Helping patients perform functional activities

When I enter a patient’s hospital room, I always introduce myself as the occupational therapist who would be working with them. Many patients are very quick to assure me they were retired and did not need a job. OTs do not find people jobs, but we will put you to work!

To an OT, the word “occupation” is defined as those activities a person engages in that bring meaning and purpose to their life.

For example, one of my occupations is sewing. For someone else, an occupation might be playing the guitar, working in the yard or cooking for their family. Occupation also includes activities that are necessary to accomplish in our daily lives, like dressing, bathing and washing dishes. Research indicates that engaging clients in activities that are meaningful to them are more successful than traditional exercise by itself. Occupational therapists believe that the use of occupation is the key to restoring a person’s quality of life and ability to participate in their life at the highest level possible.

A common misconception about therapy is that the focus is always on physical problems such as weakness or loss of joint motion. However, restoring physical abilities may not always result in restoring functional abilities. For example, restoring knee motion after a knee replacement surgery does not always ensure the person will return to their presurgery functional level. Functional activities challenge physical issues while at the same time engaging areas such as attention, memory, coordination, movement and endurance.

During the initial evaluation, the OT assesses physical abilities such as joint motion, strength, mobility and performing functional activities such as dressing. The evaluation may also include assessing cognition, psychosocial issues such as anxiety and depression, and sensation. The OT uses their training in activity analysis to observe the client as they perform functional activities and identifies limitations and barriers.

The evaluation also focuses on learning about the individual client. What are their roles? Are they a parent? Student? Employee?

What does the person value?

What are their interests and hobbies? What are their concerns about their condition? What are their goals for therapy? The OT and the client prioritize areas to address in treatment and set goals together from this holistic evaluation process.

The OT creates an individualized treatment plan incorporating the client’s occupations and traditional exercises and modalities to facilitate progress toward their goals. Treatment focuses on regaining the ability to perform functional activities, and the OT may use a variety of approaches. They may work with the client to improve the ability to perform the task in their usual manner, modify the task or train the client to use adaptive equipment.

What training does an occupational therapist have, and how do you become one?

A client may work with either an occupational therapist (OT) or a certified occupational therapy assistant (COTA). Occupational therapists have a bachelor’s or master’s degree in OT with programs now transitioning to a doctorate level.

LSU Health Shreveport has a program in occupational therapy that admits students each year and has transitioned to the doctorate degree. A COTA typically has an associate degree in occupational therapy, although bachelor’s degree programs are available. Bossier Parish Community College in Bossier City has an associate degree level COTA program.

After graduation, OT and OTA candidates must pass a registry exam before being allowed to practice. OT and OTA practitioners must meet yearly education requirements to maintain licensure in Louisiana. There are also OTs with specialty training and certification in burns, hand therapy, low vision, pediatrics and women’s health.

Who do occupational therapists work with?

OTs are trained to evaluate and treat people across the lifespan, from newborns to geriatrics. Their training allows them to work effectively with different types of disabilities, including physical, emotional and behavioral and with people with differing levels of dependency. Common diagnoses include spinal cord injury, traumatic brain injury, stroke, Parkinson’s disease, chronic respiratory issues, Covid, and upper or lower limb amputations. Common diagnoses pediatric OTs work with include autism spectrum disorder, developmental delays and cerebral palsy.

Where are occupational therapists found?

We can be found in acute care hospitals, rehabilitation centers, out-patient clinics, home health, hospice settings, community living centers, mental health facilities, community re-entry programs, pediatric clinics, public school systems and many others.

What does occupational therapy look like?

OT looks different depending on the client’s diagnosis, age and the type of setting. In an acute care hospital, patients are often experiencing physical limitations due to surgery or trauma, so the focus is on helping the patient accomplish basic self-care tasks such as dressing, bathing and toileting while making recommendations for a safe and appropriate discharge.

In an in-patient rehabilitation center, the OT works with the patient to increase their physical abilities and their overall ability to participate in self-care and mobility at the highest level possible. Treatment also focuses on ensuring a safe and appropriate discharge home by providing patient and family education, a home evaluation with recommendations for access and safety, and recommendations for appropriate equipment and support.

OTs are also skilled in medication management, splint fabrication, cognitive retraining, fall prevention, continence training, visual rehabilitation and adaptation, home assessment and adaptation, and functional mobility training.

Who qualifies for occupational therapy services?

To qualify for occupational therapy services, a person must have a disease, condition or injury that warrants the skilled services of an occupational therapist to regain function or prevent further decline. A referral from a medical doctor is also required.

Regardless of whether a person can ever be fully independent, the goal of occupational therapy is always to help a client achieve health and well-being and enable them to participate in everyday life activities to the best of their abilities.