What in the OT?
In which setting would you find Occupational Therapists?
Occupational therapists work with adults and children of all ages with a wide range of conditions; most commonly those who have difficulties due to a mental health illness, physical or learning disabilities. They can work in a variety of settings including health organisations, social care services, housing, education, voluntary organisations or as independent practitioners.
What does Occupation Mean?
Occupation" as a term refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day-to-day tasks such as Self-care, Work (Productivity) or Leisure
What gross motor skills do I need to make a cup of tea?
Static and dynamic balance.
Stabilisation
Upper Limb Strength
Active range of movement at shoulder
Core Strength
Being able to cross midline
How do we get feedback?
We attempt to be on the wards as much as possible, however, we may not always be able to be as visible as we would like. Therefore, it is essential that we communicate as a team.
Following an OT assessment, we will then make recommendations for the ward staff to follow. We may then further review for progress at a later date.
Ward staff support patient progress by discussing patients’ abilities with the Occupational Therapist who may then use this information in reports and ongoing assessments which establish the patient’s ongoing pathway of care.
If a concern is raised, then the OT will return and complete another
assessment making further recommendations.
What would an OT do if I had difficulty with toileting?
OT's complete transfers assessment to understand the impairments that may be affecting someone's ability to complete transfers. We will identify if they require equipment to complete the task or require a period of rehabilitation to re-gain skills to be able to complete task independently. We consider if they are able to initiate being able to go to the toilet, recognize how to use the toilet, manipulate their clothing to access the toilet and attend to their personal care.
What the aim of Occupational Therapy Intervention?
Occupational therapy provides practical support to empower people to facilitate recovery and overcome barriers preventing them from doing the activities (or occupations) that matter to them. This support increases people's independence and satisfaction in all aspects of life and enables individuals to achieve their full potential.
What does the acronym ADL stand for?
Within OT we refer to these using the term ADLs. Which stands for Activities of Daily Living
These essentially refer to: Showering and dressing, preparing meals, domestic activities ( cleaning washing clothes, tidying) and community access.
What fine motor skills do I need to make a cup of tea?
Hand manipulation.
Strength of grip
Modulation of grasp
How do we tell people our intervention has worked?
The Occupational Therapist may have regular conversations with you about how a patient is engaging and where they are struggling.
The Occupational Therapist uses this information to continually assess where the patient is within their rehabilitation
Please be as thorough as possible within these conversations as they are usually required for a patient report or an ongoing assessment of some kind. (FIMFAM/MOHOST)
What does an OT session look like?
This could be done on a 1:1 basis, on the unit or in the community. OT's also run groups to help patient develop skills, to provide education or increase independence. OT's will use assessment to develop intervention to practice specific skills within the task to increase independence or reduce the level of support required. We continually re-assess patients functional ability through our interventions.
With what three areas of function do Occupational Therapist want to achieve balance?
Self Care, Leisure and Productivity
Self Care - Activities we do with the purpose of looking after ourselves
Leisure - Activities that we do for the pleasure of doing them
Productivity - Activities we do for the end outcome
What do we mean by holistic?
An occupational therapist approach is Holistic. Holistic means encompassing the whole of something, and not just a part.
An OT will consider ALL areas of the patient’s needs - physical, psychological, social and environmental.
How do I know how to make a cup of tea?
Cognitive Skills
Procedural Memory
Sequencing
Selecting correct items
Navigating environment to select correct items
Initiate and terminate each step of the task
How to use hot water safely
Being able to maintain attention on task
Problem solve
Adjust to new environment
Manage emotions
Knowledge of use of equipment
How you role supports the MDT?
•Occupational Therapists may give recommendations for a patient’s routine It is important that you follow any guidelines for patient care identified by OT. Even if these may sometimes take longer than what you may automatically do within your job role.
•- Prompting a patient to gather their own breakfast items - bowl, milk, cereal, and make their own drink – rather than doing all of this for them.
•- Encouraging a patient to select and put on their own clothes as much as they can - rather than dressing them.
•- Supporting a patient to use their transfer and shower equipment – rather than giving them a bed bath.
•- Encouraging a patient to purchase their own food to make their own tea, then support them to prepare this – rather than taking their lunch order.
•Doing this will help support the patient develop a pattern of behavior to increase their independence. (Repetition and Practice is key!)
How we assess cognitive function in the community?
As Occupational Therapist we use a Multiple Errands Assessment to further assess cognitive function in a community setting. This particularly focusses on high level of cognitive skills, executive function and the application of these skills to complete a set of tasks.
How do OT's structure their intervention?
-Pre admission assessment: Before a patient arrives, we gather information from their pre admission documents.
-Initial Assessment: During their first week we complete an initial assessment which looks at all components of their abilities, including required equipment, then narrows the focus to essential needs, which are then put into goals with the patient. (Example of an initial assessment)
-Intervention: The OT will then implement sessions, either as 1:1 or as part of a group, which may address these occupational issues and support the patient to achieve their goals.
-Review and further assessment: The OT will review the patients progress and establish ongoing needs. – Ongoing intervention
-Stabilization: The Therapy aim is for the patient to establish occupational stabilization where they have reached a balance which remains consistent.
- Discharge Planning: The OT will advise and support the patient regarding moving on to a further destination which meets their needs.
What do we mean by Occupational Performance
A person's ability to combine both their cognitive skills, physical skill and knowledge of a task to perform their activities of daily living. We continually assess this through both standardised and non-standardised assessments.
How do I know what objects I need to make a cup of tea?
Perceptual skills
Being able to recognize the equipment within the kitchen as items used to prepare a cup of tea. e.g kettle on the work surface, being able to find the spoon in the drawer
What is the FIM FAM?
progress is measured by an internally recognised tool called the fimFAM (Functional Independence Measure/Functional Assessment Measure). fimFAM is designed to evaluate and monitor progress in patients with acquired brain injury and other health conditions. It rates the level of function, from total assistance given (score=1) to complete independence (score=7), on all aspects of daily living activities. The higher the score suggests positive measures. fimFAM is based on formal assessments and observations on what the patient is actually doing on a day-to-day basis rather than what they could and might be able to do. It consists of 36 items from basis self-care to advanced living skills, such as going to work.
Do OT's work with anyone else?
In Neuropsychiatry there is lots of interdisciplinary working with all of the members of the MDT. This increases the efficacy of assessment and intervention.
What type of assessment would an OT do?
Kitchen, Personal Care, Community, Domestic Skills, Transfer and Mobility, Assessment with Equipment. Risk Assessments.
What is Activity Analysis
From a simple activity, the Occupational Therapist identifies a large amount of information.
We then use that information to identify the essential NEEDS of the patient.
We do this by BREAKING DOWN an activity step by step and establishing where a problem lies.
How can I find what I need to make a cup of tea?
Visual Skills
Visual acuity, attention, scanning, visual cognition
What is a MOHOST?
How do OT's help with hand function?
OT's will complete upper limb assessments to assess, movement, sensation, tone and pain. A programme of intervention will be developed following assessment to increase or maintain functional use of hands, to manage any impairments. This could involve intervention within a functional task or remedial exercises, this could also involve splinting.