Occupational Therapy (OT)
(See also Overview of Rehabilitation.)
Occupational therapy is intended to enhance a person's ability to do basic self-care activities, useful work, and leisure activities. These activities include basic daily activities (such as eating, dressing, bathing, grooming, going to the toilet, and transferring—for example, from a chair to the toilet or bed) and more complex daily activities (such as preparing meals, using a telephone or computer, managing finances or the daily drug regimen, shopping, and driving).
This therapy focuses on the coordination of many abilities required for even simple activities:
These abilities can be impaired in many ways.
What Can Interfere With Doing a Simple Activity?
Occupational therapists may detect impairments by observing the person, by doing specific tests (such as balance tests), and by talking with other health care practitioners, family members, or caregivers.
Therapists assess needs by observing the person doing an activity in a natural environment. They try to identify potential problems with the social and physical environment. They evaluate the home for hazards, which may interfere with the person's ability to do an activity. They may then recommend ways to make the home safer. For example, they may recommend using brighter lighting, removing electrical cords that cross areas where people walk, or securing cords to the floor. Therapists also evaluate the support family members and other people are willing to provide.
Specially trained therapists may evaluate the person's ability to drive to determine whether driver retraining is needed (see The Older Driver).
People with impairments work with the occupational therapist to determine and prioritize goals and to select appropriate techniques and activities. For example, if people have difficulty eating with utensils, therapy may include activities that develop fine motor skills, such as inserting pegs on a peg board. A memory game may improve recognition and recall. Adaptive techniques can help people use their strengths to compensate for impairments. For example, a person with a paralyzed arm can learn new ways to dress, tie shoes, and fasten buttons. Activities are made more challenging as people improve.
Occupational therapists recommend devices that can help people function more independently (assistive devices). Therapists train people to use devices and may construct and fit certain devices. These devices include the following.
Devices That Help People Function
Orthoses are devices that support damaged joints, ligaments, tendons, muscles, and bones. Most are custom-made based on the person's needs and anatomy. Orthoses are commonly used in shoes, where they shift the person's weight to different parts of the foot to compensate for lost function, to prevent a problem from developing, to help bear weight, or to relieve pain, as well as provide support. Therapists may construct as well as fit orthoses. Orthoses are often very expensive and not covered by insurance.
Splints can be used to prevent joints from freezing in a flexed position. When people do not move a limb normally (for example, when they have arthritis or are paralyzed because of a stroke), the limb tends to flex slightly and freeze in that position. Splints that hold the limb straight can help prevent the joint from freezing.
Walking aids include walkers, crutches, and canes. They help people support their weight, balance, or both. Each device has advantages and disadvantages, and each is available in many models. Occupational therapists can help people choose the aid that is best for them.
Wheelchairs enable people who cannot walk to get around. Some self-propelled models are very stable. These models enable people to travel over uneven ground and up and down curbs. Other models are designed to be pushed by an assistant. These models are less stable and slower.
Mobility scooters are battery-powered, wheeled carts with a steering wheel or tiller. These models have a speed control and go backward and forward. They are used on firm, level surfaces inside and outside buildings, but they cannot be used on stairs or curbs. Scooters are useful for people who can stand and walk only short distances—for example, to and from the scooter.
Prostheses are artificial body parts, usually limbs (see Limb Amputation). For example, if an arm has been amputated, therapists may recommend an artificial arm that includes a pincer needed to hold a utensil. Most occupational therapists can train people who have had a limb amputated to use their artificial limb or other devices to help them with daily activities.