Reclaiming Everyday Life Through Occupational Therapy

People spend a lot of time performing everyday activities -- getting dressed, preparing a meal, going to work or even just engaging in a hobby. For most, these activities are second nature, we don’t give them a second thought. But for people recovering from an injury, managing a chronic illness or navigating physical, mental or developmental challenges, the simplest tasks can be overwhelming.

That’s where occupational therapy (OT) can make a difference.

What is Occupational Therapy

OT is specialized rehabilitation that helps individuals improve their ability to perform everyday activities and live as independently as possible.

Derived from the term “occupation” occupational therapy extends far beyond a job. It encompasses all the meaningful and purposeful activities that occupy our lives. Commonly referred to as the activities of daily living, these include:

• Self-care: bathing, dressing, eating and grooming
• Productivity: working, volunteering, managing a household and going to school
• Leisure: hobbies, social activities and recreation

Occupational therapists help individuals function to the best of their ability. They help patients by addressing the physical, cognitive and sensory barriers that hinder a patient’s independence and work on the strength and mobility needed to complete tasks.

From Battlefield to Bedside: OT’s Beginnings

The longstanding techniques of OT are rooted in World War I. During both World War I and World War II, soldiers were provided OT to help recover from their injuries and return to the battlefield. OT has since expanded to a variety of care settings, such as hospitals, schools and long–term care facilities, but remains entrenched in helping patients recovering from injury or illness.

When is OT recommended?

Most people are referred to an OT through their doctor. They’re generally referred if they are struggling to perform daily activities. Often, that’s due to injury, chronic illness, surgery or disability.

Initial assessment

The first visit with an OT involves an assessment of the patient. They ask the patient what’s at issue and identify areas where the patient needs help and desires independence. An OT will also examine the patient, checking motor skills, range of motion, physical condition, and medical history.

Patients – possibly with their loved ones – will also answer a series of questions about their lives and activities they struggle with. These include:

• Work
• Hobbies
• Family life
• Home setting
• Self-care

This information combines to provide the occupational therapist with an understanding of the patient’s baseline abilities and their life before the injury or illness.

The assessment is then used to set meaningful goals for the patient.

A glimpse into post-acute care OT

The goal of post-acute care is to help patients regain independence after injury or illness, making OT a vital part of the process. As a nationwide leader in post-acute recovery and rehabilitation, Select Medical* understands the importance of OT across its continuum of care.

Since OT is tailored to the individual and their current abilities, it can look different at each level of care.

Critical illness recovery

Upon admission to a critical illness recovery hospital, patients are assessed by an occupational therapist within the first 24 hours. A plan of care results from that assessment and safety protocols are established for how the team will care for that patient. The plan, which is shared with other disciplines in the care team, maps out the patient OT treatment sessions that will help the patient mobilize and advance. It includes safety protocols that evolve with the patient as their functional abilities grow and they become more skilled.

Typically, the focus is on self-care and mobility in preparation for a patient’s transition to the next level of care. Frequently initial OT and PT sessions are combined if a patient has the stamina to tolerate the combined session.  Sessions are combined because they address different but complementary aspects of a patient’s recovery. To ensure safety, vital signs are closely monitored during OT to make sure that patients remain stable.

Common OT goals in critical illness recovery hospitals include:

• Sitting upright on the edge of the bed 
• Supporting body weight sitting or standing
• Transferring to a chair or mobility aid
• Walking small distances with assistance
• Toileting independence
• Combing hair
• Washing face
• Brushing teeth

Once patients are ready for the next level of care, they are encouraged to build on the base of skills gained in OT. To smooth this transition, clinical liaisons will review all documentation from time spent in a critical illness recovery hospital.

Inpatient rehabilitation

In an inpatient rehabilitation hospital, care teams also evaluate patients within the first 24 hours to determine goals. Occupational therapists ask patients what did and didn’t work for them in previous OT sessions.

Patients participate in three hours of therapy, five days a week, across various therapy disciplines, a portion of which is OT. This concentrated rehab allows patients to make strides within a few days.

Inpatient rehabilitation patients are encouraged to do as much for themselves as they can, such as dressing and grooming. Patients have access to an activities of daily living suite to practice typical daily tasks like cooking, cleaning and other household activities.  Occupational therapists provide support and teach patients how to use adaptive equipment to compensate in areas where they’re still weak. This allows patients to build their confidence and independence while still working on mobility and strength for a particular task. 

A typical OT session at an inpatient rehabilitation hospital can consist of:

1. Mobilizing from bed, using a mobility aid if needed 
2. Navigating to the bathroom
3. Bathing 
4. Getting dressed
5. Grooming
6. Brushing teeth
7. Toileting

As patients progress, their goals may evolve. For many, each gain pushes them to strive for that next increasingly difficult task.  With each milestone met, patients are commonly restored with hope that they can get back to some sense of normal.

Here, patients work to establish the independence needed to return home safety and continue their recovery journey through outpatient occupational therapy.

Outpatient rehabilitation

There are a variety of ways patients can begin outpatient OT, including referral from a higher level of care or general physician. Several states also give individuals direct access to outpatient OT services without a referral.

On their first visit, patients are evaluated to establish how they can benefit from OT, PT or a mix of both. During this evaluation, a baseline skill and range of motion is established and  patients work with an occupational therapist to set goals to improve their function and independence.

Patients work on activities of daily living, and frequently go a step further to tackle more complex activities, depending on the individual this could include driving or participating in sports.

Each OT session can look vastly different based on the patient’s medical history and goals. An example of a session for someone who is working toward regaining hand function and arm strength following a stroke may include:

• Check how exercises are going at home
• Work on building strength and range of motion through using weights, therapy putty and resistance bands
• Practice fine motor skills by buttoning and zipping or using tweezers
• Work on dexterity using balls or dexterity boards
• Practice individual goals, such as handwriting or tying shoes
• Train on any adaptive equipment

Therapy gyms have a broad range of everyday objects on hand that patients may use --  treadmills, bikes, grip tools, jars and free weights. Patients may also bring items from home that tie to their goals, such as knitting needles or sports equipment.

While care plans, duration and frequency of visits are individualized, patients are usually seen two or three times a week for a minimum of four weeks. Their progress is reassessed throughout the duration of their treatment. This allows for goals adjustment and helps determine how many more sessions are needed.

Caregiver training

The goal of OT is to get the patient to their maximum amount of function, which doesn’t always mirror their prior level of function.  This is one of the reasons, caregiver training is an important part of OT.

In all levels of care, it’s recommended that family or caregivers participate in OT sessions. This allows the caregiver to witness how to help or support the patient while still allowing them to push themselves and continue working on their gains.

For those medically complex patients who are still hospitalized, caregivers may be encouraged to stay overnight with their loved one before their return home. This ensures that the caregiver is fully equipped to provide the necessary assistance.

Caregivers will also receive training on adaptive equipment that the patient may need to use.

Adaptive equipment

Adaptive equipment aids an individual to live more independently. Patients are commonly encouraged to have adaptive equipment they use during OT at their home as well.

Examples of adaptive equipment include:

• Dressing: button hooks, dressing stick, reacher grabber tool, sock aid, shoehorn
• Toileting: raised toilet seat
• Bathing: grab bars, shower chairs, long-handled sponge, adaptive hair brushes
• Feeding: universal cuff, plate guards, jar openers, knob turners, adaptive silverware

Restoring hope

In a world that often focuses on limitations, OT shines a light on possibilities; restoring hope while guiding many to reclaim their lives and find renewed purpose through meaningful activities.

Interested in learning more? Contact us or visit our patient success stories. 

*Helen M. Simpson Rehabilitation Hospital is a part of Select Medical’s nationwide post-acute care footprint.