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Occupational Therapy - A Guide

Occupational therapists aim to promote health and wellbeing through everyday activities

The College of Occupational Therapists describes this as a way of enabling people to "achieve as much as they can for themselves and get the most out of life. They play a vital role in the rehabilitation of ill and disabled adults and children

Introduction
When occupational therapy is used
Techniques and equipment used in occupational therapy
How occupational therapy is used for rehabilitation
How to access occupational therapy

Introduction

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.



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.

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When occupational therapy is used


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

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Techniques and equipment used in occupational therapy

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-stick 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.

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How occupational therapy is used for rehabilitation


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:

  • 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.

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How to access occupational therapy


The reason you need occupational therapy can determine how you access the service. In general:
  • for short-term conditions, such as after an operation: occupational therapy is usually accessed through the NHS
  • for long-term conditions, such as a permanent physical disability: occupational therapy is usually accessed through your local council

If you are not sure how to access occupational therapy, you can contact your local council and ask if they provide occupational therapy to someone in your situation. You can search for your local council on the Directgov website. If they cannot help you, they may suggest that you speak to your GP.

Private occupational therapy

If you do not want to access occupational therapy through the NHS or your local council, you could contact an occupational therapist directly. If you decide to see a private occupational therapist, make sure they are fully qualified and are a member of a recognised body, such as the British Association of Occupational Therapists.

Only healthcare professionals who are registered with the Health Professions Council (HPC) are allowed to use the title of occupational therapist.

See the advice below about buying your own equipment if you choose to access occupational therapy privately.

Short-term conditions

If you require occupational therapy because of a short-term condition, it is usually the responsibility of the NHS to provide this. Speak to one of the healthcare professionals treating you. They will discuss your needs with you and decide if you would benefit from occupational therapy.

If you would benefit from occupational therapy, the healthcare professionals treating you can arrange an assessment with an occupational therapist as part of your care. At your assessment, your occupational therapist will decide if you need any equipment or training. It may be provided free of charge by the NHS, although this could depend on what is available from your local primary care trust.

Long-term conditions

If you have a long-term condition that is affecting your ability to carry out everyday activities, you may be able to access occupational therapy through your local council.

Local councils usually provide occupational therapy as part of their social care services. They may work with local NHS providers and organisations and other councils to run these.

Councils normally have eligibility criteria to determine whether someone can receive social care services, such as occupational therapy. The criteria may vary between councils, but could include the following points:

  • There is a critical risk to your independence and wellbeing, for example, you are unable to wash, dress or feed yourself.
  • There is a substantial risk to your independence and wellbeing, for example, you are unable to carry on with many areas of your employment or education.
  • Your needs may be due to a physical or learning disability or a mental health condition. However, temporary medical conditions are not usually covered.

You can contact the social services department of your local council to arrange an assessment with an occupational therapist, or you can be referred for an assessment by:

  • your GP or consultant (specialist doctor)
  • a nurse
  • another healthcare professional
  • a social care professional

Assessing your needs

An occupational therapist can carry out a health and social assessment to identify what areas of your everyday life are causing problems. They will discuss your needs with you and explain what help is available. An assessment and any advice or information they give you should be free.

Accessing equipment

An occupational therapist can make decisions about what equipment would be most useful to help you live independently. These decisions are made as part of your health and social care assessment (see above).

Equipment 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

Free equipment

If an assessment has concluded that you need some equipment, it can usually be provided free of charge on a long-term loan.

Minor adaptations costing £1,000 or less (which includes the cost of buying and fitting the adaptation) are also provided free of charge. Councils can make a charge for minor adaptations that cost more than £1,000 to provide.

Larger, more expensive items and major adaptations may be the responsibility of the housing department. You may need to contribute towards the cost of these items, or you may be able to apply for a disabled facilities grant (see the box to the right) to help with the cost.

Equipment for employment

If you need equipment to help you carry out your work, the Access to Work scheme may be able to provide funding. Contact the disability employment adviser at your local Jobcentre Plus for advice and assistance.

Buying your own equipment

You may choose to buy your own equipment rather than use the equipment provided by your local council. If you are going to buy your own equipment, it is still a good idea to have an assessment by an occupational therapist. They can provide guidance on what equipment is most suitable and advise you on what is available.

Sources of advice

Ricability is a consumer research charity that produces information for disabled and older consumers. All reports are based on independent research carried out by Ricability. This includes user trials, technical tests and survey work.

Help is also available from the Disabled Living Foundation. This national charity provides free, impartial advice about all types of home adaptation and mobility products for disabled adults and children and older people.

Equipment loans

If you need some equipment on a short-term basis, for example because someone with a disability is visiting you, your local Red Cross can often lend you wheelchairs and other equipment for short periods.



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