What Exactly Is Occupational Therapy?

While watching a special on CNN last week about the future rehabilitation needs of the Boston Marathon Bombing victims, a beautiful segment was aired that showed occupational therapy at it’s finest.  This program section followed the recovery of a gentleman with a lower extremity amputation caused during an industrial accident.  His return to functional independence was emphasized through balance activities as he performed basic daily and work activities (making coffee and a shoveling-simulation task).

Unfortunately, the segment did not specify that the activities being performed were directed by an occupational therapist.  The general term “therapy” was used, and physical therapy was implied.  But the process certainly felt like an occupational therapy intervention.  Was this an oversight by CNN?  I certainly don’t think so.  But why, as happens too frequently, did occupational therapy hide in the shadows?  My thoughts:  name confusion; a professional philosophy that is difficult to describe in just a few, simple words; and the ever increasing demands of the healthcare industry.

So, what exactly is occupational therapy?  Is it fine motor control (occupational therapy) versus gross motor control (physical therapy). Or is it upper extremity rehab (arms = occupational therapy) versus lower extremity rehab (legs = physical therapy).  These are quick, easy explanations, but certainly not thorough and sets up for division of therapy efforts versus collaboration.

The roots of occupational therapy go back to World War I.  At that time, there was a large demand for the rehabilitation of injured soldiers returning home.  Rather than focusing on only the physical component of injuries,  the nearly 148,000 soldiers admitted to hospitals between 1917 and 1920 were treated with a holistic approach by “reconstruction aides” who borrowed from the fields of nursing, psychiatry, rehabilitation, self-care, and social work.  This whole-body, activity-focused and client-cenered treatment encouraged the patient to take an active roll in his recovery and used purposeful activity to enhance the rehab experience.  By 1920, the field of occupational therapy was officially founded.

Fast-forward to the 21st century, the term “occupation” is now essentially synonymous with work activity.  It’s not unusual for a client to arrive at the clinic and ask: “Are you going to get me a job?”;  or “I’m 78 years old. Why is the doctor sending me to occupational therapy?  I’m not going to go back to work.”  Historically, however, the term “occupation” meant any purposeful activity in the triad of self-care, leisure and work demands that occupied our time.

This historic definition of the term “occupation” is the basis of the occupational therapy philosophy to treatment.  It is what sets us apart from the profession of physical therapy.  Traditionally, physical therapists focus on strength and motion, on the biomechanics of an injury.  As an occupational therapist focusing on the rehabilitation of hand injuries, I borrow from those techniques.  Certainly, the physical recovery of an injury is an essential component of hand rehabilitation.  But the purpose is not just to gain motion and strength.  It goes beyond that.  The following quote, attributed to Mary Reilly, appears on the website for the American Society of Hand Therapists – “…man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health”.

The American Occupational Therapy Association states: “Occupational therapy practitioners bring an added dimension to this [hand therapy] specialty area.  They use an occupation-based and client-centered approach that identifies the participation needs of the client –  what he or she wants to be able to do in daily life that is fulfilling and meaningful – and emphasizes the performance of desired activities as the primary goal of therapy.”  The ultimate goal of occupational therapy is to preserve life roles and habits; to promote a sense of normalcy and psychological well-being during day-to-day functioning; and to make the client a partner in his or her rehabilitation rather than a passive participant.

86% of certified hand therapist are occupational therapists and only 14% are physical therapists.  Yet, the majority of clients attending hand therapy believe that they are receiving physical therapy.  To be honest, each of our professions has benefitted from using techniques from the other.  But I have a terrible confession to make – when I overhear someone on their phone telling their ride to pick them up from physical therapy in 10 minutes, I don’t always correct them.  It’s not that I’m not proud of being an occupational therapist, or that I’m a wanna-be physical therapist.  The truth of the matter is, healthcare providers are struggling to provide quality care with an increased demand for treating a larger caseload, more documentation requirements, and less financial reimbursement.  As awful as it may be, there are times when I have to choose between educating my client about the philosophical difference between OT and PT and providing practical information on scar management, control of swelling, and home exercises. And that is why occupational therapy stays hidden in the shadows rather than taking it’s place in the spotlight.

Yet, occupational therapist should be proud of what they do and of the many people they help to recover from injuries that can threaten well-being as well as physical function.  Some common examples of role disruption that we might see in the clinic include:  a child who is having difficulty with the role of student as fine motor deficits impair his or her writing skills; a young lady who is having difficulty with the role as a mother as “new mom’s tendinitis” impairs her ability to care for her baby; a graduate student who is having difficulty with the role as lab assistant as a snow board fracture impairs his ability to fill pipettes in a science lab; a baby boomer who is having difficulty with the role as wage earner as carpal tunnel syndrome impairs her ability to use a computer keyboard; a retiree who is having difficulty with the role as a volunteer as arthritis impedes his ability to make a full fist. Practically speaking, the occupational therapist looks at these life roles, assesses the amount of dysfunction the injury or illness is causing, and promotes healing through injury recovery or activity modification.   According to the University of Southern California’s Occupational Therapy Program: “no matter what injury, illness, condition, disability, lifestyle, or environment stands in the way, occupational therapists help people to perform, modify, or adapt their skills and activities in order to live healthier, happier, and more productive lives.

So, go live life to the fullest!  Marji

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mHealth – Using Mobile Devices to Improve Healthcare

What an amazing time we are living in! With an internet search and the click of a button, we have more access than ever before to even the most obscure information. With the current rapid changes in technology, we are seeing a trend towards people seeking answers to their healthcare questions online as well as through mobile devices. These emerging tools are allowing us to take charge of our healthcare in ways never before possible.

In fact, I just came across a new term that I think we will be hearing much of in the near future: mHealth. mHealth was defined by a National Institutes of Health Consensus group as the use of mobile and wireless devices to improve health outcomes, healthcare services and health research.

My goal, as an Occupational Therapist and a Certified Hand Therapist, is to provide you with reliable and helpful tips that will ease your recovery from a hand or upper extremity injury. Social Media is making this much easier than ever before. Here is how I will attempt to organize my information using mHealth:

  • Through this weekly blog (handtherapy.wordpress.com)
  • Through daily Tweets @handhajic. As a loose guideline, the tweets will be organized as follows ( but I’m sure we will throw in some random, off topic tweets as well!):
    • Medical Monday – information relating to specific hand injuries
    • Open Topic Tuesday -answers to questions generated by our followers
    • Workday Wednesday – ergonomic suggestions to help make your work activities more comfortable and less stressful
    • Therapy Thursday – tips, tricks, and advice from the clinic
    • Fun Fact Friday – interesting facts about our hands and arms; or just fun facts in general!
    • Weekend Warriors – tips to help you protect your hands from sports, gardening, home projects and leisure activities
  • Through our Facebook page – another way for you to keep in touch with the clinic. I will post my own commentary; provide injury and recovery information; give you behind-the-scenes glimpses into an active, outpatient occupational therapy clinic specializing in upper extremity rehab;; and throw in some general information about the profession of occupational therapy. Look for our logo and “Like” us at the Hand Therapy & Occupational Fitness Center.
  • HandHealthResources.com – our website is currently in the process of being updated for content and ease of use. However, it is still full of information on upper extremity injuries, recovery/therapy, ergonomics and prevention tips. Feel free to browse.

What will make this endeavor successful are the questions and feedback that will come from our followers. Please don’t be shy. My clinical experience leads me to believe that the healing process is fostered with a sense of community as people relate their experiences, frustrations and triumphs with each other as they travel on the road to recovery. So, share your journey. Ask your questions. Seek and/or provide support.

And, as always, let’s put some caring back into healthcare! Marji