Dimensões da Teoria da Natureza Ocupacional na literatura do campo da reabilitação física infantil em Terapia Ocupacional: um estudo sobre o fazer, ser, tornar-se e pertencer de crianças.

Abstract

Child physical rehabilitation has undergone significant transformations, reflecting conceptual shifts from the normalization of bodily functions toward the promotion of participation, engagement, and meaning in everyday occupations. Within this context, the Theory of Occupational Nature, developed by Ann A. Wilcock, although widely discussed in studies involving adults, still lacks investigations applied to childhood. This doctoral thesis aimed to identify and analyze the presence of elements of occupational dimensions in occupational therapy practices within pediatric physical rehabilitation, as described in recent scientific literature. The research was structured into two complementary studies. Study I consisted of an integrative literature review conducted in PubMed, Scopus, SciELO, and BVS, using the PICo mnemonic and following PRISMA 2020 guidelines. Articles published between 2022 and 2026, in Portuguese or English, open access, and describing occupational therapy practices with children aged 0 to 12 years with physical disabilities were included. The search resulted in 18 studies, analyzed regarding methodological characteristics, populations served, interventions, and contexts. Findings revealed a predominance of multidisciplinary interventions, extensive use of assistive technologies, family-centered approaches, incorporation of natural environments, and a strong focus on occupational participation and performance. Study II involved an in-depth analysis of 15 articles selected from a second literature review on pediatric rehabilitation, derived from Study I, aiming to identify evidence of the four dimensions of the theory—doing, being, becoming, and belonging—within the described practices. The interpretative analysis, grounded in Wilcock’s original definitions and in studies that operationalize these dimensions, demonstrated that these principles are consistently present, even when not explicitly named. The occupational therapy practices described in the articles highlighted doing as meaningful and transformative action; being as identity construction and self-efficacy; becoming as a process of development and change; and belonging as social, community, and family participation. The thesis concludes that the principles of the Theory of Occupational Nature permeate contemporary occupational therapy practices in pediatric physical rehabilitation, even when not explicitly adopted as a theoretical framework. The theory offers a powerful lens for understanding the child as a full occupational being, whose experiences of doing, being, becoming, and belonging support health, development, and participation. The thesis reinforces the need to expand empirical research that directly observes clinical practice, as well as studies exploring professional training and the explicit incorporation of the theory in childhood-focused contexts.