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Therapies

occupational therapy

What is It?
How Does It Work?
What You Can Expect

Health Benefits

How To Choose a Practitioner

References

Evidence Based Rating Scale
 

What Is It? 

Occupational therapy (OT) is a rehabilitation process that focuses on the whole person and helps patients perform daily activities in spite of the presence of a limitation. OT grew out of the need to rehabilitate the wounded after World War I. Many of the injured endured long periods in hospitals, and it was discovered that they recovered their health and strength far more quickly when "occupied" recreationally with everyday tasks that required using their hands. The physical and mental benefits that these soldiers clearly received from the therapy are what occupational therapists continue to strive for today. Indeed, the therapy is widely recommended by both conventional and alternative practitioners (often in combination with physical therapy) for those who are recovering from accidents, surgery, or strokes, or who have a disabling illness such as multiple sclerosis or rheumatoid arthritis. It is also useful for people who are physically handicapped. (1) 

 

How Does It Work? 

Using specialized tools, materials, and equipment customized to the needs of each individual, occupational therapy helps to restore muscle strength and basic motor skills, while keeping a person's mind engaged.  

At first glance OT may look like child's play or simple busywork, but it's far more complex than that. For example, to improve finger, hand, and wrist strength in someone with arthritis, an occupational therapist might suggest cutting out coupons, opening and refilling pill bottles, unscrewing nuts and bolts, rolling coins, writing, buttoning, or participating in crafts or games. Not only do these simple activities strengthen muscles, they also test motor skills and increase mental comprehension and concentration.  

There are three categories of activities that are addressed by occupational therapy: daily living activities, recreational or leisure activities, and work and productive activities. The goal is to help individuals adapt to their impairments and regain the optimal level of independent functioning. Daily living activities are tasks such as personal grooming, bathing, dressing, mobility, eating, health care needs, and communication. These tasks may include the use of assistive devices such as splints, walkers, or grasping aids and adapting the individual's physical environment with items like special seats or grab bars. Managing these necessary tasks reduces dependence on others. Recreational or leisure activities are tasks the individual pursues for personal enjoyment. Individuals engage in specific leisure activities and learn how participating in recreational activities contributes to their overall health and well-being. Work and productivity activities include home management tasks such as domestic tasks, job-related/career tasks, and money management. If applicable, this therapy may focus on employability training, work performance, and psychosocial aspects of the workplace. (1) 

Today, occupational therapy has also been found to be useful in recovery from injury, surgery, and stroke; and in treating a number of mental health conditions, including Alzheimer's disease, schizophrenia, substance abuse, and eating disorders. It can also be important for the elderly who want to maintain an active life. (1) Pediatric occupational therapists help children with disabilities improve skills for managing both their physical and social environments. 

What You Can Expect 

In the initial visit, the occupational therapist will perform an evaluation of the patient's physical and mental function and ability to perform daily necessary tasks. The therapist assesses balance, cognition, fine motor skills, range of motion (the linear or angular distance that a joint or body part can be moved in a particular direction), sensation, and strength to determine any deficits in these areas. Range of motion (ROM) is measured in angle degrees using an instrument called a goniometer. If ROM testing indicates limited motion in the joint, the therapist will determine if the cause is pain, or tightness in the muscles, ligaments, or tendons. Occupational therapists often work with physical therapists in this assessment.    

Other tests that may be performed to determine the patient's current level of function include the Canadian Occupational Performance Measure (COPM) and Cognitive Competency Test (CCT). The COPM is designed to detect changes in a patient's perception of their occupational performance over time while the CCT measures a patient's cognitive competency for maintaining safe and independent living. Occupational therapists evaluate the patient's home and work environment to determine accessibility and safety in these areas. OTs also ask what the patient's expectations and goals are and take them into consideration when designing the program. 

A program of specific goal-oriented activities and instruction is designed for the patient based on their physician's recommendations, the results of the evaluation, and their goals. The designated program may include adaptive strategies for work, such as using an ergonomic keyboard to prevent carpal tunnel syndrome, or mobility strategies, such as maneuvering a wheelchair in a store. Occupational therapists may show the patient general exercises for strengthening and stretching the musculoskeletal system and prescribe exercises that will improve fine motor coordination. For cognitive deficits, occupational therapists may instruct a patient to write down any instructions or information they have a hard time remembering. (1-6) 

 

Health Benefits 

The American Occupational Therapy Association's (AOTA) website lists a number of disorders for which occupational therapy may help to restore optimal function. For example, an occupational therapist may evaluate an aging person's abilities and their home and make recommendations for mobility and safety so the person can continue to live independently. Therapy may include adding adaptive equipment such as grab bars in bathrooms or reducing clutter and removing throw rugs to reduce the risk of falling.  (7) To prevent falls in elderly people or people with disabilities, occupational therapy may include suggestions to discontinue talking while walking, wearing appropriate footwear, and arranging furniture in a manner that provides less clutter and more space to walk. (8)  

Occupational therapy may benefit people recovering from substance abuse by helping them reestablish their roles and identity. A therapy plan can help a person recovering from substance abuse recognize how the abuse affects overall health and the ability to perform important tasks. For example, a person recovering from alcohol abuse may identify being a parent as their most important role.  With occupational therapy the person can learn how to deal with the stresses of parenting without alcohol. (9) 

Occupational therapy can reduce the symptoms of schizophrenia and help people with this disorder improve their social abilities. In one small study of 44 adults with significant functional problems associated with schizophrenia or other psychotic condition, 14 patients received usual care while 30 received usual care plus 12 months of individualized occupational therapy in a community setting. At the end of the study, both groups showed significant improvement in social functioning, such as relationships with others and reductions in "negative" symptoms. However, the occupational therapy group showed greater improvements than the group receiving usual care only. (10) 

A 2011 review of studies published from 1988 to 2008 looked at the efficacy of occupational therapy for study participants with chronic obstructive pulmonary disorder (COPD), depression, diabetes, heart disease, osteoarthritis, and rheumatoid arthritis. The review found that occupational therapy can improve at least one occupational outcome such as activities of daily living, social or work function, psychological health, general health, and quality of life in adults with these chronic diseases. (11) 

Specifically, occupational therapy may benefit: 

Alzheimer's Disease (AD). The AOTA's Evidence-Based Literature Review Project did a systematic review of evidence for the effectiveness of modifying activity demands in the treatment of people with AD. Activity demands are a combination of the performance requirements of a task (such as lifting or reaching); contextual demands (such as the counter height or location of faucets in a bathtub); social demands (such as ability to communicate with others); and temporal demands (such as the need to complete morning grooming in a timely manner in order to be punctual for work). (12) Results from this review indicate evidence for the efficacy of this type of occupational therapy is strong. Environmental modifications, adaptive equipment, and therapy should be individualized to elicit the highest level of retained skill and interest. Caregiver training and involvement are essential to implementing individualized programs. Cues given to people with AD to complete a task should be short and provide clear direction. (13) 

Arthritis. A 2011 review suggested there is high quality evidence to support the efficacy of rehabilitation interventions in the treatment of osteoarthritis of the hand. The 12-month use of a night splint had a large positive effect on hand pain, function, strength, and range of motion. (14) A 2008 Cochrane Review showed there are high-quality studies for the efficacy of occupational therapy in the treatment of rheumatoid arthritis (RA). Specifically, OT can help people with RA perform daily chores such as dressing, cooking, and cleaning with greater ease. In addition, splints can improve the strength of a person's grip and decrease pain although they may also decrease hand movement. (15)  

Cancer. One reference notes the role of OT in oncology “to facilitate and enable an individual patient to achieve maximum functional performance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy”. (16) Examples of this include managing daily activities and lifestyle by modifying the environment and improving fitness. However, evidence is sparse and studies are needed.  

Carpal tunnel syndrome (CTS). The National Institute of Neurological Disorders and Stroke notes an occupational therapist may supervise the stretching and strengthening exercises that may benefit people with CTS whose symptoms have abated. (17) A Cochrane review indicates that there is short-term relief from splinting/bracing, but  evidence of the benefit of ergonomic keyboards is unclear. (18) 

Chronic Obstructive Pulmonary Disorder (COPD). In one small study, four adults with COPD attended an outpatient pulmonary rehabilitation program that combined physical and occupational therapy. The features of OT that were reported to be of value were biofeedback and clinician support. Through an interview, patients reported improved mental health and confidence in performing daily activities, less fatigue, more control of shortness of breath, more physically active lifestyles, and hope for the future. However, more research is needed to determine the efficacy of OT in promoting self-management and coping skills and restoring occupational performance in adults with COPD. (19) 

Diabetes. In their fact sheet the AOTA recommends OT for diabetes management. OT can be effective in a number of areas, including helping patients modify routines to attain a healthy lifestyle, providing techniques to organize and track medications, providing instruction on measuring and reading glucose levels, and educating about diabetic neuropathy. (20) 

Eating Disorders. The Center for Eating Disorders at Sheppard Pratt (The Sheppard and Enoch Pratt Hospital) in Towson, Maryland,  recommends that OT be included in treatment for eating disorders. The center has three main goals of OT: 1) to provide a safe place for patients with eating disorders to perform multi-sensory activities; 2) to provide a setting where verbal insights learned in psychotherapy can be converted into new behaviors; and 3) to practice habits that create or reinforce healthy roles and occupations. (21) 

Multiple Sclerosis. OT is used to help with symptoms of MS. However, a 2009 Cochrane review indicates sparse evidence that OT relieves fatigue in patients with MS and no evidence for any other outcomes. (22) 

Stroke.  Occupational therapy is part of a multi-disciplinary approach in the treatment of patients who have suffered a stroke. A 2009 Cochrane review of nine studies indicates patients who have had a stroke were more independent in performing activities of daily living and more likely to maintain their independence when they received occupational therapy. More studies are needed to determine the best forms of OT for various limitations in order to plan how to best use it. (23) Results for the efficacy of OT in cognitive impairment are not as good. A 2010 Cochrane review of one small study indicates insufficient evidence for the efficacy of OT in cognitive impairment in patients who have had a stroke. More studies are needed to confirm or refute this study. (24) 

How To Choose a Practitioner 

Most health insurance plans cover occupational therapy, but some may limit the maximum number of visits within a specific time period. Read the policy carefully to see if the limit is "per condition", "per calendar year", or "per episode of care". Other plans permit a few visits, after which a "pre-authorization" will be needed for more visits. Most managed care plans require a referral from the primary care physician. 

Occupational therapists typically work in a variety of settings, including outpatient clinics, physicians' offices, assisted living or mental health facilities, hospices, and in patients' homes. Be sure the occupational therapist is a graduate of an accredited occupational therapy program and has a valid, current license to practice in the state. In the United States and its territories there are approximately 300 accredited programs for occupational therapy and occupational therapy assistants offering degrees at the associate through the doctoral level. 

After graduation, occupational therapists must pass a national certification exam, which grants them the designation of Occupational Therapist, Registered (OTR). Credentialing and other requirements for occupational therapists vary from state to state, depending on regulations. In most states, credentialing is based on results of the national certification examination. 

For additional information see the entry on Physical Therapy in the WholehealthMD Reference Library. 

References 

1. Medical Disabilities Guidelines. Available at http://www.mdguidelines.com/occupational-therapy. Accessed February 18, 2012.
2. Physical Therapy Notes. Available at http://www.physicaltherapynotes.com/2010/11/range-of-motion-types-of-range-of.html. Accessed February 18, 2012.
3. Canadian Occupational Performance Measure. Available at http://www.caot.ca/copm/. Accessed February 18, 2012.
4. Prevention and Early Intervention Program for Psychoses—Occupational Therapy Assessment. Available at http://www.pepp.ca/asses12.html. Accessed February 18, 2012.
5. Cicerone KD and Tupper DE. The Neuropsychology of everyday life: assessment and basic competencies.  1st ed. Norwell, MA:Kluwer Academic Publishers;1990:223.
6. Jacobsen Therapy Services—What to Expect. Available at http://www.jacobsentherapyservices.com/your_first_visit. Accessed February 18, 2012.
7. The American Occupational Therapy Association. Available at http://aota.org/Consumers/consumers/Adults/AginginPlace/Remain.aspx?FT=.pdf.  Accessed February 19, 2012.
8. The American Occupational Therapy Association. Available at http://aota.org/Consumers/consumers/Adults/Falls/35127.aspx?FT=.pdf.  Accessed February 19, 2012.
9. The American Occupational Therapy Association. Available at http://aota.org/Consumers/Professionals/WhatIsOT/MH/Articles/RecoveryWithPurpose.aspx. Accessed February 19, 2012.
10. Cook S, Chambers E, Coleman JH. Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial. Clin Rehabil. 2009 Jan;23(1):40-52.
11. Hand C, Law M, McColl MA. Occupational therapy interventions for chronic diseases: a scoping review. Am J Occup Ther. 2011 Jul-Aug;65(4):428-36.
12.  Radomski MV and Trombly Latham CA. Occupational Therapy for Physical Dysfunction. 6th ed. Baltimore, MD:Lippincott Williams & Wilkins;2008:780.
13. Padilla R. Effectiveness of interventions designed to modify the activity demands of the occupations of self-care and leisure for people with Alzheimer's disease and related dementias. Am J Occup Ther. 2011 Sep-Oct;65(5):523-31.
14. Ye L, Kalichman L, Spittle A, Dobson F, Bennell K. Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review. Arthritis Res Ther. 2011 Feb 18;13(1):R28.
15. Cochrane Summaries. Available at http://summaries.cochrane.org/CD003114/occupational-therapy-for-rheumatoid-arthritis. Accessed February 20, 2012.
16. Penfold SL. The role of the occupational therapist in oncology. Cancer Treat Rev. 1996 Jan;22(1):75-81.
17. National Institute of Neurological Disorders and Stroke (NINDS). Available at http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed February 19, 2012.
18. Cochane Summaries. Available at http://summaries.cochrane.org/CD003219/oral-steroids-splinting-ultrasound-yoga-and-wrist-mobilisation-provide-short-term-relief-from-carpal-tunnel-syndrome-but-other-non-surgical-methods-have-not-been-shown-to-help. Accessed February 20, 2012.
19. Norweg A, Bose P, Snow G, Berkowitz ME. A pilot study of a pulmonary rehabilitation programme evaluated by four adults with chronic obstructive pulmonary disease. Occup Ther Int. 2008;15(2):114-32.
20. The American Occupational Therapy Association Fact Sheet—Occupational Therapy's Role in Diabetes Self-Management. Available at http://www.aota.org/Practitioners/PracticeAreas/Aging/Tools/Diabetes.aspx?FT=.pdf. Accessed February 20, 2012.
21. The Center for Eating Disorders at Sheppard Pratt—Occupational Therapy for Patients with Eating Disorders. Available at http://eatingdisorder.org/blog/2009/09/occupational-therapy-for-patients-with-eating-disorders/. Accessed February 20, 2012.
22. Cochrane Summaries. Available at http://summaries.cochrane.org/CD003608/occupational-therapy-as-supportive-treatment-for-people-with-multiple-sclerosis. Accessed February 20, 2012.
23. Cochrane Summaries. Available at http://summaries.cochrane.org/CD003585/occupational-therapy-for-patients-with-problems-in-activities-of-daily-living-after-stroke. Accessed February 20, 2012.
24. Cochrane Summaries. Available at http://summaries.cochrane.org/CD006430/occupational-therapy-for-cognitive-impairment-in-stroke-patients. Accessed February 20, 2012.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

Condition

Rating

Explanation

Alzheimer's Disease (AD)

 

A review indicates efficacy for modifying activity demands in treatment of AD. (12, 13)

Cancer
OT may help patients manage daily living activities but evidence for its efficacy is sparse; studies are needed. (16)

Carpal Tunnel Syndrome
A Cochrane review notes short-term relief from the use of splints and hand braces and unclear evidence for the use of ergonomic keyboards. (18)


Chronic Obstructive Pulmonary Disorder (COPD)
Date Published: 04/19/2005
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