Intervention

Occupational therapy (OT) may occur in various settings, such as acute care, rehabilitation, outpatient, adult day care, skilled nursing, or long-term care facilities; the home (as part of home health care); senior housing developments; and life-care or assisted-living communities. OT may also be part of palliative or hospice care at home or in an institution. Occupational therapists work closely with other health care practitioners to develop and coordinate care for patients.

The need for OT ranges from one consultation visit to frequent sessions of varying intensity.

Occupational therapists develop an individualized program to enhance a patient's motor, cognitive, communication, and interaction capabilities and to help the patient do certain preferred activities. Before developing a program, a therapist observes the patient doing each activity as part of the patient's routine, so that the therapist understands what is needed for the activities: objects used and their properties, space demands, sequencing and timing, and required actions and body functions. Therapists can then recommend ways to eliminate or reduce maladaptive patterns and to establish routines that promote function and health. Specific performance-oriented exercises are also recommended. Therapists emphasize that exercises must be practiced and motivate patients to do so by focusing on exercise as a means to becoming more active at home and in the community.

Patients are taught strategies to compensate for their limitations (eg, to sit when gardening). Patients are also taught to use modified or assistive devices (eg, large-print books or newspapers, audio books, communication boards, cooking utensils or golf clubs with large handles). Using these strategies and devices often makes activities safer.

Occupational therapists may recommend interventions to improve safety in the patient's environment (home, workplace, or institution). For example, raising toilets and chairs and installing a bathtub bench reduces the need to bend; improving lighting in hallways, dining areas, and stairwells makes ambulation safer; and improving lighting in the kitchen areas makes meal preparation safer. Environmental interventions can help improve function or quality of life. For example, a night table may be moved within reach of the bed, or a family picture may be placed on a door to help patients recognize their room.

If patients need or desire to work (paid or volunteer), therapists can help them realistically consider their strengths and limitations and then set goals. To prepare patients for work, therapists introduce the simplest work activities first, followed more complex ones as patients progress. Patients may be taught new skills or modifications of previous skills. Therapists may evaluate the workplace and collaborate with the employer to modify the environment so that patients can work more easily.

Appropriate and preferred leisure activities are integrated into the patient's routine. Such activities may be sedentary (eg, playing cards, working puzzles, reading) or physical (eg, swimming, walking, gardening, golfing).

Patients are taught creative ways to facilitate social activities (eg, how to get to museums or church without driving, how to use hearing aids or other assistive communication devices in different settings, how to travel safely with or without a cane or walker). Therapists may suggest new activities (eg, volunteering in foster grandparent programs, schools, or hospitals).

Therapists may suggest devices (eg, assistive reading or hearing devices), settings (eg, community centers or colleges, local library), and strategies to enable patients to continue learning. For example, patients may be encouraged to learn how to use a computer so that they can look for information, take courses, or communicate with family members and friends. Therapists may also use computer programs to help patients improve their cognitive skills (eg, decision-making, abstract reasoning, problem-solving, perception, memory, sequencing, coordination).

Occupational Therapy for Specific Conditions

Hip surgery: Occupational therapists teach patients how to modify ways of doing basic activities of daily living (BADLs) and instrumental ADLs (IADLs) safely after hip replacement, thus promoting healing and improving mobility. For example, patients may learn to keep their hip correctly aligned, to wash dishes and iron while sitting on a high stool, to use a pillow to raise the seat of the car while transferring in and out, and to use long-handled devices (eg, reachers, shoe horns) to minimize bending over. This instruction may occur in the hospital, in longer-term rehabilitation settings, in the patient's home immediately after discharge, or in outpatient settings.

Arthritis: Patients with arthritis can benefit from activities and exercises to increase joint range of motion and strength and from strategies to protect the joints. For example, to avoid undue pain and strain to joints, patients may be taught to slide a pot of boiling water containing pasta rather than carry it from the stove to the sink. Therapists may teach patients how to get in and out of the bathtub safely and may recommend a raised toilet seat, a bathtub bench, or both to reduce pain and stress on the lower-extremity joints. Therapists may suggest wrapping foam, cloth, or tape around the handles of objects (eg, knives, cooking pots and pans) to cushion the grip or using tools with larger, ergonomically designed handles. Such instruction may occur in outpatient settings, in the home via a home health care agency, or in private practice.

COPD: Patients with COPD can benefit from exercises to increase endurance and from strategies to simplify activities and thus conserve energy. Activities and exercises that encourage use of the upper and lower extremities are used to increase muscle aerobic capacity, which decreases overall oxygen requirement and eases breathing. Supervising patients while they engage in activity helps motivate them and makes them feel more secure. Such instruction may occur in medical facilities or in the patient's residence.

Stroke: Patients who have had a stroke usually require rehabilitation, including occupational therapy (OT), in an inpatient or skilled nursing home facility; afterward, many are able to return home. Occupational therapists should evaluate the home for safety and determine the extent of social support. They can help obtain any necessary devices and equipment (eg, bathtub bench, grab bars by the bathtub or toilet). Occupational therapists can also recommend modifications that enable patients to do BADLs and IADLs as safely and independently as possible--for example, rearranging the furniture in living areas and removing clutter. Patients and caretakers are taught how to transfer between surfaces (eg, the shower, toilet, bed, chair) and, if necessary, how to modify ways of doing BADLs and IADLs. For example, patients may be taught to dress or shave using only one hand and to eliminate unnecessary motion while preparing food or shopping for groceries. Therapists may suggest using clothing and shoes with touch fasteners (eg, Velcro) or dinner plates with rims and rubber grips (to facilitate handling). Patients with impairments in cognition and perception are taught ways to compensate. For example, they can use drug organizers (eg, containers marked for each day of the week). Patients who have difficulty looking to the left may benefit from drawing a red line on the left side of the newspaper column. When they reach the end of a line of text, they scan to the left of the column until they see the red line, cueing them to begin reading the next line. Using a rule to keep focused on each line of text may also help.

Emotional disturbances: Emotional disturbances (eg, depression, anxiety) can contribute to inactivity, impair memory, and increase fatigue, leading to social withdrawal, fear of participation, and disuse atrophy. For example, fear of falling may prevent patients from grocery shopping. Occupational therapists can help determine the contribution of emotional disturbances to such problems and suggest strategies to mitigate or reverse the problems. Therapists also teach patients how emotional disturbances lead to other problems. Realizing the connection may motivate patients to become more active. Simultaneously, patients are encouraged to practice feared, but desirable activities in controlled, supervised situations; this strategy decreases fears and can increase strength, endurance, and confidence.

Sensory impairments: Occupational therapists suggest strategies to compensate for sensory impairments---whether related to aging or a disorder. Strategies may involve preventing falls and improving mobility when proprioception and balance are impaired or enabling patients to do essential manual tasks (eg, counting pills) when vision or tactile sensation is impaired. Increasing ambient lighting or marking objects used everyday with a bright, easily seen color may help patients with impaired vision. Patients with impaired hearing may use a telephone with a flashing light instead of a ring or a cell phone that vibrates.

This topic was last updated April 2006.