No. 2, Vol.

XII /2011
GYMNASIUM
Journal of Physical Education and Sport

OCCUPATIONAL THERAPY IN ROMANIA – THE HISTORY OF A NEW

BEGINNING

Hanneke van Bruggen 1*

Raveica Gabriela2
1
ENOTHE, Netherlands
2
“Vasile Alecsandri”University of Bacău, Romania

Keywords: occupational therapy, process, education, concepts

Abstract
In this article the authors wanted to emphasize the difficulties of implementation process of
a new profession in Romania: occupational therapy. Even the need of this profession was
identified in Romania since 2002, when the European Commission strongly recommended
to the Ministry of Health and to Romanian authorities for disabled people to include it in
the multidisciplinary team of health services, and 22 Centers for integration trough
Occupational Therapy (CITO) started the activities without specialists, the process of
higher education grows slowly. The complex analyzes of the involved factors relive the
fact that philosophy of occupational therapy is closed to approach of social assistance,
medicine and psychology. The interest in specific concepts is often dimmed because of
self-sufficient attitude of specialists, who considers the know-how already existent. The
conclusions of the authors are that the education could be better accepted if the specialists
became more open for the new information concerning the good practice in Europe for
increasing the quality of life, meaning the real satisfaction of individuals trough
independent life.

1. Introduction
In the assumption of European Network of Occupational Therapy in Higher
Education (ENOTHE), a foundation with a real history in the higher education’s
evolution in Europe, occupational therapy is a profession that spans the health and
social care sectors and that has its roots in the belief that the health and well-being
of individuals and communities can be maintained and improved when people are
engaged in meaningful occupations.
The influences of the present paradigms of occupational therapy comes from
Ancient Greece and Rome were the occupation, in the form of exercise, work, and
recreation (music, theatre) was recommended to improve mental and physical
health. From the Renaissance, the ideals of Humanism in Western Europe and later
in USA was centrality of man, man’s ability to control his environment and

*
E-mail: [email protected]
Hanneke B., Raveica G./ Gymnasium

improve his life on earth. In 19th Century in vogue was The Moral Treatment
Movement, meaning compassion, humanity combined with balanced occupation in
a ‘normal’ environment. The moral treatment and occupation was very used in
American Mental hospitals at peak between 1840 and 1860. In Europe, Philippe
Pinel (1745-1826) the Bicetre in Paris, and William Tuke (1732-1822) the York
Retreat in United Kingdom, used the same approach.
In the 20th century the orientation of occupational therapy moves to the Arts
and Crafts, as a reaction to industrialisation and urbanisation. The supported return
is to more natural surroundings, craftsmanship, and self reliance. Supported link is
between daily activities/life and health. William Morris, English artist and architect
and John Ruskin, English philosopher, are the promoters of this new movement. In
treatment, the new steps are made in 1904 by Dr. Herbert James Hall
(Massachusetts) who graded occupations for neurasthenia, and encouraged
craftspeople to assist the patients, and Jane Addams, who opened in Hull House in
Chicago, a labour museum and he has developed the program training for
immigrants.
Concerning the philosophy of pragmatism, John Dewey and William James
set up the holistic integration, person and environment: humans struggle to survive
in environment, giving motivation for thinking and action, a valid idea leads to
successful adaptive action and people express themselves in reality through action,
knowledge flexible, fallible and contingent. The ‘Philosophy of OT’ was lecture in
1921 by Dr Adolf Meyer, close friend of Dewey.
In 1917 American Occupational Therapy Association (AOTA) was founded.
For the first time, the associations draw the guidelines for establishing training
programs, recognition of qualified trainees, publication of articles on subjects of
interest.
2. Material and methods
Occupational therapy today - realities
World Federation of Occupational Therapists (WFOT, 2004), Australian
Association of Occupational Therapists WA define occupational therapy as ”a
profession concerned with promoting health and well being through occupation”
[1, 3, 5]. To enabling people to participate in the activities of thier life is
considerate the primary goal of occupational therapy, from WFOT (2004).
Occupational therapists achieve this outcome by enabling people to do things that
will enhance their ability to participate or by modifying the environment to better
support participation [1, 3, 5].
Occupational therapists have a broad education that equips them with skills
and knowledge to work collaboratively with individuals or groups of people who
have an impairment of body structure or function due to a health condition, and
who experience barriers to participation.
Occupational therapists believe that participation can be supported or
restricted by physical, social attitudinal and legislative environments. Therefore,
occupational therapy practice may be directed ”to changing aspects of the
 No. 2, Vol. XII /2011

environment to enhance participation” (AAOT WA).

Starting from the experience of most professional associations in the world,
the occupational therapy is practiced in a wide range of settings, including
hospitals, health centers, homes, workplaces, schools, reform institutions and
housing for seniors. According of their observations the clients are ”actively
involved in the therapeutic process, and outcomes of occupational therapy are
diverse, client-driven and measured in terms of participation or satisfaction derived
from participation” [1, 3, 5].
The need for adequate education and training in Romania
During Joint Action Project, we found that National Strategy (Monitorul
Oficial Al Romaniei, partea 1, nr.853/26.XI.2002) was introducing a new
terminology, conform the ICF (international classification on function, WHO). In
the same document the need of specialised personal, like ‘ instructori de
ergoterapie and terapeuti ocupationali ‘ and community services providing
occupational therapy and rehabilitation is mentioned [3].
In the final report of Joint Action Project [2, 3], we underlie the fact that most
of health and psychological studies in the universities from Romania are mainly
focused on disorders, defects, cure and corrections. The studies or subjects focusing
on functioning, participation and inclusion of persons with a disability in society
and adapting the home-, teaching- and work-environment, like in occupational
therapy education, are completely missing in the universities. The studies in the
social sector have been abstract, theoretical and less practical [2, 3],
The beginning of the OT in Romania starts in May 2002, when about 50
lecturers from 4 Romanian universities, representatives of 5 counties, medical
doctors, physiotherapists, social workers, representatives NGO for disabled people,
and the European Network of Occupational Therapy in Higher Education
(ENOTHE) discussed the need for occupational therapy in Romania and how to
start occupational therapy education at a level compatible to the rest of Europe [2,
3].
The outcome of the meeting was a support letter signed by all, and asking to
Ministry of Education to take in consideration the developing of occupational
therapy practice and education in Romania, in the benefit of the disabled as a way
for their inclusion in the society. This agreed letter, stating the importance of
occupational therapy in Romania was sent to all relevant ministries on the 11th of
May 2002 [2, 3].
It was proposed ”to start a postgraduate course: ‘specialisation in
occupational therapy ‘for lecturers and supervisors of the universities of Bacau,
Oradea and Timisoara, where already some knowledge was developed about this
new profession. The first group of fully trained occupational therapists should
become afterwards the lecturers in occupational therapy in the three universities
and clinical supervisors in practice” [2, 3].
The first international postgraduate programme in the field of occupational
therapy, set up by ENOTHE and other participants in Joint Action project, was
decided to start in the University of Timisoara, starting from June 2003. In this
Hanneke B., Raveica G./ Gymnasium

program, 18 students, with other professional background, from all over the
country, have been selected for the academic year 2003/2004 [2, 3].
Occupational therapy is in the rest of Europe a regulated profession within the
terms of the General Directive (89/48/EEC). Within the European Union the
purpose of the General Directive (89/48/EEC) is to facilitate the recognition of
regulated professions in other European member states.
Occupational Therapy is one of the fastest growing professions (a growth of
50% over the last 5 years) the number of OTs in Europe is now 70.000.This shows
that the profession has a very valuable and distinctive contribution to make to
society.
ENOTHE, supported by the European Commission, has developed European
curriculum guidelines, providing learning outcomes and a basis of principles on
which this joint postgraduate programme is structured. A group of ENOTHE
members (partners in this project) will develop and implement in close co-
operation with the local universities, clinical and social institutions and users’
associations the detailed content of the modules.
Within the JOINT ACTION project, funded by the European Commission, it
was planning ” to contribute to the reform of (higher) education as well as to the
reform of the social sector in an enlarged Europe through the introduction and
implementation of:
• A modular bachelor - curriculum in Occupational Therapy with a flexible
structure
• ECTS credits and guide
• Innovative teaching and training methods (like active problem and
project-directed learning and distance learning)
• New services and projects focusing on the participation of (young)
persons with disabilities in society
• The (new) policies concerning persons with disabilities
• The recognition of Occupational Therapy (practice and education) in
Romania” [2, 3].
In March 2005, 16 potential lecturers for the universities and supervisors in
the field have been fully trained at an equal level of education as in the rest of
Europe. During the project, the meetings with national authorities such as Ministry
of Education, Ministry of Labor, Ministry of Health, National Authority for
Handicapped People, had lead to recognition of this new specialization in Romania
and the need to introduce it in the list of higher education specialization and to
introduce the new profession in the Romanian Classification of Occupation (COR)
[1].
In 2009, only the University “Vasile Alecsandri” from Bacău, had applied the
evaluation documents to the Romanian Agency for Quality in Higher Education
(ARACIS) in order to start OT education, which gave the aprouval to start. In
October 2009, the first 28 students are officialy OT students in Romania.
 No. 2, Vol. XII /2011

Observation about the specific competencies of occupational therapy

profession in the world and Romania
Occupational therapy programmes had in the begginig (1935) a one-year full
–time course including technical training at an art college, in weaving, basketry,
bookbinding, cardborad construction, leatherwork, sewing, embroidery, and design.
The recommendations for training included 9 – 12 months devoted to learning
crafts in a craft school, and three months training in recreational activities,
including outdoor games, dancing, drill, music and dramatics. After the Second
World War, the profession took a greater role in the treatment of physical
conditions (ENOTHE, 2003).
In the 1950’s and 1960’s, the programmes started in Canada, Australia and
South Africa, continued to have many practical skills hours in the curricula.
The practice began to change especially in Unitated State of America,
Australia and Unitated Kingdom, during the 1970’s, when the use of arts and crafts
was replaced by exercices based on biomechanical principles (Lohss, 2002, p7). In
this new context, patients were encouraged to play games which were specially
designed to encourage particular movements (e.g. shoulder movement, or wrist
movement etc).
During the 1990’s the programmes in Europe were facing challenges, as
requirement for upgrade to bachelor degree level. At present, practical skills are
still „considerably more integrated in current education and practice in Germany”
(Lhoss, 2002, p6). Is not the same case in UK, where around 100 hours, 4 or 5
weeks full time, might be seen as the more average time devoted to the study of
practical skills. Australia and USA do similar reduction in practical skills time.
The total hours within any occupational therapy programme throughout
Europe is a factor which should be taken in account. Courses can be 3, 3.5 or 4
years, around 30 weeks and 1000 hours. The World Federation of Occupational
Therapists (2002) set these conditions as the minimum requirement for practice
placements in occupational therapy. Also, an important issue for practical skills is
that activity daily living activities (ADL) might be learnt better and realistic during
student’s practice placements if the patients are real and not the peers.
Occupational therapy has been strongly influenced by the medical model in
France, from the beginning. The biomechanical model and the analytical model are
now changing towards more humanistic occupational therapy models. French
education has also been based on separated disciplines, which is strongly subject –
based.
Education does reflect practice and many therapists wants programs to reflect
trends there is an emphasis on functional activities of daily living in many settings,
especially in physical acute and rehabilitation situation, and in Community settings,
designing adaptations to the environment.
The ENOTHE curriculum framework 2000 suggests that the design of the
curriculum must “ensure the development of practitioners fit for practice and fit for
Europe, with transferable knowledge, attitudes and skill”.
Developing the practical skills that an OT requires to perform professional
Hanneke B., Raveica G./ Gymnasium

activities, developing skills in professional judgments and decision making,

developing resource investigation skills in support of research and evidence based
practice, developing personal and professional management skills, and self
reflection skills, are considerate at this moment, the minimum competences for
every OT graduate [2].
The process of Occupational therapy studies implementation in Romania it’s
still difficult because of the lack of communication between different factors
involved in higher education system in Romania, including authorities, especially
ARACIS, Ministry of Education, Ministry of Labor and universities.
Even the need of this profession was identified in Romania since 2002, when
the European Commission strongly recommended to the Ministry of Health and to
Romanian authorities for disabled people to include it in the multidisciplinary team
of health services, and 22 Centers for integration trough Occupational Therapy
(CITO) started the activities without specialists, the process of higher education
grows slowly [1].
Many of psychological specialists considers that occupational therapy could
be only a master degree study program for psychology graduates, instead in the rest
of Europe and the world, this profession is described with specific competences,
different from psychologist profession. In the psychiatric hospitals, in rehabilitation
centers, the ergotherapy is still practiced on the level of the 1935’s. The patients are
encouraged to work, to develop skills in art or crafts, in order to “be kipped” busy.
The relationship between the person – environment – occupations is less evaluated
and less considerate important in therapy.
In our opinion the difficulties of acceptance started in Romania from the
interdisciplinary approach of occupational therapy philosophy, which is closed to
approach of social assistance, medicine and psychology. The vision of facilitation
of disabled people participation in the society, the vision of inclusive society, the
well being and quality of life are the common core of all this profession.
The different it’s the way of problem solving: in occupational therapy all this
desiderates of the society are considerate trough occupation, which means,
independent daily life activities, meaning and purposeful activities, which
contribute to the health of the person trough the satisfaction of participation in the
real life according to his/her potential, abilities and skills.
To attend this aim, occupational therapy focused on the person-environment-
occupation fit and starting the intervention process from this evaluation. Through
the top-down approach, which means from the purpose and meaning of the
activities, to the present potential, abilities, skills of the person to the
disease/dysfunction/deficiency, occupational therapy strongly affirms that a
handicap is the situation of the person excluded by the society because of the lack
of participation trough his/her occupations, including communication, indoor and
outdoor mobility, social interaction, productive activities, house activities etc.
Starting from this point, the ways of OT intervention could be: ergonomic
adaptation of physical environment (tools, building adaptation etc.), adaptation of
social environment (trough facilitation of communication from different factors) or
 No. 2, Vol. XII /2011

intervention on person, always in a multidisciplinary team [4].

3. Conclusions
The start’s need of OT education in Romania could be better accepted if the
specialists became more open for the new information concerning the good practice
in Europe for increasing the quality of life, meaning the real satisfaction of
individuals trough independent life. The longer process will affect the chance of
many people to have an independent life, if they don’t have or have loose the
chance to be physically, mentally or psychologically able to perform their daily
living activities.
References:
1. Australian Association of Occupational Therapists WA,
http://www.otauswa.com.au
2. ENOTHE, (2006), Joint Action Programme- Youth no. 113161-JA-1-
2003, Evaluation and Final Report, Amsterdam
3. ENOTHE,
http://www.enothe.eu/index.php?page=tuning/prj/tuning/fpypdee/default
4. ENOTHE, (2008), – European specific competences for OT education,
Amsterdam
5. LHOSS, I. (2002), The importance of creative media in occupational
therapy: a comparison of Germany and Britain, Queen Margaret
University College, Edinburgh
6. World Federation of Occupational Therapists, 2004