There are many activities and exercises that can be used in occupational therapy, but their application and the necessary approach differs for each patient, based on their needs and goals.
Occupational therapy (OT) can help individuals of all ages improve, learn, or maintain the ability to perform activities that are part of everyday life, such as writing, getting dressed, or caring for themselves.
While the list of things that OT treats is long, the key thing to understand is how OT helps people.
How Does an Occupational Therapist Help Patients?
The word “occupational” in occupational therapy can be misleading, since OT is not about vocational counseling or work training.
When Patrick Wholey, OTR/L, CHT, describes OT to patients, he often finds it easier to talk about what it isn’t. Namely, it isn’t the same as physical therapy. There is confusion, he says, since OT covers so many areas.
But really, it’s simple.
“We provide skills for the job of living,” says Wholey, an occupational therapist and certified hand therapist at the UPMC Rehabilitation Institute outpatient rehabilitation clinic in North Strabane, located in Washington, Pa.
Occupational therapists work in inpatient rehab, hospital, long-term care, pediatric, and outpatient settings. For people leaving inpatient rehab or a hospital but still regaining mobility, at-home therapy can also be an option.
OT serves people of all ages. Unlike physical therapy, which consumers can access directly, occupational therapy requires a referral from a doctor.
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What Can an Occupational Therapist Do for Adults?
More holistic than other therapies, occupational therapy is about helping many different kinds of people with activities of daily living (ADL). ADL includes everything from learning how to button a shirt after a stroke to preparing to return to work after an accident. Some OT begins in the hospital environment and continues outpatient.
An OT may work with you if you’ve had a specific injury or condition that affects your functional ability. For example, a musician recovering from a hand trauma or a knitter with arthritis. As a certified hand therapist, Wholey sees many traumatic hand and wrist injuries, and focuses on many deficit areas, including ergonomic training.
“OTs are also unique in the outpatient setting because we can make custom splints,” Wholey says.
He uses a thermoplastic to fabricate a removable splint that he cuts to the perfect size and custom molds for someone’s forearm or wrist. Splints can help someone better move or protect their joint while holding their hand in a functional position.
Occupational therapy is very patient-centered. “We always start out by asking you what your goals are,” Wholey says. Then, he aligns the types of activities and treatment strategies with the outcome you’re hoping for.
Wanting to be able to crochet, do woodwork, or play cards with friends could be an outcome. So could continuing to work in your chosen field or being able to live independently in your home.
What to Expect From Occupational Therapy
Inpatient rehab units often have therapy rooms that mimic the rooms in houses, like a full kitchen, bathroom, bedroom, and living room. Outpatient settings have some of that, too. Patients need to be able to practice ADL as part of therapy.
“Everything we do is based in function,” Wholey says. “When I send my patients home, I am always aware of their leisure activities.”
As a result, the “assignments” Wholey gives aren’t typical exercises that one may associate with therapy or rehab, but are instead focused on daily life skills and hobbies.
Activities he might work with patients on (or have them practice at home) include:
- Emptying the dishwasher to work on grasping and reaching.
- Tying a bow, stringing beads, or using tweezers, to work on fine motor skills.
- Buttoning, zipping, and fastening snaps on clothing.
- Playing cards with friends.
- Preparing a small meal.
Some people come to see Wholey three times each week, for four to six weeks. This mimics the way physical therapy works.
Others he may only see a few times, for a quick evaluation and some follow-ups. And some patients he sees for much longer, especially if they’ve had a traumatic injury.
“I’ve seen six patients in the past year who have had terrible injuries related to a table saw or something crushing their hand,” he says.
Treatment for these type of patients takes much longer. It’s important to keep in mind that the hand doesn’t just do practical things but is also an emotional thing, with much to re-learn. “The hand is only second to our face in terms of expressing ourselves,” he says.
How Does OT Help After Stroke and Brain Injuries?
When someone has a stroke, one or both sides of their body become weaker or non-functional. Strokes affect cognition, too, like remembering how to do something such as putting on a belt.
A stroke can also cause a vision field cut. This means that part of the visual field is reduced in both eyes. Your eye may only register half of what it’s looking at.
The eye itself doesn’t have the problem; rather, the brain isn’t receiving signals properly. “All of these things can make ADL very challenging,” Wholey says.
This is where OTs bring their holistic thinking and practice. “Much of what we do is problem-solving,” he says.
Occupational therapists also help with stroke and TBI recovery by figuring out the right adaptive equipment or strategies. For example, you may need to use custom utensils when eating. Or you may need to learn the steps for how to put a shirt on without the full function of one arm.
If someone does have their motor function return, Wholey gets them involved in fine motor activities like tying shoes and buttoning shirts. Right now, he has a patient who crochets, and he’s been working with her on regaining that ability.
OTs can also work with people to improve cognitive and social skills — something stroke and TBI patients often need. OTs can practice conversing with patients and may do memory exercises or simple word or math games.
“If they have a caregiver who is helping, we also have them come in and be involved,” Wholey says.
What Are Other Reasons a Person Might See an OT?
Within occupational therapy, there are many areas of specialty and practice. This includes pediatric occupational therapists, who work with kids in hospital, outpatient, and school settings. OTs are especially valuable for kids with:
- Autism spectrum disorder.
- Developmental disabilities.
- Hand or other injuries.
- Visual motor or visual perceptual impairments.
- Neurological disorders.
On the adult side, doctors may refer people to an OT for:
- Low vision issues. UPMC has a low vision rehab team that works with people who have vision loss that doctors can’t correct with a prescription or surgery.
- Pain management. UPMC’s program for chronic pain helps people learn exercises and techniques to manage their pain and improve ADL.
- Return-to-work training. Sometimes called industrial rehabilitation, this program helps people build the strength and functioning needed to return to work after injury or illness.
- Mental health treatment: OTs may work with people on everything from organizing medications to social skills.
- Burn treatment. OTs work in burn units, helping patients regain motion lost because of procedures and surgeries.
Occupational therapy definitely covers a broad range of functions. But after 33 years, Wholey never gets tired of seeing the tremendous progress his patients make.
“I always tell patients that I’m only 10% of you getting better,” he says. “I tell them that they are the other 90%.”
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About UPMC Rehabilitation Institute
The UPMC Rehabilitation Institute offers inpatient, outpatient, and transitional rehabilitation, as well as outpatient physician services so that care is available to meet the needs of our patients at each phase of the recovery process. Renowned physiatrists from the University of Pittsburgh Department of Physical Medicine and Rehabilitation, as well as highly trained physical, occupational, and speech therapists, provide individualized care in 12 inpatient units within acute care hospitals and over 80 outpatient locations close to home and work.