We have finished the summer semester after taking our last exam. This has been a really hectic semester. Both lab and fieldwork splinting take up two weeks of the summer semester's total time. Today's topic, Occupational Therapy in Physical Dysfunction, was one of two classes I took this semester; the other being Leadership and Management, in which we explored healthcare administration and administration. Occupational therapists are commonly found in hospitals, clinics, nursing homes, and other organisations that treat patients with physical impairments. Because of this, I figured it would be amusing to reflect on the things I've learnt and done throughout the semester. Please share your expertise in the field in the comments section below if you have experience working with people who have physical dysfunctions. To learn more about my level 1 fieldwork experience in inpatient rehabilitation, read my previous post.
Occupational therapists (OTs) may serve in a number of capacities related to physical impairment, depending on the client group and treatment environment. Here are some of the issues that occupational therapists may address:
Strengthening Lengthening one's muscles and increasing flexibility Restoration of a dysfunctional skill (via methods such as constraint-induced movement therapy (CIMT), neurodevelopmental therapy (NDT), or repeated task practise) Using less energy and safeguarding your joints Ergonomics Getting Ready for Work Adaptive methods (e.g. hemi-dressing, the lighthouse technique, red tape as a cue for unilateral neglect) Accessories that may be adjusted to fit the user (e.g. shower chair, dressing stick, reacher, sock-aid, long-handled equipment, cooking tools) The act of chewing and swallowing Suggestions for those in a wheelchair Preventing Pressure Ulcers Thinking, remembering, and focusing Insufficiency in the sack Psychological factors in environmental adaptation Modalities of Physical Agents (e.g. heat, cold, ultrasound, electrical stimulation, paraffin, etc.) Fabrication of orthoses (for more information on splinting, see my earlier post!)
OTs have a lot of responsibilities when it comes to physical impairment. There are probably more responsibilities that OTs have that I didn't mention. Disorders of the Physical Self
Within the realm of physical dysfunction, OTs may treat a variety of problems, including but not limited to:
Stroke (CVA) (CVA) Disorders of the Brain Caused by a Blast to the Head (TBI) Damage to the Spinal Cord (SCI) Scleroderma (MS) (MS) The Disease of Huntingdon Degenerative Parkinsonism Progressive Myeloma (ALS) The Guillain-Barré Symptom Complex Dysphasia Aphasia The Blinding Effect of Ignorance Breaks in Arthritic Bones Burns Oncology Diabetes Diseases of the lungs (e.g. Chronic Obstructive Pulmonary Disease [COPD]) diseases of the heart (e.g. myocardial infarction [heart attack], coronary artery disease, congestive heart failure)
I took a course in physical dysfunction practise as an occupational therapist, and every week we had a lab where we got to put what we learned into practise. We benefited greatly from our mutual mock-practice sessions. What a great lab experience! I feel like I really grew as a person there. Having the opportunity to put what I learned in class into practise in a lab setting has prepared me well for a career in the physical dysfunction field (and for the competencies). Actions in Various Situations
What I would do if I had a client or patient with this problem is outlined below. Given my lack of expertise, there is bound to be important information I omit. Before trying any of these methods, you should speak with a professional occupational therapist. Stroke
Diagnosis: Right middle cerebral artery stroke appearing as left hemiparesis and left unilateral spatial neglect. How should I proceed?
Occupational therapy interventions for L hemiparesis would include encouraging weight bearing during ADLs, teaching the patient hemi-dressing skills, recommending adaptive equipment, and encouraging the patient to use the L UE as much as possible in order to restore function (e.g. modified constraint-induced movement therapy and repetitive task practice). During the free chat session, I would stand on the patient's L side to treat L unilateral spatial neglect by providing constant cues to pay attention to the patient's L side. The lighthouse technique and other external cues, such as placing red tape or a marker on the side of a newspaper the patient prefers to read, would also be used to train the patient's eye to scan from left to right. Damage to the Spinal Cord
We have determined that the patient has a C6 ASIA A SCI with some degree of wrist extension. How should I proceed?
Occupational therapy interventions for a patient with a C6 spinal cord injury who retains use of wrist extensors. This bodes well for the patient's prospects of using tenodesis to achieve functional grasping and movement. When performing ADLs, I would put extra effort into maintaining tenodesis and developing a more functional hold. The same goes for power w/c mobility and sliding board transfer independence. Since the patient won't be able to tell whether a pressure ulcer is forming, I would recommend adapted equipment for ADLs and emphasise the significance of pressure reduction. Finally, I'd talk to the patient about sexuality and how he or she can still have intimate relationships despite the SCI. Sclerosis Multiple
Diagnosis: Exacerbation of multiple sclerosis and exhaustion associated with multiple sclerosis. How should I proceed?
The primary symptom of MS is fatigue, hence the primary focus of occupational therapy interventions is on reducing the patient's energy use. First, I'd teach them the "4 P's" of energy efficiency: (pace, prioritize, plan, posture). I would help the patient plan, prioritise, and pace activities by figuring out what kinds of things he or she hasn't been able to do because of exhaustion. If the patient has a passion for cooking but is unable to do so due to MS-related fatigue, I might suggest rearranging his or her cabinets so that heavy or frequently used items are at counter level and easy to reach, taking frequent breaks, talking to strangers and preparing meals ahead of time to cook at convenient times. To further lessen the burden of this IADL, I suggest using cooking-oriented adaptations.