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Research in Occupational Therapy

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Research in Occupational Therapy Powered By Docstoc
					Deepening insights – the view from the
occupational therapist
Jen Gellis, Masters of Applied Art in Design Candidate 2009
Emily Carr University of Art and Design, Canada;
Louise St. Pierre, Associate Professor Industrial Design
Emily Carr University of Art and Design, Canada

This paper explores how the profession of occupational therapy can contribute to and enrich
inclusive design research. We broaden the discussion on transformation design, new methods
of design research and how the occupational therapist (OT) can support these areas of design
given their skills, training and philosophy. We discuss occupational therapy‟s acknowledgement
of the „spiritual‟ aspects of a person and its emphasis on contextual understanding within
people-centered practice, in relation to design. We propose that occupational therapists hold
“hybrid research-design skills” [1], and are ideally-suited to engage in co-design methods and
use generative tools. Future implications are discussed, including OTs‟ potential influence on the
design of products such as aids for independent living, multi-sensory equipment for children,
and positioning and mobility equipment. OTs‟ adaptive perspective can support sustainable,
enduring solutions and capacity building throughout the design process. We also explore current
and future opportunities for collaboration between OTs and industrial designers. We suggest
that OTs can assist in identifying design opportunities in inclusive design, contribute to the
problem solving process and provide insight into capacity building for daily life.

Co-design, co-creation, generative tools, research designer, design research, inclusive design,
transformation design, participatory research methods, people-centered design, spirituality

This paper examines a promising perspective that occupational therapists (OTs) can bring to
inclusive design research. We consider the traditional roles of occupational therapy and
industrial design and explore how the common ground between these roles is validated by the
emergence of participatory design, as it is articulated in the writing of Elizabeth Sanders. In
response to Sanders‟ question “Who are the new hybrid research-designers?” [1, p18] we
propose that many of the methodologies for co-design research are natural for occupational
therapists due to the inherent qualities of OT practice. Additionally, occupational therapists bring
a unique skill-set and holistic perspective to enrich the new approaches to design research. We
describe why occupational therapists can extend the work of transformation and inclusive
design, and discuss future implications. The Design Council in the UK defines Transformation
Design as an emerging design discipline that centers around the individual to provide essential
and practical solutions to societal and economic issues [10]. It encourages collaborative efforts
between stakeholders and professionals and emphasizes capacity building throughout the
design process. Transformation design looks at forward movement from the design of objects
towards the future design of systems, services, and programs [10].
        The longstanding relationship between design and the social sciences is becoming more
pronounce [1]. Design teams commonly incorporate anthropologists and psychologists to help
understand how people think, act and relate to each other and objects. However, occupational
therapy, a humanities based profession, has had somewhat of a quieter history of collaboration
with industrial design. The holistic perspective of occupational therapy, while similar to the social
sciences, encompasses an adaptive and restorative, or rehabilitative, frame of reference which
is directly relevant to inclusive design. New methods of design research allow for hybridizing the
expertise of both disciplines, and offer a platform from which to take the discussion further.

Background: Occupational Therapy
       An overview of occupational therapy is helpful in understanding the ways in which OT
can contribute to inclusive design.

Creativity and collaboration
         Occupational therapists work collaboratively with a variety of people in hospitals, homes,
communities and work places to help individuals overcome or manage disability. In their work
and training, OTs are rooted in a philosophical position that makes them particularly adept at
people-centered design. This translates directly into a particular kind of creative activity that,
while it employs techniques familiar to design such as iteration, lateral thinking, and co-creation,
fosters deep and significant relationships with the user (referred to as the „client‟ in OT practice).
         As a profession, occupational therapy has been referred to as creative and engages in
an “intuitive-creative-qualitative-phenomenological” [3] process. Similar to the design process,
occupational therapists use a multi-staged, iterative approach that is often described as a
continuous loop; goals and objectives are defined, actions are taken and reflected upon,
followed by re-definition of goals and objectives, and the cycle begins again. As an example,
meeting an individual for the first time an occupational therapist might use dialogue and stories
to allow the person to identify and prioritise his/her needs in self-care, work or school, and
recreation. Through this conversation process the occupational therapist distils the unique
elements of the person, their strengths, resources, core values and beliefs. The individual
determines their own goals and how they plan to achieve them through the guidance of an OT.
Unlike in design, the end user and the occupational therapist decide together if the user has met
their goal(s). The loop may continue with a redefinition of the goals and objectives, ultimately
reinforcing the understanding of the OT toward the individual‟s context.
         If this OT model were applied to design, it would translate to a process that includes:
front end user participation followed by deep connectivity with the user throughout, and final
sign-off from the user. There are indicators that design is shifting in this direction. For example,
co-designing methods involve users much more creatively and extensively in the front-end of the
design, and rigorous sequential testing is done during software design processes. Generally, the
more complex and far-reaching the project, the more it is seen that serial involvement with users
contributes to success. Transformation design, for example, is an endeavour that reaches into
areas of human activity that are nested, multi-layered, and interdependent. Designing for this
kind of lived complexity is something that OTs do regularly when they work to develop
contextual solutions with people. While they accomplish this through a closed-loop process as
described, they have also built a body of knowledge that encompasses a humanistic philosophy.

Humanistic Philosophy
         Occupational therapy practice is guided by a humanistic philosophy that embraces
individual needs and the relationships between persons, the environment and activity. OTs are
concerned with cultural and daily rituals that impart meaning to everyday life such as “sharing a
meal with a family, caring for animals or tending a garden” [5]. This philosophy honours and
respects an individual‟s autonomy and considers them the expert of their own experiences.
There is an understanding of the strengths that a person‟s perspective can bring to the problem
solving process. The OT‟s role is often that of an advocate or a catalyst, as is the designer‟s role
in co-designing.
         OTs focus on understanding individuals‟ particular circumstances or context. For
example, Coutinho‟s [6] research seeks to better understand the meaning of caregiving for a
family members of the elderly, while Donovan, Vanliet, Crowe & Keefe [7], consider the goals of
mothers of children with disabilities within the context of time, social and emotional factors.
Taking a similar approach in design, Sanders‟ work on generative tools and co-creation
emphasises the importance of understanding a user‟s context and illustrates how generative
tools can make this possible. Sanders stresses that understanding context can lead to greater
empathy with users, avoiding assumptions on the part of the designer [8]. Occupational
therapists can help inclusive designers translate the meaning of research information in the
context of people‟s abilities and indicate how this might be realised in the design. The OT can
become a point of access for designers; all of the intangible pieces of information that a
designer may need additional time to reflect on or analyse can be quickly assessed by an OT to
result in a comprehensive picture of needs. At Emily Carr University students working with OTs
for the past several years, have come to realise that the OT perspective affirms a view of life,
and therefore a quality of design, that is more sensitive and sometimes less conventional (see
Figure 1).
         The advent of co-design research techniques highlights an increased need for contextual
understanding in design. It seems natural for occupational therapists, who value participatory,
functional, meaningful and motivating activities with people, to collaborate with designers in co-
design research. Further, it is apparent that the occupational therapists‟ strong grounding in
individual people-centered methodologies enables them to add a richer and even spiritual
perspective to co-design research.

OTs perspective on spirituality
        One aspect of occupational therapy practice that may hold particular interest for the
inclusive designer is what occupational therapists refer to as spirituality. OTs believe that
spirituality is comprised of the intangible characteristics of a person related to core beliefs and
values. For some people spirituality may be connected to religion, for others it is associated with
an understanding of significance or meaning [9] and might include a sense of compassion, joy,
purpose, hope and creativity [5]. Occupational therapists recognise that each person is unique
and has an individual way to communicate choice, motivation, intent and need [9].
        While industrial designers have a pragmatic approach toward the intangible
characteristics of spirituality, OTs are more reverent, appreciating spirituality for its intrinsic
value. Burns, Murray, Vanhall & Winhall [10] discuss industrial designers‟ concern with issues
that involve the practical details of daily life, inspiring participation, enabling others, and
promoting meaningful and motivating activity; characteristics that are congruent with
occupational therapy‟s definition of spirituality. OTs can validate the acknowledgment of the
above elements within the context of spirituality for designers.
          For occupational therapists spirituality is considered a significant element in the problem
solving process. Acknowledgement of the qualities that contribute to an individual‟s spirit can
foster respect, greater understanding, and be helpful in co-creation methods where the designer
is facilitating the end-user to convey their dreams and fears. Appreciation of an individual‟s core
values and beliefs can increase understanding of cultural rituals and routines, extending and
deepening the practice of co-design research. In many cultures the expression of spirituality
through art, nature, music and stories are traditional “ways of exploring and deepening the
connection to one‟s spirit” [5, p159]. Therefore, the creative activities of generative tools provide
a natural point of entry for the consideration of spirituality in design.
          Imelda Burgman and Abigail King explore the meaning of spirituality for children
surviving poverty, war, abuse or a lack of caring [5]. Qualities and circumstances that contribute
to children‟s sense of meaning and purpose are considered: hope, trust, faith, a connection to
nature, surrounding people, meaningful cultural experiences, and their dreams and desires [5].
These qualities provide a greater contextual understanding of the child and shape the
interactions between the child and therapist. Through this understanding the therapist is able to
support and empower the child. OTs can contribute to realising spirituality in design, and can
provide the tools and skills needed to approach this element comfortably, with an openness and
sensitivity to individual needs. By considering spirituality in design research, designers may be
more deeply attuned to the needs of the end user. Further, this perspective may allow designers
to fully invest in areas that may have been perceived as soft areas of design.

Current and future collaborations
         Historically, occupational therapists and industrial designers have collaborated with one
another in areas involving medical assistive design, designing for development, and inclusive
design. Industrial design and occupational therapy students often work together in courses and
academic design expositions in assistive devices. Industrial design and OT students at the
University of Alberta involved in a collaborative project both identify themselves as problem
solvers [11]. Benbow‟s [12] article on the same project states that OT students were impressed
with industrial design students‟ building abilities, while industrial design students are impressed
at the diversity of OT knowledge. Through these partnerships students are able to identify the
limitations of each discipline and the benefits of working with each other.
         Occupational therapists‟ inclusive perspective can contribute to understanding and
support the core values of transformation design. OTs may play a part in designing systems,
services, healthcare spaces, and designing for the aging population. Their functional
perspective, experience working in multidisciplinary teams, program planning and high regard
for people-centered and inclusive design can deepen the research within transformation design.
         Designers might find that OTs are able to provide design opportunities in the design of
medical equipment. This could include the design of aids for daily living, multi-sensory
equipment for children and positioning and mobility equipment. OT‟s can provide access to a
range of human experience not normally experienced by the design profession, and this in turn
 might lead to more exploratory and relevant design. An example of this drawn from the
 education field is the FeelGood range of products. The inspiration for these beautiful and original
 products was drawn from the unique knowledge of how children learn held by the Reggio-Emilia
 schools. The resulting designs reach much further and have greater application relevance than
 those seen in the past. One can only imagine how designers might work with the special
 understanding of the human condition that is offered by the OT. This access can also come
 through collaboration. For example, an industrial design student designed a series of Sensory
 Pods that enabled communication between the child and others (Figure 1). Through consultation
 with an OT, the student was able understand the child‟s physical, sensory and cognitive needs
 within the context of their family and environment. As a result, not only did she extend the
 physical capacities of the child she was working with, she also considered the coping level of the
                  parent in her design.
                          Occupational therapists are well positioned to engage with and contribute
                  to generative tools, such as the Co-creation Toolkit, due to their experience using
                  craft activities as a central therapeutic medium. The Co-creation Toolkit consists
                  of a variety of materials to allow people to create maps, drawings, collages,
                  models, stories, storyboards, or plans [13]. These materials allow people to
                  create meaningful creations that share stories, hopes and dreams with the
                  designer [13]. Storytelling, collage and drawing (among many other arts and
                  crafts) have been used extensively throughout occupational therapy practice and
Figure 1:
Sensory Pod,      research [3].
Sandy Wang                OTs promote the use of meaningful occupations to empower individuals
                  with cognitive or physical limitations to participate in society. Examples of these
 activities include weaving, needlework, woodwork, and copper-tooling (among others). These
 creative occupations provide motivating media to learn useful skills while improving health. The
 engagement of the person in these activities provides a wider understanding of their context,
 thoughts and feelings. Therefore, the occupational therapist already understands the power of
 the Toolkit to enable the articulation of tacit knowledge.
          In design, generative tools are used to attempt to bridge the gap
 between the researcher and the participants, in order to allow for a
 greater understanding of their needs and allow the participant to
 contribute to the design process. Sanders suggests that a participatory
 mindset that respects peoples‟ views and recognises individuals as co-
 creators in the design process is essential to the designer and researcher          Figure 2: Co-creation
                                                                                     toolkit being used in a
 engaging in co-design research [8]. Occupational therapists habitually              healthcare setting.
 engage individuals in a people-centred and participatory manner. Similar to co-design methods,
 the occupational therapist works directly with the end user or users and involves them in
 decision making throughout the entire process. OTs can support the participatory mindset of
 designers and researchers and can complement and assist the designer in the creation of the
 toolkits. They can also make an original contribution to the analysis and application of
 generative research findings.
          Possible areas of further collaboration between designers and occupational include the
 design of medical products, assistive and augmentative communication devices, healthcare
 environments, assistive aids, accessible environments including adaptations to the built
 environment, transformation design, and system/service design.
        Due to their distinct abilities, qualities and background knowledge, occupational
therapists can enhance the skills needed for the new design disciplines and research methods.
The occupational therapist brings to design research practical skills, publications and a
theoretical background grounded in a holistic perspective that considers an individual‟s physical,
social, environmental, cultural and spiritual elements. This far-reaching point of view can enable
design research to uncover more specific and relevant information from the people whose lives
they may be impacting. OTs could be a welcome addition to research teams and make original
contributions through their hybrid design/research skills.

1. Sanders, E B-N and Stappers, Pieter Jan (2008). Co-creation and the new landscapes of
design. CoDesign, vol 4, no 1, 5 – 18 March
2. Burns, C. Murray, R., Vanstone, C., & Winhall, J. (2006). Red report 01: Open Health.
Design Council: UK. Retrieved September 20, 2008, from
3. Schmid, T (2004) Meanings of creativity within occupational therapy practice. Australian
Occupational Therapy Journal, vol 51, 80-88
4. McColl, M (2003). Spirituality and Occupational Therapy. Ottawa, Ontario: Canadian
Association of Occupational Therapists Publications ACE.
5. Burgman, I & King, A The presence of child spirituality: surviving in a marginalized world. In:
Kronenberg, F, Algado, S, Pollard, N (2005). Occupational therapy without borders: learning
from the spirit of survivors. Toronto, Ontario: Elsevier.
6. Coutinho, F, Hersch, G, Davidson, H (2006). The Impact of Informal Caregiving on
Occupational Therapy: Practice Review and Analysis. Physical and Occupational Therapy in
Geriatrics, vol 25, no 1, 47-61
7. Donovan, MJ, Vanleit, BJ, Crowe, TK, Keefe, EB (2005). Occupational goals of mothers of
children with disabilities: Influence of temporal, social, and emotional contexts. The American
Journal of Occupational Therapy, vol 29, no 3, 249-261
8. Sanders, EB–N (2006). Design Research in 2006. Design Research Quarterly, vol 1, no 1,
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Ottawa, Ontario: Canadian Association of Occupational Therapists Publications ACE.
10. Burns, C, Cottam, H, Vanstone, C, &Winhall, J (2006). Red paper 02: Transformation
Design. Design Council: UK. Retrieved October 29, 2007, from
11. Lederer, R, and Liu, L (2005). Industrial Design and Occupational and Physical
Therapy Students - A Winning Combination. Presented at the International Conference on
Inclusive Design, Royal College of Art, London, 5-8 April
12. Benbow, S (2005). Express News. University of Alberta. Retrieved November 1, 2007,
13. Sleeswijk Visser, F, Stappers, PV, & Van Der Lugt, R (2005). Contextmapping:
experiences from practice. CoDesign: International Journal of Co-Creation in Design and the
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