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Cadernos Brasileiros de Terapia Ocupacional

versão On-line ISSN 2526-8910

Cad. Bras. Ter. Ocup. vol.26 no.4 São Carlos out./dez. 2018

http://dx.doi.org/10.4322/2526-8910.ctoao1773 

Original Article

Knowledge production, perspectives and theoretical-practical references in Brazilian occupational therapy: milestones and tendencies in a timeline

Sandra Maria Galheigoa 
http://orcid.org/0000-0002-3295-0188

Claudia Pellegrini Bragaa 

Mariana Aparecida Arthurb 

Catia Mari Matsuob 

aDepartamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Universidade de São Paulo - USP, São Paulo, SP, Brasil.

bUniversidade de São Paulo - USP, São Paulo, SP, Brasil.

Abstract

Throughout its history, occupational therapy in Brazil has been incorporating and modifying theoretical-methodological perspectives and theoretical-practical references in consonance with historical, social and political contexts. Academic and professional production has been an important tool for spreading new references to the profession. This article aims to present and discuss the emergence of theoretical-methodological perspectives and theoretical-practical references by the Brazilian occupational therapy, from 1956 to 2017, according to historical, social and political milestones, based on indexed national journals of the area and gray literature for the years before their creation. This is a theoretical research on the historical-epistemological foundations of occupational therapy. We mapped and analyzed the production to identify trends and regularities, and thus present a systematic proposal of incorporation of perspectives and references in the area. This study identified four main movements: (i) Constitution of the first theoretical-practical bases of occupational therapy in Brazil; (ii) Problematization of the knowledge and practices of occupational therapy, based on contributions from Collective Health and Human and Social Sciences; (iii) Constitution of the fields of knowledge and practice of occupational therapy through socio-political contextualization, theoretical-conceptual problematization and proposition of emancipatory practices; (iv) Intense theoretical-conceptual and methodological diversification in the production of occupational therapy knowledge and practices. Panoramic studies on academic and professional production are necessary for the epistemological reflection of the profession. The study identified the emergence of critical thinking in Brazilian occupational therapy at the end of the 1970s, and the continuity of practices, knowledge perspectives and references previously presented.

Keywords: Knowledge; Occupational Therapy/Trends; History

1 Introduction

Understanding occupational therapy as a profession composed of knowledge and practices (CAMPOS, 2000; MALFITANO, 2005) means exploring, knowing and debating about the tendencies and tensions that have been produced longitudinally in the professional know-how. Therefore, it is to recognize that the used perspectives, references, models, and approaches express ways of understanding and practicing occupational therapy in harmony with time, which may or may not have continuity in the historical course of the profession.

Throughout these six decades, since the creation of the first courses of occupational therapy in Brazil in 1956, theoretical and methodological references have been incorporated and replaced according to contexts and, historical, social and political changes of the country. In addition, with research and the practice projects, developed in the universities, important vectors of production of new perspectives and tendencies for the profession. The incorporation of new theoretical-methodological perspectives1 and theoretical-practical references2 also takes place in dialogue with reconfigurations within the scope of public policies, with recommendations from international organizations and with the diffusion of new technologies and trends produced in the national and/or international scenarios.

New perspectives and references can be understood as the product and expression of a process of problematizing the instituted, when certain modes of thinking and doing are discussed, in such a way as to deconstruct them as truths, opening space for new propositions. Thus, the process of problematization, which occurs in socio-historical circunstances, results in the creation of different ways of understanding the questions that arise in a given time, as well as inaugurate a set of trends of practices of the profession. In this way, the process of problematization is necessarily related to practice. Therefore, what was previously or seemed to be fixed has to be put in motion, opening the possibility of creation of new knowledge and practices.

In several historical moments of occupational therapy in Brazil, scholars have problematized about the constitution of knowledge and practices of the profession, in general (FRANCISCO, 1988; GALHEIGO, 1988, 1999, 2012; MEDEIROS, 1989, 1990, 2000, 2003; PINTO, 1990a; BARROS, 1991; SOARES, 1991; LIMA, 1997, 1999, 2003; MÂNGIA, 1998). However, there is still a shortage of occupational therapy studies in Brazil that seek to understand possible periodicities in the emergence of new perspectives, which have resulted in important incorporations, changes or ruptures of the knowledge and practices previously produced. Thus, the motivation of this study comes from the absence of studies and the assumption that a study about the emergence of problematizations in occupational therapy allows a critical reflection on the constitution of the know-how in the profession.

This article aims to show and discuss the incorporation of theoretical-methodological perspectives and theoretical-practical references by the Brazilian occupational therapy, from 1956 to 2017, in a dialogue with historical, social and political references, based on the national indexed journals of the area and gray literature.

2 Methodology

It is a theoretical research on the historical-epistemological foundations of occupational therapy through mapping and analysis of production. In the initial phase, a scoping review of indexed national journals of the area was carried out; gray literature was used for the years before their first publication. Subsequently, a theoretical analysis was carried out to identify trends and regularities in dialogue with its historical contextualization, producing a proposal of systematization of the incorporation of perspectives and references in the area.

According to Mays, Roberts and Popay (2001), the scoping review aims to map key concepts that support a particular area of ​​knowledge, as well as the main sources and types of evidence that are available. They are reviews performed in complex areas and not researched extensively in previous studies. The scoping review is different from other reviews because does not seek to answer specific research questions or assess the quality of the materials included. This type of research can revise previous phases, change search words and even questions because their main focus is on amplitude rather than depth.

Following the stages of a scoping review described by Arksey and O’Malley (2005), the research followed these steps: (i) to identify the research question; (ii) to identify the relevant studies; (iii) to select studies relevant to the issues; (iv) to organize the results into a data matrix; (v) to organize, summarize and report the results. The guiding questions of the review were: (i) which theoretical-practical references are identified in the production of occupational therapy knowledge in Brazil, from 1956 to 2017? (ii) What theoretical-methodological perspectives do they refer? (iii) What products (such as articles and theses, among others) introduce innovative concepts and theoretical-practical references, relative to what time and historical moment, and what fields of knowledge and practice of occupational therapy?

The inclusion criterion of the productions in the scoping review varied according to the period. For the survey of production in occupational therapy before 1990, gray literature authored by occupational therapists was used. It was composed of historical and reference documents whose object was occupational therapy, and which resulted in impact or reflected on the constitution of the profession: documents, books, master’s dissertations, electronic websites with historical information and complete summaries in annals of national and regional events of the category before 1990, available in personal collections. In the case of the Master’s dissertations that were later published, the books were used.

From 1990 to 2017, the two national indexed journals of occupational therapy were used, which compose most of the national production of the area: the Journal of Occupational Therapy of the University of São Paulo and the Brazilian Journal of Occupational Therapy. It was decided to manually scan the journals, to avoid discontinuities resulting from the year of indexation and for absences of fascicles identified in the databases. After reading, abstracts, articles, essays, reports of experience and debates - authored by occupational therapists with national professional affiliation - were included. Editorials, reviews on thesis and dissertations, abstracts and translations were excluded. Relevant gray literature for the area of ​​theoretical foundations of occupational therapyin the period , such as books and book chapters, was also included.

After the initial examination of the production, a matrix was organized containing the following information: title, author, year, place of professional link of the author, production details (name of periodical, event, among other reference information). Before 1990, the annals were read in full; the other materials were consulted punctually since they were known by the first author. From 1990 to 2005, the articles were read in full, seeking to identify the incorporation of concepts and new ideas, new problematization and the emergence of critical thinking in the production of Brazilian occupational therapy. Table 1 summarizes the number of productions analyzed.

Table 1 Productions analyzed by type and classification of tendencies. 

Type of production 1* 2* 3* 4* 5*
Articles 1990-2005 125 41 42 42 29 279
Title and abstract of the articles 2006-2017 596
Documents 1
Dissertations and thesis (master´s and doctorate) 5
Books 5
Completed works in event annals 27
Websites 2

Source: Own elaboration (2018). The values given by stars (*)are described in the Methodology.

The articles of this period were analyzed and categorized according to the following classification of tendency:

  • 1*. It does not introduce conceptual contributions, ideas, perspectives and/or practice experiences, innovative or significantly innovative, compared to the production by occupational therapy at the time.

  • 2*. It introduces some conceptual contributions, ideas, perspectives and/or practice experiences, innovative or significantly innovative, compared to the production by occupational therapy at the time.

  • 3*. It introduces conceptual contributions, ideas, perspectives and/or care practices, innovative and relevant to themes of the time, although with few explicit references to occupational therapy and/or little translation of knowledge for professional practice and/or associated with theoretical-practical perspectives developed previously.

  • 4*. It introduces some critical contribution, such as concepts, ideas, perspectives and/or practice experiences referring to themes and issues considered significant for the time, with expressive references to occupational therapy.

  • 5*. It introduces relevant critical contributions, such as concepts, ideas, perspectives and/or practice experiences related to themes and issues considered significant for the time, with expressive references to occupational therapy.

For the production from 2006 to 2017, titles and abstracts were read to identify unpublished conceptual contributions, ideas, perspectives and/or practice experiences, and to highlight them in a panoramic way in this article, based on the historical, social and political references. It was verified that the period demanded a specific analysis methodology to cover the volume, the complexity and the peculiarity of the productions, mostly result of researches. Although new and important references have been incorporated, a significant number of productions make little or sometimes no explicit mention of occupational therapy or the implications for professional practice, making it unfeasible to use the classification used for previous years, since the preliminary analysis indicated that most would be rated as three stars.

After the scoping review, the research sought to answer four questions based on a reflexive and contextualized approach: (i) what regularities, consonances, and tendencies can be deduced from the introduction of new theoretical-practical references and theoretical-methodological perspectives in the process of knowledge production in occupational therapy in Brazil? (ii) what historical, social and political references are related to this process? (iii)What historical references and other factors of the profession in Brazil are related to this process? (iv) what new problematization can be identified in the process of knowledge production in occupational therapy in Brazil, based on observed regularities, consonances, and tendencies?

Productions that stood out by relevance, novelty or order of appearance were chosen as references in the text, meeting the objectives of the article and considering the limits of indicating a high number of them.

3 Results and Discussion

The first level of analysis of the research enabled to identify and understand the existence of regularities in the introduction of new theoretical-practical references and theoretical-methodological perspectives in the production of knowledge in occupational therapy in Brazil, considering the national historical, social and political milestones, leading to the organization of these regularities in four movements.

The idea of movement comes from a double understanding. On the one hand, although there are consonances and synchronicities in what has been produced in certain conjunctures, the expressed ideas and practices have sometimes arisen in a non-articulated and heterogeneous way. On the other hand, the idea of movement also is the understanding that the problematization produced generated displacements in the conceptions and practices in force in the previous period.

Thus, the new references and perspectives incorporated in each period do not have a single source nor they are guided by a single school of thought; yet, the theoretical and practical references of the profession, identified in the studied production, related to a greater or lesser degree to more than one theoretical-methodological perspective. This means that it does not proceed to a one-to-one correspondence between the theoretical and practical references and the theoretical-methodological perspectives in the production of the area. In the four movements, it was possible to point out moments of incorporation of different perspectives from the introduction of new references in production, which did not mean the abandonment of a set of knowledge related to previously introduced perspectives. In a way, multiple knowledge and modes of thinking, correlated to different perspectives, characterize the production of occupational therapy; what happens is that productions express certain perspectives to a greater or lesser degree.

The first phase of the study identified four different movements in the analyzed production of Brazilian occupational therapy (Table 2); they were classified and dated from the empirical analysis of the production, with no a priori time reference, except the beginning in 1956.

Table 2 Name of movements by year of occurrence. 

Movements Start Name of the movement
1st 1956 Constitution of the first theoretical-practical bases of occupational therapy in Brazil
2nd Ends of 1970s Problematization of the knowledge and practices of occupational therapy, based on contributions from Collective Health and Human and Social Sciences
3rd 1997 Constitution of the fields of knowledge and practice of occupational therapy through socio-political contextualization, theoretical-conceptual problematization and proposition of emancipatory practices
4th 2006 Intense theoretical-conceptual and methodological diversification in the production of occupational therapy knowledge and practices

Source: Own elaboration (2018).

3.1 Brasil First movement: constitution of the first theoretical-practical bases of occupational therapy in Brazil

The first movement - in the context of the constitution of the knowledge and practices of occupational therapy in Brazil - began from the very creation and implementation of the first courses of occupational therapy at the School of Rehabilitation of Rio de Janeiro in 1956 and at the Institute of Orthopedics of the Hospital of Clinics of the University of São Paulo, in 1957 (SOARES, 1991). Although Nise da Silveira had already produced an occupational therapy practice since the mid-1940s in Rio de Janeiro and had offered a mental health training course since 1948 (SOARES, 1991), her contributions were left out of the institutionalization of the profession in the country in that first moment. The author’s academic production, related to occupational therapy, occurred later (SILVEIRA, 1966, 1979) through a historical retrospective of the previous 20 years of her work developed in Engenho de Dentro.

The training of occupational therapists that came into force in Brazil had an Anglo-Saxon origin, being implemented through the international diffusion of the rehabilitation professions in the context of the post-war capitalist world. Since the 1940s, the actions of the International Rehabilitation Movement have resulted in the conquest of a series of protectionist laws for the so-called physical or mental disabled and in the implementation of special programs in social security and hospital services (SOARES, 1991). Together, in addition to the efforts of the World Federation of Occupational Therapists created in 1952, there was the role of the United Nations and its agencies (WHO, ILO, UNESCO and UNICEF), coordinating, planning and providing reinforcements for the implementation of rehabilitation projects in the continents, which resulted in the creation of the National Institute of Rehabilitation, in 1956, in São Paulo (SOARES, 1991).

The knowledge diffused in Brazil at the time of the creation of the courses was typical of a certain theoretical-epistemological moment of the profession in the North American countries, named by Kielhofner and Burke (1977) as a “reductionist paradigm.” Therefore, in the national scenario, there was an incorporation and reproduction of professional practices under the aegis of a rehabilitation view mostly technical and consonant with the hegemonic biomedical model. The learned procedures of evaluation and treatment were merely replicated from biological, kinesiological, psychological and clinical bases to guarantee the desired scientific criteria (FRANCISCO, 1988; SOARES, 1991).

The main objectives of the interventions were: (i) rehabilitation, understood as biopsychosocial adaptation (WILLARD; SPACKMAN, 1973), through the development of skills and sensorial aspects (DOMENICO, 1972; RODRIGUEZ, 1974); (ii) behavior change (MEYERHOF, 1972; TELG; MEYERHOF; BAILÃO, 1974); (iii) restoration of physical function (DOMINGOS; TAMASO; TANIGAKI, 1974); (iv) training in activities of daily living (SCHIVARTCHE; LINDENBOJM, 1972). The psychodynamic orientation of Fidler and Azima, the Bobaths’ neurodevelopmental therapy and Rood’s technique of stimulation to mention some, were also the international references incorporated to practices (FRANCISCO, 1988; SOARES, 1991). In this sense, the first theoretical and practical references of the profession were biomechanical, neurodevelopmental, perceptual-cognitive, behavioral (operant conditioning) and also psychodynamic, which points to practices aligned with the positivist perspective and also influenced by psychoanalysis.

The occupational therapy educational programs in this first moment were environments of technical training and not of scientific production; the qualification of faculty members began only in the mid-1980s. The first faculty, composed of professionals with specialized technical training, should mostly transmit practical knowledge, from their experiences developed in the services and institutions. There was a questioning about the didactic preparation of profesors, but not a concern with the training for research and production of knowledge (EMMEL; LANCMAN, 1998; REIS; LOPES, 2018).

From the mid-1960s, other influences began to shape the practice of occupational therapy. Initially, under the influence of Luis Cerqueira’s social psychiatry (CERQUEIRA, 1965) and the advent of therapeutic communities, the professionals began to use the socio-therapeutic approach, incorporating operative groups, groups with families and workshops among other approaches (ARB, 1972). This movement inaugurated the emergence of a humanist perspective into the national production of the profession. In the early 1970s, Jô Bennetton (CENTRO..., 2018), in São Paulo, and Rui Chamone Jorge (GRUPO ..., 2018) in Minas Gerais, started cycles of studies in psychodynamics whose discussions would be the core of their occupational therapy methods later develop in Brazil, called the Dynamic Occupational Therapy Method (BENETTON, 1991) and the Method of Occupational Psychotherapy, also known as the Critical-Laborative Method of Human Relationships (JORGE, 1995). Thus, the psychoanalytic perspective began to be incorporated in the national production in a different understanding of the one initially proposed by Fidler and Azima (CASTRO et al., 2004).

3.2 Second movement: problematization of the knowledge and practices of occupational therapy, based on contributions from Collective Health and Human and Social Sciences

At the end of the 1970s, the first uneasiness about professional practice appeared since:

[...] the hegemonic technical and reductionist training..., could not justify failures in rehabilitation programs, nor could it subsidize the emergence of intervention in educational and health promotion programs (SOARES, 1991, p. 11).

One of the most important historical landmarks of the period was the centrality that the university started to have in the production of knowledge and practices of occupational therapy in Brazil. With the increasing implantation of undergraduate programs in occupational therapy in universities (SOARES, 1991) and the support of university extension projects, there was an expansion of practices in other areas of intervention besides physical rehabilitation and mental health, with the proposal of actions in institutions, territories and diverse fields - social occupational therapy, practices in hospital acute care, community health (PINTO, 1979; SOARES; MARQUES, 1979; ASSOCIAÇÃO..., 1980; NASCIMENTO, 1990a; PÁDUA, 1991).

Occupational therapy was benefited, once more and essentially, from the academic debate that the university environment enabled. At that moment, new critical problematization to the biomedical and hegemonic scientific model and to the practices performed in the total institutions were elaborated and presented. Also, as its professors formally started post-graduate qualification, a process of professional reflection began to gain theoretical consistency, by incorporating knowledge from the Human and Social Sciences, from the dialogue with thinkers such as Foucault, Goffman, Freire, Basaglia and Marxist authors. New displacements began to be produced in the way of thinking about occupational therapy, calling into question the technicist way that guided the profession. This fact provided professors with the necessary inputs for the development of historical and epistemological research on occupational therapy, begun in the early years of 1980 (MERHY, 1979; FRANCISCO, 1988; GALHEIGO, 1988; MEDEIROS, 1989, 1990; PINTO, 1990a; BARROS, 1991; SOARES, 1991).

In this context, Francisco (1988) and Pinto (1990a) performed an epistemological reading of occupational therapy from a materialist-historical perspective, discussing professional practice and showing the limits of interventions based on positivist or humanist perspectives. These works, published in the late 1980s to the 1990s, were important critical formulations, although projections about the use of the materialist-historical model of occupational therapy would be superseded by subsequent historical processes.

Also in the national scenario and in the context of redemocratization, it was crucially important that the resistance movements, which in different sectors and in dialogue with the aforementioned critics, produced ideas and debates to the production of social transformation. The beginnings of collective health, the constitution of the Sanitary Reform movement and the incorporation of the recommendations of the Alma-Ata Declaration were gradually influencing the understanding and constitution of the role of the occupational therapist as a professional involved in the health of persons and collectives in general. On one side, the Psychiatric Reform and the debate on the deinstitutionalization of Basaglian inspiration, and, on the other, the participation in the movements for the rights of people with disabilities, the defense of the rights of institutionalized children, young people and elderly people have led to a growing social and political engagement of occupational therapists in societal issues towards a commitment to the assisted populational groups (BARROS, 1990; LOPES, 1999; GALHEIGO, 2003a).

In a feedback between the developed practices and the production of knowledge constructed from a critical dialogue with the field of human and social sciences, occupational therapists gradually adopted and incorporated a critical-reflexive view into theory and practice. In the scope of knowledge production in Brazilian occupational therapy, these new reflections also began to be published by the newly created occupational therapy journals in the 1990s. Productions began to affirm the necessity and urgency of problematization and transformation of the reasoning and practices developed in certain services, with criticisms being directed at the violence of the total institutions. Thus, the paradigms and repressive devices in these institutions were problematized, and the reproduction of a disciplinary control reasoning in professional practice was questioned (BARROS, 1990, 1991; MÂNGIA; OLIVER; MARCONDES, 1990).

Also, the social mandate, the professional role and the practices developed by the occupational therapist, as a reproducer of the status quo in the fields of professional education, knowledge production and practice were discussed (BARROS, 1991; LOPES, 1993). From their practice experiences, occupational therapists began to critically positioning themselves against rationalist, biomedical and normalizing views. They started to producing discussions about the needs of the populational groups assisted by occupational therapy by means of epidemiological data and critical reflections on their life conditions (LANCMAN, 1990; PINTO, 1990b; BRUNELLO, 1991; FRANCISCO, 1991; OLIVER, 1991; ROCHA, 1991). In this context, the criticism developed by Nascimento (1990b) on the supposed therapeutic properties of the activities and on the centrality of the therapist-patient-activity tripod was emblematic for the argument in favor of moving occupational therapist practice from closed institutions and from daily life activities in closed settings to the world of life and everyday life, which take place in the real territories of existence.

This movement resulted in the production of new knowledge and problematization about the practices that would represent a vanguard for the existing proposals, in a growing process of awareness by the occupational therapists that they could do more and make different (CASTRO; SILVA, 1990; OLIVER, 1990, 1991; SILVA, 1990; CASTRO, 1992). In this line, criticisms on the norms and parameters instituted for the status of disability, madness, tutelage, social exclusion and subjection of the body were complexified, with the understanding that practical knowledge should be the guiding principle for action (BARROS, 1990, 1991; FERRIGNO, 1990, 1991; OLIVER, 1991; ROCHA, 1991). During the period, questions about the status of occupational therapy - as practice, science or technology - in journals of the area, and other publications, also continued to occur (MEDEIROS, 1990; TASSARA, 1993).

It is possible to affirm that in this second movement, the incorporation of critical thinking in Brazilian occupational therapy began, inaugurating a process of decolonization of its knowledge and practices by moving from the dominant technical and procedural roles to a social positioning based on a technical-political commitment to social transformation.

3.3 Third movement: constitution of the fields of knowledge and practice of occupational therapy through socio-political contextualization, theoretical-conceptual problematization, and proposition of emancipatory practices

The third movement identified by the research is related to the construction and consolidation of the fields of research, knowledge, and practices of occupational therapy in Brazil, towards the proposition of emancipatory practices, which appears in the scope of production from 1997, with similar productions until 2005.

As pointed out, the construction of knowledge and practices in Brazil occurred in dialogue with the increasing insertion of occupational therapists in public equipment and services implemented in the various sectors (health, social assistance, education, culture, and work). The historical reference that definitively influenced this process was the implementation of new post-constitutional social policies in the 1990s: Organic Health Law, Organic Law of Social Assistance, Law of the Guidelines and Bases of Education, Child and Adolescent Statute, among others (GALHEIGO, 1999, 2003a).

In the context of re-democratization and the struggle for citizenship, the restructuring of social policies and the construction /implementation of new sectorial policies, equipment and services in the 1990s, the concerns towards the development of an emancipatory practice for occupational therapy changed: from the previous movement of theoretical criticism into a more propositional mode regarding daily professional practice. Thus, the discussion of philosophical models became obsolete, giving rise to the construction of “fields of legitimacy” (MÂNGIA, 1998, p. 8). These were organized by means of identifying the needs of the different populational groups, developing interdisciplinary action strategies in the light of the sector’s policies (GALHEIGO, 1999).

Some studied productions argued that this movement would lead to the constitution of “multiple occupational therapies” (MÂNGIA, 1998, p. 11), given the pluralism and diversity being created in professional practices. The argument made at the time was to think “occupational therapy as a space of discursive and practical multiplicities, which comprises a diversity of fields of action” (LIMA, 1999, p. 45). Also, that this change would only be possible through a complex understanding of the different contemporary problems, that is, through a complex (LIMA, 1999) and plural (GALHEIGO, 1999) thought that was nourished by polyocular and multi-referential views. Thus, the discussion about the identity of occupational therapy gained another perspective, understood in its plurality and complexity as an “identity made of differences” (LIMA, 1999, p. 45).

This was the moment of the profession in Brazil, where each field began to be produced as a field of knowledge and practice, comprising macrostructural, historical and conceptual bases, political-operational plans and a set of actions related to the social and health needs of individuals and groups. A process marked by a search for the elaboration of an interdisciplinary and critical know-how (GALHEIGO, 1999). In this period, the productions related to the fields of occupational therapy with the people with disabilities, occupational therapy in mental health, social occupational therapy, occupational therapy in worker´s health, occupational therapy with the elderly, among others are significant. Citizenship was affirmed as the guiding axis of new practices in occupational therapy, seeking to produce access and guarantee of rights for the persons and groups traditionally attended by the profession (MEDEIROS, 1996, 1997; GALHEIGO, 1997, 2003a; ALMEIDA, 1997; BARROS; GHIRARDI; LOPES, 2002; OLIVER; NICÁCIO, 1999; LOPES; LEÃO, 2002; LIMA, 2003; BARROS, 2004). Thus, the ethical-political commitment towards the transformation of the people’s concrete conditions of existence became the framework for proposing innovative modes of action and emancipatory practices in Brazilian occupational therapy (GALHEIGO, 2011).

Although the productions in this movement were addressed to different populational groups and fields of knowledge and practice, four common ideas and some key concepts appeared as central to the construction of critical and emancipatory practices that, interconnected and feeding one another, can be identified: (i) the construction of practices from, to and with the local and territorial context; (ii) the construction of practices from, to and with the world of everyday life; (iii) the construction of practices from, to and with the subjective and collective experience; (iv) the construction of practices based on the recognition of power relationships as inherent in social exchanges, in a dialectical process of affirmation, resistance and transformation.

The first idea, identified in national productions about mental health practices, community-based rehabilitation and social occupational therapy developed in community and territorial contexts, showed the importance of contextualizing people’s histories, needs, relationships and experiences for the development of innovative practices, recognizing the diversity of persons and groups in their communities and cultures, the dynamics of power and the scenarios where life happens - home, friends, work, among others (OLIVER; NICÁCIO, 1999; MANGIA, 2000; OLIVER et al., 1999, 2001; LOPES et al., 2001; LOPES; BORBA; REIS, 2003; BARROS, 2004). These productions were significant for providing bases for a critical occupational therapy by understanding that transformative and emancipatory practices should necessarily be developed from, to and with the local and territorial context. Practices that enabled the creation of free territories of being and belonging; territories, socio-historically and culturally built, that transcended geography and helped observing and creating “ways of existing, dreaming, living, working and making all possible social exchanges” (OLIVER et al., 1999, p. 5).

The second identified idea showed that emancipatory practices should be constructed from, to and with the world of life, regarding activities and everyday life of people. From the critique of the conception of therapeutic activity (NASCIMENTO, 1990a) and the discussions on praxis and everyday life from the perspective of the materialist-historical model of occupational therapy (FRANCISCO, 1988), this idea started to incorporate the production about the practice of occupational therapy in the different fields in such a way that, from the volume of them, it would be partial to highlight some productions than others. There happened an important shift in the conception of activity: from viewing it as a therapeutic instrument and mechanistic resource of healing according to a scientific standpoint to understanding activity as an element of culture, polysemous and complex, based on a sociopolitical and affective dimension of the human condition. A shift to the world of life that affirmed the need for occupational therapists to be concerned with the concrete conditions of existence of persons and groups because:

The construction of the quality of everyday life is the concrete construction of reality [...]. Everyday life is seen as the background, the reference line that can guide us (CASTRO; LIMA; BRUNELLO, 2001, p. 48).

Thus, the productions of the period produced arguments to make the idea of everyday life be understood at the confluence of subjectivity, everyday life, history and society, that is, as the real core of praxis, which enables repetition but also transformation (ALMEIDA, 1997; CASTRO; LIMA; BRUNELLO, 2001; GALHEIGO, 2003b).

From this perspective, the production of life became the focus of emancipatory practices in their different manifestations and in dialogue with the challenges faced by those with whom occupational therapists worked. Thus, the studied productions advocated for their modes of expression and actions be recognized and valued from, to and with the world of everyday life. A concept that encompassed scenarios and doings related to: self-care, activities of daily life, play, leisure; art, work, opportunities for coexistence & sociability, collective organization, social participation, among others (ALMEIDA, 1996; MEDEIROS, 1996, 1997; KINKER, 1997; OLIVER; NICÁCIO, 1999; TISSI, 1999; CASTRO, 2000; MANGIA, 2000; LOPES et al., 2001; LOPES; LEÃO, 2002; OLIVER et al., 2001, 2002; BARROS, 2004; NICÁCIO; MANGIA; GHIRARDI, 2005).

The third idea found in the productions was to think of the construction of emancipatory practices from, to and with the subjective and collective experience. This perspective came from attributing importance to the experience of users of services and projects, not as objects of interventions but from the standpoint of their own stories. Thus, authors began to defend the need to know and understand the uniqueness and complexity of their living conditions, through listening and validating their knowledge, affections, resources, and potentialities. In this way, it was highlighted the importance of searching and building horizontal relationships, which recognized and valued the different knowledge of service users. In this perspective, occupational therapists had their professional knowledge, but people held the knowledge of the experience based on their singular life conditions. An understanding that the experiences of disability, suffering, illness, vulnerability, poverty or exclusion should be considered; also, the experiences brought about their affective & social exchanges, and their modes of expression, resistance and affirmation. In this way, life histories, narratives and biographies - elements recognized for enabling the understanding of subjective views and intersubjective relationships within groups - began to be incorporated in research and for the development of emancipatory practices in occupational therapy, as a starting point to getting into relation with someone understood as a protagonist of his/her own process (BRUNELLO, 1997; MEDEIROS, 1997; BARROS; GHIRARDI; LOPES, 1999; MANGIA, 2000; OLIVER et al., 2001; LOPES; BORBA; REIS, 2003; BARROS, 2004).

The fourth common idea found in the texts was that emancipatory practices in occupational therapy should consider and be positioned for the dynamics of power inherent in personal, institutional and social relationships in a dialectical process of affirmation, resistance, and transformation. Thus, keeping professional practice and academic knowledge under scrutiny, the debate emphasized the importance of a critical understanding of the role of the state and institutions, and of the capillarity and inequality of power relationships between practitioners and service users. Thus, the argument was that professionals should reflect critically on the power granted to them by institutions and systems and consider whether they were merely reproducing the same mechanisms of power so much criticized by them. In this perspective, occupational therapy practices to become emancipatory should be committed to broadening the contractual power of individuals, groups, and communities, and to make a stand against oppression and violence (MANGIA, 2000; OLIVER et al., 2001; GALHEIGO, 2003b; BARROS, 2004).

The practices based on the four ideas above have the emancipation of persons and collectives as a horizon, covering issues such as production of autonomy and social participation; expansion and strengthening of contractual power and social support networks; favoring creativity, play, and coexistence; recognizing personal and collective needs, desires, dreams and projects. Moreover, these practices were very interdisciplinary, the reason why it would be difficult to present a list of theoretical-methodological perspectives and theoretical-practical references; rather using the broad denomination of critical perspectives. Finally, the studies that introduced this critical view pointed out interdisciplinarity as an important resource to deal with the complexity and dimension of the issues addressed by them.

3.4 Fourth movement: intense theoretical-conceptual and methodological diversification in the production of occupational therapy knowledge and practices

Since the mid-2000s, there has been a progressive increase in academic production (LOPES et al., 2016), most of them related to research. Both the extent and the peculiarity of the material to be analyzed in the process of this research revealed the necessity of a specific study of the period, as previously explained. Therefore, with the intention of completing the historical frame presented in the article, a panoramic view on this fourth movement is shown, pointing out new theoretical-methodological references and historical-social references. The final full analysis of this movement will be presented in its own article.

The fourth movement identified takes place in contemporary time, which may hinder the analysis and interpretation of the findings given the temporal proximity. The study of production indicated that after 2006, intense theoretical-conceptual and methodological diversification began to appear in the production of occupational therapy knowledge and practices produced in Brazil. A dynamic process that encompasses their consolidation and diversification was also identified, by means of a growing incorporation of a varied set of national and international perspectives, models and practices.

The first point of emphasis is the change in the production profile: the publication of articles of empirical research becomes greater than those of theoretical research and articles of reflection, essays, and reports of experience. After 2006, there has been an increase in the research published in the periodicals resulting from scientific initiation, master’s, doctorate, postdoctoral and projects financed by the research agencies. It has also been identified a growing production, which is the result of international cooperation. The texts of a more didactic nature began to be published in books, mostly collections, whether on general occupational therapy or pertinent to a given field.

This change was developed in the process of research development done by government research agencies and higher education institutions, which fostered the creation of research groups with established lines of investigation since the 1990s. In July 2018, a consultation to the Directory of Research Groups in Brazil of the National Council for Scientific and Technological Development (CNPq) shows the significant research growth in occupational therapy, noting that, 30 (57.7%) of the 52 groups coordinated by occupational therapists were created between 2010 and 2018. This data contrasts significantly with the results of a study conducted by Barros e Oliver (2003), which at the time of the study had identified 16 groups coordinated by occupational therapists, based on the analysis of the 2000 Census of the aforementioned Directory. This data shows the expansion, also considering the 26 groups identified in a study by Lopes et al. (2010).

The theoretical-conceptual and methodological diversification, as well as the change in the production profile were also influenced by important landmarks in professional education, including: (i) the publication of the National Curricular Guidelines in 2002; (ii) the creation of postgraduate programs in Rehabilitation Sciences (Federal University of Minas Gerais and University of São Paulo) and in occupational therapy (Federal University of São Carlos); (iii) the participation of occupational therapists professors as post-graduate supervisors in other knowledge fields; (iv) the creation of the National Network of Teaching and Research in Occupational Therapy (RENETO) and; (v) the substantial increase of occupational therapy undergraduate programs in public universities (LOPES et al., 2016). Also, the productivist pressures done by research agencies, universities and by the system of graduate evaluation in the last decade, with a large international influence, seem to have contributed to the change in the profile of production in occupational therapy in Brazil.

Within the context of practice policymaking, the volume of changes, propositions, recommendations, initiatives, and perspectives also seems to have influenced the diversification of the theoretical and conceptual bases used by occupational therapists, considering the variety of practices identified in the production. Also, the articulation with international conventions, recommendations and classifications are shown, such as those related to human rights, such as the Convention on the Rights of People with Disabilities, adopted in 2006 and endorsed by Brazil in 2008 (BRASIL, 2011a), such as the International Classification of Functioning, Disability and Health (ICF) promulgated in 2001 (ORGANIZAÇÃO..., 2003).

In addition, the analysis of titles and abstracts indicated productions whose object of study was the implementation of new policies. This points to the expansion and consolidation of social policies in Brazil in the period, in the various areas such as health, education, social work, culture, work and human rights. Thus, they dialogue with the change of scenery resulting from the enactment of laws, ordinances, and regulations, as well as policies and statutes, programs, plans and strategies in different sectors and with a focus on different populations. In the area of health, productions were identified on practices in primary health units, psychosocial care centers, reference centers for workers’ health, outpatient clinics and hospitals, as well as on health care networks and the implementation of strategies: Family Health Strategy and Deinstitutionalization Strategies.

In the scope of professional training, studies focused on occupational therapy education and on professional and interprofessional training were identified as a result of the induction policies of the Ministry of Health (Pró-Saúde, PET-Saúde, Multiprofessional Health Residence). Productions have also been found regarding the participation of occupational therapists in cultural projects and social assistance services. This initiative is based on the inclusion of occupational therapists among the higher professional categories that are members of the reference teams and management of SUAS (BRASIL, 2011b).

Going further, it is possible to identify in the production, a reincorporation of international occupational therapy theoretical-methodological perspectives, theoretical-practical references and models, such as the Structure of Occupational Therapy Practice: domain and process, produced by the American Association of Occupational Therapists (AOTA), Evidence-Based Practices, the Canadian Model of Occupational Therapy, the Model of Human Occupation, with emphasis on occupational roles, and Occupational Science.

Therefore, the preliminary analysis of titles and abstracts showed the presence in contemporary Brazilian occupational therapy of plural practices with different populations in different contexts, including domiciliary, community, territorial, institutional and private services, equipment, and projects. For the moment, it can be said that in the fourth movement, diverse perspectives coexist, such as developmental, sociohistorical, constructivist, psychodynamic and behavioral, and terms derived from Collective Health, humanities, psychoanalysis, and so many other fields of knowledge. The studies revealed practices that dialogue with Deleuze’s Philosophy of Difference, with the perspective of the deinstitutionalization of Basaglia and Rotelli, with the Complexity of Morin, with the Pedagogy of Autonomy of Paulo Freire, and with feminist, gender and theory queer studies. There are also practices supported by ICF and AOTA terminology, others based on Evidence-Based Occupational Therapy, on international Occupational Therapy models, and Occupational Science.

Concluding, in this fourth period that takes place nowadays, there has been a substantive complexification of the production of occupational therapy in the country and in the use of theoretical and methodological references, without a clear and collective debate. Therefore, further research on historical-epistemological foundations of occupational therapy is needed to study the contemporary multiplicity of references in the profession.

4 Final Considerations

Studying the production of occupational therapy allowed mapping how theoretical-methodological references were incorporated into national production, marking the construction of new knowledge and practices correlated to historical, political and social references. The emergence of critical thinking in Brazilian occupational therapy, at the end of the 1970s, is emphasized initially, through criticism of hegemonic practices, and later, through propositions of emancipatory practices. It is worth mentioning again that the study of production revealed a continuity of practices, knowledge, perspectives, and references, which reproduced or renewed previous tendencies.

Panoramic studies on scientific, academic and professional production may be relevant to introduce undergraduate and postgraduate students into the epistemological reflections of the profession. They can be a starting point for the development of research on the epistemological foundations of occupational therapy. Also, it is urgent that Brazilian occupational therapy can affirm the origin and movements of its critical production and practice, an assertion that is understood by us as a decolonizing tendency.

Also, it should be noted that studies on academic and professional publications do not reveal the know-how produced in daily professional practice, which can express in diverse ways both the reproduction of hegemonic practices and also the production of new emancipatory ones. Therefore, in the studies on knowledge production, the results reveal aspects but, at the same time, can mask facets of reality. Another limit of the study is the fact that the studied production is mostly from the Southeastern region of the country and written by professors and researchers of some occupational therapy programs.

Finally, the authors of this article will continue to analyze further the contemporary production, which has proved challenging, by showing that we speak different languages and produce different occupational therapies in Brazil, in an unprecedented dimension. This diversity can mean both our strength and our fragility. Diverse perspectives and conceptions of human being, society, and worldviews coexist, either with significant or weak coherence and substance regarding conceptual & methodological frames. There is a risk of an insufficient judgement on the foundations used that may end up producing a disordered mixture of concepts, theoretical contributions, and practices. Studies of this order are essential since the theoretical-practical diversification is one of the important challenges that arise in the debate on foundations of occupational therapy in contemporary Brazil.

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Funding Source The research was supported at the Scientific Initiation level of the Unified Scholarship Program - USP.

Notes

1 It is used here “theoretical-methodological perspective” for the set of knowledge related to certain currents of thought that express a vision of human being and society.

2 Theoretical-practical reference is used here for the knowledge produced by authors within certain theoretical-methodological perspectives and for practices developed according to approaches, methods, and techniques applied to certain conditions of life or health.

Received: June 20, 2018; Revised: September 11, 2018; Accepted: October 23, 2018

Corresponding author: Sandra Maria Galheigo, Centro de Docência e Pesquisa, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânea, 51, Cidade Universitária, CEP 05360-160, São Paulo, SP, Brasil, e-mail: sandramg@usp.br

Authors´ Contributions

Sandra Maria Galheigo and Claudia Pellegrini Braga outlined and carried out the research, working in all its stages. Mariana Aparecida Arthur and Catia Mari Matsuo supported the collection, organization and analysis of productions. The first two authors wrote the text of the article working directly in its final version. All authors approved the final version of the text.

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