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Occupational Therapy (OT)

by Alex Moroz, MD, FACP

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:

  • The ability to feel and move

  • The ability to create and execute a plan

  • The ability to want to do the activity and to persevere until it is completed

These abilities can be impaired in many ways.

What Can Interfere With Doing a Simple Activity?

Ability Needed

Type of Ability

Possible Impairments

To feel and move

Sensorimotor

Impaired sensation and perception

Restricted range of motion

Weak muscles

Short endurance

Poor balance

Loss of dexterity and coordination

To create and execute a plan

Cognitive

Difficulty paying attention

Distractibility

Loss of concentration

Impaired judgment

Indecision

Memory problems

Poor problem-solving skills

To want to do the activity and to persevere until it is completed

Psychologic

Apathy

Depression

Anxiety

Perceived incompetence

Frustration

Lack of persistence

Decreased coping skills

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).

Did You Know...

  • Occupational therapists focus on helping people do specific daily activities that have become difficult to do because of a disorder or injury.

  • Many specialized devices, such as grabbers and large-handled utensils and tools, are available to help people function.

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.

Assistive devices

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

Problem

Device

Poor balance, weak legs, or dizziness

Canes, walkers, or wheelchairs

Shower chairs

Grab bars on the side and back of the bathtub or toilet

Bathtub benches

Weak grip

Built-up handles on eating utensils or shoehorns

Limited reach or movement

Grabbers that can pick items off the floor or from a shelf

Tremors

Weighted eating utensils

Cups with lids

Swivel spoons

Coordination problems

Plates with rims and a textured rubber bottom to grip surfaces and prevent the plates sliding

Hand problems

Tools with built-up handles or with spring-loaded or electronic controls

Difficulty standing up because of back problems or weak legs

Raised toilet seats

Seat-lifting chairs

Chair leg extenders (to make the seat higher)

Paralysis (including quadriplegia) and other disorders that severely limit function

Computer-assisted devices

Impaired vision

Larger dials on telephones

Large-print or audio books

Impaired hearing

Telephones with a flashing light to replace the ring

Impaired memory

Automatic dialing telephones

Drug organizers and reminders

Pocket devices that record and play back messages (reminders, instructions, and lists) at the appropriate time

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 Prosthetics). 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 an limb amputated to use their artificial limb or other devices to help them with daily activities.

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