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The neurological basis of occupation

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The purpose of the present paper was to survey the literature about the neurological basis of human activity and its relationship to occupation and health. Activities related to neurological function were organized into three categories: those that activate the brain's reward system; those that promote the relaxation response; and those that preserve cognitive function into old age. The results from the literature review correlating neurological evidence and activities showed that purposeful and meaningful activities could counter the effects of stress-related diseases and reduce the risk for dementia. Specifically, it was found that music, drawing, meditation, reading, arts and crafts, and home repairs, for example, can stimulate the neurogical system and enhance health and well-being, Prospective research studies are needed to examine the effects of purposeful activities on reducing stress and slowing the rate of cognitive decline.
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Occup. Ther. Int. 14(2): 71–85 (20 07)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
The neurological basis
of occupation
SHARON A GUTMAN, Programs in Occupational Therapy, Columbia Uni-
versity, New York, USA
VICTORIA P SCHINDLER, Occupational Therapy Program, Richard
Stockton College, Pomona, USA
ABSTRACT: The purpose of the present paper was to survey the literature about
the neurological basis of human activity and its relationship to occupation and health.
Activities related to neurological function were organized into three categories: those
that activate the brain’s reward system; those that promote the relaxation response;
and those that preserve cognitive function into old age. The results from the literature
review correlating neurological evidence and activities showed that purposeful and
meaningful activities could counter the effects of stress-related diseases and reduce
the risk for dementia. Specifi cally, it was found that music, drawing, meditation,
reading, arts and crafts, and home repairs, for example, can stimulate the neurogical
system and enhance health and well-being, Prospective research studies are needed
to examine the effects of purposeful activities on reducing stress and slowing the rate
of cognitive decline. Copyright © 2007 John Wiley & Sons, Ltd.
Key words: cognitive stimulation, neurological correlates, occupational therapy
theory
Introduction
With the advancement of medical technology in the last decade, neurological
imaging scans have enabled researchers to examine human brain function while
people are engaged in activity (Nattkemper, 2004). Functional magnetic reso-
nance imaging (MRI) and positron emission tomography (PET) are two types
of imaging technologies that provide detailed information about the neurologi-
cal mechanisms underlying human activity. Electroencephalographs (EEGs)
also enable researchers to identify neurological electrical activity while people
are engaged in occupations (Bankman and Morcovescu, 2002). Such research
has facilitated a greater understanding of the nature of human occupation and
its relationship to health.
OCCUPATIONAL THERAPY INTERNATIONAL
Occup. Ther. Int. 14(2): 71– 85 (2007)
Published online in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/oti.225
72 Gutman and Schindler
Occup. Ther. Int. 14(2): 71– 85 (2007)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
The current literature about the neurological basis of occupation is organized
into three primary categories: activities that activate the brain’s reward system;
activities that promote the relaxation response and reduce stress-related disease;
and activities that preserve cognitive function into old age. Although scholars
have argued that the terms ‘occupation’ and ‘activity’ have distinct meanings,
they will be used interchangeably in the present paper to represent the desired
participation in behaviours and events that are mediated, to a large degree, by
the neurological system.
Activities that are intrinsically rewarding to the brain
The human brain is wired to interpret all activities as rewarding or aversive
through the mechanism of the brain’s reward system (Berns et al., 2001). The
brain’s reward system, formally called the ‘mesocorticolimbic system,’ is an evo-
lutionarily old mechanism that enhances human survival by distinguishing
activities that are pleasurable and should be repeated from those which are
harmful and should be avoided (Schultz, 2000). The mesocorticolimbic system
is composed of interconnected anatomical structures located in the cortex
(conscious decision making), midbrain (maintenance of vital functions) and
limbic system (emotional system). The structures of the brain’s reward system
include the frontal cortex, ventral tegmental area, nucleus accumbens, anterior
cingulate cortex, amygdala and hippocampal formation (Figure 1) (Nestler,
2001; Nestler and Malenka, 2004).
Frontal Lobe of Cerebral Cortex
Nucleus Accumbens
Ven t ral Tegmental
Area of Midbrain
Amygdala
Hippocampus
Pons
Medulla Cerebellum
Anterior
Cingulate
FIGURE 1: The mesocorticolimbic system is the brain’s reward centre.
The neurological basis of occupation 73
Occup. Ther. Int. 14(2): 71–85 (20 07)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
The primary neural pathway of the mesocorticolimbic system originates in
the ventral tegmental area of the midbrain and sends projections to the nucleus
accumbens – a structure located deep beneath the frontal lobe. The subcortical
structures – the amygdala, ventral tegmental area and nucleus accumbens – have
a primary role in the interpretation of activities as rewarding or aversive. The
anterior cingulate and the prefrontal cortices receive projections from the sub-
cortical structures and are involved in the conscious decision to engage in or
avoid continued activity participation (Nestler, 2001; Nestler and Malenka,
2004; Hyman et al., 2006).
The amygdala also has connections with the hippocampus – a limbic system
structure located in the temporal lobe (Figure 1). The hippocampus records and
stores memories of emotionally laden events; for example, the sensory memories
of eating a favourite food or of ingesting food that caused illness. Such memories
enhance human survival by motivating people to repeat pleasurable activities
that promote survival and avoid activities that can cause harm (Skuse et al.,
2003).
The primary neurotransmitter used by the brain’s reward system is dopamine.
Most pleasurable activities increase dopamine levels in the mesocorticolimbic
system. Dopamine release has been shown to trigger the brain’s reward system
through activities such as food intake, sex and ingesting addictive substances
(Hyman et al., 2006). However, dopamine release has also been shown to occur
in response to reading humerous cartoons (Mobbs et al., 2003), viewing beauti-
ful faces (Blood and Zatorre, 2001), listening to favourite musical pieces (Aharon
et al., 2001) and playing video games (Koepp et al., 1998). Glutamate is another
neurotransmitter within the brain’s reward system and appears to have a role in
promoting the associations between the pleasurable feelings invoked by a spe-
cifi c activity and its sensory cues (e.g., the smell of freshly cut grass and the
pleasure associated with playing ball in a park) (Naranjo et al., 2001).
Musical activities
Music is one of the most pleasurable activities experienced by the brain’s reward
system. The human brain is designed to experience music as gratifying; however,
cultural factors infl uence which type of music activate the brain’s reward system
(Menon and Levitin, 2005). Stimulation of mesocorticolimbic structures, in
response to playing, listening to or singing favourite musical pieces, is often
accompanied by the experience of chills or shivers down the spine (Brown et
al., 2004). The vestibular stimulation that occurs as people move synchronously
with rhythm (e.g., during dancing) also activates the brain’s reward centre
(Blood and Zatorre, 2001).
The brain’s response to music is infl uenced by our degree of musical training.
Musicians show greater bilateral activation of both hemispheres when listening
to music in comparison with non-musicians. Musicians also demonstrate greater
left hemisphere dominance when engaged in musical tasks, whereas non-
74 Gut m a n an d Schindler
Occup. Ther. Int. 14(2): 71– 85 (2007)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
musicians display greater right hemisphere dominance (Ohnishi et al., 2001;
Seung et al., 2005). This suggests that musicians, by using both hemispheres,
are able to analyse the logical and emotional aspects of music. The logical, or
left brain, aspects of music include skills such as reading and sequencing notes
and analysing the timing of rhythm. The emotional, or right brain, qualities of
music include skills such as evaluating timbre, pitch and resonance.
Neuroanatomical data from functional imaging scans have also shown that
music with words activates the left hemisphere – which is largely responsible
for concrete language interpretation. Non-verbal music, however, activates the
right hemisphere – which is responsible for the interpretation of emotion,
whether of a person’s voice, a piece of music or someone’s body language
(Halper n and Zatorre, 1999).
The above ndings offer a greater understanding of the neurological basis
for the ability of music to evoke pleasure in the brain’s reward system. That the
human brain is designed to induce pleasure in response to music suggests that,
although music may not be essential for survival, it may possess signifi cant
benefi t to emotional well-being. In therapy music is often used to motivate
patients to engage in activities that are physically painful or challenging. Music
has been found to help patients with Parkinson’s disease to move with greater
ease when physical exercise cannot do so (Thaut et al., 2001). It has also been
used to enhance expression in patients who have diffi culty verbalizing their
emotions (Clement-Cortes, 2004). Researchers have similarly shown that music
can help patients with aphasia to enhance verbal communication (Koelsch et
al., 2004). When people engage in musical activities they may be able to access
alternate neural pathways that can stimulate brain functions, otherwise inac-
cessible due to pathology. The stimulation of alternate pathways may facilitate
functions such as the fl uidity of physical movement and communication (Thaut
et al., 2001; Koelsch et al., 2004).
Drawing
Drawing is another therapeutic activity that stimulates the brain’s reward system.
Although activation of the mesocorticolimbic structures have not been analysed
during drawing – as drawing cannot be performed adequately within the
confi nes of fMRI and PET scanners – drawing has been assessed with regard
to changes in electrical brain waves. Electroencephalograph (EEG) studies
have shown that artists are able to generate both theta and delta waves when
engaged in drawing (Bhattacharya and Petsche, 2005). Beta, alpha, theta and
delta waves are speci c electrical patterns that are measured in cycles per second
(CPS). Beta waves, which occur at 14 C PS a nd above, are produced in conscious
daily routine activities (e.g. driving to work). Alpha waves (14–7 CPS) occur
during daydreaming and in states of relaxation. Theta (7–4 CPS) and delta (4
CPS and below) wave patterns occur during sleep but have also been shown
to be present when people are engaged in activities of deep concentration,
The neurological basis of occupation 75
Occup. Ther. Int. 14(2): 71–85 (20 07)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
such as meditation, drawing and writing (Cantero et al., 1999; Bhattacharya
and Petsche, 2005).
In therapy, drawing has been shown to effectively help patients with aphasia
to retrieve desired words (Sacchett, 2002). Drawing may improve speech produc-
tion by providing an alternate neural strategy to access the semantic system.
Because drawing largely activates the right hemisphere, it may also recruit right
hemisphere semantic networks that can aid in word retrieval when left hemi-
sphere language functions are damaged (Fornazzari, 2005). Like music, drawing
can also serve as a means of expression in patients who have diffi culty verbal-
izing their feelings, or who may have repressed unacceptable emotions (Clem-
ents-Cortes, 2004).
Studies on artists and musicians who have experienced fl ow while engaged
in creative endeavours support the idea that the mesocorticolimbic system
responds positively to activities involving the desire to express creative impulses
(Csi k sz e ntmihalyi, 1998). Flow is an optimal experience in which people feel
intense pleasure and satisfaction while deeply engaged in desired activity (Csik-
szentmihalyi and Csikszentmihalyi, 1988). That artists, writers and musicians
commonly report fl ow during creative work suggests that such activities posi-
tively activate the brain’s reward system.
Activities that elicit the experience of ow
In the late 1980s Csikszentmihalyi (1990) used the term ‘fl ow’ to describe the
state in which people experience deep feelings of gratifi cation and elation in
response to engagement in highly desired activity. Csikszentmihalyi initially
studied fl ow in chess players, mountain climbers, dancers and surgeons. He
found a set of characteristics common to the fl ow experience that included the
following.
Complete absorption in the activity and diminished awareness of the exter-
nal environment.
A sense of oneness with the activity.
Tot al im me rs i on in the present moment and a lost sense of time.
Lost fear or anxiety – everyday worries fade as people become increasingly
engrossed in the activity.
Immense feelings of personal satisfaction – the activity is rewarding in
itself.
In addition to artists, musicians and writers, people who commonly experience
ow include athletes, surgeons, Buddhist monks, craftspeople and dancers
(Csi k sz e ntmihalyi, 1990, 1998; Jackson, 1996). T hese people regularly engage in
activities which require disciplined practice over time, deep levels of concentra-
tion, an ability to screen extraneous stimulation and a commitment to master
76 G u t man and Schindler
Occup. Ther. Int. 14(2): 71– 85 (2007)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
the skills of an activity. Such commitment originates from an intrinsic sense of
joy derived from the activity. Anyone, however, can experience fl ow in all activi-
ties that are experienced as deeply rewarding and engrossing. Knitting, needle-
work, gardening, hiking and cooking are also activities that can elicit the fl ow
response (Csikszentmihalyi and Csikszentmihalyi, 1988).
Although no researcher to date has measured the neurological changes that
occur during fl ow, it is theoretically plausible that the phenomenon results from
activation of the brain’s reward system and increased levels of dopamine. The
deep mental concentration that is characteristic of fl ow may also produce
the theta and delta brain wave activity that is observed during creative
endeavours.
Can patients be taught to use desired activity to elicit fl ow – just as they
have been taught to use cognitive behavioural techniques to effect change?
Learning to use activity to elicit fl ow may be able to offer patients a non-phar-
maceutical means to self-regulate emotions such as anger and obsessional
phobias. Flow could potentially help patients to dampen internal chaos and
extraneous environmental stimulation that could trigger sensory overload. The
ability to learn to use activity to elicit fl ow may help patients with remitted
depression to reduce their risk of relapse – just as researchers have shown that
a short programme of mindfulness training can reduce our risk of depression
relapse (Astin, 1997; Teasdale et al., 2000). Such studies of the fl ow phenomenon
have shown that the use of activity in human life is critical to well-being, emo-
tional health and emotional equinamity.
The similarity between fl ow and meditation
In many ways the experience of fl ow is similar to meditation. Common features
of both include:
increased levels of concentration
complete absorption in the experience and lost awareness of the external
environment
a feeling of oneness with the larger world
immersion in the present moment and an ability to release worries about the
future and regrets about the past
the attainment of contentment and well-being.
There is a large body of research documenting that meditation activates the
structure of the brain’s reward system – in particular the left frontal lobe, which
has been correlated with elevation in mood (Aftanas and Golosheykin, 2005).
Many studies have also shown that highly practised meditators are better able
to maintain emotional equinamity in response to negative stimul ations (Newb erg
et al., 2001). They also score lower than control subjects on instruments measur-
The neurological basis of occupation 77
Occup. Ther. Int. 14(2): 71–85 (20 07)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
ing levels of negative emotions. When exposed to a stressful event, highly
practised meditators are better able than control subjects to return to a state of
emotional equilibrium (Ritskes et al., 2003).
Meditation, however, does not have to be practised in a traditional cross-
legged position to attain the above-mentioned benefi ts. Many practitioners rec-
ognized the potential for meditation to be achieved through the engagement in
dynamic activity, such as in Buddhist walking meditation (Kabat-Zinn, 1995),
yogic fl ying meditation (Ascott, 2000), traditional Native American ecstatic
dancing (Oesterley, 2002) and Taoist sand painting (Huntingdon and Bangdel,
2004). Some Buddhist schools of thought suggest that all human occupation
should be carried out as a form of meditation, or deep engrossment and height-
ened awareness in everyday activity. This is one meaning underlying the Bud-
dhist adage attributed to Lao Tse: before enlightenment chop wood and carry
water; after enlightenment chop wood and carry water (Mitchell, 1998). In other
words, enlightenment is not a state that should be separated from our everyday
ordinary activities; rather, everyday activities can be opportunities for medita-
tive practice. Csikszentmihalyi (1990) advocated the same philosophy when he
proposed that people can improve their quality of life by eliciting fl ow in ordi-
nary daily occupations. He proposed that people learn to discipline the mind
to enter a state of deep concentration during daily activity that is similar to
levels generated while engaged in favoured hobbies.
If patients can be taught to engage in occupation as a form of meditation,
might they be able to use occupation to experience the same benefi ts observed
in highly practised meditators? Can patients use occupation and the fl ow experi-
ence to be less emotionally affected by aversive and stressful events? Can
patients use occupation as a tool to return to states of greater calmness in
response to stress? The use of occupation as a meditative practice to manage
stress, anxiety and emotional reactivity could be as valuable a practice to ease
daily life stress as meditation and mindfulness training have been.
Activities that elicit the relaxation response
Both meditation and mindfulness training cause precise physiological changes
in the human body:
decreased blood pressure, heart rate and respiration (Newberg et al., 2001)
increased alpha, theta and delta wave patterns (Aftanas and Golosheykin,
2005)
increased immune system response (Jacobs, 2001).
Progressive relaxation (Ghoncheh and Smith, 2004; Scheufele, 2000), visualiza-
tion and guided imagery (Lutz et al., 2004) and fl ow experience (Jackson, 1996)
78 Gutman and Schindler
Occup. Ther. Int. 14(2): 71– 85 (2007)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
also produce these physiological changes. All of these techniques evoke the
relaxation response – a term fi rst coined by Herbert Benson in the 1970s
(Benson et al., 1974; Benson and Klipper, 2000). Benson et al. (1974) suggested
that the relaxation response occurs in all activities that share specifi c common
elements. These include the following.
The activity is performed in a quiet environment.
It enhances our ability to focus inwardly and concentrate on the demands
of a specifi c task.
It encourages disregard of everyday worries.
It involves focused attention on a repetitive mental stimulus or activity.
The similarity of physiological responses in the relaxation response and the fl ow
experience suggest that both possess common underlying neurological mecha-
nisms. It is highly likely that a common element shared by the relaxation
response and fl ow is the activation of the brains reward system.
Benson and colleagues (Benson et al., 1974; Benson and Klipper, 2000) also
suggested that the relaxation response is the physiological counterpart to the
body’s stress response, or the fi ght/fl ight syndrome. The fi ght/fl ight syndrome,
which is mediated by the autonomic nervous system, is the body’s evolutionary
response to stress. Heart rate, respiration and pulse increase to prepare the body
to fi ght or fl ee. Increased blood fl ow travels to the skeletal muscles, heart and
lungs to prepare these systems for action. Simultaneously, blood fl ow decreases
to the intestines to slow their function (Jacobs, 2001). Excessive activation of the
ght/fl ight response is often caused by modern-day stress that we cannot fi ght or
ee from. There is a large body of research linking excessive activation of the
stress response with disease, illness and injury. Stress has repeatedly been corre-
lated with hypertension (Sower, 2002), increased cholesterol production
(Yasunari et al., 2002), coronary disease (Colak et al., 2005; Yudkin et al., 2000),
gastrointestinal disorders (Keefer and Blanchard, 2001, 2002), autoimmune dis-
orders (McLean et al., 2005; Picardi et al., 2005), chronic pain (Blackburn-Munro
and Blackburn-Munro, 2001), decreased immune system responses (Segerstrom
et al., 1998) and the occurrence of accidental injuries (Schnyder et al., 2001).
Activities that activate the left hemisphere
Researchers such as Benson et al. (1974), Kabat-Zinn et al. (1992) and
Csikszentmihalyi (1990) have begun to build a growing body of research dem-
onstrating that activities which elicit fl ow and the relaxation response can offer
a non-pharmacological means to manage stress. The work of Kabat-Zinn et al.
(19 92), de m on st r ating the benefi ts of mindfulness training, has now been repli-
cated in similar studies (Davidson et al., 2003; Teasdale et al., 2000; Williams
et al., 2001). Mindfulness training is a Buddhist practice in which people learn
to heighten their awareness of the present moment and conscious thought.
The neurological basis of occupation 79
Occup. Ther. Int. 14(2): 71–85 (20 07)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
Rather than seeking to stop thought, mindfulness practitioners learn to men-
tally catch negative thoughts and challenge their validity. Such thoughts are,
over time, replaced with less judgemental and critical thoughts that support the
practitioner’s ability to make adaptive responses. This is particularly helpful with
people whose worries tend to escalate when allowed to engage in uncontrolled
rumination.
Short, eight-week programmes of mindfulness training have been found to
reduce anxiety, elevate mood and increase antibody levels (Antoni, 2000;
Bedard et al., 2003; Davidson et al., 2003; Teasdale et al., 2000; Williams et al.,
2001). One reason accounting for the ability of mindfulness training to reduce
anxiety and elevate mood may lie in neurological mechanisms. Mindfulness
training has been shown to increase cerebral bloodfl ow in, and activation of,
the left prefrontal cortex – an area associated with positive mood (Davidson et
al., 2001; Davidson et al., 2003). The two hemispheres of the brain appear spe-
cialized for the processing of distinct emotions. Whilst left hemisphere activa-
tion is associated with elevated mood and feelings of emotional well-being, right
hemisphere activation is correlated with depressed mood and pessimism. Right
hemisphere infarctions disable right brain functions and allow the left hemi-
sphere to control emotional processing. Patients in acute stages of right hemi-
sphere infarctions often display euphoria and an emotional dissociation from
their illness. Conversely, left hemisphere infarctions disable left brain functions
and allow the right hemisphere to control emotional processing. Patients in the
acute stages of left hemisphere infarction commonly display severe depression
and anhedonia (Astin, 1997; Davidson et al., 2000; Newberg et al., 2001; Ritskes
et al., 2003).
Left frontal lobe activation is associated with a greater ability to react to
stress with adaptive responses that promote survival. People who typically
display greater left frontal lobe activation are more able to return to a neutral
emotional state after exposure to a stressful event (Davidson et al., 2003).
Repeated transcranial magnetic stimulation (rTMS) is a clinical technique
that effectively reduces depression in some patients by increasing activation
of the left frontal lobe. Repeated TMS involves placing an electrical magnetic
coil on the head through which stimulation is administered to the left prefrontal
cortex (Paus and Barrett, 2004). Both mindfulness training and rTMS have
been shown to elevate mood through increased activation of the left hemi-
sphere. The question must be asked, then, whether occupation that stimulates
the left hemisphere could be used to alleviate depression, prevent relapse, or
both. Activity that stimulates the left hemisphere commonly involves logic,
sequencing and categorization skills. The concrete interpretation of language
and mathematical skills are also functions of the left hemisphere. Solving
puzzles – such as crosswords and word-fi nding games – are examples of left
brain activities. So, too, are card games requiring analysis and calculation,
reading mystery novels, and games needing the translation of codes and symbols
(Barzilai et al., 2004).
80 Gutman and Schindler
Occup. Ther. Int. 14(2): 71– 85 (2007)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
Cognitively stimulating activity: protection against dementia
There is growing evidence that cognitively stimulating activity not only induces
ow and activates the brain’s reward centre but also reduces the risk of Alzheim-
er’s disease and other forms of age-related dementia. Some of the strongest
research supporting the protective factors of mentally stimulating activities have
emerged from the Nun Studies – a body of research demonstrating that nuns
who remained intellectually active throughout life and who displayed high lin-
guistic and verbal reasoning skills were signifi cantly less likely to develop
Alzheimer’s disease in later life (Snowdon et al., 2000). Maintaining intellectu-
ally stimulating activities into old age and mastering verbal reasoning were sig-
nifi cantly associated with higher brain weight, less cerebral atrophy and reduced
neurofi brillary pathology (Riley et al., 2005).
Similarly, researchers found that participation in mentally stimulating leisure
and social activities signifi cantly decreased one’s risk for Alzheimer’s disease and
related demntias (Friedland et al., 2001; Scarmeas et al., 2001; Verghese et al.,
2003; Wilson et al., 2002). Although the exact mechanism of this protection is
unknown, some have suggested that synaptic complexity and neuronal reserve
– which both result from participation in intellectually stimulating activities –
may play a role. Synaptic complexity occurs when neurons build greater con-
nections with each other as the brain learns new skills and associates newly
learnt skills with mastered ones having existing neuronal pathways. Neuronal
reserve involves the preservation of functioning neurons that are silent or non-
active. Neuronal reserve allows the brain to remain plastic and fl exibly adapt
to change – whether from the natural ageing process, illness or accident. The
more a person builds new neuronal connections and preserves existing neurons,
the less likely it is that neurodegeneration will occur (Kempermann et al.,
2002).
Conversely, participation in mentally passive activities has been found to
signi cantly increase one’s risk for the development of Alzheimer’s disease and
related dementias. Several studies have shown that television viewing actually
heighten’s one’s risk for dementia. In one study (Lindstrom et al., 2005), the risk
for developing Alzheimer’s disease increased 1.3 times for each daily hour of
television viewing a person engaged in. In contrast, for each hour spent engaged
in intellectual activities per day, the risk of developing Alzheimer’s disease
decreased by 16%.
Gerontologists suggest that participants in intellectually and socially stimu-
lating activities throughout the lifespan provides protection against age-related
dementias (Lehmann, 2000; Barzilai et al., 2004). Intellectually stimulating
activities include reading, completing crossword puzzles, playing a musical
instrument, engaging in crafts and ne arts, writing, playing cards and board
games, participating in needlework and completing handy work and home
repairs. Researchers suggest that in addition to these activities people can par-
ticipate in intellectually stimulating activities by learning new skills and hobbies,
The neurological basis of occupation 81
Occup. Ther. Int. 14(2): 71–85 (20 07)
Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti
taking educational courses, participating in book clubs and travelling to new
places (Fillit et al., 2002).
As the population in many industrialized countries ages, therapists can help
patients to use occupation to preserve mental function into old age. Such pres-
ervation of cognitive capabilities can help people to maintain their indepen-
dence for longer, thus avoiding the high costs of nursing homes and medication.
Daily engagement in intellectually stimulating activity that elicits fl ow and the
relaxation response may have the potential to preserve mental and physical
health as effectively as pharmacological intervention.
The use of occupation to enhance health: the legs of a stool
The research discussed in this paper underscores the idea that humans are
occupational beings who require constant engagement in activity to maintain
health. This research also reinforces the idea that the human brain is designed
to respond positively to activities that produce fl ow, promote the relaxation
response and enhance mental stimulation – which, in turn, preserve physical
and emotional health. The use of occupation to preserve health and emotional
well-being may be viewed as the legs of a stool. One leg involves activity that
elicits the brain’s reward system and produces enjoyment, pleasure and fl ow. A
second leg involves activity that facilitates the relaxation response and decreases
the risk of stress-related health concerns. A third leg involves activity that
stimulates mental reasoning and preserves cognitive function into old age. A
fourth leg, although not addressed in this paper, would probably involve activity
that enhances the musculoskeletal and cardiovascular systems of the body.
Occupation addressing these essential areas may have the potential to be used
as a non-pharmacological alternative to maintain cognitive, physical and psy-
chosocial function throughout the lifespan. Prospective research is needed to
promote the growing body of evidence demonstrating the health benefi ts of
daily occupation. Additionally, as medical technology advances, greater under-
standing will continue to emerge about the neurological basis of occupation and
the relationship between occupation and health.
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Address cor respondence to Sharon A Gutman PhD, OTR, Associate Professor, Columbia Uni-
versity, Programs in Occupational Therapy, 710 West 168th Street, NI – 8, New York, NY 10032,
USA. Tel: (1) 212 3 05 8703. Email: sg2422@columbia.edu
... Participation in everyday life activities that are meaningful to a person brings purpose and fulfillment to the individual, leading to improved health, organized behavior, and improved quality of life (American Occupational Therapy Association, 2014; Bar & Jarus, 2015;Ikiugu et al., 2016;Townsend & Polatajko, 2013;Wilcock & Hocking, 2015). That is why participation in meaningful occupations has been found to be associated with improved well-being, life satisfaction, physical and emotional health (Gallagher et al., 2015;Gutman & Schindler, 2007;Hilleras et al., 2001;Krause, 2004;McIntyre & Howie, 2002). Such participation is organized into patterns and habits that are dependent on the cultural context. ...
... It has been postulated that participation in meaningful occupations engenders satisfaction, happiness, and, therefore, health and well-being by activating the reward neural network in the brain, in the process causing a release of dopamine in the mesocorticolimbic system (Gutman & Schindler, 2007). In recent studies, however, it has been found that occupations that cause positive mood and therefore are likely to activate the reward neural pathways may have unique characteristics that distinguish them from other typical meaningful occupations (Ikiugu, 2019;Ikiugu et al., 2016). ...
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We investigated the internal structure, internal consistency reliability, and convergent validity of the Meaningful and Psychologically Rewarding Occupation Rating Scale (MPRORS). The American Occupational Therapy Association occupational profile interview, MPRORS, and the Meaningful Activity Participation Assessment (MAPA) were administered to 21 study participants. Principal Axis Factor Analysis indicated trends supporting the two-factor structure of the MPRORS. Internal consistency reliability was generally good for the psychologically rewarding scale and acceptable for the meaningfulness scale. Convergent validity of the meaningfulness scale, when compared with the MAPA meaningfulness scores, was not supported. Further validation research with larger heterogeneous samples is indicated.
... For example, while crafters in the U.S. judge quality of craft based on creative self-expression, Taiwanese crafters place value on how well a craft establishes or benefts a community [3]. We found our participants perspectives support Bardzell [29]. Beyond this, our participants also enjoy creating pieces that represent their own style and aesthetic, and are motivated to learn computational tools (such as spreadsheets and graphic design tools) to help further their own style. ...
... Occupation-based occupational therapy has been found to improve stroke patients' general health, emotional roles [10] and occupational performance in daily activities [11]. A literature review also found that engagement in meaningful activities enhanced health and well-being, while it also stimulated the neurological system [12]. A meta-analysis additionally suggested that occupation-based cognitive rehabilitation is beneficial for improving daily functioning and psychosocial functions in traumatic brain injury patients [13]. ...
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Background: While occupational therapists value occupation-based practice, they appear to spend less time on this approach and more time on impairment-based practices. Several barriers are reported for the occupation-based approach. Aim: To explore different aspects of occupation-based practice among occupational therapists working in hospitals and rehabilitation institutions, and to examine associations between sociodemographic factors, barriers, and occupation-based practice. Materials and methods: A cross-sectional survey was conducted. Participants were occupational therapists working in hospitals and rehabilitation institutions in Norway. The data were analysed with descriptive statistics and logistic regression. Results: The therapists (n = 124) valued occupation-based practice and reported using it frequently and to a large extent. Relatively small proportions of their practice (26% assessments and 38% interventions) were classified as occupation-based. Lack of time, space and equipment were reported as large barriers. Lack of time and lack of equipment were associated with low self-reported level of occupation-based practice. Conclusions: The participants valued occupation-based practice, while the reported assessment and intervention methods were mainly not occupation-based. Several barriers were reported, and some were associated with less use of occupation-based practice. Significance: The results can be used to raise awareness of occupational therapists' use of occupation-based practice and barriers to this approach.
... To explain the physiological connection between meaningful occupational participation and health, Gutman and Schindler (2007) argued that such participation activated the reward neural pathways in the brain, causing positive feelings and subsequently positively impacting health and well-being. However, Ikiugu et al. (2016) found that fMRI data did not support the proposition that participation in individually chosen, meaningful occupations activated the reward neural pathways, suggesting that not all meaningful occupations could activate the reward neural circuits. ...
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We investigated the feasibility of interventions based on the guidelines for use of meaningful and psychologically rewarding occupations as a means of improving perceived health and well-being among 21 students, faculty, and staff at a US midwestern University. Using a repeated measures design, we used the RAND SF-36, Warwick Edinburgh Mental Well-Being Scale, and Meaningful Activity Participation Assessment to gather data on four variables. There was a main effect of interventions on perceived well-being, F(2, 40) = 3.74, p = .03, eta squared= .40, and energy/fatigue, F(2, 40) = 4.57, p =.02, eta squared = .43. The guidelines show promise as a tool for occupational therapists.
... Making things was meaningful to Kate. Research has shown using crafts as therapy promotes skill development, relieves stress, and provides psychosocial benefits (Gutman & Schindler, 2007;Leenerts & Evetts, 2016). Knitting was an act of meaning that would empower Kate to rehabilitate her brain, body, and identity. ...
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Kate Davies, a knitwear designer and author based in Scotland, provided the cover art for the Winter 2022 edition of the Open Journal of Occupational Therapy. “Balance for Better” is a blanket made from wool and mohair. The blanket consists of 30 individual squares designed and knitted by KDD & Co. employees. The colors and pattern of each square reflect the work, achievements, and legacy of the inspirational women celebrated in the blanket. At age 36, Kate suffered a near-fatal stroke that left her paralyzed on the left side of her body. Forced to give up her career as an academic lecturer, she used the meaningful occupation of knitting to create a new path. Through knitting, Kate redesigned her life.
... This practice is supported by studies that show that handicrafts can stimulate the neurological system and improve health and well-being, and help to alleviate anxiety, depression and even chronic pain (Gutman and Schindler, 2007;Kelly, Cudney, & Weinert, 2012). Related to this, another recurring response to positive aspects of school was what is categorized as 'drawing frequently'. ...
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... Craft activities have been shown to help promote the use of right and left brain functioning, to relax and reward the brain, and to help maintain cognitive functioning. For example, crafts or games that require problem solving often stimulate left hemispheric structures (Gutman & Schindler, 2007). Stroke survivors receiving art interventions improved their spatial processing, attention, planning, and sequencing; increased the use of their affected arm; and increased social expression and interaction (Reynolds, 2012). ...
... Using this theoretical framework, one explanation why blacklight was a potential active ingredient in this intervention was that Mary might have become excited and attracted to perform the task under blacklight conditions. Accordingly, Mary's brain might have interpreted blacklight as an attractive contextual situation that was perceived as pleasurable (Gutman and Schindler, 2007). McKee et al.'s (2007) single subject study indicated that the Snoezelen room appeared to excite and activate three male inpatients with autism to demonstrate more prosocial behaviors. ...
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