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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What is Cubital Tunnel Syndrome?

Everyone has now heard of carpal tunnel syndrome. The term is seen in everyday magazines, is used commonly in texts and tweets, and is even the name of a musical group. Carpal tunnel syndrome is the most commonly occurring nerve compression of the upper extremity. It is caused by the median nerve becoming pinched at the wrist causing numbness in the thumb, index finger, middle finger, and partially in the ring finger. It can cause weakness in the muscles at the base of the thumb and cause pain that radiates up the arm into the shoulder and neck. Like the older sibling who gets blamed for all wrong-doing, carpal tunnel syndrome has become synonymous with all hand pain.

Lurking in the shadow of carpal tunnel syndrome’s fame is its counterpart, cubital tunnel syndrome. Cubital tunnel syndrome is the second most commonly occurring nerve compression of the upper extremity. It is caused when the ulnar nerve, running parallel to the median nerve in the forearm, becomes pinched at the elbow. When you hit your “funny bone”, you are actually hitting this nerve. The ulnar nerve is responsible for sensation in the small finger and partially in the ring finger. Trauma to the ulnar nerve can cause pain in the small finger side of the hand that radiates into the forearm towards the inside of the elbow. It can cause weakness to the small muscles in the hand and, if severe, loss of coordination.

It is time to bring cubital tunnel syndrome out from behind carpal tunnel syndrome’s shadow. If diagnosed correctly, there are simple modifications that can be made to help relieve the symptoms of this frequently overlooked nerve compression.

  • Avoid bending the elbow for any length of time. This stretches the nerve tautly through the cubital tunnel. Activities that can irritate the nerve and simple solutions include:
    • sleeping with the elbow bent – use pillows for support; wrap an ace wrap or towel loosely around the elbow to keep it from bending; avoid sleeping on the arm or sleeping with the hands positioned up behind the head.
    • holding a phone to the ear – use a head-set.
    • blow-drying hair.
    • driving – adjust the seat position so that the elbows are open and relaxed; avoid resting the arms on the elbow supports or window sill.
    • computer work – position the height of the keyboard and mouse so that the elbows are open a bit more than 90 degrees.
    • playing the guitar (because of the positioning of the fretting hand) – warm-up prior to playing, take frequent breaks, stretch often. 
  • Don’t lean on the elbow.
  • Don’t lean on the forearm, especially if it is placed over the hard edge of a desk or table. Place a soft support or cushioning under the forearm.
  • Position the mouse and the keyboard in front of you so that you do not need to reach forward or out to activate them.
  • The mouse and keyboard should be low enough that the shoulders are relaxed.
  • Activate the mouse by keeping the wrist solid and using shoulder movement for positioning.
  • Keep the wrists neutral. The wrists should be flat over the keyboard, not bent forward or back. The wrists should not be angled towards the small finger while typing. Using a split keyboard or a vertical mouse may help position the wrists correctly and relieve tension in the forearms.
  • Avoid repetitive elbow bending and straightening.
  • Avoid over-developing the triceps during gym and sports activities.

As with other injuries, it is important to:

  • take frequent breaks when performing repetitive work.
  • gently stretch the forearm muscles.
  • warm-up prior to performing strenuous activity.
  • avoid or modify activities that cause pain.
  • use cold packs to control post-activity pain when necessary.

Need more information?  Or want to share your experiences or ask questions of our community?  Visit us online at HandHealthResources.com or via our Facebook or Twitter accounts.

Let’s put some caring back into healthcare!  Marji

 

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

We’re Back! And Social Media Can Make us Stronger!

After a several year hiatus as a new business owner establishing a thriving clinical practice, I am now ready to make my online presence known once again!  

In the clinic, we have an open gym forum that allows those recuperating from their hand and upper extremity injuries the opportunity to share their experiences with others who are on the same life journey.  This community experience has many positive effects.  Last week, we took an informal survey of our clients.  The request for using technology as a means of assisting in both the physical and emotional aspects of injury recovery was overwhelmingly positive.  

As I am personally not technologically savvy, I have found a team of family and friends willing to take this journey with me.  So, a big welcome to Steve, Annette, Kevin and Jon who will be my Social Media Support Team.  

  • We will begin by using Facebook, Twitter, and Blogs to provide tips, tidbits and information to help make injury recovery smoother and less overwhelming.  
  • Our website, HandHealthResources is cosmetically outdated but still filled with lots of great information.  We have just started the process of updating and reorganizing.  More information on that coming soon!  
  • And, with all of the opportunities that portable technology offers, we are hoping to have some interesting and helpful SmartPhone and Tablet applications farther down the line.

I believe that the community aspect to injury recovery and wellness promotion is going to become a critical component of care as our healthcare delivery system changes.  We are already noticing a trend towards higher deductibles, fewer appointments authorized or covered, and more difficulties in obtaining reimbursement for care provided.  Social Media may allow us new ways to offer the support of a caring community that is currently in danger of disappearing.  So, let us know what you think!  Share your own stories, triumphs and advice for recovery.  Let’s put the caring back in to healthcare!