Participation in work: the necessity of addressing executive function deficits.

Participation is a broad construct that occupational therapy uses to describe the satisfactory engagement in a client’s chosen occupations and roles in home, work, and community environments [5]. Participation is so central to the practice of occupational therapy that it is one of the three overarching concepts that is used to describe the outcomes of occupational therapy services in the OT Practice Framework-2nd Edition [2]. Working with clients to help them to participate in their chosen occupations and roles is a complex process and the argument can be made that helping them to engage in their role as a worker is the most complex. The complexity of all the interrelated factors associated with work including the clients goals and expectations, the constraints of rehabilitation service delivery systems, and the dynamic nature of work, all contribute to the difficulty of helping someone with a disability reintegrate back into the workforce [25]. While the rehabilitation community is aware that this is a complex process, the problem remains that overall rehabilitation professionals have not been successful in helping individuals with disabilities return to work. The 2004 U.S. census data shows that 44% of people with a non-severe disability work full time year-round and 13% percent with a severe disability work full time year-round [32]. This is a trend that has not changed over time. In 1995, research showed that despite best rehabilitation efforts the majority of Americans with disabilities were not working and this number has been constant since at least 1986 [25]. The majority of Americans with disabilities are not working even with legislation in place to protect their right to work and in spite of the fact that an overwhelming majority of individuals with disabilities have a desire to work [4]. It is time occupational therapy to embrace the fact that there is a lot of opportunity to expand our ability to help individuals with disabilities to reintegrate back into the workforce. To support our clients in fulfilling their work related goals, occupational therapists must have a comprehensive toolbox of knowledge, skills, and measures that will be able to address the complexity of work rehabilitation. Just like other areas of practice, this toolbox must address the broad range of internal, external, and occupational factors that underlie performance and participation. This article will review executive function, one area that is extremely underrepresented in the occupational therapist’s toolbox.