What is it that OT's do?
Occupational Therapy is a diverse profession so it’s not unusual for people to ask what exactly an occupational therapist does. Often people guess .... “so you’re a bit like physio”. I recall once going out to fit some equipment for a lady to be discharged from a trauma bed – her mother shouted after me as I left her home “you toilet people are fantastic!!”
Occupational therapists work in services ranging from neonatal to palliative care and everything in between. We can assist people to regain abilities and adapt to new ways of living so that they continue to participate in meaningful roles and activities.
Activities are occupational therapists tools of practice. We use activity in a wide variety of ways to allow us to:
assess abilities
identify needs
develop skills
evoke change
evaluate progress
develop insight and self awareness
Occupational therapists evaluate the environment. A person’s ability to perceive, interact with and adapt to their environment influences their success in getting what they want and need to do done. When illness, injury or other cause results in reduced independence, occupational therapy can help to explore the problems and potential solutions.
In personal injury and clinical negligence cases, occupational therapists are often instructed directly by solicitors or through case managers to carry out occupational therapy assessment and rehabilitation as part of implementing The Rehabilitation Code and Serious Injury Guide.
Following a referral, the occupational therapist will visit a client in an appropriate environment.
A comprehensive assessment is carried out to establish a person’s present level of independence and participation in everyday activities. Factors which influence potential for change are considered and information relating to a person’s physical and social environment is gathered. The assessment typically includes:
facilitated discussion
observation of the person completing everyday activities, mobilising and using furniture and fittings
assessment of particular skills
measurement of the environment
liaison with significant others
The occupational therapist draws on their knowledge of occupational science, anatomy and physiology, brain and behaviour to understand physical and cognitive abilities and potential. A comprehensive and integrated problem analysis with relevant recommendations is outlined in a report.
Intervention is aimed at positively influencing how a person realises their own potential for independence. This may require the occupational therapist to educate, train, practise, explore or reinforce skills and strategies with the client. Equipment, adaptations or support may also be required.
Occupational therapists use a variety of scales, checklists and indexes to document observations and measure change. Change such as a person’s range of movement, strength or test scores can be useful. However, we also observe a client’s application of skills and abilities to carry out every day activities in order to measure and report change.
Case example A:
Mr B was referred for occupational therapy by his case manager due to difficulties continuing his college course following a neck and shoulder injury. Mr B was mobile and able to manage his own personal care needs. He lived at home with his family who looked after all his domestic needs. Following the injury attendance at college had been inconsistent and Mr B had been known to fall asleep in class and react angrily to peers on occasion.
The occupational therapist observed Mr B completing activities at home and at college. The assessment highlighted the following difficulties:
Reduced end range of motion in both shoulders reducing the efficiency of upper limb use and potentially exacerbating pain and fatigue
Pain in neck, shoulder arms and hands throughout the day and often worse at night
Inconsistent length and varied quality of sleep experienced throughout the week interrupted by pain and anxiety
Difficulties concentrating at college
Mr B was considering dropping out of college as he felt he was unable to maintain his attendance on his carpentry apprenticeship course.
The focus of occupational therapy intervention aimed to:
Improve shoulder strength and range of motion
Reduce pain
Establish a consistent sleep routine and quality of sleep
Explore how reasonable adjustments could be made at college
Review concentration concerns
The occupational therapist provided upper limb exercises and practical support regarding how to incorporate correct technique for shoulder use and posture within everyday tasks and work tasks.
The occupational therapist also linked in with the college to alter Mr B’s schedule to pace practical tasks more evenly across the week, incorporate rest breaks as required and ensure the most appropriate equipment was used for work tasks.
Mr B engaged in education relating to sleep and incorporated sleep preparation activities into his routine. This included using anxiety management and relaxation techniques, altering the time he went to bed and got up each day, and reviewing medication for pain control with his GP. Mr B also returned to swimming three times per week which supported his shoulder rehabilitation and assisted with sleep issues. Concentration did not continue to be a concern once the above intervention was completed.
Mr B managed to complete his college course and has since secured work as a carpenter within a family run firm.
Case example B:
Miss S sustained a brain injury as a child and was referred to occupational therapy for support with transitioning to more independent living as an adult. Her parents had been completing all aspects of her care. Miss S required a hoist to transfer from her powered wheelchair although her parents had been physically lifting her most of her life. A package of support had been set up to carry out specific care duties and Miss S and her family wanted to adapt their home to support her desire for independence.
The occupational therapy assessment was completed in conjunction with Miss S, her parents, her support team, and the architect and building site manager. The assessment was completed over several visits and detailed:
Miss S’s abilities and limitations, support and care needs, ability to use equipment and technology.
Recommendations regarding environmental needs, equipment, space and technology to be incorporated into the adaptation scheme
Recommendations to support Miss S taking on adult responsibilities relating to everyday activities.
The initial focus of occupational therapy was to establish an appropriate environment for Miss S to reside, which met her support needs and facilitated maximum independence both now and in the future. This involved the occupational therapist doing the following:
Linking in with suppliers for hoisting, toileting, showering and bathing equipment, and an accessible kitchen and door entry system
Regularly meeting with the architect and site manager to ensure adaptations met Miss S’s needs and were compatible with equipment required
Meeting regularly with Miss S and her family to ensure complex issues were communicated effectively and Miss S was included in making choices and decisions regarding equipment and environment
Miss S moved into her own home with interconnecting access to her parent's home. Miss S’s bungalow was set up with level access, a visual door entry system with intercom, a height adjustable bath with music and interactive lights, an adjustable shower room, an H frame hoisting system, an accessible kitchen, therapy space, environmental controls, slide-back double width internal doors and adequate turning circles for a powered wheelchair throughout.
Miss S is presently engaging in ongoing occupational therapy intervention with the following goals:
To manage a small budget specific to clothes, make up and entertainment purchases
To participate in a structured schedule of activities across the week
To use her door entry system independently
Miss S’s care providers to keep up to date with training in relation to brain injury and specialised equipment
Occupational Therapy concerns itself with the lived experienced of an individual, interacting with their world applying their own unique abilities, expectations and opportunities. Occupational therapy seeks to explore potential and maximise independence through use of activity and the environment around us. Occupational therapists work across a variety of physical and mental health settings in paediatric and adult services and have potential to reduce spending on long term health and care services.
About Hayley Green
Hayley is an Independent Occupational Therapist and has been practising since 2002. Hayley is a member of the Royal College of Occupational Therapy including its Specialist Sections in Independent Practice and Neurology. Hayley is Director of Independence Found Ltd, providing occupational therapy assessment and rehabilitation across the West Midlands and surrounding areas.
Copyright © 2018 Hayley Green, Independence Found Ltd. All rights reserved. This blog post may not be reproduced or used in any manner without the express permission of the author except for the use of a short extract with a link to the original blog post.
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