The Art & Science of Crafts: Treatment of Physical and Cognitive Disabilities

by SARA C. GORMLEY, OTS, College of Saint Mary

As a first year occupational therapy student, I was introduced to the history of crafts as a media used in rehabilitation, both physical and mental.  My initial impression was that craft use was indicative of turn of the century times and utilized due to lack of alternative treatment options in the early years of occupational therapy.   I confess to mental eye rolling when during this first year of my studies I repeatedly observed upperclassmen leaving class with crafts they had just completed.

As I advanced a year and became the student in the class previously responsible for my mental eye roll, I immediately grasped how the use of crafts is in no way an archaic concept for treatment or assessment of patients with physical or cognitive disabilities. It occurred to me that if I, a student in a field utilizing this medium, had so little understanding of the opportunity for and benefit of craft use as a treatment, then members of other disciplines in health care may question the appropriateness and benefits of the time an occupational therapist spends with a patient engaging in crafts.   As nursing personnel and occupational therapists have the opportunity to work together in service to the same patients, I chose to share insights of the benefits of crafts in treatment with other future health care providers, namely nurses.  Thus, this article will define the goals of occupational therapy and discuss an occupational therapist’s approach in designing interventions and choosing activities based on patient factors, performance skills and patterns, context and environment and activity demands to show the therapeutic benefit of working with crafts and justification for doing so.   A craft will also be presented and analyzed to show the therapeutic benefits.

The goal of occupational therapy is to facilitate the ability for individuals to engage in the things they need and want to do; to engage in everyday occupations that are necessary and meaningful to the individual.  Occupations are the daily activities that reflect cultural values, have meaning to individuals and are the activities that meet human needs for self-care, enjoyment and participation in society (Tubbs & Drake, 2007).

Crafts are an appropriate medium across the lifespan from toddlers stringing cereal necklaces to the elderly crocheting pot holders.  Settings appropriate for use to assess or treat disability include, but are not limited to: early intervention programs, school based settings, mental health and rehabilitation, hospitals and nursing homes.

Before implementing an intervention with a patient an occupational therapist can conduct an occupational profile.  This part of the evaluation process provides insight to the patient’s history, problems, concerns and priorities (American Journal of Occupational Therapy (AJOT), 2008).  Clinical observation skills are also required to determine a patient’s abilities and current level of functioning as well as identify factors which interfere with her ability to perform activities.
 
An occupational therapist will consider the impact that client factors have on performance. These factors include values, beliefs and spirituality (AJOT, 2008). Further consideration is given to physiological functions of the body systems, or body functions and those body structures which support function (AJOT, 2008). Performance skills that may support or inhibit execution of desired occupations and be the focus of intervention include motor and praxis skills, sensory-perceptual skills, emotional regulation and cognitive skills.  Performance patterns which include habits, routines, roles and rituals as well as context and environment are important considerations in determining impact on performance (AJOT, 2008). Information from each of these areas will be incorporated to provide the basis and reasoning for the intervention plans that will be developed and implemented in working toward goal attainment.

An occupational therapist, through activity analysis, has the ability to choose the correct craft as an intervention to address factors that impact a patient’s ability to perform or complete tasks required for his roles in life.  Through activity analysis human and nonhuman components of the activity are considered, as well as the therapeutic qualities of the activity (Tubbs, 2007). Knowledge of a patient’s disability and requirements for improved functioning, as well as knowledge of the demands an activity places on the patient, are necessary to ensure the activity has therapeutic benefit to the patient.

An occupational therapist needs to know which objects will be used, space requirements and social demands, how the craft activity will be sequenced and the amount of time required to complete the activity.  In addition, an occupational therapist must take into account body structures and patient actions required to execute completion of the craft.

A simple mosaic craft activity that includes pre-cut tiles and all items prepared and set up for the patient provides illustration for the benefit and appropriate application of the use of this craft for treatment of either a physical or cognitive disability.  While creation of a mosaic tile may appear to be a simple leisure activity, this task places demands on the patient.  The patient needs to understand and remember the instructions, attend to task and maintain body position.  Selection of and picking up the tiles requires oculomotor control, visual discrimination and specific movements of muscles and joints. These include, but are not limited to: scapular protraction and retraction while reaching for materials and finger flexion, extension and thumb flexion and opposition when manipulating the craft tiles. Applying this craft in a group setting would provide the opportunity to address social and communication skills as well.

As I continue my education I am learning to analyze crafts for appropriate application to patients with various disabilities.  I know I must consider what is meaningful and important to the patient, break the craft activity down to provide justification for use, and emphasize the physical and cognitive therapeutic benefits of craft creation. While I have a greater understanding of the importance of crafts in treatment, it is my hope that I have also been able to share the benefits of this media with other students who will also serve in the health care profession.

References
American Occupational Therapy Association. (2008). Occupational therapy practice framework; Domain and process (2nd ed.).  American Journal of Occupational Therapy, 62, 625-683.
Tubbs, C. & Drake, M. (2007). Crafts and creative media in therapy (3rd ed).  Thorofare: SLACK Incorporated.