requiring plenty of energy within the limits of her concentration span can help re-establish a pattern that has been completely broken up. Let's take the case of Major Crittenden. Something in his past experience has affected him to the degree where he now requires hospitalization and psychiatric treatment. I'm wise to what goes on in this place. It's the only reason I'm alive today. I know when my food is being poisoned and it isn't. You're in with them. You wouldn't get sore at me. You can trust me. Where have I heard that before? First they railroad me in and they try to feed me all this slop. They're going to pay. They're going to pay plenty. Major Crittenden is in a fairly typical state of acute hostility. Suspicious, fairly sharp, though. It's going to take a good deal of tact to get anywhere with him. Let him pretty much pick his own activity in the shop. Chances are he'll want to do something complicated. Well, no harm in that. But whatever it is, make sure it's within his capabilities. Any little failures have to be destructive experiences for him. He's bound to develop a mounting hostility toward anyone who's around him much. So we'll have to make a point of changing his therapist frequently. Remember the Major, don't you, Captain? Good morning, Major. How was this joint? Of course you'd notice it made you crittenden because you're not sick the way some of the others are. And we got to go through that all over again. You want to come over here? You said you'd like to work with silver. This is a setup. You'll work at this bench. I thought you'd rather mark off the silver in a circle and cut it out yourself. Here are the dividers for marking. You can make any size you like. Well, that didn't take long. Right on the line, too. Now let's see. The edge is smoothed with emery paper. Shaping comes next. I'll show you and then you can take over. Good strong blows evenly spaced. Haven't you got a bigger hammer than this? It's the correct size. It is easy to see how striking hard blows with a hammer serves as an outlet for the Major's hostility. With appropriately prescribed occupational therapy administered by trained therapists and by personnel who understand and encourage their patients, most patients can be restored to mental and physical health and resume their place in society as useful citizens. Rarely is a personality so closed that there remains no open door. Self-expression in any art form may offer an approach to otherwise inaccessible patients.