Occupational Therapy

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Expert contributor Matthew Box, an Occupational Therapist and Disability Access Auditor, has contributed this article on how Occupational Therapists work.

Click the links below to go to more on:
What is occupational therapy?
How does the OT assessment process work?
Where and when are you likely to work with an OT?
Social Services Occupational Therapists
Who can the local OT service help? 
Advice and Information
Equipment / assisted devices
Adaptations to your home
Rehousing
Other areas where OTs work

Click here to read more about the work of Inclusion, providers of specialist OT services

What is occupational therapy?

The British Association Of Occupational Therapists states that “Occupational therapists work with people of all ages, helping them to carry out the activities that they need or want to do in order to lead healthy and fulfilling lives.”

Occupational therapists, or OTs, work with anyone who may be experiencing physical, psychological and/or social problems, either from birth or as a result of trauma, illness or ageing. An OT’s goal is to help clients have independent, productive, and satisfying lives.

When people cannot participate effectively in the activities of daily living which are essential to our quality of life, and which we all take for granted – such as having a shower, preparing a favourite meal, getting dressed, or going to work – an occupational therapist has the ideal skills mix to work with that person in improving their functional capacity and therefore quality of life. They can help the individual to develop or recover daily living and work skills, either through the use of purposeful activity or via specialist aids and adaptations.

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How does the OT assessment process work?

Firstly an OT will look at identifying and assessing their client’s difficulties and strengths. They may, for example, check physical ability to carry out certain tasks, assessing a person’s range of movement, strength and balance. They then look at what items the individual may need to carry out the assessed activity, for example furniture or clothes, and finally they will look at the environment, for example the layout of the home or school. Next they will see what support is available. The final stage is to review which activities that person would like to be able to perform more easily.

Once the assessment process is complete they will start to explore new ways of doing things. Lets take for example a person who is starting to use a wheelchair for the first time. He must first learn to get around his home. It may be necessary to adapt the house by widening the doors, he may also need to look at ways of improving the strength in his upper arms. The aim of an OT is to work in conjunction with the client in looking at ways to facilitate, and put into practice, these alterations and improvements.

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Where and when are you likely to work with an OT?

Hospital patients are most likely to come across an OT as part of a rehabilitation program or at the point leading up to discharge when an OT can ensure the individual is safely supported in coming home. An example of the type of intervention an OT may be involved with in this setting is in assisting a stroke patient to practice cookery skills whilst in the ward environment or to participate in group work activities, such as craft work skills or games, designed to increase hand function.

For individuals who are already at home and are experiencing increased difficulties with activities of daily living due to a disability, a referral to your local social services Occupational Therapy department may be appropriate. They can then assess for suitable equipment or adaptations to help improve the situation, adapting the home environment to meet the needs of that individual.

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The Work of Social Services Occupational Therapists

One area of work which has become a specialist field for Occupational Therapists is that of home equipment and adaptations – both the hospital and Social Services OT can be involved here, however it is the Social Services OTs who are most heavily involved in working with service users who are at home.

Social Services OTs are able to advise on how to do things differently to make life easier at home. They may be able to lend equipment or provide minor adaptations such as grab rails in the home. They can give advice and make recommendations to a local District or Borough Council for major adaptations to the property such as a stairlift.

They may also be able to put clients in contact with organisations about access to employment, social or leisure opportunities. Referrals can be made either by an individual, their family or any health care professional which may already be working with that person.

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Your Occupational Therapy Service can help you if you live in the local council or borough area and have:

• a permanent and substantial impairment and have considerable difficulty with everyday tasks

• are having difficulty caring for someone with an impairment

• are a parent of a child with a permanent and substantial impairment

How social services OTs can help you:

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Advice and Information

An OT may be able to show you, or any one who cares for you, different and easier ways of doing things. They can also refer you for rehabilitation and other services.

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Equipment / assisted devices

OTs can arrange for the supply of equipment to help you stay living in your own home. For example:

• Bath boards and bath seats – these items offer a secure and stable platform for bathing and showering, allowing an individual to transfer more easily in and out of a bath, reducing the need to step over a bath side or stand up from the very bottom of a deep, slippery bath. One of the most important things for items such as this is to make sure that you have measured the bath correctly to ensure you get the right width and equipment size. It is also essential to ensure the equipment is securely fitted and installed to provide a stable and reliable surface for transfers.

• If a Bath board and seat do not provide enough assistance, then another item of equipment called a bathlift is also available. These fit inside the bath and can lift the person from near the bottom of the bath up to the height of the bath rim. Users must however, still be able to lift their legs over the bath rims if they wish to bathe independently. These types of equipment again come in various shapes and sizes, with many performing slightly different functions, for example some recline at the back, some are able to be lowered down further into the bath while others are more light weight and detach into segments in order to make them more easily transportable.

• Chair raisers and beds – these items are designed to improve an individual’s ability to transfer in and out of a chair or bed independently. The height of the seat, for example, can determine how easy it is to get in and out of the chair. A high seat will make it easier to stand up and sit down, particularly if you find it difficult to push up using your arms or if you have any pain or weakness in your legs.

• For individuals who still find transfers difficult then an electric riser / recliner chair may be more appropriate but these should always be assessed by a trained professional and trialed first to ensure that the most appropriate chair is provided.

• Toilet equipment – these items such as raised toilet seats, frames or grab rails are designed to again improve an individual’s ability to transfer independently, raising the level of the toilet and providing leverage to assist with difficult transfers.

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Adaptations to your home

Alterations to the home may help an individual or anyone who cares for them to manage essential daily activities more easily. For example:

• stair rails, grab rails, half steps.

If major adaptations are needed, such as a level-access shower, a stairlift or a ramp for wheelchair use, the OT can explain how these are funded and what help may be available.

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Rehousing

If the person can no longer manage in their present home, the OT can advise them about what is involved in moving to a more suitable property.

Social services OTs are governed in their recommendations by two key elements – assessed client need and articles of government legislation and guidance, the second of which can often restrict the OT in the level of provision they are able to recommend.

Grants such as a Disabled Facilities Grant can be accessed to fund major adaptations but these follow strict guidelines and procedures and it is essential that you ask your OT to clearly explain how the funding process works for all provision, especially in relation to major adaptations.

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These are not the only areas where you can find an occupational therapist working

There are over 26,000 qualified occupational therapists in the UK. An Occupational Therapist can work in a vast array of different work settings, the following provides details of just some of the fields that they can specialise in:

• Manual handling training.
• Disabled bay parking badge assessments.
• Compensation claims and functional capacity assessments in cases of litigation.
• Void property reviews for housing services or housing associations.
• Adapting materials or equipment (e.g., adjusting cutlery or writing tools for someone after they have lost hand dexterity).
• Ergonomic seating assessments.
• Disability access audits for a business or service provider such as a shop, library or school.
• Helping people to learn new ways of doing things (for example teaching someone with reduced stamina how to conserve energy when performing daily activities).

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