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key words: occupational therapy, spinal cord injury, rehabilitation outcomes
ABSTRACT
The objective of this study was to increase the evidence regarding the use of occupation-based practice and its effects on social and occupational participation in adults with spinal cord injury. Three individuals who had experienced a spinal cord injury 2 to 5 years previously, lived in the community, and received services from one of the two selected occupation-based occupational therapists participated in the study. Using a qualitative ethnographic design, they participated in one semi-structured, open-ended interview that contained questions designed to elicit experiences of life satisfaction, participation in meaningful occupations, social roles and responsibilities, and participation in occupational therapy. Data were analyzed using thematic analysis, narrative analysis, literature review, and narrative smoothing. Seven occupationbased approaches appeared to directly support the participants' current level of occupational and social participation. This study provides occupational therapists with a more practical understanding of how to apply these approaches in their own practices.
The profession of occupational therapy was built on the foundation that occupation has the power to heal (Jackson, 1998). The 1960s were a time of change for the profession, during which there was a realization that occupational therapy had neglected occupation, its main modality and unique contribution (Kielhofner, 2004). Since that time, there has been a push to not only reawaken the minds of occupational therapy practitioners to the powerful philosophical foundations of the profession, but also to show empirically that occupation as a modality has the abifity to positively affect the lives of the people therapists serve (Jackson, 1998; Kielhofner, 2004). This movement has resulted iii an increasing amount of research examining the importance of occupation-based practice and participation in occupation.
The domain of occupational therapy is defined as "engagement in occupation to support participation in context" (American Occupational Therapy Association, 2002, p. 611). Literature has shown that engagement in occupation relates to life satisfaction and that participation in occupation has a positive relationship with health and well-being (Law, Steinwender, & Leclair, 1998; Matuska, Giles-Heinz, Flinn, Neighbor, & Bass-Haugen, 2003). Law et al. (1998) performed a critical review of the literature and described multiple studies concerning individuals with spinal cord injury; they concluded that there is a "significant relationship between maintenance of daily activities, social...