The Purpose of Occupational Therapy

March 25, 2012 by  
Filed under Rehab and Recovery

If the purpose of rehabilitation is broken down into a single statement, it would be the following

“To regain the maximum amount of functional ability.”

In other words, its purpose is to allow a patient the ability to perform as many tasks as possible.  For someone who has never dealt with a therapy patient, it may be hard to imagine the frustration of  being unable to do things for yourself.  Improving range of motion, dexterity, strength, and grip control allow a patient to complete more of their own daily tasks.  The overall purpose is to overcome limitations and enable a patient to do the maximum number of tasks for themselves.

A patient who has had a stroke has weakness and loss of function on one side of the body.  Imagine being right handed and having a stroke that affected your right side.  Assuming you could walk, you would probably need a cane.  Since your right side is partially paralyzed, the cane must be held with your left hand.  Not only is your (right) hand weak and stiff, but the act of walking magnifies the problem even more.  Any type of physical exertion leads to the stroke-affected muscles tightening up even more.

Now imagine wanting a cup of coffee.  You may be able to operate the coffee pot and add creme and sugar while standing at the counter.  The problem is getting the coffee cup from the counter to the table.  Your stiff hand cannot be trusted for this task.  They make specialized mugs that prevent spillage for handicapped people, but even the “spillproof” mug is be too for many stroke patients to handle.  Experience tells you that concentrating on walking while holding such an item is just too risky.  You have lived this event before and it often has a bad ending.

The common sense approach is simply to drink your coffee while standing at the counter.  Although it is a poor solution, it is the safest and least risky way for a coffee drinker to get their daily dose of caffeine.

The morning coffee used to be time to relax, read the newspaper, and focus on the day ahead.  Now it is an experienced that requires focused attention.  With any luck you will be able to stand long enough have a few sips before retreating to sit down.  Some days the coffee will be dropped, leaving a puddle on the floor that is impossible to clean.  Once in a great while you lose your balance while standing at the counter.  There are few things worse than laying on the ground in pain and knowing that it will be hours before somebody shows up to help you.

If only the right hand could be strengthened.  If only it could be trusted.  The morning coffee routine could revert to the enjoyable experience that it was before the stroke.  Mornings could be relaxing again… maybe even worthwhile.


What is Occupational Therapy?

The bridge from deficiency to function is that of occupational therapy.  In the simplest terms, occupational therapy is meant to improve the function of a patient’s hands.  It is meant to promote strength and dexterity.  The goal is improvement in the functional tasks that we take on each day.  Carrying coffee from counter to table is just one example out of the hundreds of tasks that can be hindered by an injury.

It is easy to confuse the terms “physical therapy” and “occupational therapy.”  The practical difference is that physical therapy focuses on walking and whole-body movement while occupational therapy aids one in manipulating items and performing tasks.  A physical therapy session may include walking, weights, and treadmills.  Activities such as turning wheels, placing pins in holes, and picking up laundry baskets are commonly seen in the occupational section of the therapy gym.

Since the goal of rehab is regaining maximum function, one would assume that therapists would share a common philosophy when working with patients.  They don’t.

Therapists assign activities they like and are familiar with.  Each one considers different criteria and experiences when considering the kinds of activity to use with a patient.  Many therapists focus exclusively on one type of therapy or another.  They find themselves recommending more and more activities from one of the following schools of thought.


Weight Bearing Therapy

Some therapists subscribe to the theory that most tasks require a person to control their own body weight.  These therapists focus on weight bearing activities like standing against a table and leaning on one hand while the other hand reaches and picks up items.  In this scenario, each of the hands is performing a therapy task.  One hand is doing the work of grabbing and transferring.  The other is also working:  it is holding up the body’s weight.

Many safety activities are also classified as weight bearing. When a patient falls, they often need to crawl across the floor to a piece of furniture to climb back up.  The act of crawling is impossible if one can’t hold up their own body weight.  Climbing up onto furniture is an even more daunting task for a person with limited upper body strength.


Fine Motor Therapy      

Place a pencil on the table in front of you.  Pick it up near the end using your thumb and index finger.  Now raise it off the table.  A slight release of pressure on the pencil and it falls down into a vertical position.  This task seems so simple.  It seems automatic.  Yet it is something that millions of trauma survivors cannot do.  The ability to release pressure in such a precise fashion is quite difficult for a patient who has suffered a stroke, nerve damage, arthritis or hand trauma.

Most useful action is a result of training muscles to apply and release pressure.  Manipulating a pencil is just one example.  Consider all the simple tasks that require precision and control in a single room of the house.  Let’s take a look at the bathroom.  Imagine being unable to perform the following bathroom tasks?

  • Flicking a lightswitch
  • Operating a faucet
  • Grabbing and adjusting the shower curtain
  • Turning on the shower
  • Using soap and shampoo
  • Ripping off toilet paper
  • Flushing the toilet
  • Grabbing and pulling a drawer handle
  • Holding a toothbrush
  • Applying toothpaste
  • Opening a medicine cabinet

Most of these actions can be thought of as fine motor tasks.  Many occupational therapists subscribe to the theory that patients can sit at a table and place pins or turn nuts to develop these skills.  This school of thought is that repeating fine motor tasks is the best way to relearn how to perform them.


The Purpose of Occupational Therapy

The lack of function of an arm or hand can result in extreme changes in the everyday life of a patient.  Occupational therapy exists to provide an opportunity to regain some of that function.  It serves as a bridge from where a patient is today to where they want to be for the rest of their life.

Fear of picking up objects marks a great change in life.  The apprehension of dropping items forces one to make drastic changes in the way they live their life.  The routine of morning coffee, brushing teeth, getting dressed, and making breakfast can be transformed by regaining the ability to grab, clench, and control the muscles in our hands.

Occupational therapy bridges the gap between nonfunction and function.  It is amazing how much can be regained by putting effort into therapy activities.  Patient-centered (weight bearing) therapists do activities such as crawling across the floor.  Fine motor therapist focus on activities that reteach hands to grab and release items.

As in all things, the more effort put into it, the more results are gotten out.  Achieving maximum function means working hard and working smart. It requires therapists that can pinpoint problems and suggest appropriate therapy activities.  It also means a patient who is willing to put forth an honest effort to really enact positive change in their life.  As in most things, you get out of it what you put into it.

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One Response to “The Purpose of Occupational Therapy”
  1. Silas Knight says:

    I am glad that there are people to help with occupational therapy. Not being able to use your hands would be extremely frustrating. However, with the help of this therapy, people can regain the use of the fine-motor skills needed to live.

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