Occupational therapy

Occupational therapy aims to promote people's health and wellbeing through their everyday activities. An occupational therapist can identify problem areas that patients may have in their everyday lives, such as dressing or getting to the shops, and will help them to work out practical solutions. By using techniques to improve someone's ability or by changing the environment or equipment they are using, an occupational therapist allows that person to regain or improve their independence.

Occupational therapists are part of the team of healthcare workers who care for people in the community and in residential and hospital facilities.

Occupational therapists will examine people's day to day routines, in a holistic way, and see how their physical, home and social lives can be improved. Occupational Therapists are actively involved in rehabilitation in a variety of clinical conditions including stroke rehabilitation and hand therapy.

Who can benefit from occupational therapy?

Occupational therapy is used when someone is having difficulty with everyday tasks. This could be because of a:

  • physical disability - for example, someone who uses a wheelchair
  • learning disability - for example, someone with an autistic spectrum disorder
  • mental health condition - for example, bipolar disorder
  • medical condition - for example, rheumatoid arthritis 

Occupational therapists work with people of all ages, and can look at all aspects of daily life, from the home to the school or workplace.

Occupational therapy techniques

Occupational therapists identify the activities that are causing difficulties. They then help by doing one of the following:

  • teaching a different way to complete the activity
  • recommending changes that will make the activity easier

For example, after a hip replacement someone may find it difficult to get in and out of the bath. Grab rails could be fitted in the bathroom to make this easier.

Someone with rheumatoid arthritis (a condition that causes pain and swelling in the joints) may find it hard to lift small objects. Special equipment may be available to make tasks easier, such as a wide-handled vegetable peeler.  

If someone is feeling anxious or stressed as a result of their difficulties, their occupational therapist may recommend a course of relaxation. For example, slow breathing techniques or tensing and relaxing certain muscles may help someone feel calm.

By making these changes, people are able to carry out everyday activities despite their condition or disability.

Occupational therapy is used to treat a wide range of conditions, including conditions that:

  • are present from birth
  • develop with age
  • are the result of an accident

Occupational therapy is also often used as part of a rehabilitation programme (a programme of treatment designed to help someone recover from illness or injury), for example after surgery, or to treat depression.

Health conditions

Some of the health conditions (including mental health conditions) that occupational therapy may be used to treat include:

  • arthritis - a condition that causes pain and inflammation of the joints and bones, which can make handling objects difficult
  • depression - when you have feelings of extreme sadness that can last for a long time and interfere with your daily life
  • multiple sclerosis (MS) - a condition of the central nervous system (the brain and spinal cord) that affects the body's actions, such as movement and balance
  • Parkinson's disease - a condition that affects the way the brain co-ordinates body movements, including walking, talking and writing
  • schizophrenia - a mental health condition that causes psychological symptoms, such as hallucinations (hearing or seeing things that do not exist)
  • dyspraxia (developmental co-ordination disorder) - a condition characterised by difficulty in planning smooth, co-ordinated movements

Conditions in children

Occupational therapists may also work with children, for example those with:

  • cerebral palsy - a set of neurological conditions (conditions affecting the brain and nervous system) that affect a child's movement and co-ordination
  • Down's syndrome - a genetic (inherited) condition that affects a baby's normal physical development and causes mild to moderate learning difficulties
  • dyspraxia - a disability that affects movement and co-ordination
  • a learning disability - a disability that affects the way someone understands information and communicates
  • spina bifida - a series of birth defects that affect the development of the spine and nervous system

Ageing

Occupational therapy may be used to address problems that develop as a result of getting older. For example, you may find that certain movements are not as easy as they used to be, such as getting out of bed in the morning. An occupational therapist can help by suggesting:

  • ways of adapting your home, such as a grab rail by your bed
  • a new technique for lifting yourself so that you can get up without help

Occupational therapy can also help other conditions associated with ageing, such as dementia (an ongoing decline of the brain and its abilities) and Alzheimer's disease (the most common form of dementia). An occupational therapist may assess your ability to carry out everyday tasks, such as washing or dressing yourself, or cooking, and offer advice to help with these activities.

Rehabilitation and recovery

Occupational therapy can be used after an accident, illness or operation to help you recover and regain as much independence as possible. For example, occupational therapy may be used after:

  • a hip fracture - this usually requires surgery followed by a rehabilitation programme to help you regain full mobility (the ability to move)
  • a severe head injury - after a severe head injury you may find everyday activities at work or home difficult and occupational therapy may help you recover
  • a stroke (a serious medical condition that occurs when the blood supply to the brain is restricted) - you may have some weakness in one side of your body and need to learn new ways of carrying out daily activities
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Some of the techniques that occupational therapists may use to make everyday activities easier are explained below.

Thinking about activities differently

An occupational therapist will look at the activity you are finding difficult and see if there is another way it can be completed. For example, if you are finding it difficult to:

  • peel and chop vegetables - perhaps you could buy vegetables that are already prepared
  • walk to your local shop - perhaps there is a bus that runs past your house or you may be able to do your shopping on the internet
  • do the ironing - perhaps you could sit down while you iron

An occupational therapist will also help find new ways to carry out an activity by breaking it down into small individual movements, and will then practise the steps with you.

For example, if you cannot get up out of a chair without assistance, an occupational therapist could show you a technique for this. They will explain where to position your feet and arms, and how to push yourself up. They can run through each stage of the movement with you until you can confidently get up on your own.

For children, an occupational therapist may develop a game or activity that your child can complete daily. This could be aimed at improving your child's:

  • hand strength
  • concentration
  • social skills

Focusing on a small goal, such as improved hand strength, may eventually help with larger problems, such as your child's ability to dress themselves.

Adapting your environment

Part of occupational therapy may involve making an environment suitable for your needs. This could be your home, workplace or where you are studying, and may involve changes such as:

  • putting in ramps, so an area can be accessed in a wheelchair
  • fitting a stairlift
  • fitting grab rails, for example by the stairs or beside the bed
  • fitting a raised toilet seat, bath lift or shower seat to make the bathroom easier to use 
  • clearing up clutter or re-organising cupboards so you can safely move around and reach what you need

Using special equipment

Occupational therapists can also advise about what special tools or pieces of equipment you may find helpful. For example:

  • a walking stick, walking frame or a wheelchair
  • electric can openers or electric toothbrushes
  • knives with large handles and chunky pens (if you have difficulty holding small objects)
  • a non-slip mat for the bath
  • a special keyboard or mouse to help you use a computer
  • voice-controlled lights or voice-controlled software on a computer

You should mention any difficulties to your occupational therapist, no matter how small they seem, as there may be all kinds of specialised equipment available. For example, you could have a special comb to style your hair more easily, or a device to turn the pages of a book.

Occupational therapy aims to help you get the most out of life. As well as being able to complete everyday activities, there are other areas of your life that should also be included, in particular:

  • your work life
  • your leisure life

Vocational rehabilitation

Vocational rehabilitation, or workplace rehabilitation, means helping someone with a health condition return to work or start working, or enabling them to carry on working. In vocational rehabilitation, "work" does not have to mean a paid role; you could be a full-time parent or a volunteer.

An occupational therapist could help by:

  • advising you about possible careers
  • assessing your workplace
  • assessing your role at work
  • assessing your ability to complete work activities, and finding ways to assist you if necessary
  • finding ways to manage your condition while at work
  • providing additional training
  • helping your employers manage your return to work and increasing awareness of your condition

Leisure rehabilitation

Leisure rehabilitation could cover any fun activity, such as taking up a hobby or attending social events.

Taking part in leisure activities can prevent people feeling isolated because of their condition and improve quality of life. While you need to be able to care for yourself and work, being able to take part in activities simply for pleasure is also important.

An occupational therapist may discuss with you what goals you would like to achieve, and then break this down into single tasks. For example, if you like going shopping but find it very tiring, your occupational therapist may suggest taking regular breaks. If you have a love of gardening but find it difficult to reach the flower beds, your occupational therapist may suggest sitting on a stool rather than trying to bend down.

Activity grading

One way that your occupational therapist may encourage you to return to work or resume your hobbies is with activity grading. Activity grading is a way of breaking down an activity you want to complete into stages that become increasingly more difficult.

For example, if your goal is to walk to work but it is too far for you to complete at once, this can be broken down. On your first day, you can get the bus most of the way and then walk the last part. Each week, you could get off the bus a stop earlier and increase the distance you walk. The activity (walking) is becoming increasingly difficult and you are gradually reaching your goal of walking to work.

There are a number of ways that activities can be broken down into grades. For example:

  • Preparing a meal - By breaking down the meal preparation into single tasks, like holding the knife, lifting a pot, pouring water, the smaller tasks will improved through the activity programme. Hands-on rehabilitation will improve grip strength, coordination and sensation so that then you can complete parts of the activitiy e.g. chopping vegetables. Gradually, you will progress and eventially achieve the bigger goal of preparing a meal.
  • introducing more equipment into an activity. If you need to start using a computer, you could increase the amount of time you spend on it, then increase the amount of programmes you use on it, and then start using a printer or scanner with the computer.
  • changing the environments you are familiar with. If you are using crutches to get around the house, you could try going into the garden with them, then try walking on the pavement with them, and finally reach the shops with your crutches.

As you become more confident with an activity, you can progress to the next stage and eventually reach your goal.

 

Occupational therapists in Ireland are employed by most Local Health Offices, and they are also employed by Voluntary hospitals and agencies. Their services are generally available free of charge to medical card holders.

There is a shortage of occupational therapists in Ireland and as a result you could be placed on a waiting list and will be seen on a priority basis.

Different settings/ services will liaise closely with one another when working with you e.g. hospital Occupational Therapist will hand over a patient or refer a patient to a community Occupational Therapist.

If you require an Occupational Therapist contact your local Health Centre for more information.

Aids and Appliances

An occupational therapist ,having assessed your ability to function in relation to activities of daily living and your home arrangements, may arrange for the provision of some appropriate aids and appliances by the HSE or may certify that you are eligible for the Housing Adaptaion grant for people with a disability.

Aids and appliances might include items such as:

  • two-handled cups, tap turners and kettle tippers for the kitchen
  • grab rails and raised toilet seats in the bathroom
  • bed raisers and hoists in the bedroom
  • You can be referred to an occupaional therapist by your GP, public health nurse or hospital.

Buying your own equipment

If you are not eligible for free occupational therapy services you can be referred by your GP to a private occupational therapist who can provide guidance on what equipment is most suitable and advise you on what is available.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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