**2.4 Early occupational therapy: engagement and personal environment occupation model**

Having explained the relevance of the needs assessment, it is important to underline that taking care of patients in the acute phase is crucial because occupational therapy has the peculiarity not only to engage the person in doing activities, but also simply to make him/her participate in the activity. If it is not possible to carry out the activity in practice, the person can be engaged, giving him or her the role of coordinator of the activity, which is physically carried out by another person, who performs it according to the given instructions. The performance of occupation may provide a means to engagement; however, it is not necessary for engagement, acknowledging that an individual may engage in occupation passively [7].

This concept is defined in literature as "Engagement".

Engaging in occupations that are meaningful to the person is seen as a fundamental prerequisite for good health and well-being [7] and it is the basis of the Occupational Therapy practice [8].

The concept of occupational engagement first emerged in the work of Wilcock in 1993 [8], who described occupational engagement as something that goes beyond performing occupations in the physical sense, including engagement in the occupation on a mental and spiritual level.

The conceptual model personal environment occupation model (PEO) [9] is an excellent tool to be used at an early stage to promote the recovery of the maximum level of autonomy of the person by making the best use of his or her resources. This model explains that the rehabilitation process must necessarily start from the analysis of the characteristics of the individual, understood as a physical, emotional and psychological being ("P"). It is then necessary to analyse the significant occupations for the person (O) and finally the context in which the occupations are normally carried out (E). From the intersection of this information we obtain the "occupational performance" (**Figure 1**).

If one of these areas is reduced, the intersection with the others is also reduced, which means that the performance may no longer be possible or may not be satisfactory for the person performing it. At the reduction of the person's area (P), which occurs when a deficit and/or illness appears, the model stresses the importance of expanding the other areas (environment and occupation) to allow the person to maintain his/her occupational performance and as much as possible a satisfactory routine (graphically maintain an area of intersection between the three circles, namely performance, **Figure 2**).

In the case of the acute phase, therefore, it is essential to expand the area of the environment, which is the only area that can have a significant impact on performance, reducing disability. Expanding the area of the environment (E) can mean eliminating physical barriers, favouring accessibility, or educating and training the population to favour the reception of a person with disabilities, reducing the difficulty of social integration and promoting participation (**Figure 3**).

Expanding the area of occupations means considering whether, in order to improve performance, it may be necessary to do the activity differently, to use strategies or aids, or simply to train oneself to perform the activity more efficiently and effectively.

This model underlines the importance of addressing treatment to environments and occupations that the health care system fails to take into account very often, focusing, almost uniquely, on resolving the deficit and pathology or reducing the effects caused by it, which is important but not the only aspect to provide the person with the highest possible quality of life.
